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Gleason Scale Of Prostate Cancer

Outlook For Men With Localised Prostate Cancer

Understanding The Gleason Score | Prostate Cancer Staging Guide

Most localised prostate cancer is slow-growing and may not need treatment or shorten a mans life. For many men who have treatment for localised prostate cancer, the treatment will get rid of the cancer. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment.

What Do The Results Mean

A higher Gleason score indicates more aggressive prostate cancer. Typically, lower scores suggest a less aggressive cancer.

In most cases, scores range between 610. Doctors do not often use biopsy samples that score 1 or 2, as they are not usually the predominant areas of the cancer.

A Gleason score of 6 tends to be the lowest possible score. A doctor will describe prostate cancer with a score of 6 as being well differentiated, or low grade. This means that the cancer is more likely to have a slower rate of growth.

Scores in the 810 region are poorly differentiated, or high grade. In these cases, the cancer is likely to spread and grow quickly. The growth rates of cancers with a score of 9 or 10 are likely to be twice as high as those of a cancer with a score of 8.

A score of 7 can be broken down in two ways:

This distinction indicates how aggressive the tumor is. Scores of 3 + 4 typically have a good outlook. A score of 4 + 3 is more likely to grow and spread than the 3 + 4 score, but less likely to grow and spread than a score of 8.

Some people receive multiple Gleason scores. This is because the grade may vary between samples of the same tumor or between two or more tumors.

In these cases, doctors are likely to use the higher score as the guide for treatment.

The Gleason score is an important tool for doctors when deciding on the best course of treatment. However, additional factors and grouping systems can assist them in making this decision.

The Gleason Grading System

Screening for prostate cancer involves the prostate-specific antigen test and a digital rectal exam. If results are suspect, your doctor may recommend a prostate biopsythe only way to confirm the diagnosis.

During a prostate biopsy, a urologist uses a small needle to remove tissue samples from different parts of the prostate. These samplesalso called coresare then sent to a pathologist so they can review each one under a microscope.

The pathologist uses a pattern scale, developed by Donald Gleason, MD, PhD in 1966, to give each sample a grade from 1 to 5. Grade 1 cells are well-differentiated and look like normal tissue. Grade 5 cells, on the other hand, are “poorly differentiated” or even unrecognizable from normal tissue.

Your Gleason score is the sum of the two numbers that represent the most common types of tissue found in your biopsy. The first number in the equation is the most common grade present, the second number is the second most common grade. For example, if seven of your cores are grade 5 and five are grade 4, your Gleason score would be 5+4, or a Gleason 9.

Today, pathologists typically only flag tissue samples that are grade 3 or higher, making 6 the lowest Gleason score.

In 2014, a revised grading system for prostate cancercalled Grade Groupswas established. This system builds on the Gleason scoring system and breaks prostate cancer into five groups based on risk. This can help make it easier to understand the Gleason score scale.

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What Does It Mean If In Addition To Cancer My Biopsy Report Also Mentions Acute Inflammation Or Chronic Inflammation

Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase your PSA level, but it is not linked to prostate cancer. The finding of prostatitis on a biopsy of someone with prostate cancer does not affect their prognosis or the way the cancer is treated.

Figure 2 Why Understaging May Occur


When the prostate is removed, a pathologist examines slices of the gland for evidence of cancer. A. Under a microscope, the pathologist can distinguish tiny tumors, consisting of clumps of visibly abnormal cells. B. With current imaging technology, it is not yet possible for a pathologist to identify micrometastases individual cancer cells shed from the primary tumor that have gone on to seed adjacent tissue. In this image, for example, cancer cells have already penetrated the capsule and migrated to adjacent tissue, even beyond the margin of tissue removed during surgery.

Individual prostate cancer cells can spread to more remote areas of the body in three ways . Whats more, they can do so without being detected with our current technology, essentially escaping under the radar. So its always possible even if you are diagnosed with early-stage prostate cancer that the cancer has already spread and will manifest in the coming years. How likely is it that an early-stage prostate cancer will become active without treatment? A small study provides some clues .

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What Does It Mean To Have A Gleason Score Of 7

A Gleason score of 7 can be made up of either 3+4=7 or 4+3=7, depending on whether the pattern 3 or pattern 4 is predominant. There is a big difference between these two grades. Table 1 shows the substantial difference in five-year cure rates. The biggest therapeutic difference between these grades is that more aggressive radiation therapy protocols are often given for Gleason score 4+3=7 and above.

