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What Are The Grades Of Prostate Cancer

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What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia

Progress in Prostate Cancer Grading

All of these are terms for things the pathologist might see under the microscope that are benign , but that sometimes can look like cancer.

Atrophy is a term used to describe shrinkage of prostate tissue . When it affects the entire prostate gland it is called diffuse atrophy. This is most often caused by hormones or radiation therapy to the prostate. When atrophy only affects certain areas of the prostate, it is called focal atrophy. Focal atrophy can sometimes look like prostate cancer under the microscope.

Atypical adenomatous hyperplasia is another benign condition that can sometimes be seen on a prostate biopsy.

Finding any of these is not important if prostate cancer is also present.

How Prostate Cancer Spreads And Progresses

Prostate cancer grows within the prostate gland, often for many years. Over time, the cancer spreads outside the prostate. This happens in one of three ways:

  • It grows into nearby tissues
  • It spreads through your system of lymph nodes and lymph vessels
  • It travels to distant tissues through your blood

Prostate cancer stages describe how far the cancer has spread.

General Applications Of The Gleason Grading System

As described by Gleason, the initial grading of prostate carcinoma should be performed at low magnification using a x4 or x10 lens. After one assesses the case at scanning magnification, one may proceed to use the x20 lens to verify the grade. For example, at low magnification one may have the impression of fused glands or necrosis, but may require higher magnification at x20 to confirm its presence. However, one should not initially use the x20 or x40 objectives to look for rare fused glands or a few individual cells seen only at higher power, which would lead to an overdiagnosis of Gleason pattern 4 or 5, respectively . If the tumor is borderline between lower- and higher-grade cancer, I assign the lower grade so as to not result in overtreatment. In cores with borderline grade, additional levels are often helpful to clarify the grade.

Figure 6

Gleason pattern 3 with a few glands that appear poorly formed but are likely tangential sections off of adjacent small well-formed glands. Original magnification, 40x.

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A New Perspective On Your Health

For many people, survivorship serves as a strong motivator to make lifestyle changes.

People recovering from prostate cancer are encouraged to follow established guidelines for good health, such as not smoking, limiting alcohol, eating well, maintaining a healthy weight, and managing stress. Regular physical activity can help rebuild your strength and energy level. Your health care team can help you create an appropriate exercise plan based upon your needs, physical abilities, and fitness level. Learn more about making healthy lifestyle choices.

It is important to have recommended medical checkups and tests to take care of your health.

Talk with your health care team to develop a survivorship care plan that is best for your needs.

Talk To Your Cancer Care Team

Staging and grading prostate cancer

Your team is an important source of advice. Some men may benefit from having a low-risk tumor treated right away, even if they might have side effects. Discuss your treatment options and quality-of-life issues with your team.

This report is for you to use when talking with your health-care provider. It is not a substitute for medical advice and treatment. Use of this report is at your own risk.

04/2014

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Don’t Miss: Where Is Prostate Cancer Likely To Spread

Tnm Staging System The Most Widely Used Staging System For Prostate Cancer Isthe Ajcc Tnm System For Prostate Cancerthere Are 4 Stages Often The Stages 1 To 4 Are Written As The Roman Numeralsi Ii Iii And Iv Generally The Higher The Stage Number The More The Cancerhas Spread The Stages Can Be Further Divided Into A B Or C An Earlier Lettermeans A Lower Stage Talk To Your Doctor If You Have Questions About Staging Tnm Staging Is Based On The Following: T Describes Thetumour And Whether Doctors Can Feel It Or See It On Imaging Tests It Alsodescribes Whether The Tumour Has Grown Outside Of The Prostate To Thesurrounding Tissues T Is Usually Given As A Number From 1 To 4 A Highernumber Means That The Tumour Takes Up More Of The Prostate Or That The Tumourhas Grown Outside Of The Prostate Into Nearby Tissues Some Stages Are Alsodivided Further Into A B Or C An Earlier Letter Means A Lower Stage The Clinical T Is Your Doctor’s Best Estimate Of Theextent Of The Cancer Based On A Physical Exam A Digital Rectal Exam A Prostatebiopsy And Imaging Tests If You Have Surgery To Remove Your Prostate Apathological T Will Be Given Pt Is More Accurate Than Ct T The Tumour Has Grown Outside The Prostate And Into The Seminal Vesicles T4 The Tumour Has Grown Outside The Prostate And Into Nearby Structures Suchas The Bladder Rectum Pelvic Muscles And Pelvic Wall

N describeswhether the cancer has spread to lymph nodes near the prostate. N0 means that thecancer hasn’t spread to any nearby lymph nodes. N1 means that it has spread tonearby lymph nodes.

M describeswhether the cancer has spread to other parts of the body. M0 means that the cancerhas not spread to other parts of the body. M1 means that it has spread to otherparts of the body.

PSA level describes the amount of the prostate-specificantigen in the blood.

