What Does Staging And Grading Mean For Treatment
The prostate cancer stage and grade are important for determining your course of treatment. Some treatments are only effective for Stage I and II prostate cancer and other treatments are only necessary for Stage III and IV prostate cancer.
Grading is especially useful in early-stage disease. If the tumor shows signs of being aggressive, it may make sense to go forward with more aggressive prostate cancer treatment options. If the tumor does not seem aggressive, it may make sense to go forward with active surveillance or watchful waiting and avoid common side effects.
In any case, the stage and grade must be discussed with your doctor and healthcare team.
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High Acat1 Expression In Prostate Cancer Cells Correlates With The Tumor Gleason Score
Through the GEPIA database, we found that ACAT1 is an oncogene in prostate cancer . Therefore, we conducted a series of experiments to elucidate the prostate cancer-promoting role of ACAT1.
Fig. 1
High expression of ACAT1 in prostate cancer cells correlates with the tumor Gleason score. A and B. From the GEPIA database, the results show that in prostate adenocarcinoma , the expression of ACAT1 is significantly higher than that in the adjacent normal tissues . C. Expression of ACAT1 in prostate tissue sections. Normal prostate gland. Prostate cancer tissue with a Gleason score of 3. Prostate cancer tissue with a Gleason score of 4. Prostate cancer tissue with a Gleason score of 5. D. From the Human Protein Atlas, display of ACAT1 expression in prostate cancer cell lines. E. From the GEPIA database, the results show that in prostate cancer, high expression of ACAT1 is associated with a poor prognosis. F. Tumorigenic ability of PC3 cell line with stable and high expression of ACAT1 in nude mice compared with that in the negative control group
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Active Oxygen Detection Assays
The level of reactive oxygen species generated by prostate cancer cells was detected using the probe 2,7-dichlorodihydrofluorescein , which detected diacetate. After 48h of transfection with the SIRT5 plasmid or siRNA, the cells were cultured in the dark for 20min with 10M DCFH-DA in a humidified atmosphere at 37°C in the presence of 5% CO2. The cells were washed three times with cold phosphate-buffered saline to remove excess fluorescent probes. The cells were counted, 104 cells were added to each well of a 96-well plate, and the absorbance was measured at 488nm.
Calculating The Gleason Score
A doctor will use the results of a biopsy to calculate the Gleason score.
During a biopsy, a healthcare professional will take tissue samples from different areas of the prostate. The cancer is not always present in all parts of the prostate. For this reason, they will often collect several samples.
After examining the samples under a microscope, they will identify the two areas with the most cancer cells. They will then assign a score to each of these areas. Then, they will add these scores together to give a combined score, often referred to as the Gleason sum.
It is important to note that sometimes, a doctor will use a different method for calculating the Gleason score.
For example, when a biopsy sample has either a large number of high grade cancer cells or shows three different grades of mutation, they will modify the Gleason score to more accurately reflect how aggressive they deem the cancer to be.
A persons Gleason score can technically range from 210, but it is much more likely to range from 610. We will explain why this is in the sections below.
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Stage 2 Prostate Cancer
In stage 2, the tumor is still confined to your prostate and hasnt spread to lymph nodes or other parts of your body. A doctor may or may not be able to feel the tumor during a prostate exam, and it may appear on ultrasound imaging. The survival rate is still near 100 percent.
The PSA score for stage 2 is less than 20 ng/mL.
Stage 2 cancer is further divided into three phases depending on the grade group and Gleason scores:
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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:
- Imaging test results like ultrasound, magnetic resonance imaging or positron emission tomography scan.
- Whether cancer was found in both sides of your prostate.
- Whether cancer has spread outside of your prostate.
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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Prostate Cancer Stage Ii Treatment Options
Stage II prostate cancers are still localized, but are larger than stage I cancers. The cancer may be on both sides of the prostate and a doctor may be able to feel it with a DRE. PSA levels are medium and cancer cells may or may not resemble cancer cells. Given these changes, there is a greater risk of progression and metastasis than in stage I.
