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:
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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.
Treatment For Prostate Cancer
Because every patient is different, there are several ways to approach prostate cancer treatment. Whats right for you will depend on the stage of the cancer, your level of risk and your general overall health.
Some of the more common treatments that you and your doctor may discuss include:
- Surgery. Partial or complete removal of the prostate is commonly used as either the only treatment or in combination with chemotherapy, hormone therapy, radiation therapy or other treatments. Johns Hopkins surgeons are experts in minimally invasive surgical approaches, including robotic-assisted laparoscopic prostatectomy.
- Active surveillance. Patients with localized, slow-growing, low-risk tumors may opt to delay treatment, instead having periodic testing to monitor for disease progression.
- Radiation therapy. Radiation can be used alone or in conjunction with other treatments. It is used to slow tumor growth or destroy tumors in both localized and advanced cancer that has spread to other areas of the body.
- Chemotherapy. Chemotherapy drugs can be used to improve outcomes following surgery or to help relieve symptoms in advanced disease.
- Hormone therapy. This approach deprives cancer cells of the hormones they need to thrive. Though commonly used in metastatic prostate cancer, it is increasingly used in early-stage disease to help shrink the tumor before other treatments
Histology Results And Follow
You will have an appointment at 4 weeks post-operation. Between your operation and this date, your prostate will have been sent to a laboratory where it is thoroughly inspected to produce a final report on the precise details of your cancer. This is called a histology report. During this appointment you will be given the histology results, detailing the final Gleason grade and stage of tumour, which is very important in determining your prognosis and the probability of the need for additional treatment, such as radiotherapy.
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Risk Factors For Prostate Cancer
Some risk factors have been linked to prostate cancer. A risk factor is something that can raise your chance of developing a disease. Having one or more risk factors doesn’t mean that you will get prostate cancer. It just means that your risk of the disease is greater.
- Age. Men who are 50 or older have a higher risk of prostate cancer.
- Race. African-American men have the highest risk of prostate cancerâthe disease tends to start at younger ages and grows faster than in men of other races. After African-American men, prostate cancer is most common among white men, followed by Hispanic and Native American men. Asian-American men have the lowest rates of prostate cancer.
- Family history. Men whose fathers or brothers have had prostate cancer have a 2 to 3 times higher risk of prostate cancer than men who do not have a family history of the disease. A man who has 3 immediate family members with prostate cancer has about 10 times the risk of a man who does not have a family history of prostate cancer. The younger a man’s relatives are when they have prostate cancer, the greater his risk for developing the disease. Prostate cancer risk also appears to be slightly higher for men from families with a history of breast cancer.
- Diet. The risk of prostate cancer may be higher for men who eat high-fat diets.
Types Of Radical Prostatectomy
The prostate gland lies just under the bladder, in front of the rectum. Surgeons choose from two different approaches to reach and remove the prostate during a radical prostatectomy. One is a traditional approach known as open prostatectomy. The other, more recent approach is minimally invasive. There are two minimally invasive procedures used in radical prostatectomy: laparoscopic prostatectomy and robot-assisted laparoscopic prostatectomy.
In this traditional method of radical prostatectomy, the surgeon makes a vertical 8- to 10-inch incision below the belly button. Radical prostatectomy is performed through this incision. In rare cases, the incision is made in the perineum, the space between the scrotum and anus.
In laparoscopic prostatectomy, surgeons make several small incisions across the belly. Surgical tools and a camera are inserted through the incisions, and radical prostatectomy is performed from outside the body. The surgeon views the entire operation on a video screen.
Robot-assisted laparoscopic prostatectomy
Small incisions are made in the belly, as in regular laparoscopic prostatectomy. A surgeon controls an advanced robotic system of surgical tools from outside the body. A high-tech interface lets the surgeon use natural wrist movements and a 3-D screen during radical prostatectomy.
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What To Expect After Prostate Laser Surgery
Laser surgery is an increasingly widely-used technique in men who were diagnosed with benign prostatic hyperplasia, an enlargement of the prostate that occurs in most men, to some degree, with age. Compared to traditional prostate surgery methods, prostate laser surgery has some distinct advantages. They include a lower risk of serious post-surgery bleeding, a much shorter hospital stay or the possibility of being treated on an outpatient basis, a significantly reduced need for a urinary catheter, and a much quicker recovery.