Grade Group is a measureof how likely the cancer is to grow and spread.

How Is The Gleason Score Derived

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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The Natural History And Molecular Biology Of Low Grade Prostate Cancer

Prostate cancer develops with age in the majority of men, including those from all races and regions. In Caucasians, the chance of harboring prostate cancer is approximately the same as ones age thirty percent of men in their 30s, 40% in their 40s, 80% in their 80s . Most of these are microfoci and low grade, particularly in younger men. The high prevalence of microfocal prostate cancer has been confirmed in autopsy studies of Caucasians, Asians, and other ethnic groups going back more than 50 years. A recent autopsy study in Japanese and Russian men who died of other causes showed that overall 35% of both groups had prostate cancer, and 50% of the cancers in Japanese men aged > 70 were Gleason score 7 or above .

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What Is A Grade Group

Prostate Cancer Grade and What it Means

In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system, called the Grade Groups.

The Grade Group system is simpler, with just five grades, 1 through 5.

*Risk Groups are defined by the Grade Group of the cancer and other measures, including PSA, clinical tumor stage , PSA density, and number of positive biopsy cores.

Many hospitals report both the Gleason score and the Grade Group, but there may be hospitals that still report only the old Gleason system.

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Tnm Staging System The Most Widely Used Staging System For Prostate Cancer Isthe Ajcc Tnm System For Prostate Cancerthere Are 4 Stages Often The Stages 1 To 4 Are Written As The Roman Numeralsi Ii Iii And Iv Generally The Higher The Stage Number The More The Cancerhas Spread The Stages Can Be Further Divided Into A B Or C An Earlier Lettermeans A Lower Stage Talk To Your Doctor If You Have Questions About Staging Tnm Staging Is Based On The Following: T Describes Thetumour And Whether Doctors Can Feel It Or See It On Imaging Tests It Alsodescribes Whether The Tumour Has Grown Outside Of The Prostate To Thesurrounding Tissues T Is Usually Given As A Number From 1 To 4 A Highernumber Means That The Tumour Takes Up More Of The Prostate Or That The Tumourhas Grown Outside Of The Prostate Into Nearby Tissues Some Stages Are Alsodivided Further Into A B Or C An Earlier Letter Means A Lower Stage The Clinical T Is Your Doctors Best Estimate Of Theextent Of The Cancer Based On A Physical Exam A Digital Rectal Exam A Prostatebiopsy And Imaging Tests If You Have Surgery To Remove Your Prostate Apathological T Will Be Given Pt Is More Accurate Than Ct T The Tumour Has Grown Outside The Prostate And Into The Seminal Vesicles T4 The Tumour Has Grown Outside The Prostate And Into Nearby Structures Suchas The Bladder Rectum Pelvic Muscles And Pelvic Wall

N describeswhether the cancer has spread to lymph nodes near the prostate. N0 means that thecancer hasnt spread to any nearby lymph nodes. N1 means that it has spread tonearby lymph nodes.

M describeswhether the cancer has spread to other parts of the body. M0 means that the cancerhas not spread to other parts of the body. M1 means that it has spread to otherparts of the body.

PSA level describes the amount of the prostate-specificantigen in the blood.

Grade Group is a measureof how likely the cancer is to grow and spread.

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

Because prostate biopsies are tissue samples from different areas of the prostate, the Gleason score on biopsy usually reflects your cancers true grade. However, in about 1 out of 5 cases the biopsy grade is lower than the true grade because the biopsy misses a higher grade area of the cancer. It can work the other way, too, with the true grade of the tumor being lower than what is seen on the biopsy.

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Warning Signs Of Prostate Cancer

In many cases, prostate cancer grows slowly and men may live for many years with a small, slow-growing prostate tumor. Some cases of the disease are more aggressive, though, and spread rapidly outside the prostate gland to other organs or bones.

In its early stages, prostate cancer usually does not cause specific signs or symptoms. For this reason, prostate screening provides the best chance of identifying prostate cancer in its earliest stages. Screening tests include a prostate-specific antigen blood test and digital rectal exam . These tests, one or both, are frequently preformed during an annual physical examination in men over 50 years of age.

When symptoms of prostate cancer do appear they may include:

  • weak or interrupted flow of urine
  • urinating often
  • pain or burning when urinating
  • blood in the urine or semen
  • nagging pain in the back, hips, or pelvis

These symptoms can all arise from conditions other than prostate cancer. If you do have any of these symptoms, though, it is important to see a doctor.

