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I thought Gleason 8 was the highest? The worst?

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Posted 6/27/2021 3:14 PM (GMT 0)
Hi all,

I haven't been around in a couple of years, I had successful Davinci surgery in 7/17 and my PSAs are undetectable. I was told that the post surgery biopsy was a Gleason 8 and I thought at that time it was the highest. I am surprised to see there's a forum for Gleason 9 & 10. Has something changed?

Thank you,

Nick
Posted 6/27/2021 3:30 PM (GMT 0)
Hi Nick,

No, nothing has changes for many years with regard to the Gleason scores.

Could you post your post-op path report for us to take a look at? You should have a written copy of your complete post-op path report for your records. It has more than just your Gleason score and is of great importance if your PSA should ever begin to rise. As you may know, the Gleason score is made up of two patterns or grades, which range from 3 to 5, with 5 being worst. The predominant pattern that the pathologist sees is listed first. So there are three ways to have a G8 score:

G8 (4+4), which is the most common
G8 (3+5)
G8 (5+3)

Because Gleason pattern 5 is worse than 4, a score of (4+4) is, as far as prognosis stats, better than the two others. However, any Gleason score of 8 puts you in the high-risk category (9-10 are very high risk).

Has your PSA been stable since your RP?

Hope that helps,

Djin
Posted 6/27/2021 3:31 PM (GMT 0)
No change. Gleason 10 (5+5) is the most severe grade.
Posted 6/27/2021 3:40 PM (GMT 0)
Nick, it sounds like you're well in the 'cured' group. G8 on surgical pathology, and undetectable for going on 4 years....that's as good as it gets.

Gleason scores can go up to 5, and since one gets two scores, primary and secondary, it's possible to get a 10. Which is the worst case.
Posted 6/27/2021 3:46 PM (GMT 0)
Halbert, Gleason scores go from 6 to 10; Gleason patterns (or grades) go from 3 to 5. A Gleason Score is made up of two grades (not two score).

It is confusing because there are Gleason patterns (or grades), scores, and grade groups. But there is only one Gleason score post-op. Much of the confusion is due to our thinking of a test score and grade being synonymous. However, only the histology is "graded," and Gleason found that summing the two prevalent grades into a score worked best for categorizing the seriousness of the cancer.

It would be just too confusing to have the word "grade" refer to both the pattern and the sum of two patterns. I prefer "Gleason pattern" to "Gleason grade" although I see both terms in the literature. (One sees only "high-grade disease" or "high-grade prostate cancer," however.)

Djin
Posted 6/27/2021 11:41 PM (GMT 0)
Heh. And now there are "grade groups", intended to segregate diagnoses by the relative risk.

Grade Group 1 (Gleason score ≤6) – Only individual discrete well-formed glands
• Grade Group 2 (Gleason score 3+4=7) – Predominantly well-formed glands with a lesser
component of poorly-formed/fused/cribriform glands
• Grade Group 3 (Gleason score 4+3=7) – Predominantly poorly-formed/fused/cribriform
glands with a lesser component of well-formed glands†
• Grade Group 4 (Gleason score 8)
- Only poorly-formed/fused/cribriform glands or
- Predominantly well-formed glands with a lesser component lacking glands†† or
- Predominantly lacking glands with a lesser component of well-formed glands††
• Grade Group 5 (Gleason scores 9-10) – Lacks gland formation (or with necrosis) with or
w/o poorly-formed/fused/cribriform glands
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