Clinical Outcomes For Patients With Gleason Score 910 Prostate Adenocarcinoma Treated With Radiotherapy Or Radical Prostatectomy: A Multi
- Amar U. KishanCorrespondenceCorresponding author. Department of Radiation Oncology, Suite B265, 200 Medical Plaza, Los Angeles, CA 90095, USA. Tel. +1 825 9771 Fax: +1 825 7194.
- Department of Radiation Oncology, University of California, Los Angeles, CA, USADepartment of Radiation Oncology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
- Department of Urology, University of California, Los Angeles, CA, USADepartment of Urology, Veteran Affairs Greater Los Angeles Healthcare System, Los Angeles, CA, USA
Is It A Systemic Maybe Not
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.
Prognostic Nomogram For Css
Compared with the nomogram for OS, the nomogram for CSS integrating all the significant independent factors including AJCC stage based on the training cohort is shown in Figure 6B. The C-index for nomogram of CSS prediction was 0.838 , and 0.852 in the training and validation cohort, respectively. The calibration plots indicated an excellent accuracy in prediction for CSS probability at 5 and 10 year in the training cohort and testing cohort .
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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.
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.
Text Mining Algorithm Evaluation
A confusion matrix was used to compare the text mining algorithm extracted against the manually coded values . The confusion matrix consists of four values: True Positives : correctly extracting the GS, True Negatives : correctly extracting a biopsy without a GS, False Positive : falsely extracting a GS and False Negative : falsely extracting the manually coded GS . The precision and recall are calculated using these four values as follows: \ and \ respectively. Precision and recall are similar to positive predictive value and sensitivity respectively. The F-score is the harmonic mean of precision and recall and is calculated using the formula \. The manually coded values were assumed to be the gold standard, i.e. exact match. Therefore, we reported the data as Exact Match: Yes and Exact Match: No for both the predicted and manually coded values.
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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:
Gleason Prostate Cancer Score
1960s as a way to measure how aggressive your prostate cancer may be.
A pathologist determines your Gleason score by looking at a biopsy of your prostate tissue under a microscope. They grade the cells in the biopsy on a scale of 1 to 5. Grade 1 cells are healthy prostate, whereas grade 5 cells are highly mutated and dont resemble healthy cells at all.
The pathologist will calculate your Gleason score by adding together the number of the most prevalent type of cell in the sample and the second most prevalent type of cell.
For example, if the most common cell grade in your sample is 4 and the second most common is 4, you would have a score of 8.
A Gleason score of 6 is considered low-grade cancer, 7 is intermediate, and 8 to 10 is high-grade cancer.
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Effect On Survival Of Local Treatment In Patients With Low Prostate
Shuai Liu1#, Xiao-Ying Wang2#, Tian-Bao Huang3, Quan Niu4, Kai Yao3, Xing Song1, Shi-Yao Zhou1, Zhen Chen1, Guang-Chen Zhou3
1Department of Graduate School, Department of Urology, Subei Peoples Hospital of Jiangsu Province , China
Contributions: Conception and design: S Liu Administrative support: GC Zhou Provision of study materials or patients: S Liu Collection and assembly of data: S Liu, XY Wang, TB Huang, K Yao Data analysis and interpretation: S Liu, XY Wang, Q Niu, X Song, SY Zhou, Z Chen Manuscript writing: All authors Final approval of manuscript: All authors.
#These authors contributed equally to this work.
Background: Emerging data suggest that in patients with low prostate-specific antigen and high Gleason score, prostate cancer is more aggressive and more likely to be related to genomic characteristics of neuroendocrinology. However, the evidence for the advantages of local treatment for these men is lacking. Hence, we investigated survival in men with low-PSA values and high-grade PCa according to the treatment of the primary tumor.
In patients with low PSA values, Gleason score 810, and localized PCa, LT resulted in higher survival compared with NLT. Within LT, RP provided the most benefit relative to RT.
Keywords: Prostate cancer radical prostatectomy radiotherapy non-local treatment prostate-specific antigen propensity score matching
Submitted Oct 23, 2019. Accepted for publication Apr 07, 2020.
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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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 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.
Survival Rates For Prostate Cancer
Survival rates can give you an idea of what percentage of people with the same type and stage of cancer are still alive a certain amount of time after they were diagnosed. These rates cant tell you how long you will live, but they may help give you a better understanding of how likely it is that your treatment will be successful.
Keep in mind that survival rates are estimates and are often based on previous outcomes of large numbers of people who had a specific cancer, but they cant predict what will happen in any particular persons case. These statistics can be confusing and may lead you to have more questions. Talk with your doctor about how these numbers may apply to you, as he or she is familiar with your situation.
Very Scared: Gleason 9 Prostate Cancer
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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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:
Text Mining Precision And Recall
The first text mining algorithm output reported an F-score of 0.99 . On manual inspection of the N-grams , we identified that two different GS were reported in both the clinical history and pathological diagnosis for 16 biopsies . The algorithm was updated to report the latter GS resulting in an F-score of 1.00 . The text mining algorithm was tested on the validation dataset and reported an F-score of 0.99.
Table 3 Performance of the text mining algorithm to automate the extraction of the Gleason score from narrative prostate biopsy narrative reports
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Active Surveillance For Gleason 6 Cancer
Per the Cancer Care Ontario guideline,1 active surveillance for patients with Gleason 6 disease should include:
- PSA testing every 3 to 6 months
- Annual digital rectal exam
- 12- to 14-core confirmatory transrectal ultrasound biopsy, including anterior-directed cores, within 6 to 12 months of starting surveillance, and then a serial biopsy every 3 to 5 years thereafter
1. Chen RC, Rumble RB, Loblaw DA, et al: Active surveillance for the management of localized prostate cancer : American Society of Clinical Oncology Clinical Practice Guideline Endorsement. J Clin Oncol 32:2182-2190, 2016.
2. Cooperberg MR, Broering JM, Carroll PR: Time trends and local variation in primary treatment of localized prostate cancer. J Clin Oncol 28:1117-1123, 2010.
3. Loeb S, Folkvaljon Y, Curnyn C, et al: Uptake of active surveillance for very low-risk prostate cancer in Sweden. JAMA Oncol 3:1393-1398, 2016.
4. American Cancer Society: Key statistics for prostate cancer. Available at www.cancer.org/cancer/prostate-cancer/about/key-statistics.html. Accessed June 26, 2018.
5. Morash C, Tey R, Agbassi C, et al: Active surveillance for the management of localized prostate cancer. Available at www.cancercareontario.ca/en/guidelines-advice/types-of-cancer/2286. Accessed June 26, 2018.
6. Hamdy FC, Donovan JL, Lane JA, et al: 10-Year outcomes after monitoring, surgery, or radiotherapy for localized prostate cancer. N Engl J Med 375:1415-1424, 2016.
Prognostic Nomogram For Os
To establish a prognostic nomogram in predicting OS for prostate cancer patients with Gleason score 7, the study population were randomly divided into the training group and testing group in a 7:3 ratio. The nomogram integrating all the significant independent factors for OS based on the training cohort is shown in Figure 6A. The C-index for nomogram of OS prediction was 0.785 , and 0.788 in the training and validation cohort, respectively. The calibration plots indicated an optimal agreement between the actual observation and nomogram prediction for OS probability at 5 and 10 year in the training cohort and testing cohort .
Figure 6. Nomogram for OS of Gleason score 7 prostate cancer Nomogram for CSS of Gleason score 7 prostate cancer.
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