What Is Grade Group 2 Prostate Cancer

What Is The Prostate Cancer Gleason Score

If your doctor recommends a prostate biopsy, your pathology report will include a prostate cancer Gleason score. Doctors typically take several samples during the biopsy and each sample will have its own grade. Cell samples are graded from one to five; a grade five means the cells have mutated and no longer resemble normal cells.

A pathologist will assign one grade to the most predominant cell pattern in your biopsy samples, and a second grade to your second most predominant cell pattern. When these results are presented on your pathology report, however, they are added together, which may be confusing.

For example, you may see 3+4=7 or 4+3=7 on your pathology report. The first number in the equation indicates the predominant cell pattern in your tumor. If you see a 4+3=7 on your report, it means your cancer is more advanced than a 3+4=7. This distinction is very important for understanding the severity of your tumor. To help people better understand their prostate cancer Gleason score grade groups were developed.

New Approaches To Display Gleason Grades

For the 2016 WHO Classification of Tumors of the Urinary System and Male Genital Organs, a revised schematic diagram was created with the assistance of David Grignon at the Indiana University School of Medicine . Advantages of the new schematic diagram is that it depicts variants of Gleason pattern 3 including pseudohyperplastic, atrophic, and branching prostate cancer.

Figure 3

Treatment By Stage Of Prostate Cancer

Different treatments may be recommended for each stage of prostate cancer. Your doctor will recommend a specific treatment plan for you 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.

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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.

Prognostic Value Of The New Prostate Cancer International Society Of Urological Pathology Grade Groups

• 1Pathology of the University Hospital Schleswig-Holstein, Campus Luebeck and Research Center Borstel, Leibniz Center for Medicine and Biosciences, Luebeck, Germany
• 2Department of Pathology, Klinik am Eichert Alb Fils Kliniken, Goeppingen, Germany
• 3Department of Urology, Klinik am Eichert Alb Fils Kliniken, Goeppingen, Germany
• 4Department of Urology, University Hospital Schleswig-Holstein, Luebeck, Germany
• 5Department of Urology, Section of Molecular Urooncology, University Hospital Heidelberg, Heidelberg, Germany
• 6Institute of Pathology and Center for Integrated Oncology Cologne Bonn, University Hospital of Bonn, Bonn, Germany
• 7Institute for Applied Computer Science, Karlsruhe Institute of Technology, Karlsruhe, Germany

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Risk For Developing Prostate Cancer Discussion

Risk for Developing Prostate Cancer Discussion

African Americans men are at a greater risk for developing prostate cancer than the white men. In every six individuals from this ethnic group, there is one who is at risk of developing prostate cancer in their lifetime. African Americans are 1.8 times more exposed to the risk of developing the disease and 2.2 times more likely succumb from this disease as compared to white men. The increase in the higher risk of prostate cancer among Africa Americans is linked to socioeconomic status. There is a lower socioeconomic status of African Americans and this exposing to high cases of prostate cancer as a result of poor medical check-up and poor healthcare outcomes .

There are also racial biases and this is harming African Americans in terms of preventive care since they have lower chances of being provided with the PSA test. Recent studies reveal that men from this ethnic group are unlikely to have early diagnosis for the prostate cancer. They are also not likely to be treated in time for the disease like the white men. There are several treatment options and learning sources about the options for prostate cancer. Therefore, the evidence-based, primary care health promotion recommendation to deal with prostate cancer among African Americans involves the prevention programs that are tailored to African Americans to help in the reduction of health disparities.

References

Active Surveillance In Intermediate

Active surveillance is generally recognized as the preferred option for men with low-risk prostate cancer. Current guidelines use prostate-specific antigen of 10-20ng/mL or low-volume biopsy Gleason grade group 2 as features that, in part, define the favorable intermediate-risk disease and suggest that AS may be considered for some men in this risk category.

We identified 26,548 men initially managed with AS aged <80 years, with clinically localized prostate cancer , PSA20ng/mL, biopsy GG2 with percent positive cores 33% and who converted to treatment with radical prostatectomy from the surveillance, epidemiology, and end results prostate with the watchful waiting database. Multivariable logistic regression was performed to determine predictors of adverse pathology at RP according to PSA level and GG .

Of 1731 men with GG 1 disease and PSA 10-20ng/mL, 382 harbored adverse pathology compared to 2340 of 8,367 men with GG 2 and a PSA<10ng/mL who had adverse pathology at RP. On multivariable analysis, the odds of harboring adverse pathology with a PSA 10-20ng/mL was less than that of GG 2 after adjustment.

Our results support extending AS criteria more permissively to carefully selected men with PSA 10-20ng/mL and GG 1 disease.

Prostate cancer and prostatic diseases. 2021 Sep 10

Peter E Lonergan, Chang Wook Jeong, Samuel L Washington, Annika Herlemann, Scarlett L Gomez, Peter R Carroll, Matthew R Cooperberg

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Stages Of Prostate Cancer

Prostate cancer staging can be complex. If you have any questions about your stage, please ask someone on your cancer care team to explain it to you in a way you understand.

While the stage of a prostate cancer can help give an idea of how serious the cancer is likely to be, doctors are now looking for other ways to tell how likely a prostate cancer is to grow and spread, which might also help determine a mans best treatment options.