Grade Groups Of Prostate Cancer

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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In Addition To Boots On The Ground

I believe there are also provisions beyond âboots on the groundâ for VA benefits for PCa for Vietnam era military service. If you were on certain ships that came into areas designated as âgray waterâ then âboots on the groundâ is not necessary.

Bronx advice was excellent: Contact your VA office ASAP to file your claim. If approved, the date your claim was filed determines when benefits start. There are several other threads discussing this subject. A search using the search box feature should provide more info.

How Does Gleason Scoring Work

A Dummies Guide to Contemporary Gleason grading of Prostate Cancer-Definition Of Grades

If your doctor suspects you have prostate cancer a biopsy may be used to confirm the diagnosis and gain insight its characteristics. The two most dominant grades of cancer cells found in the biopsy are each given a score of 1 through 5.

For instance, a patient may be assigned a 4 and a 3. These two numbers are then added together to determine the Gleason Score which is a range of 2-10. In most cases, oncologists never assign a Gleason Score below 6. If we go back to our example, 4 and 3 would be added together for a sum of 7. This means 7 would the patient’s Gleason Score.

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What Does It Mean If My Biopsy Report Mentions The Word Core

The most common type of prostate biopsy is a core needle biopsy. For this procedure, the doctor inserts a thin, hollow needle into the prostate gland. When the needle is pulled out it removes a small cylinder of prostate tissue called a core. This is often repeated several times to sample different areas of the prostate.

Your pathology report will list each core separately by a number assigned to it by the pathologist, with each core having its own diagnosis. If cancer or some other problem is found, it is often not in every core, so you need to look at the diagnoses for all of the cores to know what is going on with you.

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.

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Is It A Systemic Maybe Not

Hi Lori,

Sorry for the news on the bone lesions. I wonder how extensive the metastasis exist and their location. The typical treatment of choice is ADT which is palliative, but when the lesions are fewer in number and in convenient locations one has the possibility in treating with spot radiation .

Dr. Laccetti is a medical oncologist. He may prefer recommending palliative approach but you can inquire on the possibility of a combination of ADT plus RT, or even request for a second opinion at the MSK radiation department. Many other factors could cause bone lesions.

Another aspect for inquiring is about existing bone loss. I recommend you to discuss on the need of bisphosphonates, if any. Had to the list of questions matters regarding systemic cases.

Physical Emotional And Social Effects Of Cancer

Understanding Your Gleason Score

Cancer and its treatment cause physical symptoms and side effects, as well as emotional, social, and financial effects. Managing all of these effects is called palliative care or supportive care. It is an important part of your care that is included along with treatments intended to slow, stop, or eliminate the cancer.

Palliative care focuses on improving how you feel during treatment by managing symptoms and supporting patients and their families with other, non-medical needs. Any person, regardless of age or type and stage of cancer, may receive this type of care. And it often works best when it is started right after a cancer diagnosis. People who receive palliative care along with treatment for the cancer often have less severe symptoms, better quality of life, and report that they are more satisfied with treatment.

Palliative treatments vary widely and often include medication, nutritional changes, relaxation techniques, emotional and spiritual support, and other therapies. You may also receive palliative treatments similar to those meant to get rid of the cancer, such as chemotherapy, surgery, or radiation therapy.

Before treatment begins, talk with your doctor about the goals of each treatment in the treatment plan. You should also talk about the possible side effects of the specific treatment plan and palliative care options.

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Risk Groups For Prostate Cancer

Prostate cancer is divided into risk groups.

Before planning your treatment, your cancer doctor will look closely at your risk group. This helps you and your doctors to decide on the best treatment for you. The treatment options for each risk group can be different.

Prostate cancer was previously grouped into low, intermediate or high risk groups. Doctors now use a more detailed system to work out your risk group. This is called the Cambridge Prognostic Group . It divides prostate cancer risk into 5 different groups. Your doctor may still describe your risk as low, moderate or high.

To work out your CPG risk group, your doctors look at:

  • the stage of the cancer
  • your Gleason score.

Very Scared: Gleason 9 Prostate Cancer

Hi all

I saw my specialist last week and he informed me that I had level 9 Gleason prostate cancer. I am awaiting a CT scan and then a bone scan. I am in no pain whatsoever at the moment and I consider myself quite fit playing golf 4 times a week and walking with my wife and dog the other days. I am 60 years old and am quite scared for my future. I am not scared of the pain, just not being around for my wife and 2 grown up children.

Can anyone give me hope for optimism as all I have seen about level 9 gleason is not great.

