A Gleason Score of 7 is often looked at as a middle range score, but clearly not as serious as an 8 or 9 score. Some recently combined research performed at the Department of Urology, University of Washington School of Public Health, Seattle, Washington and the Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washingtontook another look at that middle score of Gleason 7 and determined that not all 7s are the same.
They studied the different Gleason patterns as it pertains to prostate cancer specific mortality. Specifically,they evaluated the differences of the prostate specific mortality outcomes between the Gleason 7 scores of 4+3 vs. 3+4.
Their research sample consisted of men between 40 to 64 years old who were diagnosed with prostate cancer between the years of 1993 and 1996 in King County, Washington. They evaluated the recurrence/progression rates by using a follow-up survey and a medical record review. The mortality numbers and the cause of death were obtained from the Seattle-Puget Sound Surveillance, Epidemiology and End Results registry. Statistical analysis was by Cox proportional hazards regression analysis.
In the sample of 753 men with prostate cancer, 65 prostate cancer specific deaths occurred during a median follow-up of 13.2 years. The 10-year prostate cancer specific survival rate for men with a Gleason 6 or less, 3 + 4, 4 + 3 and 8-10 disease was 98.4%, 92.1%, 76.5% and 69.9%, respectively. Compared to patients with Gleason 3 + 4 disease those with Gleason 4 + 3 tumors were at increased risk for prostate cancer specific mortality in the unadjusted and multivariate models (HR 2.80, 95% CI 1.26-6.18 and HR 2.12, 95% CI 0.87-5.17, respectively).
In men undergoing curative therapy with radical prostatectomy or radiation therapy there was an increased risk of recurrence/progression (HR 2.1, 95% CI 1.08-4.08) and prostate cancer specific mortality (HR 3.17, 95% CI 1.04-9.67) in those with Gleason 4 + 3 vs 3 + 4 tumors in the multivariate models. No difference in prostate cancer specific mortality was seen between Gleason 4 + 3 and 8-10 tumors.
The bottom line was that a Gleason 7 prostate cancer shows different mortality results with Gleason 3 + 4 and 4 + 3. Mortality rates for Gleason scores of 3+4 are similar to Gleason 3+3 scores while Gleason 4+3 are similar to the more aggressive Gleason 8 scores.
These data provide important information for counseling patients with Gleason 7 prostate cancer on the natural history of the disease and may inform treatment decisions.
J Urol. 2009 Oct 15. Epub ahead of print.
doi:10.1016/j.juro.2009.08.026, Wright JL, Salinas CA, Lin DW, Kolb S, Koopmeiners J, Feng Z, Stanford JL.
Joel T Nowak MA, MSW
Pca effects approximately 1 out of 5 males. We just passed prostate cancer awareness month but that shouldn’t stop everyone over 40 from getting check out.
Thanks for setting up your website. You give us hope when we look at your cancer struggle. My mom had cancer of the vulva, my Dad prostate cancer and my brother died at 67 with acute myeloid leukemia). I have had two bladder cancer operations in the last three months with the last Dec 28th. Superficial both times but high and medium grade cells and papillary and sessile tumors. In the last operation they did a biopsy of the prostate and found cancer Gleason grade (4+3). I’m 69 but in good health otherwise. Thinking about getting a second opinion as my doc wants to wait until April to do an ultrasound on the new cancer. Any thoughts or recommendations on timing of treatment. He wants me to heal first.
Larry, Sorry to hear about your cancer experience. But, I am happy that you are otherwise in good health.. Despite having dealt with 5 primary cancers I too consider myself a healthy man who will be around in this world for a good long time. I would definitely get a second opinion, but find a prostate cancer specialists. I have a different doc for each cancer, but I make sure they talk when it is necessary. With prostate cancer you should be having an MRI and bone scan at this point and not an ultrasound. You should have these tests now, your healing from the bladder cancer treatment should not delay these tests. Remember, I am not a doctor, just an educated advocate so rely on what your doctor tells you (but do get a second opinion as I suggested)- Joel