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Archive for the ‘Gleason grade’ Category

WALL ST JOURNAL: Scientists may soon be able to answer the agonising question facing men with prostate cancer: Does their cancer need immediate treatment or can it be left alone? READ MORE>

AND: Some men with low Gleason scores have cancer that spreads quickly, while some with high scores don’t. READ MORE>

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URO TODAY: Use of a scale (the T Scale) to rank the seriousness of prostate cancer and thus guide doctors on treatment options has been called into question by new US research. READ MORE>

Analysis of biopsy samples taken from the prostate is not always accurate in determining how far a tumour has spread, a research team says in a paper to the American Urological Association (AUA) annual meeting.

Those with a T2a score have cancer that is confined within the gland and on one side (lobe) only, making them candidates for nerve-sparing surgery and other focal therapy.

“This data suggests that selection of patients who truly have pT2a disease is extremely difficult and may impact [on]successful application of focal therapies,” the researchers say.

The T scale is applied to cancer confined to the prostate and surrounding areas:

Clinical
TX — Primary tumor cannot be assessed
T0 — No evidence of primary tumor
T1 — Cannot detect tumor with imaging tests
T1a — Less than 5 percent of the prostate is affected by the tumor
T1b — More than 5 percent of the prostate is affected by the tumor
T1c — Tumor identified by needle biopsy, PSA elevated
T2 — Tumor confined within prostate
T2a — Tumor affects one-half of one lobe or less
T2b — Tumor affects more than one-half of one lobe but not both lobes
T2c — Tumor affects both lobes
T3 — Tumor extends through the prostate capsule
T3a — Tumor extends beyond the prostate capsule
T3b — Tumor invades seminal vesicle(s)
T4 — Tumor is fixed or invades surrounding areas, such as the bladder neck, external sphincter, rectum, levator muscles, and/or pelvic wall

Pathologic
pT2 — Tumor confined to the prostate
pT2a — Tumor affects one-half of one lobe or less
pT2b — Tumor affects more than one-half of one lobe but not both lobes
pT2c — Tumor affects both lobes
pT3 — Tumor extends beyond the prostate
pT3a — Tumor extends beyond the prostate
pT3b — Tumor invades seminal vesicle(s)
pT4 — Tumor invades the bladder, rectum

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URO TODAY: Giving newly diagnosed prostate cancer patients a bone scan has dropped off dramatically since the advent of PSA tests, but new research suggests reading PSA levels and Gleason score can accurately predict when bone scans are needed. READ MORE>

The combination of Gleason score and PSA enhances predictability of bone scans in newly diagnosed prostate cancer patients.

The PSA threshold for ordering bone scans should be adjusted according to Gleason score. For patients with Gleason scores less than 7, we recommend a bone scan if the PSA is higher than 30 ng/ml.

However, for patients with a high Gleason score (8-10), we recommend a bone scan if the PSA is higher than 10 ng/ml.

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URO TODAY: Not all patients with a biopsy prostate cancer Gleason score of  6 (< /=3 + 3) – usually considered safe – have low-risk disease, according to new German research. READ MORE>

High-risk Gleason score < /=3 + 3 patients have a similar risk profile as more favourable GS 3 + 4 patients. This finding warrants consideration when deciding on treatment.

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NEW PROSTATE CANCER INFOLINK: Jonathon Epstein, MD, at Johns Hopkins is widely considered to be one of the pre-eminent prostate cancer pathologists in the world today, so it is worth listening when he says that the Gleason grading system needs revision. READ MORE>

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NEW PROSTATE CANCER INFOLINK: Interpretation of biopsy sample slides by pathologists has played a significant role in a Gleason score “shift” over the past 15 years, according to a new study. However, there are some questions over some of the researchers’ conclusions. READ MORE>

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AUGUST 4: URO TODAY: A new UK study may have implications on understanding pathways of prostate cancer progression and on identifying potential targets for screening – pending further investigation of associations between PSA testing, Gleason score, and cancer stage. READ MORE>

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JULY 31: URO TODAY: What’s the most accurate way your specialist can predict your fate when you first learn you have prostate cancer? Using something called a nomogram, according to latest analysis. READ MORE>

Researchers at the University of Montreal Health Center reviewed tools available to clinicians involved in treatment decisions in newly diagnosed prostate cancer and examined their accuracy to provide individual life expectancy.

“…nomograms provide the most accurate health-adjusted life expectancy prognostication,” they conclude.

What’s a nomogram?

It’s a calculation that gives an estimate – in this case, of life expectancy – after known information is fed into it.

The Memorial Sloan Kettering Cancer Center in the US has one for prostate cancer on its website. Anyone who knows the results of PSA, biopsy and Gleason grade can use it: CLICK HERE>

Here’s an example:

Nomogram

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JULY 4: SCIENCE DAILY: Cancer experts at Johns Hopkins say a study tracking 774 prostate cancer patients for a median of eight years has shown that a three-way combination of measurements has the best chance yet of predicting disease metastasis. READ MORE>

The new prediction method comprises the length of time it takes for PSA (prostate-specific antigen) to double, Gleason score (a numeric indicator of prostate cancer aggressiveness as seen under the microscope), and the interval between surgical removal of the prostate and the first detectable PSA level.

According to Johns Hopkins investigators, combining these three measurements more accurately estimates risk that the cancer has spread than do other methods and should help determine which patients may benefit from additional therapy when PSA levels rise after surgery to remove the prostate.

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JUNE 27: NEW PROSTATE CANCER INFOLINK: The predominance of Gleason pattern 4 in Gleason 7 cancers is a critically important prognostic factor. READ MORE>

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