Disease Progression And Mortality In Patients With Gleason Score 910 Prostate Cancer
- JAMA: The Journal of the American Medical Association
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Prostate Cancer Treatment Health Professional Version
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The median age at diagnosis of carcinoma of the prostate is 66 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 2010 to 2016 with local or regional disease was greater than 99%, and the rate for distant disease was 30% 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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Not All Men With Gleason 8
There is a perception among a lot of patients especially when they get diagnosed that having a high Gleason score of 8, 9, or 10 is essentially a death sentence, regardless of how they get treated. This is not actually the case at all. Plenty of men with Gleason 8 to 10 disease actually do well after treatment. And it has long been assumed that this was the case in particular if they were identified and treated early while they had truly organ-confined disease.
A newly published paper by Fischer et al. has now confirmed this assumption through a careful retrospective analysis of data from > 450 men whose records could be identified in the SEARCH database, all of whom received surgical treatment for Gleason 8 to 10 prostate cancer.
Fischer and his colleagues set out to identify whether, among a large cohort of men who had pathologic Gleason scores of 8 to 10 after surgery, they could identify particular subsets who were at meaningfully greater of lesser risk for biochemical progression within 2 years of their surgery. To do this, they identified a total of 459 eligible patients within the SEARCH database and categorized these men into one of five different groups:
They then used the data from these five groups of men to compare their risks for biochemical recurrence at 2 years, showing the following findings:
The Number Staging System
There are a few different systems used for staging prostate cancer. A simplified number staging system is described below.
- Stage 1 The tumour is contained in the prostate. The tumour is too small to be felt when a doctor does a rectal examination or to be seen on a scan.
- Stage 2 The tumour is still contained in the prostate, but your doctor can feel it when they do a rectal examination.
- Stage 3 The tumour has started to break through the outer capsule of the prostate and may be in the nearby tubes that produce semen .
- Stage 4 The tumour has spread outside the prostate. It may have spread to areas such as the bladder or back passage . Or it may have spread further, for example to the bones.
Using the numbered staging system described above:
- stage 4 is known as advanced prostate cancer.
See also
The grade of a cancer gives an idea of how quickly the cancer might grow or spread. A doctor decides the grade of the cancer by how the cancer cells look under the microscope.
Doctors look at the grade of the cancer to help them plan your treatment.
Gleason is the most commonly used grading system for prostate cancer.
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Standard Treatment Options For Stage I Prostate Cancer
Standard treatment options for patients with stage I prostate cancer include the following:
Watchful waiting or active surveillance/active monitoring
Asymptomatic patients of advanced age or with concomitant illness may warrant consideration of careful observation without immediate active treatment. Watch and wait, observation, expectant management, and active surveillance/active monitoring are terms indicating a strategy that does not employ immediate therapy with curative intent.
Evidence :
Radical prostatectomy
Radical prostatectomy, usually with pelvic lymphadenectomy is the most commonly applied therapy with curative intent. Radicalprostatectomy may be difficult after a transurethral resection of the prostate .
Because about 40% to 50% of men with clinically organ-confined disease are found to have pathologic extension beyond the prostate capsule or surgical margins, the role of postprostatectomy adjuvant radiation therapy has been studied.
Evidence :
Evidence :
Prostate Biopsy Collaborative Group Risk Calculator
The Prostate Biopsy Collaborative Group Risk Calculator is similar in nature to the PCTP in that it looks at a variety of factors to determine candidacy for a biopsy. Thus, it can help to reduce unnecessary biopsies. However, this and the PCTP calculators have shown disparities in results across different race groups.
Prostate cancer treatment is approached with such consideration because the 5-year relative survival rate of all stages combined is high at 98%. Therefore, experts consider some treatment options unnecessary for survivability.
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Whats The Best Way To Treat Localized Gleason 9
EBRT plus brachytherapy and ADT appeared to afford the best outcomes.
The most aggressive localized prostate cancer has a Gleason score of 9-10. Whats the best way to treat it? Radiation oncologist Phuoc Tran, M.D., Ph.D., and colleagues recently took part in a multi-institutional study to find out. Their results were published in the Journal of the American Medical Association .
Investigators at 12 hospitals in the United States and Norway compared the clinical outcomes of 1,809 men with Gleason score 9-10 prostate cancer after they had either radical prostatectomy, external-beam radiation therapy with androgen deprivation therapy , or EBRT plus a brachytherapy boost with ADT the men were treated between 2000 and 2013. Of these men, 639 underwent radical prostatectomy, 734 had EBRT and ADT, and 436 had EBRT plus brachytherapy, along with ADT.
We found that treatment with either EBRT and ADT or radical prostatectomy appeared to be equivalent but EBRT plus brachytherapy and ADT appeared to afford the best outcomes of the three.
This work was published with Hopkins co-investigators Ashley Ross, Jeff Tosoian, Stephen Greco, Curtiland DeVille, Todd McNutt, Daniel Y. Song, and Theodore L. DeWeese.
Whats The Difference Between Cancer Grading And Staging
If your healthcare provider suspects prostate cancer, he or she will refer you for a prostate biopsy. During this procedure, a small sample of prostate cells from the tumor is removed and evaluated under the microscope. This microscopic examination is what gives a cancer its grade. Cancer grade refers to how quickly it may grow or spread . For the most part, the lower the grade, the slower the growth of the tumor.
In addition to finding out the grade of your prostate cancer, it is important to determine its stage. Cancer stage refers to the size of the tumor and whether or not it has spread to other parts of the body. Stages mean different things for different types of cancer, but usually the higher the number, the more advanced the cancer.
