Does anyone know what the distribution of Gleason Scores is at a first biopsy?
I'd like to know what fraction of men fall into the Gleason 6 score group, and what fraction of men fall into the GS=7 group, etc., up to GS=10.
I assume that most men are in the GS=6 group (or less), and rapidly falling off as you go to higher Gleason Scores, but it would be nice to see the real data.
Hi Janebob99
I suggest asking an AI app. Obtaining data about the diagnosis of any cancer runs head long into competing database sources that are designed to make money from that data they have accumulated. They do not willingly share that data because it helps their competitive advantage. AI has upended the access to data, and this reality is not lost on the entrenched holders of information. They do not like this change. Just my humble opinion of why we need to investigate our options and not trust the status quo.
Excellent suggestion. I will ask Mr. ChatGPT.
Here's what ChatGPT says: (which agrees with what I expected to find out).
You said:
What is the distribution of Gleason Scores for men with Prostate Cancer at first biopsy?
ChatGPT said:
"The Gleason score, a grading system used to evaluate the aggressiveness of prostate cancer, is determined by examining prostate tissue under a microscope. At the time of the first biopsy, the distribution of Gleason scores among men with prostate cancer varies depending on the population studied, screening practices, and stage of diagnosis. Here's a general overview based on typical findings from clinical and population-based studies:
Gleason 6 (Grade Group 1):
Accounts for a significant proportion of diagnoses (often 40-60% in screened populations).
Represents low-risk, less aggressive cancer.
Gleason 7 (Grade Group 2-3):
Further divided into:
Gleason 3+4=7 (Grade Group 2): Represents moderately aggressive cancer.
Gleason 4+3=7 (Grade Group 3): More aggressive than 3+4.
Together, these make up about 20-40% of diagnoses in various studies.
Gleason 8-10 (Grade Group 4-5):
Includes Gleason scores 8 (Grade Group 4) and 9-10 (Grade Group 5), indicating high-grade, aggressive cancers.
These are less common at first biopsy, typically accounting for about 10-20% of diagnoses.
Other considerations:
Age and Screening: In populations with routine PSA screening, there tends to be a higher proportion of low-risk Gleason 6 cancers due to early detection.
No screening or delayed diagnosis: In populations without regular screening, higher Gleason scores are more prevalent at the time of diagnosis.
Exact distributions can vary, and the introduction of MRI-guided biopsies and newer diagnostic tools is influencing these patterns. "
What would you do with this data?
Good question.
I thought of it after someone posted that men above 75 year old should not get screened for PCA, which seemed wrong to me. The likelihood of men having high grade prostate cancer is as high as 10-20% at first biopsy, according to ChatGPT...not 1-2 %. So, those men may want to get treated even at that age. Some men can live until 90+. I would want to know if I had cancer, even at age 75+.
Biopsies are just a best guess so not reliable in grading unfortunately. It is too bad there isn't a more accurate system to diagnose prostate cancer. Hopefully they come up with something in the near future.
Agreed. That's why I prefer to do annual MRI's rather than annual biopsies. Random biopsies can miss tumors in the far regions of the prostate.
If you're talking random biopsies using ultrasound, I agree. While any biopsy is invasive, if one is required or recommended, MRI guided biopsies, following an MRI are accurate as they target the spot found in the image. I don't know that I'd opt for an MRI unless PSA was high. I assume that's what you mean? I would do PSA, digital exam, MRI, MRI guided biopsy. Wish those were my options way back when.
I do agree that annual MRIs (and more frequent PSAs if you are at risk) are the preferable screening protocol. Although contrasted MRI on a 3T magnet picks up the significant majority of high grade cancers, it can miss lower grade tumors that don't enhance.
The majority of urologists will look at the annual rise in PSA to assess risk and consider biopsy based on that. If the year-over-year increase is >20% , that is a red flag. Most urologists will get an MRI to guide them to suspicious areas but a negative MRI imaging report doesn't negate having the biopsy.
