Does Gleason Score (GS)≤6 Have the Potential to Metastasize to Lymph Nodes? Interesting Article....

 

For the G6 guys...

"Of over 14,000 totally embedded radical prostatectomies from multiple institutions, there was not a single case of a GS≤6 tumor with LN metastases. In contrast to prevailing assumptions, GS≤6 tumors do not appear to metastasize to LNs. Rather, Gleason pattern 4 or 5, as better defined by the current ISUP updated grading system, is required for metastatic disease."

http://www.ncbi.nlm.nih.gov/pubmed/22531173

Dx @ 42 PSA 2.76 GS6
open RP 10/08
pT2 Organ Confined GS6
<0.03 All PSAs (2/24/2012 last read)

Post Edited (ChrisR) : 7/28/2012 6:58:04 PM (GMT-6)

I agree James. I know I am very fortunate to have the pathology I did, but once in a while I still need some encouragement.....

My concern is that I was scored a 6 at Lacks Cancer Center in Grand Rapids, MI and went to University of Michigan Cancer Center was scored a 7. When I talked to my Uro he insists that I'm a 6. I am a T3b, does this have any bearing if I should consider myself a 6 or a 7?

This supports those doctors that believe that low risk disease is a completely different type of cancer than intermediate risk and high risk pc. It behaves totally different. It also supports the safety of AS programs as these types of cancers do not readily matastize and only a cancer that matastizes can kill you. It also is consistant with other data that found that G6 cancers rarely cause death.
The open question is if G6s can mutate into higher grade cancers. Doctors like Scholz believe that they don't and any higher grade tumors found are new tumors that developed later and started as a higher grade. Others believe that given enough time a G6 will eventually mutate into a higher grade that can then matastize.
JT

Thanks much for insight.

This study refered only to patients who were "post-surgery" confirmed Gleason 6.  It was not speculating about the possible outcome or lymph node status of pre-surgery patients.

It has been a challenge to accurately identify low-risk "pre-surgery" patients.  As everyone knows there is approximately, from what I have read, a 30%-40% chance of your Gleason score being upgraded after surgery.

To quote a famous song,  "You don't know what you've got til' it's gone...........they paved paradise and put up a parking lot......"  O.K. I'll stop.

This study is reassuring to post-op organ confined Gleason 6 patients about the possible spread of their cancer to other parts of the body through the lymph node system.  It appears that this type of PCa does not actively spread that way.  Which only leaves the circulatory system as a possible method of spread to other parts of the body given a post-op organ confined status.  One can assume that it is also very unlikely for Gleason 6 to spread through the circulatory system since it does not appear to escape through the lymphatic system.

 

Post Edited (ChrisR) : 7/29/2012 5:52:31 AM (GMT-6)

Grade 4 usually is a different story. 2+4 is unusual these days. G6 is typically 3+3 in these studies.

As usual, John T hit the nail right on the head. If G6 cancer can progress into a higher grade, then this is all the more reason to treat a G6 before it can do so.

John T,

Thanks, I should have been more clear. I know that you do not favor aggressive treatment for a "low risk" cancer. But you hit upon the issue, which is whether or not low risk cancers progress into higher risk cancers. Most doctors believe that HG PIN is a precancerous lesion. If so, then it makes sense, to me, that lesions can and do progress. Until it is proven otherwise, I think the wise course is to treat a G6 cancer as having the potential to progress to higher risk disease.

Each person can then assess the risk/reward of treatment. In the best surgeons' hands, the chances of incontinence are 2-3% and the chance of ED in the 20-30% range. Knowing this going in, we can each make the choice of taking the side effect risk.

Of course, since we know that PCa is more often than not multi-focal, having G6 disease may mean that higher risk disease is lurking nearby. Again, something we each need to consider in making our decisions. There more information we have, the better.

I believe what you guys are talking about when you are describing G6 turning into a G7 or G8 or whatever is called "dedifferentiation."  There are a few papers written on the theroy.  As far as I know nobody has witnessed this in a laboratory.  What I mean is that nobody has "cultured" G6 or G7 or G8 cells and then watched them dedifferentiate into a worse grade.  The only witness to this, that I am aware of, is people on active surveliance starting out as a G6 and then on rebiopsy later down the road they are found to have a higher grade cancer.  It is then assumed that the cancer has progressed to a worse grade.  The problem I have with the latter is that how do they know there simply wasn't a missed higher grade tumor on initial diagnosis or thereafter.  So, you could have someone who you thought was low grade but never actually was since the prostate was not removed and fully examined.

In regards to John T's post, John I always like to read what you have to say by the way,  the death rate as John stated is .2% in other words 2/10's of 1%.  Just wanted to make sure everybody read that correctly.  I would then wonder if they examined the person's prostate who died of low risk PCa to see if there still was any sign of  higher grade PCa. 

 

Post Edited (ChrisR) : 7/29/2012 3:13:14 PM (GMT-6)

Good point, Frack. Go home, take a couple aspirins, and forget about it.

OK, that's ridiiculous, but I can understand why you would wonder why do AS with the frequent PSA tests and biopsies if G6 so rarely, almost never, progresses? It's indolent, non-aggressive, non-metastatic.....a real *****cat of a cancer, if it's even "cancer" at all. At least that's what some folks say (or something akin to that).

Then again, I don't trust biopsies or their conclusions. Mine found six cores positive for Gleason 7, all left side, but the post-op pathology found other Gleason 7 sites on the right side that were not detected by the 12-core biopsy. So, am I really to believe that the 3+4 sites sprang into existence that way.....that the 4's were always 4's? I just can't wrap my mind around that notion.

I understand, John T.  Thanks.

I see my post was automatically edited, as if I had included an obscenity.  I did not.  The word that was deleted was p.u.s.s.y.c.a.t.  (maybe spelled that way, it will show up.  I don't use obscene words when posting on this forum, and didn't want it to look as if I had.  Bill

So how is someone like me supposed to interpret this?

Although my biopsy indicated mostly grade 6 with a very small amount of grade 7, my post-op pathology downgraded me to gleason 3+3=6, 20% total involvement, with a single focal postive margin.  Two pathologists graded me a pT2cpN0 but my doctor disagrees with that finding and believes I was actually a T3a.  That was a year ago.

Since then, my PSA hasn't exactly been undetectable but still well below the threshold that any salvage therapy is needed.  I've also learned that my lab (Quest out in California) recently changed their test protocols so that .02 is the lowest they accurately measure.  My last two PSA readings of .03 may in fact just be noise but that could also be wishful thinking on my part.

So what do I do if I end up with a slowly rising PSA of what was determined to be a G6 cancer?  Do I proceed with salvage treatment in hopes of eradicating what *might* be a non-life threatening cancer, even though the success rate of salvage radiation is rather low? 

Talk about anxiety.  I have a urologist that disagrees with the pathologists and I have what *may* be a rising PSA of what *may* be PCa that *might* not even harm me?

I need to go for a long ride on my Harley.