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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2006My beef with Dr. Gleason
I think the Gleason score needs some refinement, especially for Gleason 7. It seems Gleason 6 normally means all 3's and that's pretty tame. Gleason 8 means all 4's and that's pretty bad. Of course, anything above 8 is real bad. But, Gleason 7 is a pivot point. First, we all know it could be a 3+4 or a 4+3. Some say 3+4 is much better. My first path report gave me a 4+3. Second opinion from Bostwick gave me a 3+4. When discussing this with my uro, he said it was better but my 4's made up 40% of the cells. So, a 7 can be very close to a 6 or very close to an 8. In other words, the stage 4 cells can comprise anywhere from 5% to 95% of the sample. I think it would be much better to grade 7's on a decimal system. In other words, a 7.05 would be 5% stage 4 and a 7.95 would be 95% 4's. In my case, it would be a 7.40. I think for statistics purposes, comparisons and decision-making, the Gleason 7 is just too broad. Any comments? John 3+4 or 4+3 they are both very significant prostate cancers. Other factors that are gaining recognition in importance are % cores on biopsy, and % vol in final path. Even with the current "crude" scale, it's hard to differentiate treatment outcomes between 3+4 versus 4+3. It would be even less feasible with 7.05 and 7.5 Keep in mind, even with gleason 7, cure rates after rad tx or da Vinci robotic laparoscopic prostatectomy are pretty high in many cases, and treatment morbidity/side-effects are reasonably low. === http://www.DrYew.com http://www.SanDiegoRoboticProstatectomy.com > I think the Gleason score needs some refinement, especially for Gleason > 7. [quoted text clipped - 20 lines] > > John I think that's it very nice that we have Dr. Yew...a surgeon...posting here from time to time. It can give us an insight that we don't often get. About John's note...I can see the frustration...but the study of the Gleason scale is pretty complicated. That's why group members have always suggested having results looked at by a few experts. The grading, as I understand it, is done by shapes and size of cells and it seems so tough to give an opinion...that the results are far from 'cut and dried'. Which would be why DECIMAL grading would be almost impossible. The subtleties in shapes and changes would require expert evaluation...and even THEN...there are differences of opinion. So...we have to go with the best we've got so far. I suppose that having as many experts as feasible look at the slides would be the way to go. Best of health to all, Ron B. Chicago I like John's idea. A variant could reflect Dr. Yew's observation that "Other factors that are gaining recognition in importance are % cores..." So, if you had G.S. 6 in 3 of 10 cores, it would be reported as G.S. 6.3. On the other hand there may be some objection to that because it is mixing staging w/ Gleason grading. Still, I think the idea has merit. Bill Denton RP 2/12/02 PSA .96 Memphis > I like John's idea. A variant could reflect Dr. Yew's observation that > "Other factors that are gaining recognition in importance are % > cores..." So, if you had G.S. 6 in 3 of 10 cores, it would be reported > as G.S. 6.3. On the other hand there may be some objection to that > because it is mixing staging w/ Gleason grading. Still, I think the > idea has merit. Well, here's another idea that does not mix staging and Gleason. It does seem the % of core is relevant. I had some cores of 6 in less than 5% of core. Others were 6 with 30% involvement. If we did something like 6.05 and 6.30 it would be more meaningful. Then, if my 7 in the earlier example involved 50% of core, my score on that would be 7.50.40. John > Well, here's another idea that does not mix staging and Gleason. It > does seem the % of core is relevant. To give credit where it's due, I believe it was Bostwick who said the % involvement is very important. John From my perspective, all the data is relevant. A single number Gleason cannot tell the whole story. In my case, I have 4 locations with multiple cores each with a Gleason7(3,4) and 1 locatio with 2 cores with 7(4,3). Cancer is present varying 's from 25% to 50% in the 3,4 samples and 30% in the 2 4,3 samples. My doctor said that a G7 is classified as intermediate; however, the 4,3 carries a greater significance. Based on the extent of the cancer and the 4,3 is why I took the advice to have a radical prosatectomy. That and other family factors: father died at age 57 of colon cancer for which I have already had one colonoscopy. Older brother had thyroid cancer (cured) in his late 20's. Mother, bless her heart, still alive at 95 - but barely. I have no other significat health issues at age 63, and I would like to keep it that way. -snip- I'd go with the worst finding in terms of grade. <5% Gleason 7 and multiple cores with Gleason 6 , 30-50%, I'd still treat it like 7.. but that's my bias as a cancer doc. === http://www.DrYew.com http://www.SanDiegoRoboticProstatectomy.com *IMPORTANT* Any comments by me are for general informational purposes only, and should never be used to diagnose or recommend treatments for any condition without face-to-face consultation with a qualified health-care provider. Thank you. === > From my perspective, all the data is relevant. A single number Gleason > cannot tell the whole story. [quoted text clipped - 11 lines] > > -snip- |
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