This is an entirely anecdotal case so not scientific regarding study numbers, but is illustrative. Up until 2019 my PSA had bounced around 3.5-4.5 for a number of years at my annual physical with negative DE. In 2019 it jumped to 5.5, greater than a 20% rise. MY internist referred me to a urologist. Being a practicing radiologist, I took matters into my own hands prior to my appointment. I sent a blood sample to Mayo to be fractionated. It came back "<4, normal for age, did not fractionate". Our Radiology Group had just purchased a 3T MRI so I had a contrasted exam and had our prostate MRI expert interpret it. It was negative without suspicious lesion. The urologist said my DE was normal.He said we could biopsy or follow. I decided to follow.
My PSA came down a little 6 months later but 2 years after the initial jump it went to 7.5. Alert!! Repeat MRI now showed a very suspicious 1 cm enhancing mass. Had biopsy with additional cores taken from the mass. G8 in the mass with the remainder of the biopsies negative. Because of life and researching for the best treatment and surgeon, it was 5 months until I had my RP. Six months after that solitary T8 met treated with SBRT. Three months later rising PSA with another PET showing solitary node in pelvis. Aggressive triple therapy (MO at Hopkins)and subsequent whole pelvic radiation. My PSA has been undetectable since early chemo 2 years ago. Off all meds, including Lupron over a year ago, and now starting TRT for T that didn't recover.
Just a cautionary tale. All imaging studies (I read all of them for 45 years) are fallible and can't see disease smaller than a few mm. Certainly can't evaluate microscopic disease. MRI may miss lower G grade cancer that is evolving into a higher grade. Biopsies (I did these for 45 years as an Interventional Radiologist) are usually targeted using various imaging modalities depending on the organ/site, but they are definitive for the tissue obtained. Actual tissue samples trumps all Imaging for the site biopsied. The problem in the prostate is taking random cores for increasing PSA but no definable lesion on MRI. It can miss the cancer. But, if PSA is significantly rising, relying on MRI alone is a mistake as well. The Imaging exam can miss the cancer too.
Just completed a biopsy of a met on my ischial tuberosity. What an experience.
Thanks. It is not very often that we get to peek behind the curtain and see how a doctor goes about dealing with this disease.
Thank you for your excellent message.
I'm not saying to skip a biopsy, but, rather to do a MRI first and then biopsy second, so that it can be a targeted biopsy.
Glad to hear that your PSA is undetectable now. The TRT should be very helpful. T recovery after a 1 year of Lupron is very slow...it takes at least 1 year, on average, to recover a baseline T after 1 year of Lupron.
I believe if a urologist wants to do a blind biopsy without first getting a MRI it's time to find a new urologist.
15 months after last 3 month Lupron shot my T has only risen to 52. Have all the usual low T symptoms.
It's very controversial but my MO at Hopkins was the one to say that I needed TRT if my T didn't recover. Given my response to triple therapy and undetectable PSA for 2 years, he said the aggressive clones have been eliminated. Either my PSA will remain undetectable or it may go up slowly with the T but it will be indolent and treatable. He has been treating oligo metastatic disease with aggressive therapy for close to a decade. I am totally in with his suggestions regarding treatment.
I agree 100%. Thanks for sharing.
I will go on TRT after stopping the 6-month course of Orgovyx. But, I have hypogonadism, and I will never recover a healthy level of T without supplementation.
Interesting....I worked in Radiology as a specials tech for about 20+ years and them moved into software development. Are any practices that you know of using computer assisted AI to interpret MRI scans? I know some places use that to assess mammograms even though the final result has to be reviewed by a Radiologist. Just curious....
I, too, have read about the very accurate success rates for mammograms, but I am not aware of AI being used for PCa MRI's. It's coming, though...
Outside of mammography I am unaware of any computer assisted AI used except maybe beta sites. I have used the software interpreting mammography. It is not a finished product the Radiologist fully interprets the study and does use the software as a "second look". However, the software routinely misses cancers and targets normal tissue, so it is not close to being used as the primary interpretation. It does occasionally find a cancer that the eye misses so it is useful.
