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Gleason Level 8 Prostate Cancer

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What Is A Bad Gleason Score For Prostate Cancer

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

Gleason scores aren’t good or bad, per se. They predict how quickly your prostate cancer might grow. Tumors with higher Gleason scores are likely to grow quickly. And Gleason scores aren’t the only factors healthcare providers consider when creating your treatment plan.

What other factors do healthcare providers consider?

Providers consider the results of other tests and additional biopsy information. For example, when you had your biopsy, your healthcare provider obtained several samples or cores from your prostate. They checked how many cores contained cancer and whether most of the cells in the cores were cancerous cells.

Other factors may include:

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.

Risk Groups For Prostate Cancer

Prostate cancer is divided into risk groups.

Before planning your treatment, your cancer doctor will look closely at your risk group. This helps you and your doctors to decide on the best treatment for you. The treatment options for each risk group can be different.

Prostate cancer was previously grouped into low, intermediate or high risk groups. Doctors now use a more detailed system to work out your risk group. This is called the Cambridge Prognostic Group . It divides prostate cancer risk into 5 different groups. Your doctor may still describe your risk as low, moderate or high.

To work out your CPG risk group, your doctors look at:

  • the stage of the cancer
  • your Gleason score.

Read Also: What Happens When A Man’s Prostate Is Removed

Survival Rate After Prostate Removal And Radiation

Radical prostatectomy can provide cancer-specific survival of 15 years or more in 80% of patients with limited prostate cancer.

  • In patients with well differentiated prostate cancers having Gleason scores of 2 to 4, the 10-year PSA progression-free survival is about 70 to 80% with radiation therapy or surgery.
  • The 10-year PSA progression-free survival drops to 50 to 70% for Gleason scores of 5 to 7. Eight-year survival for clinically localized tumors with Gleason score less that 7 is 85-95%.
  • The 10-year PSA progression-free survival drops further down to 15% to 30% for Gleason scores of 8 to 10 with a 8-year survival rates of about 70%.
  • The distant metastasis-free survival response to radiotherapy is influenced by the dose of radiotherapy.
  • High-risk patients with Gleason scores of 7 have 8-year survival rates of about 70%, while those with Gleason scores of 8 to 10 have an 8-year survival of about 50% following radiation therapy.

What Is The Meaning Of Different Gleason Scores

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The higher the Gleason score, the more aggressive the cancer and the more likely it is to spread. Here’s a more thorough breakdown of what your score means:

  • Low Grade: Gleason Score = 6 or less: This number indicates that most likely, the cancer will be slow-growing and not very aggressive. Typically, patients with this level of Score have the best treatment outcomes. In some cases treatment is not recommended for low grade prostate cancer patients and watchful waiting is implemented.

  • Intermediate Grade: Gleason Score = 7: A score of 7 means that the patient has a 50/50 chance of having aggressive prostate cancer. If the patient received a primary grade of 3 and a secondary grade of 4, more than likely, the cancer would grow slowly. However, if those numbers are reversed, and the primary grade was 4 and the secondary 3, the cancer may be aggressive.

  • High Grade: Gleason Score = 8-10: A score of 8-10 means the cancer is aggressive and is more likely to grow quickly and spread. Prognosis for an 8 is definitely better than a 10, but treatment will be recommended right away.

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Survival By Disease Recurrence

If a man develops an elevated PSA level after cancer surgery, then the disease is viewed as recurrent.

The number of lymph nodes at the time of prostatectomy can influence the risk of recurrence. One study suggests the removal of a large number of nodes is associated with an improvement in odds of recurrence, but this doesnt appear to impact overall survival.

But disease recurrence doesnt always influence survival times. If a recurrence does occur, the 15-year survival rate at the time of diagnosis may be as high as 94% in those with low-risk recurrence.

The main factors influencing survival rates are:

  • The Gleason score
  • The PSA doubling time
  • Whether the recurrence occurred within three years or after three years

A recurrence that occurs within three years reduces survival rates by anywhere from 15 to 20%and even more, if the doubling time is short.

