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.
What Does Gleason 6 Mean
A Gleason score of 6 is different from other prostate cancer diagnoses because it means all the biopsy samples are grade 3 . Though the samples dont look like normal tissue, no grade 4 or 5 samples were found.
Gleason 6 prostate tumors are:
- Confined to the prostate
- Not causing any symptoms
There are changes at the cellular level, but the prostate cancer is likely slow-growing and has a low-risk of metastasizing, or spreading to other areas of the body.
This knowledge allows your doctor to monitor you and see how your tumor changes over time.
Insights From Dls Region
Furthermore, we evaluated the DLSs ability to classify tissue regions within each slide. We collected exhaustive region-level annotations for 79 slides, performed by three pathologists per slide, and compared the predictions of the DLS to these annotations . We first characterized the DLSs predictions by examining regions where the pathologists were concordant. For regions where all three pathologists agree on the same region classification , the DLS concurs 97% of the time. For the subset of these regions classified as a Gleason pattern, the DLS favors the same Gleason pattern as the pathologists 88% of the time .
Next, we characterized the DLSs prediction for regions where the pathologists were discordant by plotting the confidence score of the DLS for each category as a function of inter-pathologist agreement . For tissue regions where pathologists are concordant on Gleason pattern 3, discordant between 3 and 4, or concordant on Gleason pattern 4, the DLS prediction scores change smoothly with the pathologists classification distribution. The same trend is seen as we move from Gleason pattern 4 to 5. We further used the DLSs prediction scores directly to classify regions as fine-grained Gleason patterns . We found that by doing so, that DLS was able to represent a more gradual transition from well-to-poor differentiation than allowed by the canonical coarse Gleason pattern buckets .
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Overview Of Pathologists Annotations And Reviews
A total of 35 pathologists reviewed slides for this study, all of whom completed residency in human anatomical pathology. Twenty-nine pathologists were US-board-certified and another three had genitourinary specialization . The remaining three pathologists were formerly board-certified or certified outside of North America, and provided annotations for the training and tuning datasets but not the validation dataset.
We collected slide-level reviews and region-level annotations from pathologists. Slide-level reviews categorize each slide into its Gleason Grade Group. Region-level annotations label specific tissue regions within a slide. We describe the annotation protocol for the validation dataset here, and include additional details and the protocol for the training and tuning datasets in the Grading section and Supplementary Figure in the Supplement.
Overview Of The Deep Learning System And Data Acquisition
Our approach is a two-stage deep learning system : first a deep convolutional neural network-based regional Gleason pattern classification followed by a k-nearest-neighbor-based whole-slide Gleason Grade Group classification . The first stage was trained using image patches extracted from the slide and the corresponding label derived from pathologist-labeled pixel-level annotations . In total, we collected and used 112 million image patches derived from 912 slides , which required approximately 900 pathologist hours to annotate and is roughly 4× larger in annotated tissue area than the training slides in the widely used Camelyon16 dataset. The second stage was trained using 1159 slide-level classifications provided by pathologists.
The DLS was evaluated on an independent validation dataset collected from three sources, consisting of 331 slides from 331 patients . At least three pathologists provided initial reviews for each slide. A genitourinary specialist pathologist subsequently reviewed each slide along with the initial pathologists comments to provide a final grade for use as the reference standard .
Table 1 Number and breakdown of slides in the validation dataset
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What Does It Mean If In Addition To Cancer My Biopsy Report Also Says Acute Inflammation Or Chronic Inflammation
Inflammation of the prostate is called prostatitis. Most cases of prostatitis reported on a biopsy are not caused by infection and do not need to be treated. In some cases, inflammation may increase you PSA level, but it is not linked to prostate cancer. The finding of prostatitis on a biopsy of someone with cancer does not affect their prognosis or the way the cancer is treated.
Comparison Of Dls To Pathologists On Whole
Independent of establishing the reference standard, we collected additional pathologist reviews on the validation dataset to compare with the DLSs performance. The mean accuracy among the 29 pathologists in classifying each slides Gleason Grade Group was 0.61 : 0.560.66). The DLS achieved an accuracy of 0.70 , higher than the cohort of 29 . A subgroup of 10 pathologists in this cohort reviewed the entire validation dataset, with individual accuracies ranged from 0.53 to 0.73 . The DLS was more accurate than 8 of these 10 pathologists . The remaining 19 pathologists reviewed overlapping subsets of the validation set , achieving individual accuracies ranging from 0.31 to 0.74 . Additional analyses are presented in Supplementary Tables and and Supplementary Fig. .
We additionally looked at three Grade Group decision thresholds: GG2, GG3, and GG4. The DLS achieved areas under the receiver operating characteristic curves of 0.950.96 at each of these thresholds . The largest difference occurred at the GG4 threshold, where the DLS demonstrated both a higher sensitivity and specificity than 9 out of 10 individual pathologists.
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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.
Prostate cancer treatment: The care you need is one call away
Your multidisciplinary team will work with you to develop a personalized plan to treat your prostate cancer in a way that fits your individual needs and goals.
Understanding Prostate Cancer: The Gleason Scale
Knowing the numbers
If you or a loved one has been diagnosed with prostate cancer, you may already be familiar with the Gleason scale. It was developed by physician Donald Gleason in the 1960s. It provides a score that helps predict the aggressiveness of prostate cancer.
