"Extraprostatic Extension Is Extremely Rare for Contemporary Gleason Score 6 Prostate Cancer"

[AlanMeyer]

A recent study concluded that men with "pure" Gleason 6 prostate cancer hardly ever had any cancer extending outside the prostate.

See: practiceupdate.com/journals... Have a look at some of the text below the "take-home message" as well for more info on this.

The authors concluded that "Once maximally characterized and confirmed to be low-risk, routine treatment of these cancers is unlikely to have a favorable risk–benefit profile."

I would therefore think that, if you have been diagnosed with Gleason 6 cancer and not yet been treated, first, be sure to get an accurate reading of the biopsy report. Was there any Gleason 4 in with the Gleason 3? Maybe get a second opinion on the biopsy. If the experts are convinced that you have a pure Gleason 6 cancer, then I think you should consider active surveillance very seriously.

Alan

[cards]

this is where I have doubts--what is the difference between a 3+3=6 and a 3+4=7?-is the difference that dramatic that I'm being advised to remove an organ? What happens if a different pathologist reads the biopsy different? I have to do a lot more research

[AlanMeyer Moderator in reply to cards]

The Gleason score is an evaluation of the extent of "de-differentiation" of the tumor cells. The pathologist examines them under a microscope and essentially rates them on how much they look like prostate cells, and how much they have changed so that the don't look like them. Gleason 3 looks like slightly abnormal prostate cells. Gleason 5 looks radically abnormal. If all the cells are no worse than Gleason 3, then the cancer is not far from normal. Gleason 4 is noticeably worse. 3+4 = 7 means most are Gleason 3, some are 4. 4+3 = 7 means most are 4 - which usually means the cancer is more aggressive and higher risk. That's why it's important to be sure a biopsy really is Gleason 3+3 and not something more serious before deciding on active surveillance rather than treatment.

In my own case, I was diagnosed with 3+3 by the lab my local urologist used. When I went for a second opinion, the pathologist at the other place said it was 3+4. Then I went to talk to some people at the National Cancer Institute about their clinical trials. Their pathologist said I was 4+3, and an MRI they did showed extra-prostatic extensions.

I hope that is of some help.

Alan

[cards in reply to AlanMeyer]

thank you for the reply,i think. This is exactly what I was fearing--going through the process of second opinions only to get differing views!!!It I'm in a situation where I am close to active survelllance as opposed to having my families lives drastically changed--haven't slept in days. Would you be so kind to explain what 'extra -prostatic extensions" means thanks you

[AlanMeyer Moderator in reply to cards]

Here's how I understand "extra-prostatic extension".

A tumor is a block of mutated cancerous cells within the prostate. The cells divide and multiply, making the tumor larger. If the tumor grows into and beyond the boundaries of the prostate, i.e., if it stick out of the prostate, it's an extra-prostatic extension.

I was shown an MRI image of my prostate that had relatively light areas, and some dark blotches. The dark blotches were tumors. One of those blotches stuck out of the prostate by five or so millimeters. That was the extension.

Alan