What are Prostate Cancer Gleason Scores and Grade Groups? - Dr. Ahdoot explains
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- เผยแพร่เมื่อ 26 ก.ค. 2024
- When prostate cancer is diagnosed a Gleason score is assigned based on how dangerous a cancer looks. However, in recent years the urologic community has switched over to using a different system called Grade Groups to describe how dangerous a prostate cancer can be. Dr. Ahdoot discusses what Gleason scores and Grade Groups are and how they impact you health.
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Awesome explanation of Gleason Scores! My husband brought home biopsy results and I was dumbfounded. Being a nurse he thinks I know everything. This helps with making his treatment plan.
Good to know. I now understand my Gleason score better (8). Thank you so much for posting this with images of each score. My surgery is in a couple weeks. You've helped a lot of people.
Happy I can help. Please share the channel with others in need of high quality information.
This was so much easier for me to understand. Ty. Although still confused in what to do. This is good info.
Another great/informative video Doc..... My score came back today as a 3+3 on 3 of the 12 zones tested. But my urologist graded me as a 3+4=7. I don't see a 4 anywhere on the Diagram; But do see on the last page this: Adeno CA is 3+4=7. [Again, Those 3 areas all say 3+3 in Group-1]. I have my next appointment in 1 week....but others might find your response helpful. Thanks again~~~p
Sounds like something may be amiss. Ask your doctor. This should be easy for him or her to sort out.
Very direct brief presentation. I like to the point people. I’m group 2; (5% of the Tu is grade 4). MRI indicates 1.5 cm diameter Tu. No cancer appears on the contralateral side of the prostate and no cancer in the ipsilateral base. PSA 7.7. Underwent irreversible electroporation recently. What do you think in terms of the treatment choice and prognosis?
In Europe we differentiate between 3+4 as 7a and 4+3 as 7b. :)
I had an MRI-targeted TRUS biopsy about two weeks ago. The MRI had shown two lesions that were indicated as suspicious in the radiologist’s report, and it stated there was a 50-60% chance of finding clinically significant cancer in the larger (pea-sized) of the two lesions (the other was shown as pinhead-sized). Right after the biopsy, the very experienced urologist who performed it came into the recovery room and told me, and this is verbatim: “Good news! You don’t have cancer.” The hospital personnel congratulated me and my spouse was overjoyed to tears. When I went to the later appointment to review the pathology report that came in, it showed one core at Gleason 3+4 (80%) and one core at 3+3 (15%). The other 10 were benign. Needless to say, I was pretty upset that the urologist originally told me I didn’t have cancer and the pathology report told quite a different story. Is there any way a urologist performing a biopsy could have known immediately after it that a patient didn’t have cancer? Everyone I’ve spoken to finds this whole scenario appalling.
That’s a very unusual scenario. Typically we send the tissue cores to the pathologist who does special staining and examines the tissue under a microscope to determine the Gleason grade. This process usually take at least several hours in ideal scenarios. In actual clinical practice the turn around for results from a pathology will range from 1-7 days. Given this timeline it’s improbable to have pathology results within the
Thanks for your prompt reply. I’ve decided not to continue with the urologist who did the biopsy. Even if he did some sort of intra-operative tissue exam (which was never mentioned to me), I find it highly irregular to clearly state a result of no cancer before seeing the pathology report, which was not issued until two days after the biopsy. I have found another urologist that I believe will be well able to pick up my case going forward, and he now has all of my reports and office visit notes. The previous urologist seemed to be an effective practitioner, but his bedside manner left a lot to be desired. I would never be able to develop the proper amount of trust with him after this incident. Best wishes!
@@cancerbetter Please do make a video on retzius sparing. Does that mean robotic prostatectomy? My brother and I, diagnosed within a week of each other -- he's decided on having his out. I'm still in the decision phase. I would value your clear explanation of the subject.
@muunokhoi I’m actually working on that. Retzius sparing is a new robotic prostatectomy technique that results in be try early return of continence after prostatectomy with some people having no incontinence at all post op. Problem is it’s technically challenging so there are only a handful of us in each area of the country doing them. In all of Southern California I believe I am only one of four people doing this technique.
@@cancerbetter Thanks, I'll look forward to that. My brother and I have both been diagnosed in the same month. He's decided on robotic prostatectomy at a place that specializes in it. His surgeon says he doesn't recommend retzius sparing, partly because it "doesn’t have the same statistical probably of getting all the cancer out." Is that something you can address when you make the video?
Dr. Ahdoot, your videos are some of the most helpful and well presented in all of TH-cam. I hope you don't mind if I ask: I'm an orthopaedic surgeon, but this is out of my wheelhouse. Could you address whether ASAP affects treatment decision making? I'm young (60) with grade group 1 (15% of 1/12 cores was 3+3, PSA 4.6), but half of the cores showed ASAP. I might be comfortable with active surveillance on the apparently small tumor itself, and I see that ASAP itself is not treated. But what if you have a small amount of low grade cancer and a fair amount of dysplasia? Would that prompt one to lean toward more curative treatment? Can radiation treat incidental ASAP if you choose to treat the cancer?
