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Psa Grading Scale For Prostate Cancer

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Prostate Cancer Screening Ages 55 To 69

Prostate Cancer Grading and Risk Assessment

This is the age range where men will benefit the most from screening.Thats because this is the time when:

  • Men are most likely to get cancer
  • Treatment makes the most sense, meaning when treatment benefits outweigh any potential risk of treatment side effects

Most men will get prostate cancer if they live long enough. Some prostatecancers are more aggressive others can be slow-growing. Doctors will takeyour age and other factors into consideration before weighing the risks andbenefits of treatment.

You should ask your doctor how often he or she recommends you get screened.For most men, every two to three years is enough.

Depending on the results of your first PSA test, your doctor may recommendyou get screened less frequently.

What Is Done If A Screening Test Shows An Elevated Psa Level

If someone who has no symptoms of prostate cancer chooses to undergo prostate cancer screening and is found to have an elevated PSA level, the doctor may recommend another PSA test to confirm the original finding. If the PSA level is still high, the doctor may recommend that the person continue with PSA tests and digital rectal exams at regular intervals to watch for any changes over time .

If the PSA level continues to rise or a suspicious lump is detected during a DRE, the doctor may recommend additional tests to determine the nature of the problem. These may include imaging tests, such as magnetic resonance imaging or high-resolution micro-ultrasound.

Alternatively, the doctor may recommend a prostate biopsy. During this procedure, multiple samples of prostate tissue are collected by inserting hollow needles into the prostate and then withdrawing them. The biopsy needle may be inserted through the wall of the rectum or through the perineum . A pathologist then examines the collected tissue under a microscope. Although both biopsy techniques are guided by ultrasound imaging so the doctor can view the prostate during the biopsy procedure, ultrasound cannot be used alone to diagnose prostate cancer. An MRI-guided biopsy may be performed for patients with suspicious areas seen on MRI.

Determining The Stage Of Your Prostate Cancer

Using the results of your tests, your doctor will calculate a score based on four main components. Namely your: 1) PSA level, 2) Gleason score , 3) T-stage and 4) whether the cancer has metastasized. The information below breaks down each component so you have a better understanding of what your results mean and where they land in the spectrum of cancer prognoses.

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What Are The Damico Risk Categories

The DAmico system provides an estimate of the risk of recurrence at five years after treatment. This system is one of the most widely used for risk assessment. It combines the PSA, Gleason score, and the clinical stage to create low, intermediate, and high risk categories. The higher the risk category, the higher the chance of recurrence is five years after treatment.

The DAmico risk categories are below. If one factor is putting you in a lower category but another is putting you in a higher category, then the higher category takes precedent.

Low Risk:

  • PSA is less than 10 ng/mL AND
  • Gleason score is equal to or less than 6 AND
  • Clinical stage T1-T2a
  • PSA is between 10 and 20 ng/mL OR
  • Gleason score is 7 OR
  • Clinical stage T2b
  • Gleason score is 8-10 OR
  • PSA is greater than 20 ng/mL OR
  • Clinical stage T2c-T3

How Is The Gleason Score Derived

Comparison of the percentages of different prostate cancer grades ...

The pathologist looking at the biopsy sample will assign one Gleason grade to the most predominant pattern in your biopsy and a second Gleason grade to the second most predominant pattern. For example: 3 + 4. The two grades will then be added together to determine your 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.

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When Should I Get A Psa Test

The guidelines below are adapted from the NCCN Clinical Practice Guidelines In Oncology for Prostate Cancer Early Detection. Please use these guidelines to have a discussion with your physician about your personal risk and make a plan for screening.

  • If you are between ages 45 and 75:
  • Discuss the risks and benefits of prostate cancer screening with your doctor, have a baseline PSA, and consider a baseline DRE
  • If your PSA is below 1 ng/mL and your DRE is normal, repeat testing every 2-4 years
  • If your PSA is between 1 and 3 ng/mL and your DRE is normal, repeat testing every 1-2 years
  • If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
  • If you are over 75:
  • If you continue testing and your PSA is less than 3 ng/mL and your DRE is normal, repeat testing every 1-4 years
  • If your PSA is greater than 3 ng/ML or your DRE is very suspicious, your doctor may suggest additional testing or a biopsy
  • The Role Of Psa In Staging

    Prostate cancer causes cells to become malignant and multiply uncontrollably. This can lead to overproduction of PSA, and higher levels of PSA in the bloodstream.

    However, some men who have prostate cancer do not exhibit elevated PSA levels. And certain noncancerous conditions, like a prostate infection or benign enlargement, can also cause high PSA levels.

    PSA levels are just one factor used in determining the stage of prostate cancer. Another diagnostic tool is called the Gleason scale. This rates the extent of abnormality in your prostate cells after biopsy.

    At a certain point in prostate cancers late-stage progression, Gleason and PSA become less useful. When a tumor is large enough, doctors no longer need these numbers to predict its growth or malignancy.

