Gleason 4+3 = 7
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- เผยแพร่เมื่อ 17 ส.ค. 2024
- In this video, PCRI's Alex and Medical Oncologist Mark Scholz, MD, discuss the first steps and prognosis for men who have been diagnosed with Gleason 4+3=7, intermediate-risk prostate cancer.
0:07 What is the Gleason score, and what is the difference between Gleason 3+4=7 and 4+3=7?
2:13 Do all pathologists report the newer "Epstein" 1-5 grading system instead of or along with the Gleason score?
2:53 What exactly does it mean to have 4+3 as opposed to 3+4?
3:53 Should men always get second opinions on their pathology reports?
4:47 What are the first steps after being diagnosed with 4+3, intermediate-risk, prostate cancer?
5:55 What are the survival rates for Gleason 4+3 prostate cancer?
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I have now been officially diagnosed as a groupie, you two are absolutely rock statis when it comes to informing the public about this type of cancer.
You're videos are really helpful in understanding prostate cancer
I had a TURP in 2013. I was in my early 60s. I don’t recall the urologist telling me that I was subsequently have retrograde ejaculations, but the surgery left me with this condition. I wasn’t happy about it but it did help a lot with my urinary problem. My PSA was within normal range. Five years later, as my PSA score kept going up since the surgery, I decided to see another urologist who suggested we do a biopsy when a scan showed two tumors in the prostate one of which abutted the capsule. The Gleason scores came back at 5+4 and 4+4. After another series of procedures, I opted to have robotic surgery to remove the prostate. I have now been cancer free for three years. PSA tested every six months. The surgery went well, although the results are hard to live with. No prostate=no ejeculation. Some guys are apparently able to get an erection after surgery. Unfortunately, I am not one of them. Neither Viagra nor Cialis has been of any use. I have learned to accept it but at a tremendous cost to the psyche. By the way, after the surgery I was told that my Gleason score was only a 7. Perhaps if I had known this, I might not have opted for the surgery. Too late. I did consider radiation, but I was told if it didn’t kill all the cancer cells, by then surgery would be out of the question. In sum, don’t rush to have the surgery and consider the consequences beforehand.
Thank you. I’m facing those questions now. Radiation or surgery. 4+3 and I’m thinking I should just let nature take its course as will will all die sooner or later. I don’t know how to live with surgery side effects for life.
I want to thank everyone at PCRI involved in providing this information… I was recently diagnosed with 4+3 and was close to being put on the “Conveyor belt” treatment plan… as a result of PCRI I now am about to have a PSMA Scan and my biopsy samples are being sent to Decipher… Once the results come back I am hopeful I can do Tulsa-Pro focal treatment… Even if I must go to Germany… My quality of life is most important… not the number of years I live…so I am willing to assume more risk than most to maintain my lifestyle… “Thanks” for such a informative group of videos… you may just have saved my quality of live… I will be forever grateful…
@@roberthanson6792 I was recently diagnosed with 4+3 and will be getting a PSMA scan. I had my biopsy and for the past ten days I have been catheterized because I can not urinate. I had been able to urinate well before the biopsy. I loosing faith in the medical treatment already. Did you have any problem after biopsy? Thank you.
Thank you 😊 💓 you made this G 7 4+3 feel a lot better 😊
This series of VLOGS has been very informative for me. I have by now "graduated" from Proton Radiation plus Hormone treatment therapy after having been diagnosed with Prostate Cancer that included a 4+3 score from one of the biopsy's of my Prostate. There is such good information here that I am sharing this with my friends so that they know as much as possible about this condition among men.
Thank you!
Thank you. I am 78 and diagnosed with 3+4 in 2010. I have been watching and waiting for 12 years. Current PSA 3.8 (On Finasteride) Recentlly biopsy upgraded Gleason to 4+3. It's great to hear that even if the cancer would spread, it would be possible to extend my life significantly using hormone therapy.
@Charles Papa. 12 years since with 3+4 under active surveillance since?
Please explain what's Finasteride?? A pill? or injection? How often?
@@socratesaziza8820 That's right, 12 years on watch and wait. Finasteride is a medication that is prescribed to shrink the prostate. It's also used in a smaller dosage to make hair regrow for people who are or are going bald. It's a pill taken once a day. It also has the side effect of cutting down the PSA by about half.
@@spud-from-Nam Thank you so very much Charles Pappa. Keep it up. In which country are you currently living if I may ask...
@@socratesaziza8820 USA - California.
