Wednesday, December 7, 2022

Gleason 8 Prostate Cancer Prognosis

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How We Treat Prostate Cancer

Treating High-Risk Gleason 8: A Modern Approach | Mark Scholz, MD | PCRI

The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.

New Diagnosis: Where Do I Start

You are not alone. The good news is that most prostate cancers are slow-growing and that with early detection and treatment, it can be cured. Increasing your knowledge by reviewing sections such as Coping with cancer, Choosing your treatment as well as other areas of the web site helps relieve the stress and helps make decisions clearer.

Over the last 12 months, approximately 4,600 Quebecers were diagnosed with prostate cancer. This represents an average of 12 men per day. You are definitely not alone in your fight against prostate cancer. The good news is that we know most prostate cancers are slow-growing, which means that with early detection and treatment, it can even be cured.

Once diagnosed, men will go through understandable and normal reactions, such as fear, denial, anger, helplessness and feeling of loss of control over their life. Once reality sets in, a constructive way to deal with the disease is to learn as much as you can about it. Increasing your knowledge about prostate cancer helps relieve the natural fear of the unknown, and makes the decision-making process easier.

Frequently Asked Questions

Click here for the full list of prostate cancer-related FAQs.

Questions about survival

Talk to your doctor about your prognosis. A prognosis depends on many factors, including:

  • how the cancer responds to treatment

We are here for you

The Ajcc Tnm Staging System

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.

The TNM system for prostate cancer is based on 5 key pieces of information:

  • The extent of the main tumor *
  • Whether the cancer has spread to nearby lymph nodes
  • Whether the cancer has spread to other parts of the body
  • The PSA level at the time of diagnosis
  • The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .

*There are 2 types of T categories for prostate cancer:

  • The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
  • If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.

Also Check: How To Relieve Prostate Pressure

What Does A Gleason Score Of 9 Mean

. Herein, is Gleason 9 prostate cancer curable?

Radiation therapy and radical prostatectomy offer men with Gleason score 910 prostate cancer equivalent cancer-specific and overall survival, according to a new study. Of these, 230 underwent external beam radiation therapy , 87 were treated with EBRT and brachytherapy , and 170 underwent RP.

Subsequently, question is, what is the prognosis for a man with a Gleason score of 9? Conclusions and RelevanceAmong patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

Similarly, it is asked, can Gleason 9 Be Cured?

For prostate cancer patients with aggressive, Gleason 9-10 disease, treatment with radiotherapy plus hormone therapy was at least as effective as surgical strategies in a retrospective study.

What does a Gleason score of 10 mean?

The lowest Gleason Score of a cancer found on a prostate biopsy is 6. These cancers may be called well-differentiated or low-grade and are likely to be less aggressive â they tend to grow and spread slowly. Cancers with Gleason Scores of 8 to 10 may be called poorly differentiated or high grade.

Bone Pain In Prostate Cancer

Gleason 8 Prostate Cancer

Many advanced prostate cancer patients often suffer from bone pain that adversely affect quality of life. The management of pain or other cancer related functional impairment is integral part of palliative care. Palliative management can include analgesics, glucocorticoids, palliative chemotherapy, radioisotopes or radiotherapy.

Radioisotopes that selectively concentrate in bone lesions are approved for the palliative treatment of painful bone metastases. The treatment is of more value in patients with multiple metastases . The radioisotopes have been found to reduce the need for opioid painkillers in such patients.

EBRT is effective in painful bone lesions in advanced prostate cancer patients but not an ideal option if there are multiple lesions at different sites. The lesions in multiple sites will progress after EBRT in one site and pain will reappear in a short time afterwards, unless other systemic therapies are initiated to control the disease process. Read more on EBRT under prostate cancer treatments.

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New Contemporary Prostate Cancer Grading System

Discrete Well-formed Glands

Copyright 2013 The Johns Hopkins University. All rights reserved. Jonathan Epstein, M.D.

Gleason Patterns 1-3: from left to right1st Row: Closely packed uniform sized and shaped large glands Large variably sized and shaped glands, some with infolding Uniform medium sized glands Variably sized glands2nd Row: Occasional tangentially sectioned glands amongst well-formed small glands Occasional tangentially sectioned glands amongst well-formed glands with open lumina Back-to-back discrete glands Branching glands

Cribriform/Poorly-formed/Fused Glands

Copyright 2013 The Johns Hopkins University. All rights reserved. Jonathan Epstein, M.D.

Gleason Pattern 4: from left to right3rd Row: Large irregular cribriform glands with well-formed lumina Irregular cribriform glands with slit-like lumina, glomeruloid structures, and fused glands Irregular cribriform glands with small round lumina Small round cribriform glands4th Row: Poorly-formed glands with peripherally arranged nuclei Small poorly-formed glands Small poorly-formed glands Fused poorly-formed glands

Sheets/Cords/Single Cells/Solid Nests/Necrosis

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Prostate Cancer Grading & Prognostic Scoring

The Gleason Score is the grading system used to determine the aggressiveness of prostate cancer. This grading system can be used to choose appropriate treatment options. The Gleason Score ranges from 1-5 and describes how much the cancer from a biopsy looks like healthy tissue or abnormal tissue . Most cancers score a grade of 3 or higher.

