Prostate cancer 7 Gleason

Gleason sum of 7 (3+4 or 4+3)

Prostate tumors with a Gleason value of 7 are considered moderately aggressive tumors. But a 3+4 sum is less aggressive than a 4+3 sum. How can this be?

A score of 3 indicates moderately malignant prostate cancer cells. A score of 4 indicates more malignant cells. Compared with cells of the 3rd grade, they are more atypical, more deviated in their structure and shape from healthy cells of the prostate. They are characterized by invasive rapid growth.

At a sum of 3+4, cells with a Gleason score of 3 are more common, i.e. less malignant. The higher the percentage of cells with a score of 3, the more the tumor behaves like a tumor with a Gleason sum of 6 (3+3).

If the sum is 4+3, it means that atypical cells predominate. In this case, the tumor is more malignant and has a more aggressive behavior. And such a carcinoma behaves more like a tumor with a Gleason value of 8-10.

In any case, with a Gleason value of 7, regardless of the sequence of numbers, it is recommended to start treatment immediately. If the tumor is locally limited, then the best solution is to perform a complete (radical) removal of the prostate.

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Prostate cancer grades - TNM, Gleason sum

For the correct treatment of Prostate cancer, it is very important to establish the stage of development and course of the disease. The degree of prostate cancer depends on the size of the tumor and the spread of cancer cells to other organs (the presence of metastases), as well as the aggressiveness (malignancy) of the tumor. To make and describe the diagnosis, urologists use the international system for determining the degree of prostate cancer - TNM (it describes the size of the prostate tumor and the spread of cancer cells to other organs), in combination with the Gleason sum / scale (it describes the degree of aggressiveness of prostate cancer) and the level of PSA in the blood (it describes the presence in the blood of the oncomarker of prostate cancer - the PSA protein).

Prostate cancer stages - TNM system

The TNM international system for describing the stage of development and spread of prostate cancer describes the following factors (these letters and numbers can be found in the diagnosis made by the urologist and recorded in the Consultation report, for example: T2 N0 M0):

Category T - the size of the main (largest) tumor. Category N - whether the cancer has spread to nearby (pelvic) lymph nodes. Category M - absence or presence of metastases (whether the cancer cells have spread to other organs).

Thus, the diagnosis of T2 N0 MO means that the tumor is limited to the prostate gland, and that there are no metastases in other organs. A diagnosis of T3b N0 M0 means that the tumor has spread to the seminal vesicles, but there are no metastases in the lymph nodes and other organs.

Gleason score

The Gleason score/sum is used to describe the malignancy of a tumor found on a prostate biopsy. The higher the Gleason score, the more aggressive/malignant the tumor tissue.

The Gleason score is based on the degree to which cancer cells found in prostate tissue differ from normal prostate cells. If the cancer cells look like regular prostate cells, then the tumor gets a score of 1. If cancer cells differ as much as possible from normal cells, then the tumor receives the maximum number of points - 5. Most often in diagnoses, there are estimates of 3 points or higher.

The Gleason score includes Gleason scores (scores of 1 to 5) for the two largest or most malignant tumors found in prostate tissue (usually prostate cancer affects multiple areas of the prostate). For example, a Gleason score of 7 means that the two largest or most malignant tumors scored 3 and 4 respectively (3+47): Gleason score). Tumors with a Gleason score of 7 are called intermediate Gleason scores. - Tumors with a Gleason score of 8 to 10 (10 is the maximum score) are called high-grade Gleason scores.

Prostate cancer stages

For the correct treatment of prostate cancer, it is very important to establish the stage of development and course of the disease.Prostate cancer is staged based on a combination of TNM diagnosis, Gleason score, and blood PSA levels. The stages of prostate cancer are given a Roman numeral from I (initial stage of development of prostate cancer) to IV (advanced stage of development and spread of prostate cancer). For example, if the TNM diagnosis is T1 N0 M0, the Gleason score is 6 or less, and the PSA level is 10 ng/ml or less, then the doctor may make a diagnosis of "grade I prostate cancer":. But given that the diagnosis of prostate cancer is a very difficult thing, only a urologist can make an accurate diagnosis.

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Gleason score for prostate cancer: classification and diagnosis of the stage of the disease

Donald Gleason created a scale that allows you to draw conclusions about the aggressiveness of prostate cancer. It was created based on the results of the biopsy. The scale is considered one of the most reliable, therefore it is used almost always when it comes to prostate cancer. They have data and prognostic value. The more differentiated the cells, the more chances for a favorable outcome:

• 1 point - low aggressive score,
• 5 points - the least degree of differentiation, highly aggressive tumor.