@@spud-from-Nam Thank you 1 million times. Just saw my Radiation Oncologist. Nothing changed from my last mri but he is acting like if I don't start tomorrow it's going to be too late. I just don't think it's time for treatment for me. Gleason 3+3 everywhere except one core 3+4....PSA 17 ....that's the bothering part...According to him if I was less than 10 it would be fine....Still have not made a decision yet
Thank you for all your videos. I have just been diagnosed with Prostrate Cancer. I had 14 core samples taken with 3 coming back as a 3+3=6 and 2 coming back as a 3+4=7. The 2 Gleason 7 have a level of 15%. My urologist has given me the option of Surgery, radiation or possibly Active Survellience given the 15% rating of the Gleason 7 cores. She has recommended surgery as the first option. I am leaning towards Active Survellience and will decide once the Polaris test comes back later this week. If it wasn't for the information found in your videos, I probably would have rushed into a decision but I am now taking a much slower pace in my decision-making. Thanks again for your videos and please let me know of any other videos about the benefits of active surveillanced with a 3+4=7 Gleason score.
you can try Hormone Therapy while you will have more time to think the Radiation therapy or surgery . I do this way for controlling spread out of control ..
I am 71, in good health and had no physical symptoms. My recent biopsy 4+3=7 and 3+4=7 Gleason. PSMA/PeT revealed no spread. I want to avoid surgery but sense that I am being pressured in that direction, The surgeon who did the biopsy has already bad-mouthed Brachytherapy, Cyberknife and most other non-surgical treatments. The surgeon has also told nerve bundles on one side would likely not be spared in RP.
For all I've read Brachytherapy or SBRT would be my choice . I have an appointment with a radiologist referred by my surgeon, so I will probably be seeking other opinions.
You would think that by now there is a definitive way to handle certain cases of cancer. Just wondering what did you finally go with?
@@iamric23 I went with Brachytherapy in November. Had PSA checked at six months- 0.23 and hoping it stays low!
@@skinfiddler That's great, it's like you have won the lottery. Did you go with the low dose or high dose?
Thank you Alex, your videos have been very informative and providing so much clarity to the family members or the patients themselves
Thank you very much for another very informative vedio God bless you.
I am a patient of Dr Kwon with stage 4 and I enjoy watching your videos also. Thanks for doing them. Never can learn enough.
Dr Kwon is the best Doctor I’ve ever met.
Dr Kwon is our Dr. Glad we found him
Thank you again for good quality information. I am encouraged by your info!
Thank you very much for this prostrate cancer information. I have been checking my PSA since I was 50, every six months and in 2016, the Urologist performed a TURP and did a biopsy.The lab results showed no sign of cancer. I continued with my regular PSA checks and in August of 2020 it was 4,2 mmol/...by the next 6 month it rose to 5.4mmol/ ...the third time we checked during last six months of 2021 it had gone up to 6.67mmol/...the urologist did a TURP and a biopsy and the lab results showed a 4+3 gleason grades giving a Glasson score of 7, and the sign of an aggressive cancer that is likely to have moved out of the of the confines of the prostrate. The MRI confirmed the result and small tumors were noted outside the prostrate. I was put on ADT( Androgen Deprivation Therapy) for 6 months and on a One year programme for testosterone reduction in the testicles through the injection of Zoledex every 3 months At the point of writing this text, I have already undergone brachy therapy and 25 iodine 103 seeds were inserted in my prostrate( i had quite a small prostrate due to hormone therapy and it weighed a mere 13.5 mg. I am due for external beam radiation for 25 sessions starting end of January 2023. Your videos have been very helpful in enabling me to understand prostrate cancer and how to deal with the fact that I have been diagonised with this type of cancer and what the prognosis is for my particular case. Keep the good work and keep educating many men out there I surely learn a lot from your vidoes. Thank you very much. I profoundly appreciate the information you provide through your interviews with the Dr.
Your videos are immensely helpful! I'd like you to do a video that addresses the protocol of bringing an oncologist onto the treatment team. Does the oncologist displace the urologist? Work in conjunction with the urologist? What if their opinions regarding treatment are significantly different? As a patient, I'm concerned about the process of navigating the medical system.
Excellent explanation. Very clear and easy to understand.
Thanks for an excellent summary.
Its my father in law. A 4+3 at two sites. Glenson 7, stage 3 there and 3+4 in all other four locations at biopsy. No metastasis in bone scan.
Our doctor prescribed inj. pamorelin 11.25 mg every three months.
