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
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.
Active Surveillance For Prostate Cancer
If diagnosed with localized prostate cancer , disease management can take many forms, depending on the risk category of disease. Patients with low-grade, slow-growing tumors confined to the prostate gland may consider active surveillance. This involves monitoring prostate cancer in its localized stage until your doctor feels that further treatment is needed to halt the disease at a curable stage.
According to the American Society of Clinical Oncology, patients with low-risk, low-grade disease can consider active surveillance. It may also be an option for patients with a Gleason score of 7. Patients within these categories may choose to postpone prostate cancer treatment because of its associated risks and side effects.
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Gleason 6 Prostate Cancer: Serious Malignancy Or Toothless Lion
Nicholas M. Donin, MDOncology
There is strong evidence from longitudinal cohort studies of men with both treated and untreated Gleason 6 prostate cancer to suggest that Gleason 6 disease, when not associated with higher-grade cancer, virtually never demonstrates the ability to metastasize and thus represents an indolent entity that does not require treatment.
Autopsy studies of men without known prostate cancer suggest that a substantial reservoir of prostate cancer that does not cause symptoms or death exists within the population. The majority of these cancers are Gleason 6 tumors and are frequently detected by prostate-specific antigenbased prostate cancer screening. There is strong evidence from longitudinal cohort studies of men with both treated and untreated Gleason 6 prostate cancer to suggest that Gleason 6 disease, when not associated with higher-grade cancer, virtually never demonstrates the ability to metastasize and thus represents an indolent entity that does not require treatment. Whether Gleason 6 has a propensity to progress to higher-grade cancer is still under investigation. Because the term cancer has historically been used to represent a disease state that leads to progressive illness that is uniformly fatal without treatment, we believe Gleason 6 disease should not be labeled with this term. Our challenge now is to develop the technology to differentiate true Gleason 6 disease from the higher grades of dysplasia with which it can be associated.
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.
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Is Gleason 6 Cancer
The Gleason score has been the universal grading system for prostate cancer for half a century. In the late 1960s, Donald Gleason developed his classic grading system, which was solely based on the classification of tumor growth patterns and is unique in taking account of tumor heterogeneity.
In 2005 the International Society of Urologic Pathology significantly modified the Gleason grading system. This modification resulted from alterations in clinical presentation and pathological diagnosis of prostate cancer in the preceding 40 years in Gleasons day prostate cancer was commonly discovered at a late stage or incidentally at transurethral resection for hyperplasia, since Prostate Specific Antigen was only introduced in the late 1980s. Immunohisto-chemistry for basal cells was not included in the pathologic diagnosis of lesions suspicious for prostate cancer at that time. Many closely packed, slightly atypical glands originally classified as Gleason grade 1 or 2 probably represented atypical adenomatous hyperplasia since immunohistochemical staining for basal cells is a prerequisite for differentiating these lesions. In November 2014, the ISUP updated the Gleason grading system again with relatively minor changes in relation to the 2005 modification.
Figure 1: Gleason score 6 prostate cancer glands with expansion into extra-prostatic fat tissue . Hematoxylin & Eosin, 200x
Renaming Gleason Score 6 Tumors As Noncancer Would Result In Medical Liability
Undoubtedly, renaming Gleason score 6 tumors as benign lesions would risk medical liability for pathologists and urologists.25 Pathologists could be liable for underdiagnosing cancer, leading to a delay in diagnosis. Currently, medical liability is virtually unheard of for a pathologist who undergrades a carcinoma. Although the issue is one of semantics, the change in diagnosis from noncancer to cancer would seem to be more significant than one of grade change in a carcinoma, especially to a lay jury. Similarly, some urologists would be liable if they did not treat a tumor that was later discovered to be incurable.
There is a precedent for retaining the term carcinoma for tumors that are indolent. For example, squamous cell carcinoma of the skin is a common tumor that like low-grade prostate carcinoma is morphologically carcinoma yet has a negligible risk of mortality. Patients are reassured about the typically benign clinical course of this tumor and consequently not overly concerned when diagnosed with carcinoma, accepting conservative treatment. Rather than avoid the term carcinoma, patients and physicians need to be educated about the indolent behavior of Gleason score 6 tumors and alternatives to immediate treatment.
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.
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.
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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.
The Gleason 6 Cancer Deception
The all-inclusive prostate cancer label is deceitful by implying that all prostate cancers are equal and have the power to kill rapidly whereas it has been well established that the very common Gleason 6 type of prostate cancer fails to behave as a cancer and, should not be called a cancer.
In fact, Larry Klotz M.D. and others, have shown irrefutably that the Gleason 6 prostate cancer is a not a real cancer at all for two fundamental reasons: no man has died from this disease and, this so-called cancer lacks a number of molecular biological mechanisms normally found in cancerous behaving cells. Furthermore, unlike a typical cancer cell, this cell has a very long doubling time at 475 +/ 56 days so that from mutation to a growth of about 1 cm in diameter takes some 40 years.