Proposal For A New Grading System

Although Gleason scores range from 2 to 10, there are 25 potential scores . If one were coming up with a new grading system starting from scratch one would want to distill it down to a simple system with the least number of grades, each with their distinct prognosis. Based on a series of 6462 men treated by RP where both the needle biopsy and RP were graded using the current modified Gleason grading system, this author showed both for biopsy and for RP that the following Gleason grade groups accurately reflects prognosis: Gleason score 26 ; Gleason score 3+4=7 ; Gleason score 4+3=7 ; Gleason score 8 ; and Gleason scores 910 .

In a recent meta-analysis of over 20000 men treated by RP from five institutions, Grade Groups were strongly correlated with risk of biochemical recurrence after surgery. Assigning a risk of 1 to Gleason score 6, the relative risks of progression for Grade Groups 25 were 2.6, 8.5, 16.8, and 29.3. The 5-year biochemical risk-free survival was 97.5%, 93.1%, 78.1%, 63.6%, and 48.9% for Grade Groups 15, respectively. These grade grouping was also validated on biopsy correlating with risk of progression after RP and following radiation therapy. Following these initial studies, there have been numerous works that have validated the new grading system following RP and radiation therapy, including its correlation with prostate cancer death and distant metastases., , , , , , , , ,

Table 1 Definition of Grade Groups

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Design Setting And Participants

A machine learning approach was developed for ICC segmentation using 70 RP patients and validated in a cohort of 749 patients from four sites whose median year of surgery was 2007 and with median follow-up of 28 mo. ICC was segmented on one representative hematoxylin and eosin RP slide per patient and the fraction of tumor area composed of ICC, the cribriform area index , was measured.

Data Source And Definition Of Outcome

The primary outcomes of our analyses were prostate cancer incidence and Gleason grade. Patients with prostate cancer and the corresponding Gleason grade of their tumors were identified in the electronic medical record of the VA New England Healthcare System using the Automated Retrieval Console . Briefly, from a dataset of patients with an ICD-9-CM code for prostate cancer, Automated Retrieval Console identified pathology reports consistent with prostate cancer. Automated Retrieval Console was able to separate reports consistent with a biopsy from reports consistent a prostatectomy. We then used natural language processing to identify Gleason grade within these reports. If we identified a pathology report consistent with prostate cancer, we defined that patient as having been diagnosed with prostate cancer on the date of the pathology report. We further stratified our outcome by high- and low-grade prostate cancer. Low-grade prostate cancer was defined as a total Gleason score of less than or equal to 7 , and high-grade prostate cancer was defined as a total Gleason score of greater than or equal to 7 . Our method of identifying prostate cancer grade was found to have 97% recall and 95% precision .

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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.

Staging Of Prostate Cancer

The stage of a cancer describes its size and how far it has spread. The results of your;tests;help your doctors decide on the stage and plan your treatment.

We understand that waiting to know the stage and grade of your cancer can be a worrying time. We’re here if you need someone to talk to. You can:

Macmillan is also here to support you. If you would like to talk, you can:

• Chat to our specialists online.;

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Reporting Rules For Gleason Grading Reporting Secondary Patterns Of Higher Grade When Present To A Limited Extent

High-grade tumor of any quantity on needle biopsy, as long as it was identified at low to medium magnification should be included within the Gleason score. Any amount of high-grade tumor sampled on needle biopsy most likely indicates a more significant amount of high-grade tumor within the prostate due to the correlation of grade and volume and the problems inherent with needle biopsy sampling. Consequently, a needle biopsy that is entirely involved by cancer with 98% Gleason pattern 3 and 2% Gleason pattern 4 would be diagnosed as Gleason score 3+4=7.

In RP specimens with the analogous situation of a tumor nodule having 98% Gleason pattern 3 and 2% pattern 4, the current recommendation is to grade these foci in an analogous manner to that done on needle biopsy and interpret the case as Gleason score 3+4=7 and record the percentage of pattern 4.

Minor high-grade patterns do not change the Grade Groups with minor pattern 5). If Grade Groups 15 eventually were to replace Gleason scores 210, the 2014 Consensus Conference suggested options how to incorporate tertiary patterns with Grade Groups. Suggestions included, for example, Grade Group 2 with minor high-grade pattern or Grade Group 2+.

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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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.

Limitations Of The Gleason Grading System

Although current revisions have improved the Gleason grading system, it continues to have limitations. Recent modifications have made the Gleason grading system much more complex than its original version. This complexity can be confusing for patients and clinicians. Gleason score 6 is now recommended as the lowest grade to be assigned on prostate biopsy. This is counterintuitive in that the Gleason scale ranges from 2 to 10. Patients may assume that a diagnosis of Gleason score 6 on biopsy means their tumor is in the mid-range of aggressiveness rather than having the best prognosis. In addition, many former Gleason score 6 tumors are now reclassified as Gleason score 7 in the modified system. Modern Gleason score 6 tumors have a much better prognosis than reported in the older literature. Studies have shown that virtually no pure Gleason score 6 tumors are associated with disease recurrence after radical prostatectomy and pure Gleason 6 cancer at radical prostatectomy lacks the potential for lymph node metastases . Another problem in the modern Gleason grading system is the lumping of Gleason score 7, as noted above in the NCCN Risk Classification System. Whereas many clinicians consider Gleason score 7 on biopsy to be intermediate risk, multiple studies have shown that Gleason score 4+3=7 demonstrates worse pathological stage and biochemical recurrence rates than 3+4=7 .

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