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Survival For All Stages Of Prostate Cancer

Generally for men with prostate cancer in England:

  • more than 95 out of 100 will survive their cancer for 1 year or more
  • more than 85 out of 100 will survive their cancer for 5 years or more
  • almost 80 out of 100 will survive their cancer for 10 years or more

Survival for prostate cancer is also reported in Scotland and Northern Ireland. But it is difficult to compare survival between these countries because of differences in the way the information is collected.

Cancer survival by stage at diagnosis for England, 2019Office for National Statistics

These statistics are for net survival. Net survival estimates the number of people who survive their cancer rather than calculating the number of people diagnosed with cancer who are still alive. In other words, it is the survival of cancer patients after taking into account the background mortality that they would have experienced if they had not had cancer.

Tertiary Grade On Needle Core Biopsy

Gleason 4+4=8 Prostate Cancer Treatments | Ask a Prostate Expert, Mark Scholz, MD

In contrast to the original Gleason grading system, it is now recommended that on a needle core biopsy both the most common and highest grade are added together for the Gleason score . For example, if there is 60 % Gleason pattern 3, 35 % Gleason pattern 4, and 5 % Gleason pattern 5, the Gleason score would be 3+5=8. Needle core biopsy is an imperfect, non-targeted, random sampling of the prostate gland. Thus any amount of high-grade tumor sampled on needle biopsy most likely indicates a more significant amount of high-grade tumor within the prostate. In all specimens, in the setting of high-grade cancer, one should not report a lower grade if it occupies less than 5 % of the total tumor. For example, if there is 98 % Gleason pattern 4 and 2 % Gleason pattern 3, the Gleason score would be reported as 4+4=8 .

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What Tests Check For Prostate Cancer

Common tests to check for prostate cancer include:

  • Digital rectal exam: Your doctor inserts a finger into your rectum and touches your prostate gland. The doctor feels the shape of the prostate gland and checks for any hard spots.
  • PSA blood test: This blood test tells how much PSA is in your blood. Many men with prostate cancer have PSA levels that are higher than normal or that have gotten higher over time.
  • A high PSA level does not always mean a man has prostate cancer. As men get older, their prostate gland may grow larger over time. This growth, and other health conditions, can cause a high PSA level in men who do not have prostate cancer.

If the test results are not normal, your doctor may recommend more tests, such as a biopsy. During a biopsy, the doctor uses a needle to take out a tiny piece or pieces of the prostate gland. An ultrasound probe may be used to guide the needle. Another doctor called a pathologist looks at the tissue under a microscope to check for cancer cells.


Prostate Cancer: The Gleason Score Explained

How aggressive is my prostate cancer? Is it growing slowly or quickly?

If youve been diagnosed with prostate cancerand this year alone nearly 165,000 men nationwide will bethese may be among the first questions youll ask your doctor. And the answers will most likely take into account something called a Gleason score.

The Gleason score is a grading system used by urologists to assess a prostate cancers aggressiveness based on how cells from the tumor look under a microscope. Less-aggressive tumors are more likely to resemble healthy prostate tissue. More-aggressive tumors look less like normal tissue.

The higher the Gleason score, the more aggressive your cancer is likely to beand the greater the chance that it will spread. Doctors use the Gleason score to help choose appropriate treatments.

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What Does It Mean If In Addition To Cancer My Biopsy Report Also Says Atypical Glands Or Atypical Small Acinar Proliferation Or Glandular Atypia Or Atypical Glandular Proliferation

All these terms mean that the pathologist saw something under the microscope that suggests cancer may be present. However, the actual evidence for cancer is insufficient to be conclusive. Finding any of these is of no relevance to the overall outlook if cancer has already been diagnosed in another part of the biopsy.

Can The Gleason Score From A Random Biopsy Really Tell What The Cancer Grade Is In The Entire Prostate

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The Gleason score on biopsy usually reflects the cancers true grade. However, in about 20% of cases, the biopsy underestimates the true grade, resulting in under-grading. This can occur because randomly directed biopsy needles occasionally miss a higher grade area of the cancer. Under-grading is statistically more likely to occur in men with: 1) larger tumors, 2) higher PSA levels, and 3) smaller prostates.

Somewhat less commonly, the true grade of the tumor is lower than what is seen on the biopsy, resulting in over-grading. For example, studies show that 16% of cases with a Gleason score of 3+4=7 on biopsy, will end up having Gleason score 6 when the surgically removed prostate is examined. Discrepancies between the biopsy Gleason and the final Gleason after surgery may be caused by inaccurate over-grading of the biopsy specimen by an inexperienced pathologist, or because the actual quantity of pattern 4 originally detected in the biopsy core turned out to be so small that it could not be found by the pathologist who examines the surgically removed prostate.

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