Taken 1st dose.
Hoping reduction in PSA.
Please lets hear from rhe doctor.
Thanks in advance. 🙏
Thanks for your informative explanation.
I was diagnosed with Gleason 4+3 in February 2022. I was sent for a PSMA Pet scan, which showed the cancer hadn’t spread outside the prostate. My Radiation Oncologist though suggested I have treatment. I underwent 20 radiation treatments in May 2022. So far everything is good. My question is should I have waited before having treatment, since the cancer hadn’t spread outside the prostate?
Hello,
The standard of care for most people diagnosed with Gleason 4+3 is local treatment (surgery, radiation, or focal therapy) with the possibility of adjuvant hormone therapy. If a PSMA PET scan is negative, it could mean that a person could shorten or forgo the hormone therapy, but the ideal protocols have not been determined yet since the PSMA PET scan was just recently approved. Local therapy is still the standard for Gleason 4+3 regardless if it has spread except, perhaps, in elderly men with low life expectancies who might be watched instead.
@@ThePCRI I’m not elderly just yet 😃. Late 60s. My first blood test after the radiation showed the PSA had dropped from 5.7 to 1.3. Next test is in 2 weeks. Be interesting what the reading is then.
Hi Ben, did you just go for radiation therapy in its own.
@@daveyeddie8176 Yes, just 20 radiation treatments. So far so good. It’ll be 12 months since the last treatment at the end of May.
@@Benb55 I have a big decision to make, I don't think I can handle Hormone therapy, chemical castration, Testicle shrinking, penis shrinking, cardio problems, losing bone density, night sweats, mood swings, loss of muscle mass, fat gain, fatigue, anxiety and depression to name but a few, it all seems crazy.
I'm willing to have Radiation Therapy over 20 sessions, I'm in the UK and we have the NHS, I have to put my case about RT only, it's really stressing me out, thing is I'm 4+3 gleason intermediate, obviously a bit worse than 3+4 but some folk are saying they will want to put me on up to three years of hormone therapy, quite a few studies I have looked at say the cancer returning after 10 years without Hormone therapy is not much different something like 92 per cent with Hormone therapy to 85 per cent without
I would take that 85 per cent all day.
Hope you continue to improve. All the best me old son.
65 years old. Any views on how things change with IBD (Crohns/Ulcerative Colitis)? Apparently men with IBD seem to have an enhanced incidence of prostate cancer so I thought there would be stuff available but apparently not well studied! I have been diagnosed with 4+3, and, largely influenced by these videos, decided I didn't want surgery, but protocols suggest surgery as the only treatment for patients with IBD. My IBD doctor says since the disease is only in the ileum (away from the prostate) radiation should be fine, and I have some radiation oncologists saying that IF a colonoscopy shows no active disease in the rectum/colon, and if the PET PSMA is free from surprises, then they would do a 44 day dose external beam radiation. My prostate at 65cc is too large for seeds they say. But they keep mentioning the risks of radiation on IBD patients...
Am I being too risky because these videos have made such a good case against surgery!
Oh, and IBD can light up a PET PSMA, so I hope there is no confusion there (the doctors say the new prostate cancer doesn't spread to the ileum/small intestine, so a pathologist should know to ignore signals there)
Great video Alex
Thank you. Thank you thank you 💗
Thank you.
9 samples are 3+3 =6
1 sample is 4+3=7
bone scan is negative
psa is 85
mri is negative
impression : on ct scan is multiple lesions seen in acetabulum could be bone island...
Thank you!
great video once again
What does that mean that the likelihood of spread with a 3+4 is so small that a PMSA is overkill. How does one determine 3+4 spread is low risk and unlikely to spread.
Hello,
It depends on the number of positive cores (if it was a random biopsy) the percentage of those cores that were Gleason 4 (as opposed to the more prevalent 3) and other factors. We have videos discussing this that you can find by searching "PCRI Gleason 3+4=7" or "PCRI Teal Stage Prostate Cancer" or "PCRI intermediate-risk prostate cancer."
They look at the biopsy cancer cells under a microscope and from other science know how aggressive the cells are. Cancer cells can evolve through stages that changes their behavior.
Other test that can help...Decipher test(genomic test,), 4K test(blood test used to predict the risk of high risk prostate cancer-can be used used as a replacement for the PSA test, as it provides more information about the risk of for aggressive cancer) 2nd opinion on the biopsy--in other words have another pathologist read the slides. MRI of the prostate.