Treatment options for stage II prostate cancer include:
- Radical prostatectomy
Bone Protection In Patients Receiving Androgen Blockade
Two drugs, the bisphosphonate zoledronic acid and the RANKL inhibitor denosumab, have been approved to treat osteoporosis secondary to androgen deprivation. Zoledronic acid is administered as an intravenous infusion. Denosumab is administered subcutaneously. These drugs are given along with supplemental vitamin D and calcium. Patients should be monitored regularly for hypocalcemia. Both agents are associated with a low incidence of osteonecrosis of the jaw. Both drugs delay the risk of skeletally-related events by relieving bone pain, preventing fractures, decreasing the need for surgery and radiation to the bones, and lowering the risk of spinal cord compression.
A double-blind, placebo-controlled, multicenter study in men with primary or hypogonadism-associated osteoporosis found that over a 14-month period, treatment with zoledronic acid reduced the risk of vertebral fractures by 67%. New morphometric vertebral fracture occurred in 1.6% of men taking zoledronic acid and in 4.9% taking placebo. Patients receiving zoledronic acid had significantly higher bone mineral density and lower bone-turnover markers. However, the rate of myocardial infarction was higher in the treatment group .
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Immunohistochemistry And Gleason Scores
The 57 tissue sections were incubated with ACAT1 rabbit polyclonal antibody at 4°C overnight. Thereafter, they were incubated with the secondary antibody for 2h at 37°C. The nuclei were stained with hematoxylin for 10min 100L of 3,3-diaminobenzidine chromogenic solution was added to each tissue section and ACAT1 expression was observed under a microscope. Next, the tissue sections were strictly scored according to the latest Gleason scoring system. The 2 test was used to determine the correlation between ACAT1 expression and clinicopathological characteristics. P< 0.05 was considered to indicate a statistically significant difference.
Percent Gleason Pattern 4 In Stratifying The Prognosis Of Patients With Intermediate
Meenal Sharma1, Hiroshi Miyamoto1,2,3
Department of Pathology and Laboratory Medicine, 2 University of Rochester Medical Center , , USA
Contributions: Conception and design: All authors Administrative support: None Provision of study material or patients: None Collection and assembly of data: All authors Data analysis and interpretation: All authors Manuscript writing: All authors Final approval of manuscript: All authors.
Correspondence to:
Abstract: The Gleason score remains the most reliable prognosticator in men with prostate cancer. One of the recent important modifications in the Gleason grading system recommended from the International Society of Urological Pathology consensus conference is recording the percentage of Gleason pattern 4 in the pathology reports of prostate needle biopsy and radical prostatectomy cases with Gleason score 7 prostatic adenocarcinoma. Limited data have indeed suggested that the percent Gleason pattern 4 contributes to stratifying the prognosis of patients who undergo radical prostatectomy. An additional obvious benefit of reporting percent pattern 4 includes providing critical information for treatment decisions. This review summarizes and discusses available studies assessing the utility of the percentage of Gleason pattern 4 in the management of prostate cancer patients.
Keywords: Gleason grading prognosis prostate biopsy radical prostatectomy
Submitted Dec 12, 2017. Accepted for publication Mar 14, 2018.
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Prostate Cancer: Stages Grades And Treatment
Cancer stage refers to the size of the tumor and whether or not it has spread to other parts of the body prostate cancer is staged using the TNM system. Cancer grade refers to how quickly the cancer cells will grow and spread prostate cancer is graded using the Gleason score. Treatment of prostate cancer is based on a combination of age, life expectancy, and personal preferences, in addition to cancer grade and stage. In general, the higher the grade or stage, the more likely it is that the cancer will spread.
Impact Of Percent Gleason Pattern 4 On Active Surveillance
Active surveillance is now common practice for patients with clinically localized, low-volume Gleason score 3+3=6 prostate cancer . In addition, depending on age, comorbidity, PSA level, tumor extent, and patient desire, some Gleason score 3+4=7 tumors, with only focal, low-volume areas of pattern 4 disease, may be appropriate for active surveillance . Therefore, recording the percentage of pattern 4 in the pathology report is clinically relevant in such cases.
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Top Candidates For Active Surveillance
You may be a candidate for active surveillance if you meet the following qualifications:
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Your cancer is confined to the prostate.
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Your tumor is small and is expected to grow slowly.
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You arent experiencing any symptoms.
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You have the ability to live with cancer without worry reducing your quality of life.
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You value near-term quality of life to a greater extent than any long-term consequences that could occur.
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You have a relatively long life expectancy and may benefit from curative local therapy if your cancer progresses.