How cancer is assessed on a scale

The Gleason score defines prostate cancer as the two largest tumors. The sum of the tissue studies obtained from the biopsy is the index. Its minimum value is 2 points, the maximum is 10.

Based on the results of this classification, the doctor can determine the degree to which the cells:

• have changed their shape or size,
• have lost the ability to perform their functions.

All possible amounts are divided into three large groups:

After surgery, these data may change both up and down.

Some subtleties of calculating scores and conducting a survey

The indication for a biopsy may be a clinical picture or a change in the level of PSA. Diagnosis is carried out under TRUS control. In most cases, a transrectal method is used to evaluate cells on a scale, but in some cases a transperineal method is prescribed.

If the Gleason classification sets the minimum values, then a second biopsy is performed, but the timing of this is not set. It is determined taking into account the growth of PSA, the presence of a burdensome history.

According to Gleason, prostate cancer is measured not only in amount. For example, a diagnosis would be worse at 4+37 than a diagnosis at 3+47. This is due to the fact that in the first case the highest participation of aggressive cells is determined.

The most unfavorable combination is 5+510. The lowest index after a targeted biopsy is 3 + 2, but more often doctors set 3 + 3. It turns out that the first value indicates the most common cell type.

Detailed breakdown of the Gleason index

If the Gleason sum contains 1 and 2, we can talk about typically non-aggressive behavior and a slight degree of deviation from healthy cells. In practice, it turns out that the degree of difference is so small that doctors often cannot determine the deviations. Therefore, German standards are used, according to which the Gleason scale starts from 3 to 10. If these values \u200b\u200bare present in the sum, then the histological examination is repeated.

Index 6 points

An index of 6 points (3+3) indicates that the majority contain cells of the same trip. Such a prostate has a heterogeneous structure. Such cancer cells have the following features:

• grow slowly
• reach a certain size and stop growing
• do not go beyond the capsule,
• do not lead to metastases.

This oncology is asymptomatic, and the PSA level rises at a slow pace. The forecast is considered favorable.

Index 7 points

If the Gleason score for prostate cancer shows 7 points, we can talk about a tumor of an average degree. With an indicator of 4, cells are considered more atypical, deviated in structure and shape from healthy ones. With a sum of 3 + 4, the tumor is less malignant. The more cells with a score of 3, the more likely the tumor will behave like with an index of 6.

At this index, immediate treatment begins. If education is limited, then complete removal of the prostate is recommended. At the same stage, another complex therapy is performed using chemotherapy and radiation.

Index 8 points

The prognosis for such indicators is less favorable. Such tumors are characterized by rapid growth, infiltration of the capsule, damage to neighboring organs and the lymphatic system. The rise in PSA is rapid.

Such neoplasms are usually detected already at the stage of metastasis, but with an early diagnosis, there is still a chance for a full recovery. With a total of 8 points, surgery as the first treatment is considered inappropriate.

Index 9 points

At the sum of 4+5, the tumor is considered less aggressive compared to 5+4. Usually, with such indicators, we are talking about highly aggressive carcinomas. Such formations:

• grow very fast
• spread to neighboring organs,
• give early metastases.

In this case, the risk of death is high. It is possible to prolong life, but it depends on a well-chosen treatment regimen. If the tumor has not gone beyond the prostate capsule, then the gland is removed, treatment with hormones and radiation is prescribed.

Index 10

Prostate cancer with a Gleason index of 10 points, even with treatment, the chance of recurrence is very high. The operation at the last stage is carried out only as part of the provision of palliative care, but in practice it is rarely performed, since it reduces the quality of life. With timely treatment, it is possible to slow down the growth of the tumor.

This type of cancer has large abnormal cells that affect the connective tissue.

The Gleason classification of prostate cancer dates back to 1974. Then, for the first time in history, its author formulated the principles that determine the aggressiveness and complexity of a prostate tumor.

When predicting, not only the indicators obtained during the histological examination are taken into account, but also the level of PSA. The latter, when determined before the verification of the diagnosis, is called prediagnostic. It shows how much the tumor has progressed until it was discovered.

It has been established that the higher the pre-diagnostic PSA level, the higher the Gleason score. Therefore, these two indicators together make it possible to predict how sensitive it will be to various methods of influence.