A study supporting the distinction of G9-10 vs G8 within "high risk" categorization

This is a 2013 study, but I just ran across the abstract from the ASCO conference while looking for something else (yay, Bing).

Association of Gleason 9-10 prostate cancer with worse outcomes compared to Gleason 8 disease.

Gleason 9 & 10 are distinct from Gleason 8 in the median time to biochemical recurrence, and to metastatic disease. This isn't surprising, since the presence of those crummy Type 5 cells has shown as a singular risk factor in many studies. However, usually there aren't enough of the G9-10 types in any study to develop statistics for them, so we get lumped in with the G8, and also with other things like PSA >20, or T3/T4 disease. The idea being those factors are the same elevation of risk as the high Gleason scores.

It's seemed to me that the G9-10 categories present a distinct risk apart from all of those others, but we just get blurred in with other things to make the numbers work. After all, you have to publish the study to justify the grant funding, right?

The newer 5 category Gleason Grade Group system has distinguished Grade Group 5 as G9 and G10, with Grade Group 4 being G8. Hopefully, this system may drive studies that isolate those risk groups.

The point, really, is still that G9-10 are formidable, and need everything we have to fight them. Aggression with extreme prejudice is warranted! Even though the side effect burden gets worse with aggressive treatment, it's worth considering the treatments anyway. As our good forum friend SteelGuy once said, we go after it with everything, pliers and blowtorch if necessary!

The encouragement here is that new treatments, new protocols, are becoming available frequently. All the best, fellow warriors!

[Edit: Here's another study that shows similar distinction. (It may be the study underlying the whole revised Grade Group system. Sorry if it's been hashed out before, as it probably has been.) Anyway, the Grade Group 5 had a quite different outcome.
Prognostic Gleason grade grouping: data based on the modified Gleason scoring system]

[Another edit: Here's another study showing type 5 cells to be problematic. These are outcomes following radical prostatectomy. I ended up choosing radiation therapy for my G9 case, as my uro onc wasn't very encouraging about surgery being "curative" for my case (which included the extra fun of a cT3 staging).
Gleason pattern 5 is the strongest pathologic predictor of recurrence, metastasis, and prostate cancer–specific death in patients receiving salvage radiation therapy following radical prostatectomy].

As discussed before at this forum, Gleason Grade Group 4 (by mistake?) also included GS 5 + 3 (and GS 3 + 5). GS 5 + 3 should be treated as Gleason Grade Group 5. GS 5 + 3 behaves as and has the same risk as G9-10.

www.healingwell.com/community/default.aspx?f=35&m=3642746

There was another similar publication last year

A couple more thoughts..

I was hesitant to even post this stuff because it could seem like fear-mongering. Not my intent, not at all. (And BoloTrolololo, remember Galaxy Quest motto, "Never give up, never surrender". You exaggerate for humorous effect, but in reality yes, tertiary 5 is a concern.)

It was just to reinforce for anyone on the fence, that the presence of those rascally type 5 cells means we need to pursue the most aggressive paths available. The side effects may be unpleasant, unattractive, but we need to suck it up and dive in (not to mix metaphors...).

Second, regarding the Grade Group terminology, maybe I misunderstood where they're going with it. They do still give the Gleason score breakdown, don't they? I mean, they'd say, "You have a Gleason 7, 3+4, so you're in prognostic Grade Group 2", or some such, right? They wouldn't just say, "You're Grade Group 2.", period, would they? I agree, we still need to hear the actual Gleason scores.

And for sure I think the presence of type 5 cells is the key factor. So maybe they need to add another criterion to the whole system, that the presence of any type 5 (3+5, 4+3+T5, etc.), lands one into Grade Group 5. That seems like a pretty straightforward adjustment, and appropriate.