Deciding on the appropriate treatment decision is a very difficult time for men newly diagnosed with prostate cancer. They are worried that if they make the wrong decision that the cancer will progress. Analysis of a new factor as part of the Gleason score may help men and their doctors decide if they need more aggressive treatment. US News& World Report has an article that discusses a new report in the Journal of the American Medical Association (JAMA). They say:

“The less it looks like normal tissue, the more aggressive [the cancer] is,” Patel explained. They then add up the two numbers to arrive at a Gleason score. A score of 7 calls for treatment such as radiation therapy, Patel said, while higher scores indicate an even more dangerous tumor.

In the new study, the Brigham and Women’s team looked for a third pattern of disorder from another part of the samples. Such disorderly patterns are found in about 5 percent of cases but usually are ignored. The new report included that third pattern in the diagnostic process……

The time to what physicians call “PSA failure” averaged five years in these men, compared to 6.7 years in men with a Gleason score of 7 but no disorderly third pattern. In fact, the failure time for men with a Gleason score of 7 and the third pattern of disorderly cells was the same as for men whose cancers had a Gleason score of 8 or greater.

The results and conclusions from the JAMA abstract are:

Results Men with Gleason score 7 and tertiary grade 5 disease had a significantly shorter time to PSA failure than men with 7 without tertiary grade 5 (median time, 5.0 vs 6.7 years, respectively; adjusted hazard ratio (HR), 0.56; 95% confidence interval [CI], 0.32-0.97; P = .04) or score of 6 or less (median time, 15.4 years; adjusted HR, 0.24; 95% CI, 0.13-0.43; P < .001). However, a significant difference was not observed when these men were compared with men with Gleason score 8 to 10 disease (median time, 5.1 years; adjusted HR, 0.96; 95% CI, 0.54-1.71; P = .90).

Conclusion In this study population, men with prostate cancer having biopsy Gleason score 7 and tertiary grade 5 had a higher risk of PSA-failure when compared with men with Gleason score 7 without tertiary grade 5 and had a comparable risk with men with Gleason score 8 to 10.

To read the US News& World Report article click here.

To read the JAMA abstract click here.