What Is The Normal Gleason Score
Theoretically, Gleason scores range from 2-10. However, since Dr. Gleason’s 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.
Otherwise, is a Gleason score of 9 a death sentence?
Not all men with Gleason 8-10 disease are going to do badly after treatment. 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.
Although, is Gleason score the same as PSA? A Gleason score of 8 or higher, accompanied by a PSA level of higher than 20 ng/ml and a more advanced tumor stage, signifies a high risk of advancing cancer. In high-risk cases, the prostate cancer tissue looks very different from normal tissue.
So too, what is a Gleason score of 7 mean?
A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
What if prostate biopsy is positive?
If prostate cancer is found on a biopsy, it will be assigned a grade. The grade of the cancer is based on how abnormal the cancer looks under the microscope. Higher grade cancers look more abnormal, and are more likely to grow and spread quickly.
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Prostate Cancer Metastases Prognosis
Major factors in metastatic disease pointing to adverse prognosis at the time of diagnosis include :
- low hemoglobin levels
- elevated alkaline phosphatase levels
- poor performance status
Extent of the disease, Gleason score of 8 to 10 and presence of bone pain are other important prognostic factors in metastatic prostate cancer.
- The median progression-free survival in patients with minimal disease is about 2 years and in extensive disease about 18 months.
- The median overall survival with androgen deprivation therapy in patients with metastatic disease is 3 to 5 years.
- For men with resistance to androgen the overall survival ranged from 8 months to 20 months depending on the extend of spread.
- In patients with HRPC, higher baseline PSA levels and greater PSA velocity predicts higher-risk for metastatic disease and shorter overall survival.
- Significant rise in the acute-phase reactants is often a finding in the late stages of disease and suggest a poor prognosis.
Changes In Psa Levels After Surgery
In patients with rising PSA levels after radical prostatectomy, the important prognostic factors are the :
- pathologic stage
- time taken post-operatively to reach detectable PSA levels
- Gleason score at the time of prostatectomy
- time required for doubling of PSA values
PSA doubling time of 15 months or more are better managed with surveillance. The have median time to metastatic disease in these years is about 8 years and the median survival is about 13 years. Patients with PSA doubling times of less than 3 months are at very high risk of prostate cancer related death and have a median survival of 5 to 6 years.
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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.
Radical Prostatectomy Versus Radiation Therapy
The natural history of the disease, life expectancy of the patient, and potential for cure provide compelling reasons to treat the patient presented in this point-counterpoint discussion aggressively, with the intent to cure the prostate cancer. The next question, and the primary subject of this point-counterpoint discussion, is whether to offer radical prostatectomy or radiation therapy. The decision to offer one treatment or the other must reflect a critical analysis of benefits and risks.
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Understanding Prostate Cancers Progression
To determine the appropriate treatment, doctors need to know how far the cancer has progressed, or its stage. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score.
- Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. The area of cancer cells in the prostate will also be graded. The higher the grade, the more abnormal the cells.
- Gleason score: The two grades will be added together to get a Gleason score. This score tells doctors how likely the cancer is to grow and spread.
After a biopsy confirms prostate cancer, the patient may undergo additional tests to see whether it has spread through the blood or lymph nodes to other parts of the body. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan.
New Diagnosis: Where Do I Start
You are not alone. The good news is that most prostate cancers are slow-growing and that with early detection and treatment, it can be cured. Increasing your knowledge by reviewing sections such as Coping with cancer, Choosing your treatment as well as other areas of the web site helps relieve the stress and helps make decisions clearer.
Over the last 12 months, approximately 4,600 Quebecers were diagnosed with prostate cancer. This represents an average of 12 men per day. You are definitely not alone in your fight against prostate cancer. The good news is that we know most prostate cancers are slow-growing, which means that with early detection and treatment, it can even be cured.
Once diagnosed, men will go through understandable and normal reactions, such as fear, denial, anger, helplessness and feeling of loss of control over their life. Once reality sets in, a constructive way to deal with the disease is to learn as much as you can about it. Increasing your knowledge about prostate cancer helps relieve the natural fear of the unknown, and makes the decision-making process easier.
Frequently Asked Questions
Click here for the full list of prostate cancer-related FAQs.
Questions about survival
Talk to your doctor about your prognosis. A prognosis depends on many factors, including:
- your age
- certain characteristics of the cancer
- the treatments chosen
- how the cancer responds to treatment
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Disease Progression And Mortality In Patients With Gleason Score 910 Prostate Cancer
- JAMA: The Journal of the American Medical Association
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Natural History Of The Disease
Several studies reported in the literature provide insights into the natural history of high-grade prostate cancer in a 70-year-old man. Albertsen and associates6 examined the survival of men 6575 years of age who had clinically localized prostate cancer, comparing those treated with hormonal therapy with aged-matched, untreated controls. The survival expectancy for men with Gleason 810 adenocarcinoma of the prostate treated with hormonal therapy was 68 years less than that for controls. If one assumes that hormonal therapy does not extend survival, then the difference in survival between the hormonally-treated group versus the control group represents the impact of high-grade, clinically localized prostate cancer on survival.
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Questions To Ask Your Doctor
To help understand the progression of prostate cancer, discuss these questions with your doctors:
- What is my Gleason score?
