Thursday, February 9, 2023

Gleason Score 7 Prostate Cancer Treatment Options

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What Is A Gleason Score

Option for Gleason 7 or intermediate risk prostate cancer? | Mark Scholz #1

If you have prostate cancer, your Gleason score is one factor healthcare providers consider to develop your treatment plan.

Your score reflects what providers learned about your cancer after examining tissue samples from your prostate cancer biopsy. They looked for patterns of normal and abnormal cells, noting where your cells look more like cancerous cells and where they look more like healthy cells.

Then they graded each piece of the pattern on a 3 to 5 scale. Pattern pieces with cancer cells that look like healthy cells were graded low. Pieces with cancer cells that don’t look like healthy cells get high grades.

Providers add those scores to set an overall Gleason score between 6 and 10. They might refine their analysis by classifying your cells by group, with Gleason scores listed in grade groups 1 to 5.

Choosing The Best Treatment

It can be difficult to choose the best treatment for you. Your doctor and specialist nurse will explain the different treatment options and help you make a decision. The Predict Prostate tool can also help you decide between monitoring and radical treatment. We have more information about this tool further down this page.

A UK trial showed that there can be very little difference in survival between the treatments especially if you are diagnosed with early prostate cancer.

The table below shows how many men survive different treatments for CPG 1, 2 and 3 localised prostate cancer after 10 years.

Treatment

General Information About Prostate Cancer

In This Section

The median age at diagnosis of carcinoma of the prostate is 67 years. Prostate cancer may be cured when localized, and it frequently responds to treatment when widespread. The rate of tumor growth varies from very slow to moderately rapid, and some patients may have prolonged survival even after the cancer has metastasized to distant sites, such as bone. The 5-year relative survival rate for men diagnosed in the United States from 2011 to 2017 with local or regional disease was greater than 99%, and the rate for distant disease was 31% a 98% survival rate was observed for all stages combined. The approach to treatment is influenced by age and coexisting medical problems. Side effects of various forms of treatment should be considered in selecting appropriate management.

Many patientsespecially those with localized tumorsmay die of other illnesses without ever having suffered disability from the cancer, even if managed conservatively without an attempt at curative therapy. In part, these favorable outcomes are likely the result of widespread screening with the prostate-specific antigen test, which can identify patients with asymptomatic tumors that have little or no lethal potential. There is a large number of these clinically indolent tumors, estimated from autopsy series of men dying of causes unrelated to prostate cancer to range from 30% to 70% of men older than 60 years.

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Can The Gleason Score On My Biopsy Really Tell What The Cancer Grade Is In The Entire Prostate

Prostate biopsies are tissue samples from different areas of the prostate. The Gleason Score on a biopsy usually reflects the cancer’s true grade. However, it is possible that the Gleason Score from your biopsy is lower or higher than the true grade. To reduce the risk of over-or-under scoring, multiple biopsies are usually taken from different areas within the prostate.

Prostate Cancer Stage Ii Treatment Options

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Stage II prostate cancers are still localized, but are larger than stage I cancers. The cancer may be on both sides of the prostate and a doctor may be able to feel it with a DRE. PSA levels are medium and cancer cells may or may not resemble cancer cells. Given these changes, there is a greater risk of progression and metastasis than in stage I.

Treatment options for stage II prostate cancer include:

  • Radical prostatectomy
  • Radiation therapy with ADT or brachytherapy
  • Active surveillance

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The Stages Of Treatment

Because the stage of your cancer is the most influential factor in how your treatment will progress, weve divided the rest of this article into segments based on the stage of your cancer:

Stage 1 prostate cancer is the least advanced stage. This means your cancer is small and hasnt advanced past your prostate.

In this stage, PSA and Grade Group levels are low. Over 99% of people with prostate cancer caught in this stage survive the effects of cancer for at least 5 years. This means that you can still die of other causes, but you have a less than 1% chance of dying of prostate cancer complications.

for stage 1 prostate cancer usually consists of some combination of active surveillance, surgery, or radiation therapy. You may also be eligible for clinical trials that offer newer treatment techniques.

Cancer May Spread From Where It Began To Other Parts Of The Body

When cancer spreads to another part of the body, it is called metastasis. Cancer cells break away from where they began and travel through the lymph system or blood.

  • Lymph system. The cancer gets into the lymph system, travels through the lymph vessels, and forms a tumor in another part of the body.
  • Blood. The cancer gets into the blood, travels through the blood vessels, and forms a tumor in another part of the body.

The metastatic tumor is the same type of cancer as the primary tumor. For example, if prostate cancer spreads to the bone, the cancer cells in the bone are actually prostate cancer cells. The disease is metastatic prostate cancer, not bone cancer.

Denosumab, a monoclonal antibody, may be used to preventbone metastases.

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Good Prostate Cancer Care

Your MDT will be able to recommend what they feel are the best treatment options, but ultimately the decision is yours.

