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Prostate Cancer Gleason Score 9 Prognosis

What Does It Mean If My Biopsy Report Also Mentions Atrophy Adenosis Or Atypical Adenomatous Hyperplasia

What Does Gleason 9 & 10 Mean? | Ask a Prostate Expert, Mark Scholz, MD

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.

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.

Tertiary Grade On Needle Core Biopsy

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 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.

Prostate Cancer Grading & Prognostic Scoring

Prostate Cancer Gleason Score 9 Survival Rate

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

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.

Prognostic Grouping Of Prostate Cancer

TNM prognostic grouping for prostate cancer is based on the stage, PSA level and Gleason score. This grouping is more accurate in predicting a prognosis than TNM staging alone. It goes without saying that the lower the scores, the best outlook and chance that your cancer can be successfully treated without the cancer coming back .

In contrast, if the prognosis is darker for men with higher scores, there may still be treatment options to control your cancer, improve your quality of life and prolong your survival.

Doctors also use nomograms to predict a prostate cancer prognosis. Nomograms are predictive tools.

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In Addition To Boots On The Ground

I believe there are also provisions beyond “boots on the ground” for VA benefits for PCa for Vietnam era military service. If you were on certain ships that came into areas designated as “gray water” then “boots on the ground” 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.

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

Understanding the Gleason Score on Your prostate Biopsy

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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Quality Of Life On Eligard

I was on Eligard 6 month shot injected into the stomach. Ouch. I was scheduled for 4 shots but I changed docs and the new doc agreed 2 shots was enough. I can still feel the pellet from the last shot- those things seem to last forever!

I think it gave my wife some comfort- she is afraid of this cancer thingie. both Lupron & eligard have lots of side effects- and I think I had them all. So I was delighted to not get the third injection. As far as my quality of life- well that is a complicated question. What is intolerable to me might be very easily within your comfort zone. I am also still leaking and the combination the after effects of surgery has not been good for me. But it is better than dying. so many difficult choices with PC- and none of them are easy or comfortable.

Also, I want to comment on that 1020 surgery date- must have been some surgeon!!! LOL and you must be some kind of patient!! LOL


Thanks for your info and a GREAT sense of humor! I’m 67, at time of surgery last month had a PSA of 7.4. Trying to keep my wife from being afraid for me is a task.

God Bless and…Success To You!!!

Outlook For Men With Localised Prostate Cancer

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.

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What Does A Gleason Score Of 9 Mean

. Herein, is Gleason 9 prostate cancer curable?

Radiation therapy and radical prostatectomy offer men with Gleason score 910 prostate cancer equivalent cancer-specific and overall survival, according to a new study. Of these, 230 underwent external beam radiation therapy , 87 were treated with EBRT and brachytherapy , and 170 underwent RP.

Subsequently, question is, what is the prognosis for a man with a Gleason score of 9? Conclusions and RelevanceAmong patients with Gleason score 9-10 prostate cancer, treatment with EBRT+BT with androgen deprivation therapy was associated with significantly better prostate cancer-specific mortality and longer time to distant metastasis compared with EBRT with androgen deprivation therapy or with RP.

Similarly, it is asked, can Gleason 9 Be Cured?

For prostate cancer patients with aggressive, Gleason 9-10 disease, treatment with radiotherapy plus hormone therapy was at least as effective as surgical strategies in a retrospective study.

What does a Gleason score of 10 mean?

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 – they tend to grow and spread slowly. Cancers with Gleason Scores of 8 to 10 may be called poorly differentiated or high grade.

Gleason Prostate Cancer Score

cancer treatment: Gleason 6 Prostate Cancer Treatment

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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Thanks Kongomy Thinking Was

thanks kongo

my thinking was that if cancer cells go after your testosterone which is in your prostate then get rid of it completely. plus radiation would of just shrunk the tumor. my cancer would of inevitably came back.so i had them both taken out. the 1 down fall of all this is that my erectile disfunction will never be normal again unless i go and have major surgery for implants since all my tissues were taken during the operation. so for me you can radiate til the cows come home but unless you get rid of the prostate where the cancer is living, it will keep coming back.

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.

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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.

Grading In Different Prostatic Tissue Samples

Gleason score in advanced prostate cancer

Gleason grading should be performed in all prostatic tissue samples, including needle core biopsy specimens. Indeed, of Gleason’s original series of 2911 patients, 60% were graded solely on the basis of a needle biopsy. A Gleason grade should be assigned even to needle biopsy cases with minimal prostatic carcinoma, defined as less than 1mm of tumor., Of importance, a small amount of carcinoma in needle biopsy tissue should not be equated with well-differentiated Gleason score 24 adenocarcinoma. Most minimal adenocarcinomas in needle biopsy tissue are intermediate Gleason grade, usually of a score of 6. Comparisons of Gleason grade in needle biopsy with Gleason grade in the matched whole prostate gland indicate exact correlation in 43% of cases and agreement to within±1 score unit in 77% of 3789 cases . Undergrading of tumor in the needle biopsy, with a higher Gleason score in the matched whole gland, is the most common problem, occurring, on average, in 42% of all cases. Overgrading of carcinoma in needle biopsy tissue also takes place, but with a much lower mean of 15% of all cases. For needle biopsy cases, there are several sources of grading error, including difficulty in appreciation of an infiltrative growth pattern, tissue sampling error , tissue distortion, pathologist experience, and observer variability.

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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.

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.

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Stage Iv Prostate Cancer Prognosis

Prostate cancers detected at the distant stage have an average five-year survival rate of 28 percent, which is much lower than local and regional cancers of the prostate. This average survival rate represents stage IV prostate cancers that have metastasized beyond nearby areas to lymph nodes, organs or bones in other parts of the body.

How We Treat Prostate Cancer

The prognosis for metastatic prostate cancer can be discouraging, but some treatment centerslike the Johns Hopkins Precision Medicine Center of Excellence for Prostate Cancerspecialize in innovative, individualized therapy with the potential to improve outcomes.

Grading After Radiation And Hormonal Therapy

Gleason Score 9 Prostate Cancer

In general, the Gleason grading system should be applied only to tumor that shows no evidence of treatment effect. For radiation therapy cases, where there is no evidence or minimal evidence of therapy effect, Gleason grading may be utilized. Hormonal therapy can cause pattern alterations resembling high Gleason grades. Overall, the consensus view is that one should not report histologic grade after hormonal therapy.

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