- Has the cancer spread outside my prostate?
- Whats my prostate cancer stage?
- Are other tests needed to determine my cancer stage?
- What are the treatment options for my stage of cancer?
- Can I avoid treatment right now and go on active surveillance?
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.
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How Important Is The Gleason Score
The Gleason score is very important in predicting the behavior of a prostate cancer and determining the best treatment options. Still, other factors are also important, such as:
- The blood PSA level
- How much of each core is made up of cancer
- The number of cores that contain cancer
- Whether cancer was found in both sides of the prostate
- Whether the cancer has spread outside the prostate
Gleason Score Vs Grade Groups
The International Society of Urological Pathology released a revised prostate cancer grading system in 2014. The grade group system seeks to simplify Gleason scores and give a more accurate diagnosis.
One of the major problems with the Gleason score is that some scores can be made up in different ways. For example, a score of 7 can mean:
- 3 + 4. The 3 pattern is the most common in the biopsy and 4 is the second most common. This pattern is considered favorable intermediate risk.
- 4 + 3. The 4 pattern is the most common in the biopsy and 3 is the second most common. This pattern is considered unfavorable and may mean local or metastatic spread.
So, although both situations give a Gleason score of 7, they actually have very different prognoses.
Heres an overview of how the two grading systems compare:
| Cancer grade | |
|---|---|
| grade group 5 | 910 |
Not all hospitals have switched to the grade group system. Many hospitals give both grade group and Gleason scores to avoid confusion until grade groups become more widely used.
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What Is A 5
A relative survival rate compares people with the same type and stage of cancer to people in the overall population. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed.
How Is Prostate Cancer Staged
Prostate cancer is one of the most common types of cancer that develops in men and is the second leading cause of cancer deaths in American men, behind lung cancer and just ahead of colorectal cancer. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations.
The prostate gland is a walnut-sized gland present only in men, found in the pelvis below the bladder. The prostate gland wraps around the urethra and lies in front of the rectum. The prostate gland secretes part of the liquid portion of the semen, or seminal fluid, which carries sperm made by the testes. The fluid is essential to reproduction.
The term to stage a cancer means to describe the evident extent of the cancer in the body at the time that the cancer is first diagnosed.
- Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies.
- The stage of a cancer helps doctors understand the extent of the cancer and plan cancer treatment.
- Knowing the overall results of the different treatments of similarly staged prostate cancers can help the doctor and patient make important decisions about choices of treatment to recommend or to accept.
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What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia
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.
Where Do These Numbers Come From
The American Cancer Society relies on information from the SEER database, maintained by the National Cancer Institute , to provide survival statistics for different types of cancer.
The SEER database tracks 5-year relative survival rates for prostate cancer in the United States, based on how far the cancer has spread. The SEER database, however, does not group cancers by AJCC TNM stages . Instead it groups cancers into localized, regional, and distant stages.
- Localized: There is no sign that the cancer has spread outside the prostate.
- Regional: The cancer has spread outside the prostate to nearby structures or lymph nodes.
- Distant: The cancer has spread to parts of the body farther from the prostate, such as the lungs, liver, or bones.
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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.
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.
Bone Pain In Prostate Cancer
Many advanced prostate cancer patients often suffer from bone pain that adversely affect quality of life. The management of pain or other cancer related functional impairment is integral part of palliative care. Palliative management can include analgesics, glucocorticoids, palliative chemotherapy, radioisotopes or radiotherapy.
Radioisotopes that selectively concentrate in bone lesions are approved for the palliative treatment of painful bone metastases. The treatment is of more value in patients with multiple metastases . The radioisotopes have been found to reduce the need for opioid painkillers in such patients.
EBRT is effective in painful bone lesions in advanced prostate cancer patients but not an ideal option if there are multiple lesions at different sites. The lesions in multiple sites will progress after EBRT in one site and pain will reappear in a short time afterwards, unless other systemic therapies are initiated to control the disease process. Read more on EBRT under prostate cancer treatments.
What Is The Gleason Grade Or Gleason Score What Do The Numbers In The Gleason Score Mean For Example 3+4=7 Or 3+3=6
Pathologists grade prostate cancers using numbers from 1 to 5 based on how much the cells in the cancerous tissue look like normal prostate tissue under the microscope. This is called the Gleason system. Grades 1 and 2 are not often used for biopsies most biopsy samples are grade 3 or higher.
- If the cancerous tissue looks much like normal prostate tissue, a grade of 1 is assigned.
- If the cancer cells and their growth patterns look very abnormal, a grade of 5 is assigned.
- Grades 2 through 4 have features in between these extremes.
Since prostate cancers often have areas with different grades, a grade is assigned to the 2 areas that make up most of the cancer. These 2 grades are added to yield the Gleason score . The highest a Gleason score can be is 10.
The first number assigned is the grade that is most common in the tumor. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4, and they are added for a Gleason score of 7. Other ways that this Gleason score may be listed in your report are Gleason 7/10, Gleason 7 , or combined Gleason grade of 7.
If a tumor is all the same grade , then the Gleason score is reported as 3+3=6.
The higher the Gleason score, the more likely it is that your cancer will grow and spread quickly.