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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005Gleason Score
When I was diagnosed for PCa last July (I am now on hormone therapy prior to radiation) I was told that my Gleason score was 7, but only now have I learned that specifically it is 4,3. Can you tell me what the difference is between 4,3 and 3,4? Is one set of those numbers more "encouraging" than another or does it make no difference? Thanks very much. (I am still in the learning stage of things obviously. I am trying to learn my clinical stage grade.)) I have just learned that my clinical stage is T2a > When I was diagnosed for PCa last July (I am now on hormone therapy prior > to radiation) I was told that my Gleason score was 7, but only now have I [quoted text clipped - 4 lines] > (I am still in the learning stage of things obviously. I am trying to > learn my clinical stage grade.)) I haven't a clue how many T1a, T1c, T2a, T2b, etc. we have here, but I'd guess it's about average for those of use who have been diagnosed. It's better than mine and I'm still converting oxygen and carbon dioxide if that helps.  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > I have just learned that my clinical stage is T2a > [quoted text clipped - 6 lines] > > (I am still in the learning stage of things obviously. I am trying to > > learn my clinical stage grade.)) Stavros, Gleason score is the sum of two predominant prostate cancer grades in any patient. Gleason grade can be anywhere from 1 (least aggressive) to 5 (most aggressive). The first grade used in any Gleason score is the dominant grade (the majority of a patient's cancer consists of it). Unfortunately, Gleason score of 4+3 is worse (grade 4, which is more aggressive is dominant) than Gleason score 3+4 (where grade 3 (less aggressive grade) is dominant). Grades 1 to 3 tend to be very treatable, while grades 4-5 are very aggressive. The difference between Gleason scores 3+3 (6) and 4+4 (8) is huge. That's why Gleason score of 7 is extremely tricky. You never know whether it is going to behave more like Gleason 6 or Gleason 8. Generally, the less grade 4 you have, the better it is. Thus, Gleason 3+4 generally tends to be better than Gleason 4+3. Some researchers even try to treat Gleason 3+4 and Gleason 4+3 as two different Gleason scores. Hope this helps. Gordan > When I was diagnosed for PCa last July (I am now on hormone therapy prior > to radiation) I was told that my Gleason score was 7, but only now have I [quoted text clipped - 4 lines] > (I am still in the learning stage of things obviously. I am trying to > learn my clinical stage grade.)) Unfortunately there is a difference between 4,3 and 3,4. The first number represents the most common type of cancer cells present in the biopsy samples, the second represents the next most common cancer cells. Statistically a 4,3 leans a bit more toward 4,4 (Gleason 8) and 3,4 leans a bit more toward 3,3 (Gleason 6). Dave Perry > When I was diagnosed for PCa last July (I am now on hormone therapy prior to > radiation) I was told that my Gleason score was 7, but only now have I [quoted text clipped - 4 lines] > (I am still in the learning stage of things obviously. I am trying to learn > my clinical stage grade.)) There are five 'grades' of cancer cells. 1 is the best defined cell and least aggressive. 5 is an obliterated cell that cannot be readily discerned as a cell and it is the most aggressive. Pathologists look at your samples and find that you have cells ranging from 1 through 5 or smaller ranges. They determine the most common type of cells and then the second most common type of cells. They add the two together and come up with your Gleason. No one here has a Gleason 4. In 3 years and over 400 participants, I've only seen a handful of Gleason 5s. Most (little more than 40%) are diagnosed with a Gleason 6. A little less than 40% have a Gleason 7. Since the pathologist is adding the most present to second most present, then if you have a Gleason 7, you would prefer a 3+4. But, a 4+3 is still better than a Gleason of 8, 9 or 10. SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > When I was diagnosed for PCa last July (I am now on hormone therapy prior to > radiation) I was told that my Gleason score was 7, but only now have I [quoted text clipped - 4 lines] > (I am still in the learning stage of things obviously. I am trying to learn > my clinical stage grade.)) If your Gleason score is based only on a biopsy only, it may not be accurate. I was a Gleason 7 (3+4) from my biopsy, but the patholigist reduced it to a Gleason 6 after examining my entire prostate (after an RRP). With radiation treatment, the pathologist will never get a chance to look at the entire prostate to give you a more accurate score. At biopsy I was a Gleason 6, then after RRP the path report came back a 5. At the time the general