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Prostatic Adenocarcinoma Gleason Score 3+3

When A Gleason Score Increases

Is Gleason 3+3=6 Really Cancer? No Prof L Klotz

If your Gleason score changes while youre on active surveillance, its time for a discussion with your urologist to better understand the situation.

You may find it helpful to ask these questions:

  • In what way did my Gleason score increase? Remember that the numbers that comprise your Gleason score represent the two most common grades of tissue in your biopsy. Finding out which number increased is important to understanding how your tumor has changed. A change in your first number means that most of your tissue samples are now grade 4 . A new Gleason score of 3+4 means that grade 3 is still the most prominent type of tissue in your biopsy.
  • How does this impact my risk level? Your risk level is based on the distribution of grade 3 and grade 4 samples. A Gleason 7 has a more favorable risk level than a Gleason 7 .
  • Is it time to consider active treatment? It can be unsettling to find out that your prostate cancer has changed or may be getting worse. However, even if your urologist recommends staying on active surveillance, it may bring you peace of mind to better understand at what point youll need to consider other options.

What The Numbers Mean

The pathologist who examines the cellstaken during your biopsywill look at their patterning in the samples. Each area is graded on a scale of 1 to 5, and the two numbers are added together to get the Gleason score.

If a Gleason score is written in your pathology report as 3+4=7, this means most of your tumor is grade 3 and less of it is grade 4. These numbers are then added together for a total Gleason score of 7.

Grades 1 and 2 are not usually used to describe cancer these grades are for tissue that almost looks normal and isn’t considered cancerous. The lowest possible Gleason score of a cancer found in a prostate biopsy is 6cancer with the least risk of spreading quickly. The highest score is 10cancer with the most risk of being aggressive.

Because a scoring system that starts with the number 6 can be confusing, recently the Gleason Grade Grouping were introduced. This group number is based on the numbers used to create a samples Gleason score, but start with 1 instead of 6 and range from 1 to 5 .

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.

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Important Takeaway Message About As

From our viewpoint at the Sperling Prostate Center, AS is a good thing for the right patient. This Johns Hopkins study shows the diagnostic inadequacy of the TRUS biopsy to determine who those men are.

Who wants to wake up from radical prostatectomy only to learn that the cancer was worse than originally thought? The fact is, at the time of surgery, nearly 25% of study patients with Gleason 3+4 cancer were harboring more dangerous disease than their doctors found using TRUS biopsy.

We have to ask, what if these men had undergone a 3T multiparametric MRI scan before they had a biopsy? And, if the 3T mpMRI had picked up significant lesions, what would an in-bore MRI-guided targeted biopsy have found? Many published studies have shown that real-time MRI-guided biopsies are superior over TRUS biopsies at detecting significant cancer using fewer needles.

At our Center, we support AS patients by offering

  • The most accurate imaging to detect significant disease
  • The most precise biopsy method, superior to fusion-guided biopsy, for accurate diagnosis
  • A monitoring protocol using PSA plus periodic 3T mpMRI scans to pick up any cancer changes as early as possible, to facilitate decision-making at each step along the way.

Patel HD, Tosoian JJ, Carter HB, Epstein JI. Adverse Pathologic Findings for Men Electing Immediate Radical Prostatectomy: Defining a Favorable Intermediate-Risk Group. JAMA Oncol. 2017 Jul 13. doi: 10.1001/jamaoncol.2017.1879.

Prostate Cancer Grading & Prognostic Scoring

Pathology Outlines

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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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.

What Is A Normal Gleason Score For Prostate Cancer

Your Gleason score doesn’t rank potential ranges like ranges set for elevated PSA tests. Instead, providers break Gleason scores into three categories:

  • Gleason 6 or lower: The cells look similar to healthy cells, which is called well differentiated.
  • Gleason 7: The cells look somewhat similar to healthy cells, which is called moderately differentiated.
  • Gleason 8, 9 or 10: The cells look very different from healthy cells, which is called poorly differentiated or undifferentiated.

What are grade groups?

Healthcare providers established grade groups to clarify the Gleason score system. Those grade groups are:

  • 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.

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What Makes It Cancer

Although PSA levels or a digital rectal exam may hint at cancer, only a pathologist looking at cells in tissue samples can make the diagnosis. The following are among the key features they look for:

  • Proliferation of relatively uniform small glands lined by a single layer of cells
  • Cells with prominent nucleoli, components of the nucleus that help build proteins
  • Enlarged nuclei
  • Lack of basal cells, which sit below the epithelium in normal tissue
  • Cells that stain readily with dyes
  • Evidence of perineural invasion .

There is no consensus about the correct terminology to use for such lesions. Often youll see the term atypical small acinar proliferation, or ASAP, but it could also be labeled atypical hyperplasia, atypia, atypical glands, or focal glandular atypia.

Fortunately, such atypical findings are reported in only about 8% of pathology reports, according to a review of 39 studies involving needle biopsy specimens. But the trend toward doing more biopsies and finding smaller cancers has led to an increase in atypical diagnoses. Studies have shown that nearly half of the men who receive such an atypical diagnosis initially will find they have prostate cancer during a follow-up biopsy. This happens regardless of PSA levels or results of a digital rectal exam , which appear to be unrelated. In addition, compared to other pathologic diagnoses, atypical findings have the highest likelihood of being changed on expert review, usually to a diagnosis of cancer.

The Tnm System For Prostate Cancer Stages

What are Prostate Cancer Gleason Scores and Grade Groups? Dr. Ahdoot explains

As they do for most cancers, doctors use the TNM system to describe prostate cancer stages. The system uses three different aspects of tumor growth and spread:

  • Tumor. Whatâs the size of the main area of prostate cancer?
  • Nodes. Has it spread to any lymph nodes? If so, how far and how many?
  • Metastasis. How far has the prostate cancer spread?