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    Prostate Cancer Screening Ages 40 To 54

    The PSA test is a blood test that measures how much of a particular protein is in your blood. Its been the standardfor prostate cancer screening for 30 years.

    Your doctor will consider many factors before suggesting when to startprostate cancer screening. But hell probably start by recommending the PSAtest.

    While the general guidelines recommend starting at age 55, you may need PSAscreening between the ages of 40 and 54 if you:

    • Have at least one first-degree relative who has had prostate cancer
    • Have at least two extended family members who have had prostate cancer
    • Are African-American, an ethnicity that has a higher risk of developing more aggressive cancers

    Estimating Life Expectancy And Health Status

    Understanding The Gleason Score | Prostate Cancer Staging Guide

    5.4.1. Introduction

    Evaluation of life expectancy and health status is important in clinical decision-making for screening, diagnosis, and treatment of PCa. Prostate cancer is common in older men and diagnoses in men > 65 will result in a 70% increase in annual diagnosis by 2030 in Europe and the USA .

    Active treatment mostly benefits patients with intermediate- or high-risk PCa and longest expected survival. In localised disease, over 10 years life expectancy is considered mandatory for any benefit from local treatment and an improvement in CSS may take longer to become apparent. Older age and worse baseline health status have been associated with a smaller benefit in PCa-specific mortality and life expectancy of surgery vs. AS . Although in a RCT the benefit of surgery with respect to death from PCa was largest in men < 65 years of age , RP was associated with a reduced risk of metastases and use of androgen deprivation therapy among older men . External beam RT shows similar cancer control regardless of age, assuming a dose of > 72 Gy when using intensity-modulated or image-guided RT .

    5.4.2. Life expectancy

    Life expectancy tables for European men are available online: . Survival may be variable and therefore estimates of survival must be individualised. Gait speed is a good single predictive method of life expectancy . For men at age 75, 10-year survival ranged from 19% < 0.4 m/s to 87%, for > 1.4 m/s .


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    How Important Is The Gleason Score

    The Gleason Score is very useful for predicting the behavior of a prostate cancer. However, other factors also contribute to determining the stage of prostate cancer, including:

    • Findings from a rectal exam
    • The number of biopsy core samples that contain cancer
    • The percentage of cancer making up each biopsy core sample
    • If cancer is found in one or both sides of the prostate
    • If the cancer has spread outside the prostate

    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.

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    The Sum Of Two Numbers

    The pathologist assigns two separate grades to the two predominant cancer cell patterns in the prostate tissue sample. They determine the first number by observing the area where the prostate cancer cells are most prominent. The second number, or secondary grade, relates to the area where the cells are almost as prominent.

    These two numbers added together produce the total Gleason score, which is a number between 2 and 10. A higher score means the cancer is more likely to spread.

    When you discuss your Gleason score with your doctor, ask about both the primary and secondary grade numbers. A Gleason score of 7 can be derived from differing primary and secondary grades, for example 3 and 4, or 4 and 3. This can be significant because a primary grade of 3 indicates that the predominant cancer area is less aggressive than the secondary area. The reverse is true if the score results from a primary grade of 4 and secondary grade of 3.

    Prostate Cancer Stagemeans For Treatment

    Comparison of the percentages of different prostate cancer grades ...

    The stage of your prostate cancer isnt a result of one factor. Multiple tests are required to evaluate the aggressiveness of the cancer in your cells and the how far it has spread. Some of these tests include a Digital Rectal Exam , blood tests, imaging studies and biopsy results. Before you choose a treatment plan, its beneficial to familiarize yourself with how your stage is assigned, why it can influence your treatment decisions and what it means for the future.

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    Stage 4 Prostate Cancer Treatment

    This is the last stage of prostate cancer and describes a tumor that has spread beyond the seminal vesicles to nearby tissues or organs, such as the bladder, rectum, lymph nodes or bones. At this point, treatment of the whole body with hormonal therapy or systemic therapy is the mainstay of stage 4 prostate cancer treatment. Local therapy with surgery or radiation therapy may be needed to help control symptoms. Proton radiation treatment may be used for advanced or late-stage prostate cancer to shrink tumors or control pain. While treatment can only cure a small percentage of T4 tumors, treatment may still be recommended to prolong or improve quality of life. For these distant stage cancers, the 5-year survival rate is 29%.

    What Does It Mean When There Are Different Core Samples With Different Gleason Scores

    Cores may be samples from different areas of the same tumor or different tumors in the prostate. Because the grade may vary within the same tumor or between different tumors, different samples taken from your prostate may have different Gleason Scores. Typically, the highest Gleason Score will be the one used by your doctor for predicting your prognosis and deciding treatment.

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    Does The New Grading System For Prostate Cancer Work For Australian Men

    In late 2016 a new grading system for prostate cancer was endorsed by the International Society of Urological Pathologists . This five-tier grading system is a modification of the Gleason system, based on extensive research. The Modified ISUP Gleason system was designed to better indicate the risk of cancer progression and mortality than the current Gleason system. It’s not widely used yet, but new data show that it’s an accurate measure of prostate cancer risk when used for Australian men.

