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The complexity of Gleason 6

Steelchuggin26
Posts: 36
Joined: Mar 2013

Hello all, my father's recent "positive" result in his post op psa test got me to thinking about gleason 6 cancers. As we know, they are slow growing cancers that the vast majority of the time do not pose a threat to a man's life. It is even said they lack the ability to metastasize. One study I found, cntr remember the source, but they studied 14000 gleason 6 prostatectomy specimens, and 22 of them exhibited nodal metastasis. 19 of these were available for review, and further investigation revealed that all 19 of those positive nodes exhibited some degree of Gleason pattern 4, thus upgrading the score to 7. As a result of these findings, the uthor of this study concluded that true gleason 6 lacks the potential to metastasize to local lymphnodes, and theoretically, also lacks the ability to metastasize distaly or even to areas in and around the pelviS.

So that intrigues me, if that were indeed true, would that mean once gleason 6 cancers are removed, they should be gone for good following prostatectomy? It hinted the gleason 6 cancers not being able to thrive outside of the gland

So if one was to have a recurrence of their cancer following a pathological report confirming gleason 6, would that mean there was actually some gleason 7 within that was under diagnosed? Just curious.

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

The Gleason classification of cancerous cells is subjective to the interpretation done by a pathologist. Differences may exist and what looks like pattern 3 to some could look like pattern 4 to others. Some pathologists even prefer to mention on a tertiary pattern when attributing a score, as such may exist but in a very minimal volume. There are also those cells that are lower in rate (pattern 2) that have been upgraded to 3 due to the newer AUA standards since 2005, which could belong to a case of Gleason score 4 (2+2), therefore quite low in aggressivity, and never becaming an issue to the holder. 

I do not know the purposes of the study you are referring to but one should understand that cancerous cells can become upgraded (worse differentiated) if their DNA have been subjected to damage. This would mean that Gleason rate 3 could turn rate 4 after a number of duplications involving cells that were damaged while in their life cycle but instead of dying they survived.
In other words, the original classification of cells could alter after any intrevention (medication, radiation, etc) and become more aggressive. Example: Gleason score 6 (3+3) turn into score 7 (3+4).

Best,

VG

Steelchuggin26
Posts: 36
Joined: Mar 2013

Yeah that woukd be interesting to know. If thry aren't slready doing so, maybe they can do a study on gleason 6 and look for certain factors that may promote a gleason 6 to de-differentiate to a cancer with at leadt one component of pattern 4. Would it be possible in cases of gleason 6s that have metastasized to biopsy a metastatic lesion and examine it to see if indeed there was a mutation from 3 to pattern 4, therefore making it it at least a gleason 7?

 

I ask this and found the study interesting because gleason 6 is kind of a grey area, and ofgen people do just fine never doing anything for it. However, i also wonder, as you alluded to, how readily can gleadon 6 de-differentiate to a worse grade. If tgey could identify factirs in gleason 6 cases thst might indicate a chance of it indeed morphing into a pattern 4 in st least one component, then that would likely lead to more men getting trearment.

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

It is known that there are several varieties of prostatic cancerous cells, which types are identified via their difference in DNA. From studies on cells' strands (genome) one can now identify those with tendency of being more aggressive or even those that would respond better to a certain treatment. In other words, even Gleason rates of 4 or 5 would fall into groups of worse aggressive (prune to lead to failed therapy) than others lesser aggressive.

I believe that AS (now highly recommended to Gs6 guys) will start being recommended according to the type of cancer. There will be Gleason 6 and 7 guys more selective for AS than others. It all depends on how much a cancerous cell has an higher probability of being indolent. They even could group patients into different regimens in AS. For instance; those that should have a biopsy every two years and those that would do well enough to get the biopsy every 5 years. The PSA would be useless as the marker regulating intervention. Aggressive type of cells would lead to judging for earlier or deferred treatment.

https://csn.cancer.org/node/211951

https://myriad.com/patients-families/disease-info/prostate-cancer/

http://www.webmd.com/prostate-cancer/news/20150731/five-types-prostate-cancer

http://www.webmd.boots.com/prostate-cancer/news/20140221/gene-test-aggressive-prostate-cancer

Best,

VG

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