Since prostate tumors are often made up of cancerous cells that have different grades, two grades are assigned for each patient. A primary grade is given to describe the cells that make up the largest area of the tumor and a secondary grade is given to describe the cells of the next largest area. For instance, if the Gleason Score is written as 3+4=7, it means most of the tumor is grade 3 and the next largest section of the tumor is grade 4, together they make up the total Gleason Score. If the cancer is almost entirely made up of cells with the same score, the grade for that area is counted twice to calculated the total Gleason Score. Typical Gleason Scores range from 6-10. The higher the Gleason Score, the more likely that the cancer will grow and spread quickly.

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How Important Is The Gleason Score

The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:

  • The blood PSA level
  • How much of each core is made up of cancer
  • The number of cores that contain cancer
  • Whether cancer was found in both sides of the prostate
  • Whether the cancer has spread outside the prostate

Changes In Psa Levels After Surgery

Gleason 4 4=8 Prostate Cancer Treatments | Ask a Prostate Expert, Mark Scholz, MD

In patients with rising PSA levels after radical prostatectomy, the important prognostic factors are the :

  • pathologic stage
  • time taken post-operatively to reach detectable PSA levels
  • Gleason score at the time of prostatectomy
  • time required for doubling of PSA values

PSA doubling time of 15 months or more are better managed with surveillance. The have median time to metastatic disease in these years is about 8 years and the median survival is about 13 years. Patients with PSA doubling times of less than 3 months are at very high risk of prostate cancer related death and have a median survival of 5 to 6 years.

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What Does It Mean If In Addition To Cancer My Biopsy Report Also Says Atypical Glands Or Atypical Small Acinar Proliferation Or Glandular Atypia Or Atypical Glandular Proliferation

All these terms mean that the pathologist saw something under the microscope that suggests cancer may be present. However, the actual evidence for cancer is insufficient to be conclusive. Finding any of these is of no relevance to the overall outlook if cancer has already been diagnosed in another part of the biopsy.

Active Surveillance And Focal Therapy For Low

Laurence Klotz

Division of Urology, Sunnybrook Health Sciences Centre, University of Toronto, Canada

Correspondence to:

Keywords: Active surveillance focal therapy low risk prostate cancer minimally invasive conservative management biomarkers

Submitted Jun 01, 2015. Accepted for publication Jun 05, 2015.

doi: 10.3978/j.issn.2223-4683.2015.06.03

Read Also: What Is The Definition Of Prostate Gland

Quality Of Life On Eligard

I was on Eligard 6 month shot injected into the stomach. Ouch. I was scheduled for 4 shots but I changed docs and the new doc agreed 2 shots was enough. I can still feel the pellet from the last shot- those things seem to last forever!

I think it gave my wife some comfort- she is afraid of this cancer thingie. both Lupron & eligard have lots of side effects- and I think I had them all. So I was delighted to not get the third injection. As far as my quality of life- well that is a complicated question. What is intolerable to me might be very easily within your comfort zone. I am also still leaking and the combination the after effects of surgery has not been good for me. But it is better than dying. so many difficult choices with PC- and none of them are easy or comfortable.

Also, I want to comment on that 1020 surgery date- must have been some surgeon!!! LOL and you must be some kind of patient!! LOL

Stages Of Prostate Cancer

Characterization of Prostate Cancer with Gleason Score of at Least 7 by ...

Doctors combine the T, N, and M results with the Gleason score and PSA level in a process called stage grouping. The system uses Roman numerals from I to IV . The stage helps your doctor choose the best course of treatment for you.

Stage I

  • The cancer is growing in your prostate but hasnât spread beyond it.
  • In most cases, the doctor canât feel the tumor during a DRE or see it in imaging tests.
  • The Gleason score is 6 or less, and the PSA level is less than 10.
  • The tumor is in half or less of one side of the prostate.

Stage IIA

  • The cancer is growing in your prostate but hasnât spread beyond it.
  • The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
  • The tumor can touch more than half of one lobe of the prostate but doesnât involve both lobes.
  • The Gleason score is 7 or less, and the PSA level is less than 20.

Stage IIB

  • The cancer is growing in your prostate but hasnât spread beyond it.
  • The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
  • The tumor can be in one or both lobes of the prostate.
  • The Gleason score is 7, and the PSA level is less than 20.

Stage IIC

  • The cancer hasn’t spread beyond the prostate.
  • The doctor may or may not be able to feel the tumor during a DRE or see it on an imaging test.
  • The tumor can be in one or both lobes of the prostate.
  • The Gleason score is 7 or 8, and the PSA level is less than 20.
  • The cancer cells appear more abnormal than in stage IIB.