A PSMA test can depend on your insurance, and the diagnosis grade of your prostate cancer.
Some Medicare insurance will only allow 3 lifetime approval for PSMA. If you have been diagnosed with cancer before you get Medicare, always, always sign up for a supplemental plan, that will cover any possible future cancer treatments.
If you pick an Advantage plan, know that cancer treatments are very limited, Cancer centers will be out of your network, and more modern diagnostic testing, and treatments will be strictly limited or not approved at all.
Highly recommend you get a cancer and hospital indemnity plan with advantage.
I was diagnosed 4+3 unfavorable last year with PSA 6.5. After 5 weeks of radiation the PSA was down to .5. I feel fine. The doctor now suggests simply screening PSA every six months. This seems to me to be too easy for something called ‘unfavorable’. How does the original ‘unfavorable’ description affect long term treatment plan? Thanks as always for your channel’s help.
Your PSA was the same as mine.I had 6 week of True Beam radiation. And now I am on Orgovyx Meds got follow up this month. Your case sounds promising to me.God Bless You. ( Maurice).🙏🏽
@@mauricedudley2674 Thank you, sir.
Ransom Coates. Which kind of radiation therapy you had? Did you have to also have hormone therapy???
@@socratesaziza8820
Yes! I am on Orgovyx Meds now for 6 months...
@@socratesaziza8820 It was the old-fashioned EBRT. And while the urologist recommended hormone therapy, I had a friend who said it was the worst thing he had ever suffered with, so I talked the radiation oncologist into not doing it (and he didn’t offer any resistance). My first appointment after radiation seemed to confirm my judgment. He does not seem too keen on any sexual activity, however. (This is sophisticated, university-connected practice in a large city.)
My 65 year old father PSA 226. Gleason score 9. Prostate cancer spread to two lymph nodes and possibly one spot on his pelvic bone. Can i ask what his odds are of going 10plus years?
Hello! My father was diagnosed as well, with PSA 430. I have seen some people living long with advanced disease, but it all depends on the person, treatment etc. On The bright side - there are constantly new treatments for prostate cancer, many clinical trials etc. In 3-4 years there could be new treatments that will help. There are already for example LU-177 radiation, niraparib. People didn't have this treatments few years back. Keeping my fingers crossed for both of you!
I have just finished my radiation therapy of 20 sessions and still on monthly zoladex implant and tamsolusin what should I do to check if I cured?
Hey can u just tell me your experience regarding 20 radiation sessions.? Any side effects
I’ve recently been diagnosed 3+4 Gleason and don’t know what treatment is best for me. I’m leading towards radiation treatment not surgery and I’m looking for advice. Best regards Stephen Blakey
This was great info!
I had a Robotic Prostatectomy 3 months ago for a 4+3 prostate cancer. I have PSA persistence at my first PSA test 0.7. Can you discuss this topic of PSA persistence.
They didn’t get all the cancer. I’d expect you would need a psma pet scan to help them find the rest of the cancer to kill it with further treatment
How were your margins after the surgery?
@@robertmonroe3678 They were positive in 3 places
I'm a 71 year old newly diagnosed with two lesions on the left side of the prostate: Gleason score of 8 (T2B) in one and 7 (4+3) T2B in the other, if that makes sense. PSA: 4.5. I'm considering surgery or SBRT radiation. The MRI shows no spread outside the prostate. I'm getting abdominal and bone scans. Do you know of anyone in Canada (Montreal) who would favour a PSMA PET scan at this point? I'm getting mixed signals in the public system.
I had a TURP and afterwards a bladder check. They found a cancer on the walls but superficial. Then followed BCG and bladder was pronounced clear. 2 years went by with no further tests due to COVID and then cystoscopy showed large polyp which on operating showed to be cancer gleeson 7 (4+3) at the neck of the bladder and in urethra coming from the prostate.
. They now call it stage IV, because it has spread outside the gland but PET test shows no spread to bones or lymphs. Question is, after ERBT and hormones, can it still spread to lymphs and bones since not all the cancer cells are probably killed or starved. PSA was 3 before RT and 0.03 after. How can I be certain that the neck of bladder has been cleared and what possibility exists in it spreading to the bladder walls?
My husband was diagnosed with a 4+3=7. 28 cores were taken, 26 were 3+3, and 2 were 4+3 with 4% in one core and 28% in the other.
He did a Pet scan, and the impression states "Mild uptake in the prostate but no convincing evidence of metastatic disease or adenopathy." He also had Prolaris genetic testing which staged him at T1c.