Risk Factors Predicting A Postoperative Gs Upgrade To 8

3.3.1 Analysis of Risk Factors Predicting a Postoperative GS Upgrade to 8 Based on Univariate and Multivariate Logistic Regression

Univariate logistic regression showed that the PSA level, prostate volume, number of positive cores, CRMP4 promoter methylation ra[te, and clinical T stage were factors predicting a postoperative GS upgrade to 8 . Multivariate logistic regression showed that prostate volume, number of positive cores, and the CRMP4 promoter methylation rate were all factors predicting a GS upgrade to 8. The positive predictive rate was 85.2%, the negative predictive rate was 99.3%, and the overall predictive rate was 97.9%. The smaller the prostate volume, the higher the possibility of a GS upgrade to 8 . The higher the number of positive cores, the higher the possibility of a GS upgrade to 8 . The higher the CRMP4 promoter methylation rate, the more likely a GS upgrade to 8 .

Table 2 Univariate and multivariate logistic regression to identify risk factors predicting a postoperative upgrade in GS to 8.

3.3.2 Comparison of the Predictive Performance of Different Pathologic Factors for a Postoperative GS Upgrade to 8 Based on ROC Analysis

Figure 1 ROC curves for predicting a postoperative upgrade in GS to 8. V, prostate volume PC, Positive cores C4, collapsin response mediator protein 4.

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Where Do These Numbers Come From

The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.

The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.

  • Localized: There is no sign that the cancer has spread outside the prostate.
  • Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
  • Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.

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What Is A 5

Understanding The Gleason Score | Prostate Cancer Staging Guide

A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.

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What Is A Normal Gleason Score For Prostate Cancer

Your Gleason score doesn’t rank potential ranges like ranges set for elevated PSA tests. Instead, providers break Gleason scores into three categories:

  • Gleason 6 or lower: The cells look similar to healthy cells, which is called well differentiated.
  • Gleason 7: The cells look somewhat similar to healthy cells, which is called moderately differentiated.
  • Gleason 8, 9 or 10: The cells look very different from healthy cells, which is called poorly differentiated or undifferentiated.

What are grade groups?

Healthcare providers established grade groups to clarify the Gleason score system. Those grade groups are:

  • Grade Group 1 = Gleason 6 .
  • Grade Group 2 = Gleason 3+4=7.
  • Grade Group 3 = Gleason 4+3=7.
  • Grade Group 4 = Gleason 8.
  • Grade Group 5 = Gleason 9-10.

Seminal Vesicle And Lymph Node Positive

The determination of risk is not straightforward. As discussed earlier, the three standard prognostic factors are Gleason score, PSA and stage. There are subgroups in each that appear to have a very high risk of recurrence. So the first place to start is whether there are any single factors that portend such a great risk that they alone would indicate the need for adjuvant treatment. One that easily falls into this category is that of positive lymph node metastasis. The risk of failure in these patients is non-controversial and we wont discuss it further. We would submit that the second of these is that of seminal vesicle involvement, which has been extensively studied .

Table 1

56%

Definition of failure and disease free survival: based on biochemical failure and includes biopsy proven local recurrence and radiologically detected distant metastasis

* 2 year endpoint for all groups. Mar+ is margin positive Mar- is margin negative EPE+ is extraprostatic extension present EPE- is extraprostatic extension absent foc is focal Ext is extensive Est is established Gl is Gleason score

The limitations of the small numbers of patients in the more favorable subgroups make selecting those patients for avoidance of intervention a risky proposition. In a subgroup analysis of the SWOG adjuvant study , all the subgroups benefitted from adjuvant radiation to the same degree .

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Should I Get A Second Opinion About My Gleason Score And Prostate Cancer Diagnosis

It is always the patients right to obtain a second opinion about a cancer diagnosis or any other medical condition. Talking to a radiation oncologist will allow them to review your pathology report and request any other tests they may need to make sure you have the right information to make a decision about your treatment plan.

