Gleason score 3+4=7

I have never heard of anyone being offered SRT with an undetectable PSA just in case of future recurrence. Have you really been offered this choice?

Best wishes,

Chris

Edited by member 16 Dec 2022 at 13:08  | Reason: Not specified

If you have some form of recurrence it will be essential to know exactly where it is and at this stage there's not enough to go on. If, for example, there's cancer is a lymph node, targeting that with RT is specific rather than general.

No fun waiting to see what might show up obviously but it's the best path to dealing with any actual recurrence as against possible recurrence.

Jules

I read the article you referred to and I found it rather peculiar [others might comment]. I can only say what I said above, there has to be a specific target for RT. I would have expected that before giving RT that patient would have had some sort of investigation to find out firstly if he was having recurrence and secondly, if that was the case, where the recurrence was so that if he needed RT it could be targeted.

One difference between 2012 and now is that PSMA PET scans are now available and are a useful tool for accurately locating small areas on cancer.

As Cheshire Chris says, it would be very unlikely for an oncologist to put someone through RT "just in case". I think there might be some key information missing from the yananow story.

Jules

Edited by member 24 Feb 2023 at 20:50  | Reason: Not specified

Free PSA is not relevant to a man who has had his prostate removed. It is a test that helps doctors predict whether a man might have prostate cancer when his PSA is between 4-10 and whether or not to do a biopsy

I agree with Fred, the logic says a Gleason score could never go down. To have a G7 biopsy there must have been at least one tiny bit of Gleason pattern 4 in the samples. In the path lab they can now examine all of the prostate, they 'must' see that area of pattern 4 again so it cannot go down, and if they happened to see some pattern 5 it would go up. You might say well if they spotted a lot of pattern 1 or 2 that would bring it down? No, Gleason score is about the maximum and secondary maximum in two samples it is not about averages.

So now if we follow the mathematical logic, we have to ask. Was the pattern 4 in one place and tiny, and completely removed by the biopsy needle? Extremely unlikely, about 0% chance that that is the reason. Maybe the cancer just got better? Again extremely unlikely, yes the immune system attacks cancer, but only in the early stages once it has got hold it won't die on its own, about 1% chance this is the explanation.

So our maths and logic has not given us the answer.

Now if you go on the internet and look up pictures of biopsy samples you will see how ordered Gleason patter 1 is and how disordered pattern 5 is. If you then look at more samples you can start saying what you think the pattern is, and then check with what the expert says. 80% of the time you will agree with the expert on what a pattern 2,3 or 4 looks like, but some will be marginal, maybe pattern 3 maybe pattern 4.

So I would guess that all the samples from biopsy and pathology looked about the same and it was a bit more disorders than patten 3 but not quite as bad as a typical pattern 4. One pathologist decided to call a 4 the other called a 3. Hence Gleason score 8 and 6, because of the difference in the person looking at the sample not the samples themselves.

Histology on a removed prostate is still sampling that can miss something more significant. It's typically about 6 slices through the prostate so it's a bigger sample than the biopsy, but it could still miss something that a biopsy found, or indeed they could both miss something more significant.