prostate cancer discovery

 

The Gleason Score as Crystal Ball

 

In last year’s Discovery, we featured the research finding by pathologist Jonathan Epstein, M.D., the Reinhard Professor of Urologic Pathology, that when Gleason 6 cancer is found at radical prostatectomy, the cancer never spreads to the pelvic lymph nodes. In a recent study, published in the British Journal of Urology, Epstein and colleagues further demonstrated what he calls the “good behavior” of Gleason 6 cancer. “Even when there are multiple cores of Gleason grade 6 on a biopsy, the prognosis is still favorable,” he says. For example, “even with more than 6 cores containing Gleason score 6 cancer, 84 percent of men will be cur ed with surgery.” With a low PSA (less than 4 ng/ml), despite having four to six positive cores, the tumor will s till be confined to the prostate in more than 75 percent of men. “The good news is that low-grade cancer trumps more extensive tumor on biopsy.”

 

“The good news is that low-grade cancer trumps more extensive tumor on biopsy… and even with the worst Gleason grade, there are some men with limited disease who do well and can be cured by surgery.”

 

Epstein and colleagues also explored the significance of cancer at the other, most aggressive end of the Gleason spectrum, Gleason 9 and 10 tumors . This work was published in the Journal of Urology. “For the relatively few men with low-volume Gleason 9 cancer, limited to one core, there is a good chance that the tumor will be organconfined at radical prostatectomy,” Epstein reports. “However, in most men with more extensive Gleason 9-10 cancer on biopsy, fewer than one out of five men will have tumor confined to the prostate.” These two studies show why the Gleason score remains such a powerful barometer indicating the aggressiveness of prostate cancer. However, Epstein notes, “even with the worst Gleason grade, there are some men with limited disease who do w ell and can be cured by surgery.”

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