I agree that AI will eventually provide complete interpretation of all Imaging studies. Probably a few decades away. If I was a medical student today I would not go into Radiology.
Thanks. I agree.
Probably sooner than a few decades...
AI image analyses is being used very successfully to "read" biopsy pathology slides and predict a survival probabilities for PCa, as well as flagging if someone is likely or not to benefit from doing ADT. The company is called Artera Ai, and they have Level 1 evidence supporting their program's analytical method.
Retired Ph.D (Nuclear Engineering). Worked on magnetic fusion reactor design for 25 years, and then switched gears and became a registered patent agent. I'm still working nearly full time at 70 y.o. for an IP law firm in Detroit, writing patent applications for inventors at General Motors, NASA, and (previously) Boeing.
Cool. The atomic process involved with nuclear fission and, more so, star driven fusion has always fascinated me. Especially the supernova chain reaction producing the heavier elements. So eloquent.
Na. The age is too random for one. Who decides this? Quality of life should be the driver. A healthy 75 year old may be in better shape than a 50 year old. It's a discussion men should have with their physician. If it becomes an AMA recommendation, many docs will advise against treatment without even testing. Good to know the odds according to AI, but many who have cancer will refuse treatment despite the odds while others will chase every option available.
I saw that post as well and I figured it came from a place with a state run healthcare system. Heck, we’re all living a lot longer because of other factors (including improved healthcare). Why not get tested and treated, if necessary. I was pretty bummed and pessimistic at first word of being 4a. But since starting ADT and completing RT, I feel pretty good and know “the End” is, in fact, not near. 👍👍
Yes, there's a huge spectrum of responses to learning you one has prostate cancer" I also agree with your comment about age. Tall Allen says it should be the physiological age, not the chronological age. I agree.
How does one determine physiological age???
Here's what ChatGPT says:
"Physiological age, also referred to as biological age, reflects how well your body is functioning compared to the average population, rather than your chronological age (how many years you've been alive). It is influenced by factors like genetics, lifestyle, and health conditions. Here are the primary ways to determine physiological age:
1. Biomarker Assessments
Physiological age can be estimated by evaluating key biomarkers that indicate the health and functioning of your body systems. Common biomarkers include:
Blood pressure: Elevated blood pressure can indicate a physiological age older than your chronological age.
Resting heart rate: A lower resting heart rate is often associated with better cardiovascular health and a younger physiological age.
Lung capacity: Tests like spirometry measure how well your lungs function.
Blood markers: Levels of glucose, cholesterol, triglycerides, and inflammatory markers (like C-reactive protein) can reveal metabolic and cardiovascular health.
2. Body Composition Analysis
Metrics such as:
Body fat percentage and muscle mass (via DEXA scans or bioelectrical impedance analysis)
Bone density (measured with DEXA scans to assess bone health)
3. Fitness and Strength Tests
VO2 max test: Measures aerobic capacity, a key indicator of cardiovascular and overall health.
Grip strength: Associated with overall muscular health and longevity.
Flexibility tests: Indicates joint and muscle health.
4. Epigenetic Testing
DNA methylation patterns are one of the most advanced methods to determine biological age. These tests analyze how your environment and lifestyle have altered gene expression, which can predict aging processes.
5. Lifestyle and Cognitive Assessments
Your mental health and lifestyle habits contribute to your physiological age. Factors include:
Sleep quality
Dietary habits
Exercise routine
Stress levels
Cognitive performance tests
6. Specialized Age Calculators
Several online tools and apps, based on health data, provide physiological age estimates. While these are not always precise, they give a useful overview. Examples include:
Levine Biological Age Calculator (based on the "Phenotypic Age" model).
Apps or platforms using AI-driven health metrics.
Takeaway:
To determine physiological age accurately, consult with a healthcare professional who can perform a detailed analysis. Combining multiple assessments will give the most reliable and actionable insights."
I use the simple calculation, I feel like I'm 40.