If you would like one of our radiation oncologists to review your pathology report, you only need to sign a release so we can have your biopsy material sent to us. We can then determine the Gleason score our team sees. Most of the time, the Gleason score we determine is the same, but not always. Because the Gleason score is the most important issue about your particular cancer, we want it to be as accurate as possible.

Its critical to personally research prostate cancer treatment options to make an informed decision that is best for you and your family. And, with few exceptions, your first treatment gives you the best chance for success. If your urologist has told you that you have a Gleason score of 6 10, or you would like a second opinion, request an appointment for a consultation.

What Is Prostate Cancer

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Prostate cancer occurs when the cells in the prostate gland begin to grow rapidly and out of control. Usually, it starts out growing slowly and stays within the prostate.

There are 5 types of prostate cancers:

  • Adenocarcinomas
  • Transitional cell carcinomas

Chances are high that when you are diagnosed with prostate cancer, it is adenocarcinoma, which starts in the gland cells.

The other 4 types of prostate cancers are less common. Like all cancers, prostate cancer is graded to determine how aggressive and rapidly it is growing. No matter the type of cancer, all patients diagnosed are staged. This means assigning a grade that defines how aggressive the cancer is. For staging prostate cancer, the Gleason Score is the method used.

Related reading: Prostate Cancer: When Should Men Be Screened?

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What Do The Different Gleason Scores Mean

The Gleason Score is based on the aggressiveness of the prostate cancer. The lower the number, the closer to normal the cell tissue, and slower-growing the cancer is likely to be. Anything less than 6 is not considered cancer.

The Gleason Score is based on the aggressiveness of the prostate cancer.

The higher the number, the more aggressive the cancer and the more likely it is to spread. Let’s take a look at what the different scores mean:

  • Low Grade: Gleason Score = 6: This indicates that more than likely the cancer will be slow-growing and not very aggressive. Patients with these scores have the best prognosis.
  • Intermediate Grade: Gleason Score = 7: A score of 7 means that the patient has a 50/50 chance of having aggressive prostate cancer. If the patient received a primary grade of 3 and a secondary grade of 4, more than likely the cancer will grow slowly. However, if those numbers are reversed and the primary grade was 4 and the secondary 3, the cancer may be aggressive.
  • High Grade: Gleason Score = 8-10: A score of 8-10 means the cancer is aggressive and likely to grow and spread at a rapid pace.

Screening Information For Prostate Cancer

Screening for prostate cancer is done to find evidence of cancer in otherwise healthy adults. Two tests are commonly used to screen for prostate cancer:

Digital rectal examination

A DRE is a test in which the doctor inserts a gloved, lubricated finger into the rectum and feels the surface of the prostate through the bowel wall for any irregularities.

PSA blood test

There is controversy about using the PSA test to look for prostate cancer in people with no symptoms of the disease. On the one hand, the PSA test is useful for detecting early-stage prostate cancer, especially in those with many risk factors, which helps some get the treatment they need before the cancer grows and spreads. On the other hand, PSA screening may find very-slow-growing prostate cancers that would never threaten someone’s life. As a result, screening for prostate cancer using PSA may lead to treatments that are not needed, which can cause side effects and seriously affect a person’s quality of life.

ASCO recommends that people with no symptoms of prostate cancer and who are expected to live less than 10 years do not receive PSA screening. For those expected to live longer than 10 years, ASCO recommends that they talk with their doctor to find out if the test is appropriate for them.

Other organizations have different recommendations for screening:

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Gleason Score For Grading Prostate Cancer

Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.

The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.

Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. 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.

The Tnm System For Prostate Cancer Stages

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As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:

  • Tumor. Whatâs the size of the main area of prostate cancer?
  • Nodes. Has it spread to any lymph nodes? If so, how far and how many?
  • Metastasis. How far has the prostate cancer spread?

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