A pathologist begins by examining tissue samples from a prostate biopsy under a microscope. To determine the Gleason score, the pathologist compares the cancer tissue pattern with normal tissue.
According to the
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Is Active Surveillance Right For Some Intermediate
Though metastasis is a major problem when it occurs, Dr. Klotz emphasizes that roughly 80% of the intermediate-risk men in the study have so far avoided that outcome. And these men, he said, are also avoiding cancer treatments that would otherwise have a significant effect on their quality of life. Still, Dr. Klotz urges caution when selecting intermediate-risk men for active surveillance. Based on these findings, I would strongly encourage that these men be further evaluated with magnetic resonance imaging and/or genetic biomarkers, he said.
These longer-term data shed new light on the ultimate outcomes of men considered for active surveillance who had components of higher-grade cancer when they were initially diagnosed, or who were found to have it on subsequent biopsies while on active surveillance, said Dr. Marc Garnick, the Gorman Brothers Professor of Medicine at Harvard Medical School and Beth Israel Deaconess Medical Center, and editor in chief of HarvardProstateKnowledge.org. Many variables factor into whether active surveillance should be considered for intermediate-risk men. Dr. Klotz highlights MRI and biomarkers, but medical diagnoses, family history, and the patients emotional capacity to address a higher likelihood of metastases should all be considered.
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How Prostate Cancer Spreads
- The cells escape into the bloodstream, initially by invading small blood vessels around the tumor, then traveling to larger blood vessels that enable the cells to circulate around the body .
- The cells are filtered through the bodys lymph system although some are captured in lymph nodes, others may travel elsewhere in the body.
- The cells migrate along the length of a nerve, escaping from the prostate into adjacent soft tissue .
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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.
Genetic Testing For Prostate Cancer
You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.
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Measuring Effectiveness Of Gleason Scoring In Risk Stratification For Disease Progression
Lastly, we compared the ability of the DLS, the cohort of pathologists, and genitourinary specialist pathologists to risk stratify patients for biochemical recurrence or disease progression . In this analysis, we measured prognostic performance using the c-index, which is an extension of AUC that handles censored data in survival analysis. On the validation set, the DLS-predicted Gleason Grade Group achieved a c-index of 0.65. The pathologist-provided Grade Groups yielded a median c-index of 0.63 , while the genitourinary specialist pathologists achieved a c-index of 0.69. KaplanMeier and hazard ratio analyses using a binary GG3 threshold, where hazard ratios for GG3 have previously been shown to be three-fold higher than GG2, to stratify patients into high risk and low risk categorizations showed the same trend .
How Active Surveillance Works
The Gleason score is just one way that doctors monitor prostate cancer during active surveillance. They also do periodic follow-up biopsies and measure PSA levels, which may rise if cancer starts to spread in the prostate. Doctors may recommend treatment sooner if PSA begins to rise quickly or if a follow up biopsy reveals a higher Gleason score or more widespread cancer within the prostate. Its an inexact science that depends on a doctors skill and experience and a mans willingness to wait for signs that a cancer poses a clear threat before opting for treatment and its potential for side effects.
Penney says she and her Harvard colleagues are among the many scientists now searching for better ways to predict which prostate cancers are likely to be lethal and which can be monitored and not treated. The answer may be found in genetic changes in prostate cancer cells that signal a higher threat. But finding a better way to predict which prostate cancers are likely to turn lethal is far from guaranteed.
Some believe its not possible, Penney says. After the cancer is diagnosed, so many things can change in unknown ways. Diet, exercise, and other lifestyle factors, for example, could affect whether low-risk prostate cancers become more aggressive or threatening over time.
About the Author
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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.
An Integrative Approach To Prostate Cancer
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Prostate Cancer Caregiver Podcast Series
We are proud to announce a new podcast series geared toward helping give support, hope and guidance to prostate cancer caregivers. The goal of this Prostate Cancer Caregiver Podcast Series is to help others connect with a diverse group of people who have felt the impact of prostate cancer in their lives and empower them on their journey.
Why Is The Gleason Score Important
According to a study conducted by the University of Geneva, the Gleason score correlates very closely with the clinical behavior of the cancer cells. This makes is a very important indicator of how the cancer will act slowing growing versus aggressive.
It tells oncologists a great deal about the characteristics of the prostate cancer although its not the only tool used to determine whether you need to move ahead with treatment. Other factors are used and evaluated as a whole. This can include one more of the following:
- PSA blood test score
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Prostate Cancer Stage Ii Treatment Options
Stage II prostate cancers are still localized, but are larger than stage I cancers. The cancer may be on both sides of the prostate and a doctor may be able to feel it with a DRE. PSA levels are medium and cancer cells may or may not resemble cancer cells. Given these changes, there is a greater risk of progression and metastasis than in stage I.
Treatment options for stage II prostate cancer include:
- Radical prostatectomy
What Is Prostate Cancer
Prostate cancer develops in the prostate a small gland that makes seminal fluid. It is one of the most common types of cancer in men. Prostate cancer usually grows over time and in the beginning usually stays within the prostate gland, where it may not cause serious harm. While some types of prostate cancer grow slowly and may need minimal or no treatment, other types are aggressive and can spread quickly.
Prostate cancer that is caught early has a better chance of successful treatment.
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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.
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.
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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.