Therefore, because the Gleason 6 lacks the hallmarks of a cancer, it is not a health risk, it does not progress to become a health risk, needs no detection and, needs no treatment. The Gleason 6 is a pseudo-cancer mislabeled as a cancer this false cancer tag is a monstrous medical error and public health disaster, inviting legal retribution. Only the 15% or so of the high-grade forms of prostate cancers have the potential to kill and, only they demand detection and treatment.
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What Do My Test Results Mean
Your doctor will look at your test results to find out if the cancer has spread and how quickly it might be growing.
How far has my cancer spread?
The stage of your cancer tells you whether it has spread outside the prostate and how far it has spread. You might need scans, such as an MRI, CT or bone scan, to find out the stage of your cancer.
Depending on the results, your cancer may be treated as:
- localised prostate cancer its contained inside the prostate
- locally advanced prostate cancer its started to break out of the prostate or has spread to the area just outside it
- advanced prostate cancer its spread from the prostate to other parts of the body.
Is my cancer likely to spread?
Your doctor may talk to you about the risk of your cancer spreading outside the prostate or coming back after treatment.
Your prostate biopsy results will show how aggressive the cancer is in other words, how likely it is to spread outside the prostate. You might hear this called your Gleason grade, Gleason score, or grade group.
Your cancer may be low risk if:
- your PSA level is less than 10 ng/ml, and
- your Gleason score is 6 or less , and
- the stage of your cancer is T1 to T2a.
Your cancer may be medium risk if:
- your PSA level is between 10 and 20 ng/ml, or
- your Gleason score is 7 , or
- the stage of your cancer is T2b.
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.
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The Following Is A Duplicate Of One That I Posted Here: Http: //csncancerorg/node/305388
. . . People here know me as an outspoken advocate for CK and against surgery of any kind. I was treated w/CK 6 years ago . You can troll the forum for my many comments on this point. Here are the highlights of what you need to consider:
1) CK currently is the most precise method of delivering radiation externally to treat prostate cancer. Accuracy at the sub-mm level in 360 degrees and can also account for organ/body movement on the fly during treatment. Nothing is better. Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding. Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.
2) IMRT is the most common form of external radiation now used. Available everythere. Much better accuracy than before but no where near as good as CK. So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding. Unless things have changed, IMRT treatment generally requires 40 treatments 5 days a week for 8 weeks to be completed. I think some treatment protocols have been reduce to only 20 but Im not sure. Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.
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The Updated Gleason Grading System Is Misleading For Patients And Physicians
The Gleason grading system, based on five architectural patterns of a tumor, has evolved over time.4 For practical purposes, Gleason patterns 1 and 2, or scores 2 to 4 noted in the classic system, are not diagnosed on needle biopsies because of poor correlation with radical prostatectomy grade and poor reproducibility among expert pathologists.5 The Gleason system has been modified based on a 2005 consensus conference,4 whereby lesions previously referred to as Gleason scores 2 to 4 in the classic system are now assigned a higher grade in the modified system however, those previously graded as Gleason score 6 in the classic system are often graded as Gleason score 7 tumors in the modified system. Although this modification of grading could improve the prognosis of some men who have cancer-specific outcomes intermediate between the modified Gleason score 6 and the classical Gleason score 3 + 4 cancers,6 the larger effect of the 2005 modification has been to improve the perceived cancer-specific survival by 26% through the Will Rogers phenomenon.7
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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.
What Is A Grade Group
In 2014, the International Society of Urological Pathology released supplementary guidance and a revised prostate cancer grading system, called the Grade Groups.
The Grade Group system is simpler, with just five grades, 1 through 5.
*Risk Groups are defined by the Grade Group of the cancer and other measures, including PSA, clinical tumor stage , PSA density, and number of positive biopsy cores.
Many hospitals report both the Gleason score and the Grade Group, but there may be hospitals that still report only the old Gleason system.
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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.
So Why Does Gleason 3+3 Mean Cancer
Thats the question raised by Wolinsky. If we strictly interpret the original Gleason scores, a grade of 3 is given once cells that look like cancer are starting to appear, disrupting the structure of normal prostate tissue. Tucked into this score is the assumption that these early cancer cells will inevitably mutate into increasingly aggressive rogue cells.
This assumption may very well be fake news. The facts show otherwise. According to PCa expert Dr. Laurence Klotz, who is one of the earliest proponents of the notion that Gleason 3+3 is NOT cancer, we now know that Gleason 3 and Gleason 4 are like night and day, that the molecular genetics of most Gleason 3 is normal. The metastatic potential is approximately zero.
This means that just because it looks like a cancer cell under the microscope doesnt mean it behaves like a cancer cell. Most types of tumor cancers become more aggressive, eventually spreading to other organs and parts of the body. Klotz and others point to three cancers that are exceptions:
- Glioblastoma, a deadly brain cancer that infiltrates throughout the brain but does not metastasize beyond the brain
- Basal cell carcinoma, a common skin cancer that can grow but almost never metastasizes beyond itself
- Gleason 3+3 prostate cancer, in itself, has never been proven to metastasize.
Wolinsky quotes Dr. Scott Eggener of the University of Chicago:
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