comments here were that three pathologists examining the same slide could come up with three different results, so there was some degree of judgment/error in this thing. Am I correct that a high Gleason does not necessarily mean that the cancer has escaped the prostate, so even with a higher Gleason score it does not mean that the patient cannot be successfully treated (pardon the double negative please)? > If your Gleason score is based only on a biopsy only, it may not be > accurate. I was a Gleason 7 (3+4) from my biopsy, but the patholigist > reduced it to a Gleason 6 after examining my entire prostate (after an > RRP). With radiation treatment, the pathologist will never get a > chance to look at the entire prostate to give you a more accurate > score. > At biopsy I was a Gleason 6, then after RRP the path report came back a 5. > At the time the general comments here were that three pathologists examining [quoted text clipped - 3 lines] > with a higher Gleason score it does not mean that the patient cannot be > successfully treated (pardon the double negative please)? You are right. The higher the Gleason score, the more likely the cancer has penetrated the prostate wall or even got to the lymph nodes, but it is matter of odds. Even for Gleason 7 cancers, the odds are still fairly high that the cancer can be treated successfully. The Partin tables give estimates for those things happening based on PSA, Gleason core from the biopsy, and stage. In my case, I had a Gleason 7=3+4, T1c, PSa 4.5 diagnosis before surgery. The odds were about 60 percent that the cancer was confined to the prostate, and pretty low that it had got to the seminal vesicles or lymph nodes. Pathology after surgery revealed that the cancer was apparently confined to the prostate and the Gleason score had not changed. (I say "apparently" because one can never be entirely sure about such matters; it just means the pathologist saw no evidence of such spread.) >>If your Gleason score is based only on a biopsy only, it may not be >>accurate. I was a Gleason 7 (3+4) from my biopsy, but the patholigist >>reduced it to a Gleason 6 after examining my entire prostate (after an >>RRP). With radiation treatment, the pathologist will never get a >>chance to look at the entire prostate to give you a more accurate >>score. One problem is that a high (>7) Gleason score carries a greater chance of micromets -- tiny undetectable metastases out there waiting for the opportunity to "sprout" -- just because it's a more aggressive cancer. That's why my docs want me on hormone therapy with my Gleason 8 even though I had negative surgical margins and my PSA is .006. My Gleason score was a strong motivator for my RP, as I wanted the guidance provided only by first-hand examination of my excised prostate to aid me in subsequent decisions. I.P. > Am I correct that a high Gleason > does not necessarily mean that the cancer has escaped the prostate, so even > with a higher Gleason score it does not mean that the patient cannot be > successfully treated (pardon the double negative please)? Please check your lab sheet. I know of no lab that is able to report PSA scores in the thousandths. It is probably 0.06 not 0.006, in fact, the best labs using the very best equipment are not able to see anything less than 0.03 If your lab is reporting a 0.006 then consider it a typo. Bev > One problem is that a high (>7) Gleason score carries a greater chance of > micromets -- tiny undetectable metastases out there waiting for the [quoted text clipped - 12 lines] > > with a higher Gleason score it does not mean that the patient cannot be > > successfully treated (pardon the double negative please)? My oncologist merely said about the 0.006, "That's great". I'll quiz him more closely about that when we meet next week. I.P. > Please check your lab sheet. I know of no lab that is able to report PSA > scores in the thousandths. It is probably 0.06 not 0.006, in fact, the best > labs using the very best equipment are not able to see anything less than > 0.03 If your lab is reporting a 0.006 then consider it a typo. > Please check your lab sheet. I know of no lab that is able to report PSA > scores in the thousandths. It is probably 0.06 not 0.006, in fact, the best > labs using the very best equipment are not able to see anything less than > 0.03 If your lab is reporting a 0.006 then consider it a typo. The DPC Immulite 3rd Generation ultrasensitive test has a lower detection limit of 0.002 ng/ml of PSA. This is a widely used ultrasensitive test. Due to accuracy issues, many labs report results from this test to only two decimal places, so a measurement of 0.006 would be reported as <0.01 ng/ml. But a number of labs do report all three digits, so some people do get reports with numbers like 0.006 ng/ml on them...Best wishes and good health, Ron |
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