Nonetheless, prostate laser surgery, though delivered through concentrated beams of light that either vaporize or cut off excess prostate tissue rather than with a scalpel, is surgery. All forms of surgery carry some degree of risk, and all forms of surgery depend on you the patient to follow the appropriate aftercare guidelines delivered by your surgeon to the letter.
What To Expect After Prostate Removal
Prostate removal is an effective treatment option for prostate cancer. A radical prostatectomy, which removes the entire prostate gland as well as some surrounding tissue, takes a few hours to complete.
Here are three things you can expect after your prostate is removed.
Prostate removal is major surgery, so expect some soreness and pain. Youll receive IV pain medications at first, and your doctor may prescribe you pain medication to use at home. You will also have a urinary catheter in place for about the first week, which you might find uncomfortable.
Most patients are up and moving the day of surgery and go home the following day. Although you will need to rest and gradually resume physical activity, urologist Mina Fam, M.D., emphasizes the importance of movement. I want patients up and walking the same day of surgery because any kind of cancer surgery has a risk for blood clotting, Dr. Fam says. I encourage patients to keep walking during their recovery.
Expect it to take about four weeks to start feeling back to your normal self if your surgery was done robotically and up to six weeks with a traditional open approach.
Treatment options include:
Work with your doctor to find a treatment that is right for you.
Another change to expect in your sex life is that, because the seminal vesicles are removed during surgery, you wont ejaculate semen during orgasm.
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Who Gets Prostate Cancer
You need a prostate gland to get prostate cancer.
So it mostly affects men. Trans women and non-binary people who are born male can also get prostate cancer.
Prostate cancer is most common in older men. On average each year 35 out of 100 of new cases are in men aged 75 and over.
It is more common in black Caribbean and black African men than in white men. It is less common in Asian men. A mans risk of developing prostate cancer depends on many factors. These include:
When To See A Doctor
Consult with your doctor if you experience any of the symptoms discussed on this page particularly if they have been going on for a while. You will need a thorough work-up to determine the underlying cause, which may or may not be prostate cancer.
Its important to understand that other diseases or disorders can share these same symptoms. Benign prostatic hyperplasia , also called enlargement of the prostate, and are quite common. Men with these benign conditions can experience symptoms more often and more severely than men with prostate cancer.
Erectile dysfunction is relatively common, especially as one ages, and can also have causes unrelated to prostate cancer, such as smoking or cardiovascular disease. Experiencing a lower amount of fluid during ejaculation can be related to something as simple as diet or dehydration.
Its important to keep track of your symptoms, determining whats normal or abnormal for your own body. If you are worried about a particular symptom, or if its interfering with a relationship, you should discuss your concerns with your primary care physician.
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Changes You Shouldnt Ignore
Early-stage prostate cancer rarely causes symptoms but as the disease progresses, you may experience certain warning signs. Knowing the signs of prostate cancer will help you keep an eye out for any concerning changes to your health.
Keep in mind, though, these symptoms dont indicate trouble with your prostate, Dr. Weight says. In fact, almost all of them come standard with aging. But if you experience several symptoms or have other concerns, it may be a good idea to visit a urologist.
What Is Prostate Removal
A prostatectomy is a surgical procedure for the partial or complete removal of the prostate, which is a small gland about the size of a ping-pong ball, located deep inside the groin, between the base of the penis and the rectum in men. The prostate supplies part of the seminal fluid , which mixes with sperm from the testes. Sperm needs this fluid to travel and survive for reproduction.
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What Is The Source Of The Information
Researchers funded by the Agency for Healthcare Research and Quality, a Federal Government research agency, reviewed studies on treatments for localized prostate cancer published between January 1, 2007, and March 7, 2014. The report included 52 studies and was reviewed by health care professionals, researchers, experts, and the public.
Recent Findings About Regaining Potency After Radical Prostatectomy
It is important to remember that regaining erectile function takes time after radical robotic prostatectomy. Most studies in the literature use endpoints of 18-36 months after prostate cancer surgery. Nerve tissue can be easily damaged during robotic prostatectomy, regardless of the skill of the surgeon, and takes a long time to regenerate. It is believed that early postoperative medical therapy can aid an earlier return to potency.
Dr. Ahlering, a physician with UC Irvine Medical in Orange County, CA. has pioneered the use of electrocautery-free preservation of the neurovascular bundles which are essential for the return of potency after prostate surgery. A recent study by Dr. Patrick Walsh and associates at John Hopkins has shown that mono and bipolar cautery near the potency nerves severely impact the erectile function of dogs. Mono and bipolar cautery are routinely used by many institutions to limit the bleeding during surgery by heat-sealing or cauterizing the bleeding vessels.