You should be able to talk with a named specialist nurse about treatment options and possible side effects to help you make a decision.

You should also be told about any clinical trials you may be eligible for.

If you have side effects from treatment, you should be referred to specialist services to help stop or ease these side effects.

Predictive And Prognostic Role Of Lipocalin

Understanding The Gleason Score | Prostate Cancer Staging Guide

Abstract

Lipocalin-2 has an important role in tumor progression, invasion, and metastasis. However, its role in prostate cancer remains unclear. The objective of this study is to determine the expression level of lipocalin-2 in human prostate cancer tissues and to evaluate the relationship between its expression level and clinicopathologic parameters including response to docetaxel treatment, Gleason score, progression-free survival , and overall survival . We retrospectively analyzed paraffin-embedded tissue sections from 33 metastatic castrate-resistant prostate cancer patients whose clinical outcomes had been tracked after docetaxel treatment. The expression status of lipocalin-2 was defined by immunohistochemistry using the anti-lipocalin-2 antibody. Lipocalin-2 was highly expressed in 36% of the examined specimens. There was no significant correlation between high lipocalin-2 expression and docetaxel response . High lipocalin-2 expression was signicantly associated with a higher Gleason score . KaplanMeier survival analysis failed to show a significant correlation between expression levels of lipocalin-2 and both OS and PFS although patients with high lipocalin-2 levels had a numerically shorter PFS and OS time compared to patients with low levels. Consequently, it is clear that further studies are needed to evaluate the predictive and prognostic role of lipocalin-2 in prostate cancer patients.

1. Introduction

2. Methods

2.1. Patient and Tissue Samples

3. Results

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What Is Advanced Prostate Cancer

When prostate cancer spreads beyond the prostate or returns after treatment, it is often called advanced prostate cancer.

Prostate cancer is often grouped into four stages, with stages III and IV being more advanced prostate cancer.

  • Early Stage | Stages I & II: The tumor has not spread beyond the prostate.
  • Locally Advanced | Stage III: Cancer has spread outside the prostate but only to nearby tissues.
  • Advanced | Stage IV: Cancer has spread outside the prostate to other parts such as the lymph nodes, bones, liver or lungs.

When an early stage prostate cancer is found, it may be treated or placed on surveillance . Advanced prostate cancer is not curable, but there are many ways to treat it. Treatment can help slow advanced prostate cancer progression.

There are several types of advanced prostate cancer, including:

Biochemical Recurrence

With biochemical recurrence, the prostate-specific antigen level has risen after treatment using surgery or radiation, with no other sign of cancer.

Castration-Resistant Prostate Cancer

Non-Metastatic Castration-Resistant Prostate Cancer

Prostate cancer that no longer responds to hormone treatment and is only found in the prostate. This is found by a rise in the PSA level, while the testosterone level stays low. Imaging tests do not show signs the cancer has spread.

Metastatic Prostate Cancer

  • Lymph nodes outside the pelvis
  • Other organs, such as liver or lungs

Metastatic Hormone-Sensitive Prostate Cancer

What Does It Mean To Have A Gleason Score Of 6 7 8 Or 9

Because grades 1 and 2 are not often used for biopsies, 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 that is, they tend to grow and spread slowly.

Cancers with Gleason scores of 8 to 10 may be called poorly differentiated or high-grade. These cancers are likely to grow and spread more quickly, although a cancer with a Gleason score of 9-10 is twice as likely to grow and spread quickly as a cancer with a Gleason score of 8.

Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:

  • Gleason score 3+4=7 tumors still have a good prognosis , although not as good as a Gleason score 6 tumor.
  • A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor.

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What Is A Bad Gleason Score For Prostate Cancer

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:

Treatment Option Overview For Prostate Cancer

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In This Section

Local treatment modalities are associated with prolonged disease-free survival for many patients with localized prostate cancer but are rarely curative in patients with locally extensive tumors. Because of clinical understaging using current diagnostic techniques, even when the cancer appears clinically localized to the prostate gland, some patients develop disseminated tumors after local therapy with surgery or radiation.

Treatment options for each stage of prostate cancer are presented in Table 6.

Table 6. Treatment Options by Stage for Prostate Cancer

Stage Standard Treatment Options
EBRT = external-beam radiation therapy LH-RH = luteinizing hormone-releasing hormone PARP = poly polymerase TURP = transurethral resection of the prostate.
Stage I Prostate Cancer
PARP inhibitors for men with prostate cancer and BRCA1, BRCA2, and/or ATM mutations

Side effects of each of the treatment approaches are covered in the relevant sections below. Patient-reported adverse effects differ substantially across the options for management of clinically localized disease, with few direct comparisons, and include watchful waiting/active surveillance/active monitoring, radical prostatectomy, and radiation therapy. The differences in adverse effects can play an important role in patient choice among treatment options. Detailed comparisons of these effects have been reported in population-based cohort studies, albeit with relatively short follow-up times of 2 to 3 years.

