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What Is Gleason 9 Prostate Cancer

Outlook For Men With Advanced Prostate Cancer

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

While it isnt possible to cure advanced prostate cancer, treatments can help keep it under control, often for several years. Treatments will also help manage any symptoms, such as pain.

Some men may not respond well to one treatment, but may respond better to another. And when your first treatment stops working, there are other treatments available to help keep the cancer under control for longer.

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.

What Is A Gleason Score

If you have prostate cancer, your Gleason score is one factor healthcare providers consider to develop your treatment plan.

Your score reflects what providers learned about your cancer after examining tissue samples from your prostate cancer biopsy. They looked for patterns of normal and abnormal cells, noting where your cells look more like cancerous cells and where they look more like healthy cells.

Then they graded each piece of the pattern on a 3 to 5 scale. Pattern pieces with cancer cells that look like healthy cells were graded low. Pieces with cancer cells that don’t look like healthy cells get high grades.

Providers add those scores to set an overall Gleason score between 6 and 10. They might refine their analysis by classifying your cells by group, with Gleason scores listed in grade groups 1 to 5.

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An enlarged prostate can also be the cause of other problems. If the enlarged prostate is causing symptoms, the best treatment would be a natural remedy. In the meantime, there are treatments for a wide range of conditions that cause a man to experience pain. A common surgical procedure involves an electric loop, laser, or electro-stimulation. The procedure is a safe and effective option for treating enlarged or symptomatic BPH.

Prognostic Grouping Of Prostate Cancer

Prostate cancer gleason score

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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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

REFERENCES

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.

The Ajcc Tnm Staging System

A staging system is a standard way for the cancer care team to describe how far a cancer has spread. The most widely used staging system for prostate cancer is the AJCC TNM system, which was most recently updated in 2018.

The TNM system for prostate cancer is based on 5 key pieces of information:

  • The extent of the main tumor *
  • Whether the cancer has spread to nearby lymph nodes
  • Whether the cancer has spread to other parts of the body
  • The PSA level at the time of diagnosis
  • The Grade Group , which is a measure of how likely the cancer is to grow and spread quickly. This is determined by the results of the prostate biopsy .

*There are 2 types of T categories for prostate cancer:

  • The clinical T category is your doctors best estimate of the extent of your disease, based on the results of the physical exam and prostate biopsy, and any imaging tests you have had.
  • If you have surgery to remove your prostate, your doctors can also determine the pathologic T category . The pathologic T is likely to be more accurate than the clinical T, as it is done after all of your prostate has been examined in the lab.

Numbers or letters after T, N, and M provide more details about each of these factors. Higher numbers mean the cancer is more advanced. Once the T, N, and M categories have been determined, this information is combined in a process called stage grouping to get the overall stage of the cancer.

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Surgical procedures to remove the diseased prostate are usually necessary. Surgical procedures are not always necessary. If the disease is caused by bacterial infections, a doctor can treat the symptoms using alpha-blockers or surgery. Physical therapy, relaxation exercises, and warm baths are all recommended. A physician may also prescribe antibiotics to cure the infection. A bacterial infection can also cause a recurrence of the condition.

An enlarged prostate can be uncomfortable for both men and women. Some of the symptoms of an enlarged male reproductive organ include a weakened urine stream, urgent need to urinate, and urinary tract infections. BPH can also cause damage to the kidneys. A sudden inability to urinate can be life-threatening, as it can lead to bladder and kidney damage. Unfortunately, most men with enlarged prostrates put up with the symptoms for years before they seek treatment. However, many of the men with symptoms finally decide to go to a doctor for proper gynecological evaluation and to begin enlarged prostatic therapy.

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

What Does Gleason 7 Mean? | Ask A Prostate Expert, Mark Scholz, MD

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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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

Prostate Cancer Treatment Health Professional Version

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The median age at diagnosis of carcinoma of the prostate is 66 years. Prostate cancer may be cured when localized, and it frequently responds to treatment when widespread. The rate of tumor growth varies from very slow to moderately rapid, and some patients may have prolonged survival even after the cancer has metastasized to distant sites, such as bone. The 5-year relative survival rate for men diagnosed in the United States from 2010 to 2016 with local or regional disease was greater than 99%, and the rate for distant disease was 30% a 98% survival rate was observed for all stages combined. The approach to treatment is influenced by age and coexisting medical problems. Side effects of various forms of treatment should be considered in selecting appropriate management.

Many patientsespecially those with localized tumorsmay die of other illnesses without ever having suffered disability from the cancer, even if managed conservatively without an attempt at curative therapy. In part, these favorable outcomes are likely the result of widespread screening with the prostate-specific antigen test, which can identify patients with asymptomatic tumors that have little or no lethal potential. There is a large number of these clinically indolent tumors, estimated from autopsy series of men dying of causes unrelated to prostate cancer to range from 30% to 70% of men older than 60 years.

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Outlook For Locally Advanced Prostate Cancer

Many men with locally advanced prostate cancer have treatment that aims to get rid of their cancer. For some men, this treatment can be very successful and they may live for many years without their cancer coming back or causing them any problems. For others, treatment may be less successful and the cancer may come back. If this happens, you might need further treatment. Read more about the risk of your cancer coming back.

Some men with locally advanced prostate cancer will have treatment that aims to help keep their cancer under control rather than get rid of it completely. For example, if you have hormone therapy on its own, it can help to keep the cancer under control, usually for several years. And there are other treatments available if your hormone therapy stops working.

Prognostic Nomogram For Os

The Basics of Tumor Grading and Cancer Staging

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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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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What You Need To Know About The Prostate What Is The Prognosis For Gleason 9 Prostate Cancer

The main purpose of the prostate is to produce semen, a milky fluid that sperm swims in. During puberty, the body produces semen in a large number of cases, including enlarged prostate. This fluid causes the prostate to swell and cause a number of bladder-related symptoms. This is why the prostate is important to the body. It can be caused by many factors, including infection and inflammation.

A enlarged prostate can also cause blockages in the urethra. A blocked urethra can also damage the kidneys. A patient suffering from an enlargement of the prostate may have pain in his lower abdomen and genitals. If pain is present, a digital rectal examination will reveal hard areas. A doctor may prescribe surgery or perform an endoscopic procedure. If the enlarged prostate is not completely removed, it will shrink.

While the size of an enlarged prostate will influence the extent of urinary symptoms, men may experience a range of urinary symptoms. Some men have minimal or no symptoms at all. Some men will have a very enlarged prostate, whereas others will have a mild enlargement. Generally, the symptoms can stabilize over time. Some men may have an enlarged prostate but not notice it. If they have an enlarged colon, their physician can perform a TURP procedure.

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What Are Grade Groups

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.

Monitoring And Treatment Decisions

Treating High-Risk Gleason 8: A Modern Approach | Mark Scholz, MD | PCRI

In the past, men with prostate cancerregardless of whether it was aggressive or notwere almost always treated right away with a targeted therapy like surgery or radiation. However, in recent years, experts have revisited this one-size-fits-all approach to prostate cancer.

Experts now understand that low-risk prostate cancerlike Gleason 6 tumorsmay not need treatment right away. In fact, major medical associations, including the American Urological Association and the Society for Urologic Oncology, now recommend the use of active surveillance for low-risk prostate cancer.

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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.

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:

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