The nerves for potency are intertwined with a bundle of blood vessels, which must be controlled during prostate cancer surgery to prevent large blood losses. Thus to preserve the nerves of potency, a surgeon also must prevent the bleeding of these vessels also. Cautery is considered a standard method of sealing the blood vessels, allowing the nerve bundles to now be properly visualized.
For comparison we show the standard data on open prostatectomy potency :
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Lower Your Risk For Prostate Cancer
Prostate cancer is a serious disease, but early detection is key. Talk to your doctor about your risk factors and when or if you should be screened for prostate cancer sometimes as early as age 40, if youre considered high risk.
Theres no way to eliminate the risk of getting prostate cancer, Dr. Weight says, but if youre at a higher risk for developing the disease, there are steps you can take to lower your risk.
- Get regular prostate screenings.
Early Stage Prostate Cancer
If the cancer is small and localized, a doctor may recommend:
Watchful waiting or monitoring
The doctor may check PSA blood levels regularly but take no immediate action. Prostate cancer grows slowly, and the risk of treatment side effects may outweigh the need for immediate treatment.
A surgeon may carry out a radical prostatectomy to remove the tumor. In addition to removing the prostate, the procedure may also involve the removal of the surrounding tissue, seminal vesicles, and nearby lymph nodes. A doctor can perform this procedure using either open, laparoscopic, or robot-assisted laparoscopic surgery.
This uses radiation to kill cancer cells or prevent them from growing. Options for early stage prostate cancer may include :
External radiation therapy: This method uses a machine outside the body to send radiation toward the cancer cells. Conformal radiation therapy is a type of external radiation that uses a computer to help guide and target a specific area, minimizing the risk to healthy tissue and allowing a high dose of radiation to reach the prostate tumor.
Internal radiation therapy: Also known as brachytherapy, this method uses radioactive seeds that a doctor implants near the prostate. A surgeon uses imaging scans, such as ultrasound or computed tomography to help guide the placement of the radioactive substance.
Treatment will depend on various factors. A doctor will discuss the best option for the individual.
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The Risk Of Your Cancer Coming Back
For many men with localised or locally advanced prostate cancer, treatment is successful and gets rid of the cancer. But sometimes not all the cancer is successfully treated, or the cancer may have been more advanced than first thought. If this happens, your cancer may come back this is known as recurrent prostate cancer.
One of the aims of your follow-up appointments is to check for any signs that your cancer has come back. If your cancer does come back, there are treatments available that aim to control or get rid of the cancer.
Your doctor cant say for certain whether your cancer will come back. They can only tell you how likely this is.
When your prostate cancer was first diagnosed, your doctor may have talked about the risk of your cancer coming back after treatment. To work out your risk, your doctor will have looked at your PSA level, your Gleason score and the stage of your cancer. If your prostate has been removed, it will have been sent to a laboratory for further tests. This can give a better idea of how aggressive the cancer was and whether it is likely to spread. If you dont know these details, ask your doctor or nurse.
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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.
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What Is The Prognosis For People Who Have Prostate Cancer
Because prostate cancer tends to grow slowly, most men die from something other than the disease. Early detection is key to better outcomes. Almost all men 97% to 98% diagnosed with localized cancer that hasnt spread outside of the prostate live at least five years after diagnosis. When metastatic cancer has spread outside of the gland, one-third of men continue to survive after five years.
Screening For Prostate Cancer
There are no tests available with sufficient accuracy to screen populations of men for early signs of prostate cancer. However, early detection and treatment can significantly improve prostate cancer survival.
The test most commonly used to aid early detection of prostate cancer is the prostate specific antigen blood test. This is not a diagnostic test as it can only indicate changes in the prostate. If you are concerned about prostate cancer you should talk to your doctor and make an informed choice about whether to have one of the tests designed to find early signs of prostate cancer, in view of the potential risks and benefits.
There are no proven measures to prevent prostate cancer.
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Small Cell Prostate Cancer
Small cell prostate cancer is a rare type of prostate cancer. Around 1 in every 100 prostate cancers are small cell prostate cancer. They can also be classed as a type of neuroendocrine cancer. Small cell prostate cancers are very different from the most common type of prostate cancer.