Diagnosed with Prostate Cancer, Gleason 6

VascodaGama said:

What's the real Gleason pattern?

Flyer,

Welcome to the board. You are doing well by researching about the problem. I believe that AS is the best option we PCa patients can have if the conditions are proper. In any case, some guys think on AS as an escape to a treatment but the truth is that AS is a procedure done pre treatment that follows a strict regimen of actions. The benefit of AS against a radical is the assurance of less invasive intervention that reflects in fewer risks for nasty side effects. AS should be seen as an option in the care of prostate cancer, that may fail just like any other intervention. It can last a life time or it can do well for a period postponing a radical treatment doing it under a certain control.

Not every case can follow AS in its ultimate goal but the option provides time to the patient to become knowledge on the matters of treatments, risks and consequences. While on AS one will follow any progress doing periodical tests and exams and will intervene timely, now better equipped with the latter tools that moved up from the drawing boards to real action.

AS is not practiced equally by all doctors or at all medical centers. There are standards for acceptance by the doctor which lead many to not recommend. Being a Gleason score 6 is not enough. The percentage in each core and the number of positive cores may negate a recommendation, as well as it does a negative DRE and high PSA.
Apart from that, Gleason score 6 varies much. A case diagnosed with a lower score of 4 or 5 is now graded 6 to follow the 2005 standards, introduced and imposed by the Urological Associations around the world. Those standards have eliminated Gleason rates lower than 3, turning the rate 1 and 2 into a 3 (therefore; 1+1=6; 1+2=6; etc). My diagnosis in the year 2000 was a Gleason score 5 (2+3) but it was later in 2006 upgrade to Gleason score 6.

Probably if I have been diagnosed today some doctors may have been tempted to recommend me AS, however, even with a lower rate of 2+3 (5) I had all cores positive (voluminous case) and a very high PSA (22.4 ng/ml) which lead to surgery that failed. I needed later salvage radiation and ten years later I had to start hormonal treatment.

In your shoes I would do extra tests before deciding on anything. The Genomic test recommended by the Greenteaguy can help you in the decision. A second opinion on the biopsy slides is also a good step forward to confirm the rates and at the same time have the opportunity for requesting for the real Gleason pattern. Pathologists differ in their interpretation of what they read under the microscope tempting them to give 3 to all that is not considered a 4 or 5. A detailed request will get a higher inspection of the cores.

Best wishes and luck in this journey.

VGama 

Thank you for sharing this interesting information I was not aware of.

"Those standards have eliminated Gleason rates lower than 3, turning the rate 1 and 2 into a 3 (therefore; 1+1=6; 1+2=6; etc). My diagnosis in the year 2000 was a Gleason score 5 (2+3) but it was later in 2006 upgrade to Gleason score 6."

Greenteaguy and Flyer,

The Gleason score is a grading system devised by a pathologist called Dr. Donald Gleason, an American pathologist, who, in the decade of the 1960th created a scale giving rates to cancerous cells. The division was done from 1 to 5 according to the pattern of each cell. The aggressivity was then classified by a score of the two types most prevalent in a piece of tissue, from 2 (1+1) to 10 (5+5). At the time not all individual clinical institutions accepted the grading but in time a great number of phisicians started using the scale. In 1992 the International Society of Urological Pathology was formed and took control over the norms regulating pathological affairs providing guidelines to the many. The first grading took place in 1998 and that was then revised in 2005 in particular with regards to the aggressiveness found in each rate (1 to 5). Some low rates cells presented higher aggressiveness even with the pattern of a benign cell. That was when the newer Pseudohyperplastic Adenocarcinoma was introduced. This type of cells resembles benign hyperplasia but some pathologists classified it as Gleason rate 1 or 2. In fact not much consensus has been drawn from the findings and many doctors never reached to such details when seeing the cells under the microscope.

Accordingly, saying that Gleason score 6 is indolent is not true if the cells present similarities to a pseudohyperplastic type. I would accept such indolent term if the pathological analysis has been done to the full extent recommended by the ISUP, including the mention on the lower grades of 1 and 2 (a complete report).

Please refer to the following links regarding my subject;

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5791407/

http://www.pathologyoutlines.com/topic/prostatepseudoCA.html

https://www.auanet.org/education/auauniversity/education-products-and-resources/pathology-for-urologists/prostate/adenocarcinoma/prostatic-adenocarcinoma-gleason-grading-(modified-grading-by-isup)

https://www.ncbi.nlm.nih.gov/pubmed/27415753

https://isupweb.org/isup/

Best,

VG

greenteaguy said:

VGama

Thank you for sharing this interesting information I was not aware of.

