Difference between 5+4 and 4+5 Gleason score

[dress2544]

My Gleason score at the time of diagnosis was 5+4. I have seen many people in our community with GS 4+5. The sum of both are 9. Is there any difference between these two. There are many experts in our community who have very deep knowledge in all aspects of prostate cancer. I hope they will give a good explanation.

[pjoshea13]

The Gleason number (not score) goes from 1 to 5, depending on the degree of "differentiation" of the cells. Better differentiated cells (lower number) are better behaved.

With a Gleason score [GS] of 5+4, you have more of the 5 type than the 4.

The GS says nothing about how dominant the first number is.

The PCa literature on PubMed often lumps 4+4, 4+5, 5+4 & 5+5 together as GS 8-10 (high-risk PCa).

While it seem better to be 4+5 than 5+4, it's not clear to me how that affects the response to current therapies.

Having any type 5 cells (4+5, 5+4 or 5+5), increases the risk of recurrence after prostatectony, compared to GS 4+4. [1]

Similarly:

"After a median follow-up of 5.7 years, men with a Gleason Score of 8 had a lower risk of PSA recurrence than those with a Gleason Score of 9-10" [2]

"Our results highlight the importance of further substratification of the high-risk Gleason Score category of 8-10 into 8 vs. 9, 10".

I doubt that you will find a useful distinction between 4+5 & 5+4, or indeed 5+5. Certainly not from PubMed.

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/287...

[2] ncbi.nlm.nih.gov/pubmed/191...

[dress2544 in reply to pjoshea13]

Thank you for your detailed explanation

[Dr_WHO]

The first number is always the most prevalent cancer in the sample. In the case of a Gleason of 9 a 5+4 reading indicates a more advanced case of cancer than a 4+5. However, in both cases they are very advanced. You should consider an agressive treatment plan.

Walt (a chemist not a medical doctor)

[dress2544 in reply to Dr_WHO]

Thank you Walt for your information and advice.