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Evaluation Of The Tumor

Prostate Cancer Gleason Score

Clinical T stage

  • cTX: cannot evaluate the primary tumor
  • cT0: no evidence of tumor
  • cT1: tumor present, but not detectable clinically or with imaging
  • cT1a: tumor was incidentally found in 5% or less of prostate tissue resected
  • cT1b: tumor was incidentally found in greater than 5% of prostate tissue resected
  • cT1c: tumor was found in a needle biopsy performed due to an elevated serum PSA
  • cT2: the tumor can be felt on examination, but has not spread outside the prostate
  • cT2a: the tumor is in half or less than half of one of the prostate gland’s two lobes
  • cT2b: the tumor is in more than half of one lobe, but not both
  • cT2c: the tumor is in both lobes but within the prostatic capsule
  • cT3: the tumor has spread through the prostatic capsule
  • cT3a: the tumor has spread through the capsule on one or both sides
  • cT3b: the tumor has invaded one or both seminal vesicles
  • cT4: the tumor has invaded other nearby structures
  • It should be stressed that the designation “T2c” implies a tumor which is palpable in both lobes of the prostate. Tumors which are found to be bilateral on biopsy only but which are not palpable bilaterally should not be staged as T2c.

    Pathological T stage

    • pT2: organ confined
  • pT3a: Extraprostatic extension or microscopic invasion of bladder neck
  • pT3b: Seminal vesicle invasion
  • pT4:Invasion of rectum, levator muscles, and/or pelvic wall
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    What Is The Difference Between 3+4=7 And4+3=7

    Gleason Score: 3 + 4= 7

    Gleason Score 3+4=7 is considered low to intermediate risk because the 1st number is Grade 3. Grade 3 is less aggressive than Grade 4, and is the most common cell pattern found in the biopsy sample.

    Gleason Score: 4 + 3 = 7

    Whereas, Gleason Score 4+3=7 is considered intermediate to high-risk because the 1st number is Grade 4. Grade 4 is the most common cell pattern found in the biopsy sample and is more aggressive than grade 3.

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    What Is The Gleason Score

    The Gleason score will be described using a number from 6 to 10. The pathologist will add the two most common grades together to make the Gleason score.

    If the most common grade in the sample is 3, and the second most common grade in the sample is 4, then your Gleason score will be 7 . If only one grade is found, then this grade is added to itself. So if all the sample is only grade 3, then the Gleason score will be 6 .

    • Lower grades are slower growing.
    • Higher grades are faster growing.

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    Prostate Cancer Risk Groups

    In addition to stage, doctors may use other prognostic factors to help plan the best treatment and predict how successful treatment will be. Examples of these include the National Comprehensive Cancer Network risk group categories and the Cancer of the Prostate Risk Assessment risk score from University of California, San Francisco.

    Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. The next section in this guide is Types of Treatment. Use the menu to choose a different section to read in this guide.

    Grade Groups Of Prostate Cancer

    Prostate Cancer Grading and Risk Assessment

    The Grade Group is the most common system doctors use to grade prostate cancer. It is also known as the Gleason score.

    The grade of a cancer tells you how much the cancer cells look like normal cells. This gives your doctor an idea of how the cancer might behave and what treatment you need.

    To find out the Grade Group, a pathologist

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    What Are Grade Groups

    Grade Groups are a new way to grade prostate cancer to address some of the issues with the Gleason grading system.

    As noted above, currently in practice the lowest Gleason score that is given is a 6, despite the Gleason grades ranging in theory from 2 to 10. This understandably leads some patients to think that their cancer on biopsy is in the middle of the grade scale. This can compound their worry about their diagnosis and make them more likely to feel that they need to be treated right away.

    Another problem with the Gleason grading system is that the Gleason scores are often divided into only 3 groups . This is not accurate, since Gleason score 7 is made up of two grades , with the latter having a much worse prognosis. Similarly, Gleason scores of 9 or 10 have a worse prognosis than Gleason score 8.

    To account for these differences, the Grade Groups range from 1 to 5 :

    • 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

    Although eventually the Grade Group system may replace the Gleason system, the two systems are currently reported side-by-side.

    Progress In Prostate Cancer Grading Summary:

    M. Scott Lucia, MD, reviews the historical utilization of the Gleason grading score as an indicator of prostate cancer prognosis and the refinements the system has undergone to improve predictive accuracy. He examines changes to the grading of cribriform carcinoma, as well as an improved 5-tier grade classification system.

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    Tests To Identify Prostate Cancer Stage

    After a prostate cancer diagnosis, your doctor will do tests to see how far the cancer has spread. Not all men need every test. It depends on the results of your biopsy, a test that checks tissue from your prostate gland for cancer. Tests that help your doctor figure out the stage of your prostate cancer include:

    • CT scan of the abdomen and pelvis to see if the cancer has spread
    • Nuclear medicine bone scan to see if the cancer has spread to your bones
    • Surgery to check the lymph nodes in your pelvis for prostate cancer spread

    Stage 1 Prostate Cancer

    Prostate Cancer Stages

    Stage 1 is the least advanced form of prostate cancer. Cancer in this stage is small and hasnt spread past the prostate gland. Its characterized by a PSA of less than 10 ng/mL, a grade group score of 1, and a Gleason score of 6.

    Stage 1 prostate cancer has a 5-year survival rate of nearly 100 percent.

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