G7 at biopsy and G9 post RALP pathology here
Hi and Gleeson sites differ from men to men and many times the higher score is less aggressive depending on Your physiology much like a bigger man can drink more than a smaller one, some time that's not true. The science is not an exact or perfect calculation that can Apply to All men. You should know that this is medicines best educated guess based on historic data and sometimes it doesn't match you specifically. In ny dating don't trust your clinicians, in saying hey as many opinions as you can and drive from that data what course you need to take. All on all a high score is NOT a death sentence, take your time try to get a team that really knows You And YOUR tolerances that's netted than hit or miss because one may say this is the b best treatment option. Cheers hope that helped.
Hello Janebob99,
I discovered I had a Gleason 9 prostate cancer in July of 2017. It was in only 3 of the 12 biopsies they took of my prostate so the said it was caught early enough that it shouldn't be a problem as long as I had surgery quickly. In August I had surgery thanks to my son-in-law who is a certified first assist that works in the O R's with the doctors and he recommended I come all the way across the country to Seattle Washington to let Dr. Willis do the surgery because he was the best he had ever worked with and he took more time than any doctor that he knew and had done his fellowship at M D Anderson. Even though it was only a month later it had already spread into 19 of the 22 lymph nodes that he took from the system. Believe it or not I went home the next day because we were staying with my daughter who is an RN and my son-in law. Dr. Willis even recommended the doctor I should see in NC where we live. I went almost a year before my PSA started rising again and had to have 40 radiation treatments and the doctor that I am seeing for my cancer said it was so aggressive he didn't even want to see my PSA hit 0.1 and it hit that a little over a month ago. Without a prostate they shouldn't even be able to read my PSA. So guess what I have to have a PET scan in the next few days and probably another round of radiation.
That's a sad tale told too often.
I fired my first urologist when all he said was to "take it out". Fortunately, I found a better urologist who steered me to an excellent RO and MO. I skipped the surgery, and did 5 sessions of SBRT and then Orgovyx ADT for 6 months. My PSA is not down to 0.03 and I expect the next reading to be ever lower.
You may want to consider SBRT for your next radiation.
A much more telling question :
" What % of a Biopsy 2nd or 3rd opinion , agrees with the initial result . " ?
You will be surprised , yet most patients never ask for a 2nd or 3rd opinion , as for example is recommended in Dr. Patrick Walsh's book . " Guide to Surviving Prostate Cancer " .
Good point. But, I doubt anyone has studied that...
My 1st Transperineal MRI Fusion Biopsyy result was NEGATIVE . ( 5 cores in target area )
My 2nd Biopsy was all Gleason 6 in the target area . ( 6 cores out of 16 )
My 2nd Opinion was all upgraded to Gleason 3 + 4 = 7 in the target area .
My 3rd Opinion was 4 Cores Gleason 6 , 2 Cores werre Gleason 3 + 4 = 7
Take your pick .
It was my call to have a 2nd Biopsy and 2nd and 3rd opinions . Neither my Urologist or the Urologist who performed the 1st Biopsy suggested anothher biopsy or 2nd opinion even though my PI- RADS 5 on both my MRI's ( prior to both biopsies ) were in conflict with a possible NEGATIVE RESULT .
As you know a RADS 5 has a 98 5 probability of prostate cancer .. Therefore a negative is betting against long odds .
Very interesting. Thanks for sharing.
Well, I'm not exactly sure what you are going for here but the Gleason Score we see at first biopsy may or may not represent what the score should be. For example I have had three biopsies all within a year of each other. The first two biopsies each consisted of I believe 12 samples each and each individual sample is graded and graded out at Gleason 6 as all samples were 3+3. Later I had a third biopsy and 11 of the samples graded at 3+3 but one sample came back as 4+3 which means my Gleason was now 7 not six. Now in all likely hood that sample was missed since the tumor is small....the needle might pass thru that portion so the actual sample was taken from behind it or maybe in front of it. Now there is a possibility that the pathologist that read the last sample as a 4+3 misread it. Not likely as my PSA continues to rise, albeit slowly so given the PSA continues to rise I tend to believe that 7 is the actual gleason score and the other core samples just missed that spot that was a bit more aggressive. Not sure this helps you but thought I would point out what is probably obvious. Cheers!