Men with localized prostate cancer that is intermediate risk or higher and with more than a limited life expectancy usually require local treatment. They are not good candidates for active surveillance.
When it comes to active surveillance, each patient should carefully weigh the potential loss of quality of life with treatment against the possibility that the window of opportunity for cure will disappear without treatment.
Dropping Psa Score With Gleason Score Of 7
How can a PSA drop with a Gleason score of 7? The biopsy showed that the cancer had attacked the nerves. Should I consider monitor with this situation?
Hi Cayandray,Good question regarding the relationship between PSA and Gleason score. Im tagging fellow members to see what they may add this conversation.
You may also be interested in joining these discussions on Connect:
prostate cancer treatment choices Prostate cancer treated with Leuprolide Why did you choose brachytherapy for prostate cancer
Have you had any treatment for prostate cancer or have been on active surveillance ?
Hi Cayandray,Good question regarding the relationship between PSA and Gleason score. Im tagging fellow members to see what they may add this conversation.
You may also be interested in joining these discussions on Connect:
prostate cancer treatment choices Prostate cancer treated with Leuprolide Why did you choose brachytherapy for prostate cancer
Have you had any treatment for prostate cancer or have been on active surveillance ?
You may also be interested in joining these discussions on Connect:
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Gleason Prostate Cancer Score
Dr. Donald Gleason originally developed the Gleason prostate cancer score in the 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.
The Importance Of The Gleason Score
It’s important to understand the Gleason score because studies indicate that it correlates closely with the behavior of the cancer cells in your body. The score itself can give your doctor an idea of whether or not the cancer will be slow-growing or more aggressive.
While the Gleason score can tell your oncologist a lot about the behavior of your cancer and what type of treatment plans may be best, it is not the only method used to understand your cancer. Other factors about your cancer can also help paint the entire picture. Other points to consider include:
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PSA blood test score
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Whether cancer was found on both sides of the prostate
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Whether cancer has spread outside the prostate
Your oncologist can provide more information about what these particular points mean for your cancer diagnosis and treatment plan.
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Gleason Score For Grading Prostate Cancer
Prostate cancer is also given a grade called a Gleason score. This score is based on how much the cancer looks like healthy tissue when viewed under a microscope. Less aggressive tumors generally look more like healthy tissue. Tumors that are more aggressive are likely to grow and spread to other parts of the body. They look less like healthy tissue.
The Gleason scoring system is the most common prostate cancer grading system used. The pathologist looks at how the cancer cells are arranged in the prostate and assigns a score on a scale of 3 to 5 from 2 different locations. Cancer cells that look similar to healthy cells receive a low score. Cancer cells that look less like healthy cells or look more aggressive receive a higher score. To assign the numbers, the pathologist determines the main pattern of cell growth, which is the area where the cancer is most obvious, and then looks for another area of growth. The doctor then gives each area a score from 3 to 5. The scores are added together to come up with an overall score between 6 and 10.
Gleason scores of 5 or lower are not used. The lowest Gleason score is 6, which is a low-grade cancer. A Gleason score of 7 is a medium-grade cancer, and a score of 8, 9, or 10 is a high-grade cancer. A lower-grade cancer grows more slowly and is less likely to spread than a high-grade cancer.
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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How Prostate Cancer Is Diagnosed And Staged
Cancer staging helps you and your doctor understand how advanced your cancer is and how much it has spread at the time of diagnosis. Knowing your cancer stage also helps your doctor determine the best treatment options for you and estimate your chance of survival.
The most widely used staging system for cancer is the American Joint Committee on Cancers TNM system that classifies cancer from stage 1 to stage 4.
TNM stands for:
- Tumor: the size and extent of the tumor
- Nodes: the number or extent of nearby lymph node involvement
- Metastasis: whether cancer has spread to distant sites in the body
The TNM scale is used for many types of cancer. When a doctor uses it to determine your prostate cancer stage, theyll consider several other factors as well, including:
- Prostate-specific antigen levels
Genetic Testing For Prostate Cancer
You may hear a lot about genetics or genomics. Both terms are related to genes and cell DNA, but they are different. These tests are being used to learn more about the DNA of cancer cells, and link DNA mutations with treatments. In the future, genetic testing may be the first step doctors take when diagnosing prostate cancer.
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