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Understanding Your Pathology Report: Prostate Cancer
When your prostate was biopsied, the samples taken were studied under the microscope by a specialized doctor with many years of training called a pathologist. The pathologist sends your doctor a report that gives a diagnosis for each sample taken. Information in this report will be used to help manage your care. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy.
The Prostate Cancer Grading System
Prostate cancer grading is based on the appearance of the tumor cells under the microscope. Low-grade cancer cells look more like healthy cells than do high-grade cells. The two methods used to measure prostate cancer grade are the Gleason score or Grade Group.
While examining the tumor cells, the pathologist looks at the two most common tumor cell patterns referred to as the primary and secondary patterns. Each of these patterns is then graded based on how closely they resemble normal prostate tissue.
Grade 1 cells look like normal prostate cells. Grade 5 cells are very abnormal appearing cells. Grades 2-4 are in between the higher the number, the less the cells look like normal prostate tissue. Almost all prostate cancer has grade 3 cells or higher. Once the pathologist has assigned a grade to the primary and secondary cell patterns, these two numbers are added together to get a total Gleason score. The higher the Gleason score, the more likely the tumor is going to grow or spread to other parts of the body. Since the lowest grade a cancer cell can have is grade 3 , the lowest Gleason score for a cancer is grade 6 and is considered low-grade prostate cancer.
Using the Gleason score, prostate cancers can be divided into three groups:
| Gleason Score |
|---|
ISUP Prostate Cancer Grade Groups:
| Grade group |
|---|
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Stage 2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still near 100 percent.
The PSA score for stage 2 is less than 20 ng/mL.
Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:
- Grade group: 1
- Gleason score: 6 or less
Standard Treatment Options For Stage Iii Prostate Cancer
Standard treatment options for patients with stage III prostate cancer include the following:
External-beam radiation therapy with or without hormonal therapy
EBRT alone, luteinizing hormone-releasing hormone agonist, or orchiectomy, in addition to EBRT, should be considered. Definitive radiation therapy should be delayed until 4 to 6 weeks after transurethral resection to reduce the incidence of stricture.
Hormonal therapy should be considered in conjunction with radiation therapy especially in men who do not have underlying moderate or severe comorbidities. Several studies have investigated its utility in patients with locally advanced disease.
Evidence :
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What Is A Gleason Score
Cancer cells donât look the same as healthy cells. The more different they appear, the more aggressive the cancer tends to be.
The Gleason system uses the numbers 1 to 5 to grade the most common and second most common patterns of cells found in a tissue sample.
- Grade 1: The tissue looks very much like normal prostate cells.
- Grades 2-4: Cells that score lower look closest to normal and represent a less aggressive cancer. Those that score higher look the furthest from normal and will probably grow faster.
- Grade 5: Most cells look very different from normal.
Doctors add your primary and secondary numbers together to form your total Gleason score. That tells you how aggressive the cancer is. The lowest score for a cancer 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.
Generally speaking, the higher your Gleason score, the more aggressive the cancer. That means itâs more likely to grow and spread to other parts of your body. Doctors use this information, along with the stage of the cancer, to choose the best treatment for you.
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Diagnosed In March 2020 Prostate Cancer
I just found this group tonoght My husband is 65 He is diagnosed with prostate cancer that has spread to his bones and pelvis as well His PSA is 23 He had biopsy in April along with bone scan and MRI He had a pain pump unplanted 2 weeks ago to control pain as Oxycotin was not helping He recently had a 3 injections at cancer center I do not have the names with me but I know after a month he is going to start Fermagon?? He started taking chemo pills last Thursday Aeateda?? I will get correct names and post again later As you can tell I am VERY new and do not know what questions I should be asking His next appoint ment is May 7 Please let me know what I should be asking His Gleason is 9 Please I need all the advice I can get to help my husband live a normal life as possible Thank you
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What Does It Mean If My Biopsy Mentions That There Is Perineural Invasion
Perineural invasion means that cancer cells were seen surrounding or tracking along a nerve fiber within the prostate. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. Still, perineural invasion doesnt mean that the cancer has spread, and other factors, such as the Gleason score and amount of cancer in the cores, are more important. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor.
Survival By Tumor Grade
One way cancer is staged is by looking at the grade of cancer. Grade refers to how cancer cells look like under a microscope.
Traditionally for prostate cancer, this has been done using the Gleason Score, which was developed in the 1960s. Under this system, cancerous cells are categorized on a scale from 1 to 5. Grade 1 cells are considered normal prostate tissues, while cells in the grade 5 range have mutated to such an extent they no longer resemble normal cells.
In determining a Gleason score, a pathologist will examine a biopsy sample under a microscope and give a Gleason grade using the above scale to the most predominant pattern displayed, then a second grade to the pattern that is the second most predominant. Those two grades are then added to form the overall Gleason score .
In theory, Gleason scores could range from 2 to 10, but pathologists today rarely give a score between 2 and 5 and are more likely to be in the range of 6 to 10 with 6 being the lowest grade of prostate cancer.
Under the Gleason Score system, a 6 is considered low grade, 7 is intermediate and scores of 8, 9, or 10 are considered high-grade cancers.
The higher the Gleason score, the more likely it is the prostate cancer will grow and spread quickly.
However, there have been some issues with the Gleason system, and a new grading system, to act as an extension of the Gleason system, has been developed.
Under this system Gleason scores are now categorized into grade groups:
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