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Relationship between Gleason score and PSA

User
Posted 02 Jan 2023 at 20:41
User
Posted 02 Jan 2023 at 20:41
User
Posted 06 Dec 2023 at 06:27

The Gleason score and prostate-specific antigen (PSA) level are two important indicators used in the assessment of prostate cancer, providing complementary information about the disease.

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User
Posted 03 Jan 2023 at 02:51

Wow difference between G4 and G3 is surprising.

Dave

User
Posted 03 Jan 2023 at 08:58
Explains why I had a large t3 tumour but a PSA of 4.8??

Doesn't explain why some high G tumours are low PSA producing?

User
Posted 03 Jan 2023 at 09:00
It doesn't say anything in the extract but presumably almost all of the samples were adenocarcinoma?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 03 Jan 2023 at 15:33

A much higher PSA than can be accounted for from biopsy results can set alarm bells ringing. That was my case: biopsy G3 with a tiny amount of G4, but a PSA of 32. Conclusion: a strong suspicion of undetectable spread ("micro mets"). Recommendation: whole pelvic RT to zap said postulated but unseen nasties.

Chris

Edited by member 03 Jan 2023 at 15:37  | Reason: Not specified

User
Posted 06 Dec 2023 at 06:27

The Gleason score and prostate-specific antigen (PSA) level are two important indicators used in the assessment of prostate cancer, providing complementary information about the disease.

User
Posted 06 Dec 2023 at 08:08

Originally Posted by: Online Community Member
Explains why I had a large t3 tumour but a PSA of 4.8??

Doesn't explain why some high G tumours are lom PSA producing?

Still can't fathom mine out PSA 5.6 Gleason 6 (3+3). 20 months later Gleason 8 (4+4) PSA only 6.6

User
Posted 06 Dec 2023 at 13:40

Originally Posted by: Online Community Member

Originally Posted by: Online Community Member
Explains why I had a large t3 tumour but a PSA of 4.8??

Doesn't explain why some high G tumours are lom PSA producing?

Still can't fathom mine out PSA 5.6 Gleason 6 (3+3). 20 months later Gleason 8 (4+4) PSA only 6.6

The roulette wheel of biopsies I'm afraid. No one really knows what they had unless the pathologist had the whole gland to look at!

User
Posted 06 Dec 2023 at 14:39
I had a PSA of 11.6 and a Gleason score of 5+5=10, that’s a low PSA for a maximum Gleason, locally advanced to Lymph nodes.
User
Posted 11 Jan 2024 at 17:52

NB the post below was related to a post by a new member which has since been deleted by the moderators. There are no concerns about the link Chris included in his first post.

Note to other members - don't click on the above links (2 are embedded but set out to look like one). Whatever studies there may have been on inverse correlation, this link doesn't take you to them :-(

Edited by member 13 Jan 2024 at 23:41  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 11 Jan 2024 at 20:26

Originally Posted by: Online Community Member
Note to other members - don't click on the above links (2 are embedded but set out to look like one). Whatever studies there may have been on inverse correlation, this link doesn't take you to them :-(

It seems to be getting more frequent on here. 

 

Edited by moderator 11 Jan 2024 at 23:00  | Reason: Not specified

User
Posted 11 Jan 2024 at 21:41

Originally Posted by: Online Community Member
Note to other members - don't click on the above links (2 are embedded but set out to look like one). Whatever studies there may have been on inverse correlation, this link doesn't take you to them :-(

Lyn , I did check the site before clicking the link, it did go to a medical journal site and an article about the merits or not, of using forums. As you say nothing to do with inverse correlation.

Thanks Chris 

User
Posted 13 Jan 2024 at 15:09

Good Chris,  I always enjoy a psa discussion.  I haven't clicked on your link due to the warnings but some time ago I posted a link from Practise Update with an analysis saying psa density rose with Gleason.   

I also did some calcs and decided the known size of my tumour pre-Op, 13mm dia, Gleason 4+4 seemed about right with psa =9.9 using perhaps 'convenient' assumptions.

More interestingly from that I did some calcs to work out how large my current tumour as of May23 might be with a psa of 0.09.  The article and my calcs are below although off hand I no longer fully understand the working.

 

Per cc
My tumour was said to be 13mm diameter pre-op. 