Generally we don't even recommend treatment for low grade (i.e. Gleason 6) prostate cancer unless it's high volume cancer or there is evidence of disease extension into other organs. In some situations watching even grade group 2 cancer (Gleason 3+4) makes sense as the risk of metastasis over a 10 year period is estimated to be less than 20% in people with low volume disease.
In the case of ASAP surveillance with the possibility of rebiopsy is often the most conservative management.
Again I don't have all the details to comment specifically on your case but I hope this helps you.
You may also want to consider getting a re-read of your slides to make sure the first pathologic assessment is corroborated. Hope you are doing well!
Hello Dr. I'm 57 with a Gleason of 4+3 with 5/12 cores showing cancer and all on one side of the prostate. My PSA is less than 4. Do you think I would be a candidate for brachytherapy if it is determined that the cancer has not spread beyond my prostate? I am going in for my scan later this week.
Brachytherapy can be used to treat that type of cancer. As well as external radiation sources or surgery. Speak with the doctors about the pros and cons of each
I have a Gleason 6 grade 1. PSA 5.5.
On core 8% another core 55%.
How does that 55% increase my risk ?
Likely doesn’t much. Still Gleason 6
My father had a Pelvic MRI to check if he had prostate cancer and it came back clear. The doctor wanted to still do a biopsy just to make sure. He did and it revealed that my dad has prostate cancer, 3+4, Gleason score of 7. Is it common for the MRI to miss the cancer?
Hi Kevin,
Good question. It occurs in 10% of people with a normal MRI. Often if a person has a normal MRI but the PSA is high for the size of their prostate(I.e. elevated PSA density.) then a biopsy is still indicated despite the normal MRI. Sounds like your doctor made a wise choice. Hope this helps. - Michael Ahdoot MD
@@cancerbetter thank you for your reply. Why does that happen? Does that happen because the cancer is deep and not as visible as others?
@kevinesmeraldas8740 usually it occurs bc the area of cancer is too small for the MRI to detect it or the cancer is not growing in a dense enough pattern to be detected.
@@cancerbetter I see. I really appreciate you replying!
Thank You for your video information. Very well put together. I have been having a hard time with my decision to have the prostate removed but seem to feel it is the right decision. I had elevated PSA score found when I got a physical last March. Urologist next and he suggested the biopsy and 5 out of twelve came back as 100% and mucinous. Gleason Score 4+4 on all five. I am 59 yoa and type 2 diabetic. I feel the RP is the best choice and am 10 days from surgery. Just too much time to go that I am second guessing my decision. I hope you can reply soon with your input on my decision.
David it's very difficult to comment on your particular situation given that I do not have all the details of your case. That being said based on what you have said here it does seem like surgery is the right choice.
In general when people are in doubt I suggest getting a second opinion. Unfortunately, with the treatment of prostate cancer there is no clearly superior treatment in all situations. We need to consider each person's individual situation. In cases like yours of high volume, high risk disease I often choose surgery when...
1. the cancer is confined to the prostate and looks like it can be removed surgically. The MRI report will often have a line about extra prostatic extension. If there is extraprostatic extension the cancer has likely grown outside of the confines of the prostate and you'd have to ask your surgeon if s/he thinks they can reasonable get it all out. If they do not feel they can then surgery is unlikely to be curative and I often have an honest conversation with my patients about their options. Often in this situation I recommend radiation.
2. The person is young. We know that the bad side effects from radiation often come greater than 10 years after treatment and can be really difficult to manage. For this reason I often discourage radiation in men below 65, who are in good health.
3. The area of cancer is too big to be treated with focal therapy. (Video on focal therapy to come).
For each of these 3 factors it sounds like you would be better off with surgery in my opinion. Again, I don't know all the details of your case so take this with a grain of salt. My goal is to try to educate people so they can understand the risks and benefits of each treatment option and make educated choices. I commend you for starting the education process by seeking out evidence based videos like those on cancer better.
Most prevalent plus most dangerous for the Gleason score you say. However Gleason 4+3 has the most prevalent as a four and the second number is the least dangerous. I’m confused.
It appears you caught an error in my video. I will correct this. The Gleason score is a sum of the most prevalent cancer score (first number) and second most prevalent cancer observed (second number). If any cancer subtype is represent in less than 5% of the total cancer present it is not considered for the Gleason score but is often reported as a tertiary pattern. Thank you again for the comment. I will probably have to take this video down and re-record it
You are the best!!
Doctor ..could you please share your email so that I can send you my situation about Gleason 3+4.
You can reach me by filling out the contact section at cancerbetter.com/contact-us