    When prostate cancer is diagnosed, a number of tests are used to estimate how risky the cancer is, and therefore guide the best treatment and management strategy. These tests include imaging, such as MRI, biopsy , digital rectal exams and blood tests such as the PSA test. These tests contribute to the staging and grading of prostate cancer. The staging process describes the cancer’s size and whether it has spread beyond the prostate. The grading process estimates how quickly the cancer will grow and if it will spread.

    Aside from the Gleason score, other information from the biopsy helps to determine how risky the cancer is. This includes the amount of each needle sample that has abnormal cells, how many samples are affected and whether the abnormal regions are found on one or both sides of the prostate gland.

    The new grades are summarised as:

    Grade group 1: Gleason score 3+3=6 or less

    Grade group 2: Gleason score 3+4=7

    Grade group 3: Gleason score 4+3=7

    Stage 3 Prostate Cancer Treatment

    PSA 1-10 Grading Scale Explained! Defining Each Grade & Showing Real Example Cards!

    Prostate cancer has spread beyond the outer layer of the prostate and may have spread to the seminal vesicles. Tumor has not reached bladder, rectum, lymph nodes or distant organs. Surgery and radiation or proton therapy with hormonal therapy are the curative treatment options with stage 3 prostate cancer. Radiation or proton therapy may still be needed after surgery to provide additional local and distant cancer control. Active surveillance may still be recommended for older men or those with other serious health issues. Similar to local stage prostate cancers, the 5-year survival rate is nearly 100%. That being said, the chances of prostate cancer coming back after treatment is more likely at this stage.

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    Prostate Cancer Stages Based On Standard Scores

    After calculating the TNM categories, your doctors will combine your TNM score, Gleason score and PSA levels to assign of a specific stage to your prostate cancer. Keep in mind that every case is different, and statistics and other recommendations are purely general guidelines.

    Stage 1
    10 years 15 years

    *Percentages factor in all stages of prostate cancer. Relative survival rate means the percentage of patients who live x number of years after their initial diagnoses, not after stoppage of treatment.

    What Does It Mean

    A Gleason score of 6 is low grade, 7 is intermediate grade, and a score of 8 to 10 is high grade cancer.

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    Its also important to know whether any cells rated at Gleason grade 5 are present, even in just a small amount, and most pathologists will report this. Having any Gleason grade 5 in your biopsy or prostate puts you at a higher risk of recurrence.

    But because many prostate cancer cases are extremely slow-growing, the Gleason system didnt necessarily do a good job of communicating the risks for these cases. Patients with scores of 6 and 7 didnt have a clear picture of the nature of their particular cancer.

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    What Does Staging And Grading Mean For Treatment

    The prostate cancer stage and grade are important for determining your course of treatment. Some treatments are only effective for Stage I and II prostate cancer and other treatments are only necessary for Stage III and IV prostate cancer.

    Grading is especially useful in early-stage disease. If the tumor shows signs of being aggressive, it may make sense to go forward with more aggressive prostate cancer treatment options. If the tumor does not seem aggressive, it may make sense to go forward with active surveillance or watchful waiting and avoid common side effects.

    In any case, the stage and grade must be discussed with your doctor and healthcare team.

    More Detail On Prostate Cancer Staging

    Risk Profiles and Treatment Patterns Among Men Diagnosed as Having ...

    The standard Tumor, Node, and Metastasis system is used to stage prostate cancer. The T category is based on the extent of the tumor itself. The N category is based on whether the cancer has spread to nearby lymph nodes. The M category is based on whether the cancer has spread beyond nearby lymph nodes to distant organs.

    T Categories:

    • T1: the tumor cannot be felt with a DRE or seen with imaging
    • T1a: the tumor is found accidentally during a surgery for benign prostatic hyperplasia or another prostate condition. The tumor takes up less than 5% of the removed tissue
    • T1b: the tumor is found accidentally during a surgery, and the tumor takes up more than 5% of the removed tissue
    • T1c: the tumor is diagnosed with a needle biopsy, usually because of an elevated PSA
  • T2: the tumor is confined to the prostate and can be either felt with a DRE or seen with imaging
  • T2a: the tumor is confined to half of one lobe of the prostate
  • T2b: the tumor is present to more than half of one lobe, but is not in both lobes
  • T2c: the tumor is present in both lobes of the prostate
  • T3: the tumor has grown outside of the prostate and may be present in the seminal vesicles
  • T3a: the tumor is outside of the prostate, but is not in the seminal vesicles
  • T3b: the cancer is outside of the prostate and has spread to the seminal vesicles
  • T4: the tumor has grown into tissues beyond the seminal vesicles
  • N Categories:

    M Categories:

    Each of the stages is based on some combination of these categories.

    Stage I:

    Stage IIA:

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