V=(4/3)πr3 

Pre operation my psa was 9.9 and gleason 4+4 and 13mm diameter.
Gleason 4 = 0.7  times 9,2  would be psa 6.4.  Plus what might be assumed a normal psa of around 3. Means my total calculated psa = 9.7 using the stated assumptions.   The actual value was 9.9.

...........................................................................................

Current lesion size(May 23).   Using the above calcs with my psa at May23 which is 0.09

I can't be certain of the Gleason.  But if still Gleason 4 the lesion could be 0.09/0.7=0.1286mm  

Or if Gleason 3 could be 0.09/0.11=0.8182mm i.e. bigger.

If benign could be 0.09/0.05=1.8mm i.e. bigger.

.............................................................................................

The article text:

OBJECTIVE 

To evaluate how blood levels of prostate-specific antigen (PSA) relate to prostate volume of benign tissue, Gleason pattern 3 (GP3) and Gleason pattern 4 (GP4) cancer. 

METHODS 

The cohort included 2209 consecutive men undergoing radical prostatectomy at 2 academic institutions with pT2N0, Grade Group 1-4 prostate cancer and an undetectable postoperative PSA. Volume of benign, GP3, and GP4 were estimated. The primary analysis evaluated the association between PSA and volume of each type of tissue using multivariable linear regression. R2, a measure of explained variation, was calculated using a multivariable model. 

RESULTS 

Estimated contribution to PSA was 0.04/0.06 ng/mL/cc for benign, 0.08/0.14 ng/mL/cc for GP3, and 0.62/0.80 ng/ml/cc for GP4 for the 2 independent cohorts, respectively. GP4 was associated with 6 to 8-fold more PSA per cc compared to GP3 and 15-fold higher compared to benign tissue. We did not observe a difference between PSA per cc for GP3 vs. benign tissue (P = 0.2). R2 decreased only slightly when removing age (0.006/0.018), volume of benign tissue (0.051/0.054) or GP3 (0.014/0.023) from the model. When GP4 was removed, R2 decreased 0.051/0.310. PSA density (PSA divided by prostate volume) was associated with volume of GP4 but not GP3, after adjustment for benign volume. 

CONCLUSION 

Gleason pattern 4 cancer contributes considerably more to PSA and PSA density per unit volume compared to GP3 and benign tissue. Contributions from GP3 and benign are similar. Further research should examine the utility of determining clinical management recommendations by absolute volume of GP4 rather than the ratio of GP3 to GP4. 

 

From <https://www.practiceupdate.com/content/contribution-of-gleason-pattern-4-prostate-tissue-to-blood-psa-levels/146431/55/3/1 

 

 

User
Posted 13 Jan 2024 at 19:42

Peter, a bit of confusion here. The link referred to by Lyn and mentioned in my most recent post was contained in a post that has been deleted, presumably by the moderators. 

The link in your post is to the same article as the link in my original post that was posted a year ago.

Thanks Chris 

Edited by member 13 Jan 2024 at 19:49  | Reason: Not specified

User
Posted 13 Jan 2024 at 21:44

Chris, Amusing, I hadn't noticed the year.  Although the calc that says a psa 0.09 lesion is about 0.1mm to 1.8mm for different Gleasons might be useful.  I'm not sure if a benign has more cells than a Gleason 4 as abnormal cells look larger.  Yet it gives off more psa for its size.

User
Posted 14 Jan 2024 at 09:00

Originally Posted by: Online Community Member

NB the post below was related to a post by a new member which has since been deleted by the moderators. There are no concerns about the link Chris included in his first post.

Note to other members - don't click on the above links (2 are embedded but set out to look like one). Whatever studies there may have been on inverse correlation, this link doesn't take you to them :-(

 

Lyn. Thanks for the additional note. I googled part of the link in the now deleted post and it came up with a legitimate medical website, although it didn't relate to my original post. The member who posted it has also posted a couple more posts including a new conversation with his own backstory.

I do often notice that new posts replying to old conversations are often from dubious sources and have links to dodgy sites.

Thanks Chris 

User
Posted 14 Jan 2024 at 09:03

WOW. The difference is astounding!!

Rory

User
Posted 14 Jan 2024 at 14:32

The full paper is available here without a paywall:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10515713/

I haven't read it yet, but I'll put it on my reading list. As someone with a PSA of 58 but 3+4, I may be an anomaly.

 
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