Stage IIIA

Read Also: Common Sites Of Prostate Cancer Metastasis

What Does It Mean If My Biopsy Report Mentions The Word Core

The most common type of prostate biopsy is a core needle biopsy. For this procedure, the doctor inserts a thin, hollow needle into the prostate gland. When the needle is pulled out it removes a small cylinder of prostate tissue called a core. This is often repeated several times to sample different areas of the prostate.

Your pathology report will list each core separately by a number assigned to it by the pathologist, with each core having its own diagnosis. If cancer or some other problem is found, it is often not in every core, so you need to look at the diagnoses for all of the cores to know what is going on with you.

Grading In Different Prostatic Tissue Samples

Gleason grading should be performed in all prostatic tissue samples, including needle core biopsy specimens. Indeed, of Gleasonâs original series of 2911 patients, 60% were graded solely on the basis of a needle biopsy. A Gleason grade should be assigned even to needle biopsy cases with minimal prostatic carcinoma, defined as less than 1mm of tumor., Of importance, a small amount of carcinoma in needle biopsy tissue should not be equated with well-differentiated Gleason score 24 adenocarcinoma. Most minimal adenocarcinomas in needle biopsy tissue are intermediate Gleason grade, usually of a score of 6. Comparisons of Gleason grade in needle biopsy with Gleason grade in the matched whole prostate gland indicate exact correlation in 43% of cases and agreement to within±1 score unit in 77% of 3789 cases . Undergrading of tumor in the needle biopsy, with a higher Gleason score in the matched whole gland, is the most common problem, occurring, on average, in 42% of all cases. Overgrading of carcinoma in needle biopsy tissue also takes place, but with a much lower mean of 15% of all cases. For needle biopsy cases, there are several sources of grading error, including difficulty in appreciation of an infiltrative growth pattern, tissue sampling error , tissue distortion, pathologist experience, and observer variability.

Read Also: Best Treatment For Gleason 7 Prostate Cancer

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Prognostic Factors For Failure After Prostatectomy

Gregory P. Swanson1, Joseph W. Basler2

1. Departments of Radiation Oncology, Radiology and Urology, UT Health Science Center San Antonio, San Antonio, TX 78229, USA.2. Department of Urology, UT Health Science Center San Antonio, San Antonio, TX 78229, USA.

Corresponding author: Gregory P. Swanson, MD, Associate Professor of Radiation Oncology, The University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive MC7889, San Antonio, TX 78229, USA. Tel: 210-450-1109 Fax: 210-450-5085 Email: swansongeduMore

Citation:J Cancer

What Can Affect My Outlook

Gleason 4 4=8 & Hormone Therapy | Ask a Prostate Cancer Expert, Mark Scholz, MD

No one can tell you exactly what will happen. How prostate cancer affects you will depend on many things.

  • Your stage Whether your cancer is localised, locally advanced, or advanced.
  • Your Gleason score or grade group The higher your Gleason score, the more aggressive the cancer, and the more likely it is to spread.
  • Your treatment options You may be able to have treatment aimed at getting rid of the cancer. Or you may be able to have treatment to keep the cancer under control. Read more about choosing your treatment.
  • Your health If you have other health problems, you may have fewer treatment options. And you may be more likely to die from another condition, such as heart disease.
  • Your PSA level After youve been diagnosed, PSA tests are a good way of monitoring your prostate cancer and seeing how youre responding to treatment.
  • How successful your treatment is Your treatment may be successful at getting rid of your cancer or keeping it under control. But for some men, treatment may not work as well as expected.

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Ethics Approval And Informed Consent

This study was approved by the regional Swedish Ethics Review Authority in Stockholm, Sweden . In registry-based studies, such as this one, the requirement for informed consent is typically waived because the benefits to patients and the health care in general outweigh potential liabilities. The data handling complied with relevant data protection and privacy regulation .

What Is The Normal Gleason Score

Theoretically, Gleason scores range from 2-10. However, since Dr. Gleasons original classification, pathologists almost never assign scores 2-5, and Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer.

Otherwise, is a Gleason score of 9 a death sentence?

Not all men with Gleason 8-10 disease are going to do badly after treatment. There is a perception among a lot of patients especially when they get diagnosed that having a high Gleason score of 8, 9, or 10 is essentially a death sentence, regardless of how they get treated. This is not actually the case at all.

Although, is Gleason score the same as PSA? A Gleason score of 8 or higher, accompanied by a PSA level of higher than 20 ng/ml and a more advanced tumor stage, signifies a high risk of advancing cancer. In high-risk cases, the prostate cancer tissue looks very different from normal tissue.

So too, what is a Gleason score of 7 mean?

A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.

What if prostate biopsy is positive?

If prostate cancer is found on a biopsy, it will be assigned a grade. The grade of the cancer is based on how abnormal the cancer looks under the microscope. Higher grade cancers look more abnormal, and are more likely to grow and spread quickly.

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