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Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will work with you to develop a specific treatment plan based on the cancers stage and other factors. Detailed descriptions of each type of treatment are provided earlier on this same page. Clinical trials may also be a treatment option for each stage.

Early-stage prostate cancer

Early-stage prostate cancer usually grows very slowly and may take years to cause any symptoms or other health problems, if it ever does at all. As a result, active surveillance or watchful waiting may be recommended. Radiation therapy or surgery may also be suggested, as well as treatment in clinical trials. For those with a higher Gleason score, the cancer may be faster growing, so radical prostatectomy and radiation therapy are often recommended. Your doctor will consider your age and general health before recommending a treatment plan.

ASCO, the American Urological Association, American Society of Radiation Oncology, and the Society of Urologic Oncology recommend that patients with high-risk early-stage prostate cancer that has not spread to other areas of the body should receive radical prostatectomy or radiation therapy with hormonal therapy as standard treatment options.

Locally advanced prostate cancer

Watchful waiting may be considered for older adults who are not expected to live for a long time and whose cancer is not causing symptoms or for those who have another, more serious illness.

Active Surveillance Testing Schedule

Medical experts offer various recommendations regarding frequency of testing and when to start treatment during active surveillance. The American Society of Clinical Oncology recommends the following periodic evaluations while under active surveillance for prostate cancer:

  • PSA testing every three to six months

  • A digital rectal exam at least once a year

  • A prostate biopsy at least every two to five years

If test results or symptoms indicate the cancer is progressing, treatment is recommended with the intention of curing the disease.

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What If My Biopsy Shows Cancer

If the biopsy shows prostate cancer, your doctor will determine how likely your cancer is to grow quickly and spread. Sometimes, prostate cancer grows slowly over many years. But other times, it grows quickly.

Your doctor can use your PSA level, Gleason score, and tumor score to determine your risk level. The following pages give more information about Gleason score, T-score, and prostate cancer risk levels.

Gleason Score

The Gleason score is a common scale used to determine how fast your prostate cancer is likely to grow. Gleason scores can range from 2 to 10, but most often range from 6 to 10. The higher the Gleason score, the more likely your cancer is to grow and spread.

Tumor Score

The T-score tells how far your prostate cancer has grown.

  • T1: The cancer is too small to be felt during a digital rectal exam or seen in an imaging test . The cancer is found from a biopsy done after a man has a high PSA level or has surgery for problems urinating. The cancer is only in the prostate gland.
  • T2: The cancer can be felt during a digital rectal exam and may be seen in an imaging test. The cancer is still only in the prostate gland.
  • T2a: The cancer is in one-fourth of the prostate gland .
  • T2b: The cancer is in more than one-fourth of the prostate gland , but has not grown into the other side of the prostate gland.
  • T2c: The cancer has grown into both sides of the prostate gland.

Risk Level

Table 1. Determining risk level

Risk Level*

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What Active Surveillance Means

How To Interpret a Gleason Score of 7

For many men, prostate cancer never affects their lives, said Christopher L. Runz, DO, attending urologist at University of Maryland Shore Regional Health. Active surveillance means we actively watch the cancer and make sure it stays low-grade, which means the cancer may potentially never spread.

Active surveillance requires regular prostate specific antigen screenings and MRIs, with occasional biopsies. Men who are older and have a shorter life expectancy become candidates for active surveillance when they have a Gleason score of 7 .

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Treatment Recommendations For Clinically Localized Prostate Cancer

Very low risk of recurrence:

  • Patients with clinical stage T1c, Gleason score 6, PSA < 10 ng/mL, fewer than three positive prostate cores, 50% cancer in each core, and PSA density < 0.15 ng/mL, with a life expectancy 20 y, should be treated with active surveillance.

  • Active surveillance includes periodic PSA testing, digital rectal examination , and prostate biopsy. The optimal protocol for surveillance is still unknown, but may include PSA as often as every 3 mo or at least every 6 mo, DRE as often as every 6 mo but at least every 12 mo, and repeat biopsy within 18 mo but as often as every 12 mo or if PSA and DRE change.

  • For treatment recommendations for patients with a life expectancy 20 y, see initial therapy for Low Risk of Recurrence, below.

Low risk of recurrence:

Intermediate risk of recurrence:

High risk of recurrence:

  • Clinical stage T3a, Gleason score 8-10, PSA > 20 ng/mL

  • Treatment options include RP plus PLND for selected patients or

  • Radiation therapy with 3D-CRT/IMRT plus long-term neoadjuvant/concomitant/adjuvant ADT for 2-3 y or

  • Radiation therapy with 3D-CRT/IMRT with daily IGRT plus brachytherapy with or without short-term neoadjuvant/concomitant/adjuvant ADT for 4-6 mo or

  • High-risk cancers may be treated with combination EBRT and brachytherapy with or without 4-6 mo neoadjuvant/concomitant/adjuvant ADT

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