Good points. My question was mostly out of curiosity.
If you don't mind me asking, what is your most recent PSA and doubling time?
And, have you had a MRI done?
Well I have only been diagnosed about 18-20 months ago and early on was on Active Surveillance until the PSA jumped and I went for my first biopsy. I don't have every single PSA reading but here is what I have. I have not had an MRI yet....getting one next Thursday. I had fiducial markers and spacer gel placed yesterday in preparation for RT beginning soon. I actually spoke with my urologist yesterday about the outlier in the above list since it dropped and then showed back up. Unfortunately not all the PSA test were done by the same lab so unsure what differences if any there might be between the different methods.
Thank you for the data.
My PSA showed a very similar history, but my doubling time was slower than yours. I'm glad you're getting RT. I did 5 sessions of SBRT (plus six months of Orgovyx) and my PSA dropped from 10 to 0.03. Glad you are doing a rectal spacer (I did, too).
The MRI will likely show a tumor, because of your relatively fast doubling time (4 months).
Are you on, or going to be on, ADT?
From Wikipedia.
Donald F. Gleason (November 20, 1920 – December 28, 2008) was an American physician and pathologist, best known for devising the "Gleason score" which predicts the aggressiveness of prostate cancer in patients. He was a former chief of pathology at the Minneapolis VA Medical Center, and received three degrees from and taught at the University of Minnesota.
Early life
Gleason was born in Spencer, Iowa, though he grew up in Litchfield, Minnesota, where his father, Fred Gleason, ran a hardware store, and his mother, Ethel, was a schoolteacher. He attended the University of Minnesota, and received his bachelor's degree, M.D., and Ph.D. from that institution. He entered the U.S. Army Medical Corps, serving an internship at the University of Maryland, Baltimore and training as a resident in pathology at the VA hospital in Minneapolis.[1]
Career and test development
Gleason remained at the Minneapolis VA Medical Center after World War II. In 1962, Dr. George Mellinger, the hospital's chief of urology, who was administering a cooperative research project involving fourteen hospitals, asked Gleason to develop a standardized pathological testing system to measure the development of prostate cancer. At the time, no single system existed to measure the speed at which prostate cancer spreads, nor was there a single system to describe the architecture of prostate cancer cells as seen under a microscope. While many classifications existed, but they were in practice difficult to apply, and pathologists would invent their own. This lack of a single standard led to confusion in patients' treatment and difficulties in evaluation of potential new treatments.[1]
Gleason's technique, which he published in the journal Cancer Chemotherapy Reports in 1966, focused on two details of the architecture of the cancer cells, and assigned a score of one to five to each attribute. Thus, any given patient could have a score of between two and ten——the higher the score, the more aggressive the cancer, and the lower the chance of survival. Gleason found the score directly related to survival rates in a study of 270 patients, which was the basis of his journal report. Subsequently, a study of 4,000 patients confirmed the relationship.[1]
Dr. Akhouri Sinha, a colleague of Gleason's for forty years, described the scoring system as "comprehensive, yet simple so that the grading system can be used by pathologists, clinicians and scientists throughout the world".[2] The scoring was adopted slowly until 1987, when several leading experts in the field recommended its use in all scientific publications regarding prostate cancer. The test became even more widely utilized following a surge[when?] in prostate cancers identified through a blood test, the prostate-specific antigen (PSA) test.
Personal and later life
Gleason was for many years a resident of Richfield, Minnesota. He died of a heart attack on December 28, 2008 in Edina, Minnesota and was survived by his wife, Nancy (to whom he was married for 62 years) and three daughters, Donna, Sue, and Ginger.[2]
Good Luck, Good Health and Good Humor.
j-o-h-n
In recurrent Pca, is it possible to know to which gleason-grade group the surviving cancer cells belong?
Protocel Entelev 23
What is the difference between a Gleason 4 + 3 and Gleason 4 + 4 (or Gleason 8)
Newbie
