Gleason Scores ....was Let Sleeping Dogs Lie

[Guest guest]

you ask:

<snip>To me it kinda

means that the two doctors that graded the two cell configurations had

different opinions of what they say and grading is a bit of a matter of

opinion. Am I correct in assuming that? <snip>

And although you have had some good

technical answers about Gleason Grading, I think that no one answered this

question directly. The answer is that Yes, the grading of material from needle

biopsy is indeed subjective and largely a matter of opinion. There are many

studies that show that pathologists will not agree precisely on the Gleason

Grades of a particular biopsy sample with some grading the sample higher and

some lower. After surgery, almost as many samples will be changed to a lower

grade as are changed to a higher grade – and about the same percentage

will be graded the same. It is for this reason that men are urged to get the

best pathologist they can find to give a second opinion on needle biopsy

samples – see http://www.yananow.org/pathlabs.htm

- before they make a final decision on treatment options

To confuse the issue, there has been what

is termed a “migration” of Gleason Grades from lower grades to

higher grades over the past five or ten years. You can read about it here http://tinyurl.com/2jnpbu

And finally…….in January 2010,

announcements were made in the United

States that significant changes had been

agreed by the International Society of

Urological Pathology in the way in which prostate cancer tumours

were graded internationally. The summary of these changes is here http://www.yananow.net/StrangePlace/forest.html#gleason

and, as you will see that the ‘entry level’ for a diagnosis of prostate

cancer from a needle biopsy is 3+3=6 A specimen from a needle biopsy with Grade

2 material would not be labeled as “prostate cancer “ but

some other label would be attached. This may change again if the somewhat

contentious proposal to include tertiary material is accepted. In that case for

example if the main focus was graded as 3, the secondary as 2 and even a minute

amount of tertiary focus material as 4, the final Score would be rendered not

as 3+2= 5, but as 3+2+4= 7. All very confusing for everyone.

All these changes make the comparison of

outcomes from older studies even more difficult to interpret because the

diagnoses will not match and care must be taken with some of the predictive

tools available on the Internet which also use old data.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of White

Sent: Saturday, 13 November 2010

11:26 PM

To: ProstateCancerSupport

Subject: Re:

Let Sleeping Dogs Lie

For me it is to late to read the book to help make a decision on what

to do since I had robotic three and a half years ago. But I will still read it

and print a cop for my two sons(now 32 and 27). I have a question in regards to

the biopsy Gleason score and the pathology Gleason score after removal. I

can understand a score going up once the gland is removed and looked

at more completely. But one that goes down like mine(3+3 at biopsy and 3+2

after surgery)is a little more confusing. To me it kinda means that the two

doctors that graded the two cell configurations had different opinions of what

they say and grading is a bit of a matter of opinion. Am I correct in assuming

that?

To: ProstateCancerSupport

Sent: Fri, November 12, 2010

10:03:06 AM

Subject: Re:

Let Sleeping Dogs Lie

I think of the Gleason score as a snapshot of the cancer at the time of

the biopsy. It shows how far the cancer has progressed in it's development. If

it is neat and orderly then the Gleason number is low. If it is messy and

disorderly the the cancer is growing more actively. It doesn't have time to be

neat.

That said, it isn't a way to predict perfectly what will happen with an

individual especially with treatment. Gleason 8 and above in most cases need

aggressive treatment. About 50% of Gleason 7 cancers need aggressive treatment.

Gleason 6 and below most likely can do AS. That said, biopsy is inexact and

that is how we get the Gleason score. Think of it as sticking a needle into a

haystack to get a sample of all of the straw in a haystack. That is probably

why some men's Gleason score is upgraded after surgery.

Then unfortunately you have the situation where the tools that we have

now still can't see all the cancer and give us a complete evaluation of the

cancer for decision making. That is why researchers are working so hard to

identify better markers that can differentiate between aggressive and

nonagressive cancers.

Right now decisions have to be made with the tools that we have which

is better than people have with most other cancers.

Kathy

From:

Terry Herbert

Reply-To: <ProstateCancerSupport >

Date: Fri, 12 Nov 2010 12:12:22

+1100

To: <ProstateCancerSupport >

Subject: RE:

Let Sleeping Dogs Lie

Harry,

As our dear departed friend Aubrey Pilgrim

used to say to newcomers about prostate cancer : The Golden Rule is There Are

No Rules.

Having said that, you are right when you

say that the Gleason Grading system is the prime indicator of aggressiveness,

but there are other aspects to consider. It is simply not possible to say

beyond any doubt that in any specific case there is the certainty of prostate

cancer related death (albeit it in many years time), or on the other hand that

there is absolutely no danger of prostate cancer related death. I have

suggested, in the piece I wrote The Elephant In The Room at http://www.yananow.net/elephant.htm

the specific aspects of the disease that indicate aggressiveness.

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 andstill

going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From: ProstateCancerSupport

[mailto:ProstateCancerSupport ]

On Behalf Of Harry Trentes

Sent: Friday, 12 November 2010

11:09 AM

To: ProstateCancerSupport

Subject: Re:

Let Sleeping Dogs Lie

Hi Terry

I have just

finished reading the book and found it very interesting. Of course since

I have already had surgery, Radiation and hormone theray it was not helpful

from that point of view. I do wonder however, how it is really determined

which type of cancer cells are the agressive kind that quickly kill and the

ones that are there but just stay there and one dies with them rather than

from them. I always thought the Gleason score was a measure of that.

Maybe not. I am

also 76 years old so I guess I am a head of the game. Anyway, it was an

interesting book.

Harry

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