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Gleason is dead ...

User
Posted 14 Sep 2018 at 14:49

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 ....

Fresh

Edited by member 14 Sep 2018 at 17:09  | Reason: Not specified

Base jumping without a parachute should be frowned at, never criticised. Fresh

User
Posted 14 Sep 2018 at 14:49

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 ....

Fresh

Edited by member 14 Sep 2018 at 17:09  | Reason: Not specified

Base jumping without a parachute should be frowned at, never criticised. Fresh

User
Posted 14 Sep 2018 at 16:11
Not new news - PCUK has been involved in funding research at the main PCa centres for a few years now, looking for techniques to identify which are the pussycats and which are the tigers. Until they have it nailed, Gleason remains a good indicator of risk but not the only indicator.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

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User
Posted 14 Sep 2018 at 16:11
Not new news - PCUK has been involved in funding research at the main PCa centres for a few years now, looking for techniques to identify which are the pussycats and which are the tigers. Until they have it nailed, Gleason remains a good indicator of risk but not the only indicator.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 14 Sep 2018 at 17:04

where Lyn?. This test proves Gleason, excluding G5 (not enough data) and differentiates well on G3/4 is no good at all. It could not be implemented in trial unless tissue is being harvested. This is not the same as determining the likelyhood of getting PCa (I have already discussed bio markers trials at UCLH with researchers) its stratifying PCa aggressiveness based on science not patterns and for the first time establishing a dna driven scale for risk. Properly. Post operative prostates are no good. They have been preserved.

PSADT by itself is more useful than Gleason. Can’t load images in this website - needs improving. See my new image.

Fresh

Edited by member 14 Sep 2018 at 17:08  | Reason: Not specified

Base jumping without a parachute should be frowned at, never criticised. Fresh

User
Posted 14 Sep 2018 at 17:23

Originally Posted by: Online Community Member

Can’t load images in this website - needs improving.

Fresh

The whole thing is very poor. The search function is not intuitive, lengthy posts are lost between sending and appearing on-line, it is difficult to follow threads one has contributed to.

When typing it is sometimes awkward to correct things, hyper-links are impossible in members’ profiles and from first draughts of posts - they have to be edited. The comments page sometimes locks up, and what has been written is lost.

I only use an iPad for this site, and it seems the community board has not been fully optimised for that device as there are loads of frustrations involved when trying to submit posts. As if we haven’t got enough to worry about, coping with cancer!

Why do PCUK seem to have developed their own clunky bulletin board programme when off-the-shelf alternatives like Ultimate Bulletin Board and its more advanced successors are readily available?

MacMillan is even worse!

Cheers, John

Edited by member 14 Sep 2018 at 18:23  | Reason: Not specified

User
Posted 29 Mar 2021 at 13:57

If anyone is still watching this thread, can they please set a beginner right on old Gleason.

I gather the cells are graded with two numbers from 1(normal) to 5(very abnormal). The first number is the most common grade, the second is the highest grade visible in the sample. This means the second number is always greater than or possibly equal to the first. The two numbers are added to produce the total.

The Macmillan blurb on Gleason then remarks that a score of 7 might be 3 plus 4, or 4 plus 3. But that must be wrong. A score of 4 plus 3 means the highest (3) is less than the most common (4) which is a direct contradiction.

I can't believe they would make a simple error like that, so it must be me. Where did I go wrong?

Edited by member 30 Mar 2021 at 18:16  | Reason: Mistyping

User
Posted 29 Mar 2021 at 14:05
The first number is the most prevalent grading observed, the second number is the second most prevalent observed. So in a G3+4, the majority of cells were moderately differentiated but there were also observed cells which were at a higher grade. In a G4+3, the majority of cells were of the higher grade but the samples also observed cells which were of the lower grade.

The exception to this would be if any G5 was observed but was only tiny - in this case, the patient would be given a Gleason score of G7 (3+4) (tertiary 5) to flag up to medics that although the majority of cells were a 3 and the next most common pattern was 4, there are also some 5s which increases the risk significantly.

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

User
Posted 30 Mar 2021 at 18:26
Thanks, Lyn. I dare say the professionals can work with that - and you also - but I find it difficult to follow.

Since I am not a histologist I suppose that doesn't matter, but the Macmillan description seems simplified to the edge of deception.

User
Posted 30 Mar 2021 at 19:39
I think that Macmillan just hasn't been very clear with their language- what they should have said is "highest grade of what is left"

There is a better explanation on the PCUK website.

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

User
Posted 31 Mar 2021 at 01:23
Incidentally, to revert to what Fresh the OP suggested, Gleason score is still used in many cases so not dead yet if wounded!
Barry
 
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