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What Does It Mean

A Gleason score of 6 is low grade, 7 is intermediate grade, and a score of 8 to 10 is high grade cancer.

Get More Information

Its also important to know whether any cells rated at Gleason grade 5 are present, even in just a small amount, and most pathologists will report this. Having any Gleason grade 5 in your biopsy or prostate puts you at a higher risk of recurrence.

But because many prostate cancer cases are extremely slow-growing, the Gleason system didnt necessarily do a good job of communicating the risks for these cases. Patients with scores of 6 and 7 didnt have a clear picture of the nature of their particular cancer.

About Dr Dan Sperling

Dan Sperling, MD, DABR, is a board certified radiologist who is globally recognized as a leader in multiparametric MRI for the detection and diagnosis of a range of disease conditions. As Medical Director of the Sperling Prostate Center, Sperling Medical Group and Sperling Neurosurgery Associates, he and his team are on the leading edge of significant change in medical practice. He is the co-author of the new patient book Redefining Prostate Cancer, and is a contributing author on over 25 published studies. For more information, contact the Sperling Prostate Center.

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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.

Relationship Of Gleason Grade To Pathologic And Clinical End Points

Adenocarcinoma Prostate Gleason Score 3 3 6

Increasing Gleason grade is directly related to a number of histopathological end points, including lymphvascular space invasion by carcinoma, tumor size, positive surgical margins, and pathological stage, including risk of extraprostatic extension and metastasis .

Prediction of pathologic stage by needle biopsy Gleason grade alone is possible but is not absolutely accurate for the individual patient. So, patients with lower-grade carcinomas are still at risk for having cancer spread outside the prostate, and not all patients with a high-grade carcinoma component will have carcinoma extension beyond the confines of the prostate gland. Clinically, needle biopsy Gleason grade is usually combined with other pretreatment factors, such as serum total PSA, % free PSA, local clinical T stage, and amount of tumor in needle biopsy, to predict pathologic stage. Perhaps the most commonly used data clinically are the so-called Partin tables, which combine needle biopsy Gleason grade, serum PSA, and clinical stage to provide estimates of risk for extraprostatic extension, seminal vesicle invasion, and lymph node metastasis. . Another nomogram available on the web uses biopsy Gleason grade, pretreatment PSA, clinical stage, and treatment information to calculate pathologic stage, and 5-year progression-free probability for radical prostatectomy, external beam radiation therapy, or brachytherapy.

Figure 11

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Tests To Identify Prostate Cancer Stage

After a prostate cancer diagnosis, your doctor will do tests to see how far the cancer has spread. Not all men need every test. It depends on the results of your biopsy, a test that checks tissue from your prostate gland for cancer. Tests that help your doctor figure out the stage of your prostate cancer include:

  • CT scan of the abdomen and pelvis to see if the cancer has spread
  • Nuclear medicine bone scan to see if the cancer has spread to your bones
  • Surgery to check the lymph nodes in your pelvis for prostate cancer spread

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

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Celia Maria Jesuino Bittencourt1

1Centro Estadual de Oncologia , Av Vasco da Gama s/n, Brazil2CLINAZZA Pathology Laboratory, Rua do Cabral, Brazil3IMAGEPAT Pathology Laboratory, Rua Lucaia, Brazil4Department of Pathology, Largo do Terreiro de Jesus s/n, Federal University of Bahia, Brazil5Gonçalo Moniz Research Center, Rua Waldemar Falcão, Brazil6Hospital Universitário Professor Edgard Santos , Rua Augusto Viana s/n, Brazil

*Corresponding author: Daniel Abensur Athanazio, Departamento de Patologia e Medicina Legal, Universidade Federal da Bahia, Faculdade de Medicina da Bahia, Praça XV de novembro, s/n – Largo do Terreiro de Jesus, 40025010 – Salvador, BA, Brazil, Tel: 55 32835563, Fax: 55 32408406, E-mail: Int Arch Urol Complic, IAUC-1-003, , Research Article ISSN: 2469-5742Received: February 05, 2015 | Accepted: March 18, 2015 | March 20, 2015Citation: Bittencourt CMJ, Athanazio DA, Santos ACD, Érica Curvelo Dantas Senna ECD, Silva TMC, et al. A Comparison of Prostatic Acinar Adenocarcinoma Gleason 3+4 versus 4+3 in Different Laboratory Practice Settings. Int Arch Urol Complic 1:003. 10.23937/2469-5742/1510003Copyright:© 2015 Bittencourt CMJ, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Prostatic Neoplasms, Pathology, Prostate-specific antigen, Neoplasm Grading

This work was supported by a grant from CNPq .

What Are Grade Groups

Understanding The Gleason Score | Prostate Cancer Staging Guide

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.

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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.

What Is A Bad Gleason Score For Prostate Cancer

Gleason scores aren’t good or bad, per se. They predict how quickly your prostate cancer might grow. Tumors with higher Gleason scores are likely to grow quickly. And Gleason scores aren’t the only factors healthcare providers consider when creating your treatment plan.

What other factors do healthcare providers consider?

Providers consider the results of other tests and additional biopsy information. For example, when you had your biopsy, your healthcare provider obtained several samples or cores from your prostate. They checked how many cores contained cancer and whether most of the cells in the cores were cancerous cells.

Other factors may include:

A note from Cleveland Clinic

Healthcare providers use Gleason scores to learn more about your prostate cancer. But numbers don’t tell the whole story about your prostate cancer. That story starts with your treatment plan and understanding what to expect from your treatment. Think of your Gleason score and other analysis as the next chapter in your story. Talk to your healthcare provider any time you have questions about your Gleason score or any other test result. They’ll be glad to help you understand what the numbers mean.

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