Does Gleason Score Change as Years Go By?

[OldFart81]

This report was fascinating to me:

Gleason Grade Progression Is Uncommon

US National Library of Medicine

National Institutes of Health

Cancer Res. 2013 Aug 15; 73(16): 5163–5168. doi: 10.1158/0008-5472.CAN-13-0427

Especially this abstract:

the knowledge that Gleason score largely does not progress may make the choice of active surveillance more appealing for patients with low grade disease.

If we suppose that a Gleason score 3+3 will remain 3+3 for the entire course of the disease, active surveillance could be considered a definitive treatment for selected patients with ≤10 years life expectancy and could significantly delay (potentially forever) the treatment of selected patients with >10 years life expectancy. This option would prevent side effects from radiation or surgery for patients who do not need these more aggressive treatments.

So does that mean my 3+3 in 2002 may still be the same in 2018? PSA in 2002 was 2.5. It went to 11.1 this spring and now is 10.0.

Yes, I'm wondering about another biopsy. Would it be wise or unwise at age 81?

[pjoshea13]

25-30% of Gleason score 3+3 will progress.

Perhaps something like the 4Kscore test would be useful for reassuring the 70-75% who will not progress?

-Patrick

[OldFart81 in reply to pjoshea13]

Many thanks, Patrick. I'll email my doc to send a script to Quest for me.

Should I just ask for a "4Kscore test"?

[Tall_Allen in reply to OldFart81]

4K score is not covered by Medicare, but Prostate Health Index (PHI) is. They have about equal accuracy.

[pjoshea13 in reply to OldFart81]

One thing to remember is that the Gleason score from biopsy is prone to error. It is often upgraded or even downgraded by the pathologist after surgery. While on active surveillance, reclassification at repeat biopsy might not reflect progression so much as a more accurate result. This is another reason for getting a test that includes markers of more serious disease. Depending on the result, one might act quickly or sleep comfortably at night.

-Patrick

[Tall_Allen]

About half of GS6 will progress- but it may take 15 or more years. Here's an article with more info:

pcnrv.blogspot.com/2017/11/...

[OldFart81]

Thank you Allen, Thank you Patrick.

You've given me helpful references, and I appreciate it.

[charlesmeyers1964]

they only go by the gleason score at first dx. once u take treatment its not mention

charlie

[OldFart81 in reply to charlesmeyers1964]

Gotcha! Thanks.

[OldFart81]

Tall_Allen...

I requested a PHI and here's the response from my PCP:

WE HAVE CALLED THE LAB COMPANY AND DETERMINED THAT THE ONLY TESTING WE CAN DO IS A PSA REFLEX TO FREE, THE PROPSA IS NOT A TEST THAT IS OFFERED OUTSIDE OF CERTAIN CLINICAL OFFICES. BASICALLY THE PROPSA IS IN CLINICAL TRIALS AND NOT OFFERED AT THIS TIME FOR REGULAR SCREENING

Would you happen to know if that is correct or incorrect?

[JustMe1000]

I think you will find the article you refer to states that the Gleason score is not likely to change but the cancer can spread. So you could start with a Gleason 3+4=7 that in confined to the interior prostate or you could have one that has spread further to the edge of the prostate or even have metastasised.

I have read a copy this paper and its upshot is that Gleason score seem to be linked to stage of the cancer. The following sentence from the abstract of this journal article is relevant to this point: "As the dramatic shift in stage since the introduction of PSA screening was accompanied by a more modest shift in Gleason grade, these findings suggest that grade may be established early in tumor pathogenesis."