"Those standards have eliminated Gleason rates lower than 3, turning the rate 1 and 2 into a 3 (therefore; 1+1=6; 1+2=6; etc). My diagnosis in the year 2000 was a Gleason score 5 (2+3) but it was later in 2006 upgrade to Gleason score 6."

To all,

Another factor that must be carefully monitored is your Doubling Rate, also known as PSA Vector.  After a positive biopsy, this can be almost as important as Gleason.  Doubling Rate requires frequent PSA draws (from the same lab) and intelligent analysis.  Results that are too close together in time may skew the interpretation inaccurately.  A plotted trend over time, and consistency in vector are the most accurate.  As Vasco noted, Gleason and even PSA itself are not always perfect bellweathers of what is going on.  At times, a low PSA will be the most aggressive forms of PCa malignancy.

Yet another factor to recall is that PCa biopsies tend to underestimate cancer involvement much more often than that they are simply 'accurate.'  The only way currently to "absoultely" know a precise Gleason is to undergo R.P. and have the pathologist cut it up in a lab.  Often, even today, a good multicore biopsy will detect NO cancer present at all, when in fact some, or even a significant amount, is present, and at various Gleasons.    When I had my first biopsy (MRI-guided), the gun "broke" on the 12th, and last, core.  The doc said we could skip it, or wait to repair the gun, which took about 5 minutes. I waited.  The results came back positive in only one core, the 12th. And, it said Stage 1.   I had DaVince R.P. a few weeks later, too soon for much to change, and the pathologist showed that it was actually a significant case of State 2 disease. Hence, in my case,  I was very nearly told I had NO PCa at all, when in fact I was Stage 2.  These sorts of stories are not uncommon here.

It seems to me there is an "Unspoken Premise" (logical assumption) present in this, and most, AS discussions.

That premise is that "A Gleason of 6 is Always Going to Remain a Gleason of 6."  Such is NOT my undestanding of how the pathology evolves, and I have seen no proof to that effect presented here, ever.    Related to this is the fact that a very high percentage of the men here who are on HT due to metastatic disease, and even men who have died, wrote that they were first diagnosed with "Gleason 6." Read their histories. 

The idea that Gleason 6 cancer never becomes metastatic or kills is proven false daily throughout the US, where 30,000 men die annually of PCa.

To me, AS is whistling in the dark, a pipe-dream.   But I'm glad it is available as a modality, and that many men have success with it.

Prostate cancer is very slow growing and a 1.4 PSA is well below the threshold of a 4, so I wouldn't worry.  Your condition is highly unlikely to change in six months and I think the doctor is doing the right thing.

Almondfarm said:

Yesterday I was told that my

Yesterday I was told that my biopsy from a TURP surgery has a Gleason 6, however, my PSA is 1.4.  The doctor wants to do another biopsy in October because he wants my TURP surgery to heal first.  So I am just waiting for 6 months and am in a lot of emotional pain now.  Any comments are welcome.

 

Thank you

same happened to me. Had TURP for bladder neck obstruction to relieve my urinary retention. Turp was done on 6.1.16 and pathoogy l came back positive for prostate Ca. Had biopsy on 8.11.16 which confirmed Ca but higher Gleson 4+3 (55% pattern 4).My highest PSA was 1.85 and my base PSA was 0.52 at age 45. At time of biopsy, was 0.7 and that was after Turp.

It was removed 8 grams of prostate tissue during Turp.

I had RP on 11.2.16 and my Gleson was downgraded to 3+4 ( pathern 4 was 40%)

MK

sross111 said:

Gleason 6

Flyer -

You're in exactly the same situation as me.  Last fall I had a PSA level of 4.7, and had a biopsy done and came back with a Gleason score of 6.  Two different docs said to do "active survalience" which bascially is seeing the doc every six months and biopsy as needed.  Well I just had my PSA checked again and it jumped to 19.  I'm anxious about this and am seeing my doc next week.  

sross,

'What a difference a day makes.'

A//S works, until it doesn't.  I make observations occasionally regarding it, but get no reactions from the True Believer crowd.  I hope your condition is treatable and that you achieve cure,

max