| Senior Veteran (male)
Join Date: Nov 2007 Location: Annandale, VA, USA
Posts: 1,748
| Re: Gleason: 3+5 Questions.
Hi Zodiart,
I know you would prefer to have no reason to be here, but I hope we can help, so welcome to the board anyway!  I'll insert some thoughts in green. I'm a layman patient with no medical credentials, so please bear that in mind. Quote:
Originally Posted by Zodiart  Hi,
I have some questions about my dad's biopsy.. 
I really shocked and petrified for hours after i read the biopsy. | Your reaction is the way most of us react, whether patient or caring mate, relative or friend. Gaining knowledge is one of the best ways to get back to where you can be effective and feel better. Quote:
1. Gleason:3+5, How bad is that? with (good)1---10(bad) scale.
2. What's the difference between gleason: 3+5 prostate with 5+3? Isn't it's the same, gleason:8?
| Let's look at your questions in reverse order, dealing with question 2 first. Actually, with modern Gleason scoring, there could be a major difference between a 5+3 and a 3+5. Only a few years ago, the first score given was for the most prominent grade of the cancer, with 1 being at the low end and 5 at the high end, and with 3 being typical; the second score given was for the second most prominent pattern. Sometimes a third grade was added if there was any high risk cancer, grade 4 or 5, in the biopsy core (or set of cores for the summary).
That has changed, but it would be worthwhile to contact the doctor to find out if the new or old scoring method was used. In the new scoring method, the first grade is still the one that is most prominent, but, if any grade 5 or grade 4 cancer is found, the second one will be a 5 or a 4, with the 5 given the nod if both are found. That's the way its done if either are present, even if found in only a very small percentage of the biopsy core. Therefore, you could have a core with 55% Gleason 3, 20% Gleason 2, 20% benign, and only 5% Gleason 5, and it would still be scored as a 3+5=8. Of course, it could be 55% Gleason 3 and 45% Gleason 5, which would likely be more serious.
Okay, now back to question 1 - how serious is a 5+3=8 on a scale of 1 (good)to 10(bad)? First, your scoring sequence reverses the Gleason sequence, where the 10 is the riskiest and a 2 the least risky, but we'll use your scale. Clearly, a Gleason 3+5=8 is above average in risk, so on your scale it would fall in the 1 to 5 range. It is also higher than intermediate risk, so that would put it roughly in the 1 to 3 range. However, it is not the most risky, which we could call a 1 and would fit with a Gleason of 10, and I feel that it is well below the next notch, your score of 2, which would roughly fit a Gleason of 9 or maybe a 5+3=8. Therefore, roughly speaking, I would assign your dad's biopsy a 3 on your scale.
In practical terms, all by itself - no other factors needed, that rules out an approach that is arguably the best for low-risk patients - active surveillance. I suppose the lone exception would be where the patient is in extremely poor health where some other condition was life threatening. A Gleason 8 cancer also lowers the general odds that a local therapy will be enough to cure the cancer on its own. Surgery, cryotherapy, and radioactive seed therapy (brachytherapy) are all local therapies. However, if the cancer is in fact confined to the prostate, then a local therapy could be curative, despite the high grade. At this point, the doctor has probably told your dad the stage of the cancer, which is the indication of whether it is likely confined or has spread beyond the capsule of the prostate. Do you know the stage?
Also, unless the Gleason scoring was done by a pathologist expert in prostate cancer, it may not be accurate. It is wise to make sure that an expert pathologist has scored the biopsy samples; if not, that can be done. My own Gleason was raised from a 3+4=7 to a 4+3=7 upon expert review. Quote: |
3. How to treat the cancer? any recommendation (activity, method, food, medicine, etc)?
| I've covered that a bit above, but you really need more information to assess that. The other two critical pieces are the stage and the PSA level. It would also help to know the number of biopsy cores taken, the number that were positive for cancer, the percent of cancer in each, the size of the prostate, and the dates and levels of any previous PSA tests. A key initial tool used to assess whether surgery will likely cure is the Partin Tables. These tables consider PSA, Gleason and stage in giving us odds of certain events happening, including whether the cancer is confined to the prostate (the best case), has penetrated the prostate capsule, has spread to the seminal vesicles, or has spread to the lymph nodes. Based on what you have stated so far, a Gleason of 8 falls in the 8-10 range in the Partin Tables, and, in the best PSA range in the tables (0 to 2.5), and best stage (T1c), there would be a 66% chance of the cancer still being confined to the prostate. That's not great, but it's still good enough that a lot of men would be willing to give solo local therapy a try. In a more typical situation for Gleason 8, with a PSA in the 6.1 to 10 range, with a stage of T2b, there would be only a 15% chance of the cancer's still being confined to the prostate. (Figures are from the 2001 version of the tables; a later version is quite close to these numbers.) With odds of 15% success, I personally would not choose surgery, or any local therapy on a solo basis. However, some men do choose to go for the gold even with such low odds. To most of us, the likelihood of some substantial bothersome side effects and possible complications in exchange for a slim shot at a cure will deter us from such a choice, especially when other options have much better chances of success. That said, it is really up to the patient to make the decision.
Many Gleason 8 patients with likely spread beyond the prostate are treated with radiation that includes non-local radiation, meaning that some of it goes beyond the prostate, especially in the area where nearby lymph nodes are located. This could include a combination of radioactive seeds plus some form of radiation delivered by beams external to the body. Hormonal therapy (drugs) is often used to boost the effectiveness of the radiation and to add some additional help on its own. Some patients with higher risk cases chose to use hormonal therapy as their sole therapy with the idea of controling the cancer but not curing it. That decreases the side effect burden, in my view, and can help for many years if done well and the patient has some luck (me). I also believe that lifestyle tactics help, including diet, nutrition, exercise and stress reduction. One of the best books on nutrition for prostate cancer is "Beating Prostate Cancer: Hormonal Therapy & Diet," by Dr. Charles "Snuffy" Myers, MD. It appears that statin drugs - known for controlling cholesterol, also help to substantially reduce deaths from prostate cancer.
There are other approaches, but these are some of the important ones. Quote:
4. Is it possible to cure it completely? any recommendation method?
I will really really appreciate any reply.. pls help guys.. | Yes, a cure is possible based on what you have said so far, but it is not at all a nearly sure thing for a patient with Gleason 8 cancer. That's the bad news. On the good side, even if the cancer cannot be cured, in the US patients with prostate cancer are living many years. Even those with "high-risk" prostate cancer are doing well with the aid of modern advances. In the US, 95% of high risk patients are alive at the ten year mark, many doing very well. For instance, I'm now closing in on my twelfth year with a very high-risk case, and I'm doing quite well, looking forward to more good years. So, even if cure is not achievable, long-term control is likely. Many of us with high-risk cases will live out our lives and pass on from something other than prostate cancer.
Good luck to your dad, to you and to your family in dealing with his cancer.
Take care,
Jim |