This may have been discussed on the site before, if so please let me know.
The Gleason score as a means to stratify PCa Risk is dead. This research paper and its conclusions are startling and enlightening for all. Published in 2015 I am very surprised that more is not being made of this.
The study sought to validate and cross reference a Cambridge based study to one done in Stockholm. The study cohort mostly focussed on pT2, pT3a, pT3b staging accross G3+3, G3+4, G4+3 and G3+5 with only 2 G4+5's, they were all RP/Surgical samples and incorporated Positive Margin and Extra Capsular cases. Aggressiveness is measured in time to biochemical relapse (they have some neet graphs). They identified 100 genetic markers and clustered them into 5 groups with different outcomes. The groupings are made on the basis of genetic copy and transcript error rates within the Prostatic DNA.
They found that Gleason 3+3, 3+4, 4+3 and 3+5 were distributed accross all five iCluster risk categories some of those iClusters being much more aggressive than others. As you know Gleason is based on the cell architecture seen under a microscope. Gleason is a crap shoot and no indicator of aggressiveness and survival rates for PCa sufferers. New risk scale needed urgently, this should be in trial stages and a new charter for anyone undertaking AS;
1) Only for patients whoes biopy material has undergone genetic screening (see above)
2) 3 monthly PSA checks
2) mpMRI 12 monthly or event driven
4) etc ....
Edited by member 14 Sep 2018 at 17:09
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