He is adamant about doing active surveilance , changing his diet, increasing his excercise and holistic medicines for a year to see if the cancer will moves.
Has anyone done active surveilance with a 4+3?
Hi, the results of my MRI guided Fusion 15 core biopsy just came back today as one 3+4 and 0ne 4+3. Dr. arranges a PSMA pet scan and also a genetic test. One year ago after a random 12 core, I had two 3+3 cores found and was doing active surveillance. he mentioned even MRI biopsy's could miss significant cancer, so depending on the results of the PSMA, I may go for the RPT rather than active surveillance. I dont want to take another chance and find something else was missed...
Active surveillance is the last step in any treatment for prostate cancer.. My husband's Gleason is 4+3=7(random biopsy) .
But his diagnosis is not defined by one procedure or test.. He had several tests to verify the biopsy results before a treatment plan was finalized for him. MRI, PSMA, and a 4K test were the most vital parts in determining his optimal treatment regime. Not every test is 100 percent accurate.
His tx: ADT Lupron treatment, one 6 month injection, LDR brachytherapy with Dr. Agarwal from California who's practice does 7,000 procedures a year, Then 5 weeks of beam radiation, the final step active surveillance.
He is currently doing the Beam radiation tx
His doctor is expecting a high cure rate once he's done with his treatments. How does he know this? Years of experience, and tweaking of his treatment regimen
His cancer only was diagnosed because his PSA jumped 2 points to 4.7 from his last PSA 6 months prior.
Wouldn’t the location of the tumor, size, and the MRI be another (or even primary) tool to look for spread outside the prostate initially. This seems like an impossible timing issue as it would seem men would wait to the lost moment for treatment if spread outside the prostate could be determined in real time.
Hello,
Those are all used in the staging process, but historically, Gleason score has been the most significant and informative in factor predicting whether prostate cancer has spread to other parts of the body (which is what causes the risk of mortality) or if it will spread eventually. A large Gleason 3+3 tumor, for example, (assuming it is truly 3+3) has no potential to spread and does not require treatment, but a small Gleason 5+5 tumor has a high potential to spread and most doctors will treat this person unless, perhaps, if they are elderly.
Physicians want to know if the cancer has spread when they are staging prostate cancer because it can help determine how aggressive they should be to try and cure it on the first try, but it would not be standard for them to, upon receiving negative scan results, forgo local treatment if a person has a Gleason 4+3 or 3+4 with a significant amount of 4 because these types of cancer have a risk of spreading, regardless if it has already spread or not. We have other videos discussing the differences between Gleason 3+4s in which treatment would be recommended versus cases in which active surveillance may be an option. You can find those by searching "PCRI Gleason 3+4."
Hello thank you for your explanation it give some hope us men. I haven't yet diagnos with cancer but I am pretty sure I have this shit in my prostate, according my MRI result my urologost told me that they saw 2 suspicious tumor in my protate and one in my bone, I just wondering if I have camcer how come that is spread already? I have 3.8 PSA. so this coming Friday they will scan my whole body. Next well be my prostate biopcy. I hope I still have 10 years to live I will be satisfied. Keep posting thanl you.
Dad has Gleason 4+3=7, intermediate unfavorable stage 2C. Dad is in great health, no issues with heart, lungs, DM and surgical history of zero. Currently on Lupron, he is interested in pursuing the 5 visit SBRT therapy however his radiation oncologist states he is not a good candidate. Any idea what the rational would be?
I had similar situation. I had also had BPH and was on flomax to improve my urinary symptoms. Both my surgeon and rad onc recommended surgery due to the radiation spillover to the bladder which would cause addition urinary issues.
If there is a concern for radiation spillover, why not discuss Brachytherapy? this procedure inserts only the radiation into the prostate gland. This is a procedure where experience really matters--seek out the best for this procedure. Was his biopsy confirmed with other testing?
What kind of insurance does your dad have? Insurance approval does affect treatments protocols
Doesn't PSMA PET scans miss 10% of metastasized cancer as around 10% of prostate cancers don't express any (or only a little) PSMA on the cell surface. There are also heterogeneous cancers where a portion of the cancer doesn't express PSMA so the PET scan wont detect mets until they are more advanced.
Psma PET is the best that we have right now. There’s no guarantees in life or with cancer.
No scanner will ever see single cancer cells.
Doc I wish you were in Ohio…. Keep the info coming…..