Originally Posted by: Online Community Member Adrian
Thank you very much for taking the time to reply with some very helpful information. I think your post also confirms what I had previously suspected, namely that my G9 if caught earlier could have been a G7.
Rory
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Generally speaking, no - the prostate cancer doesn't evolve over time from a G3+3 to a G3+4 and then a G4+3, G4+4, etc. Most men with a G4+3 cancer at biopsy will still have a G4+3 when they die. What might happen is that the G3+3 also had a small number of 4s which weren't picked up at diagnosis but which will replicate faster than the 3s over time. This is most significant when a man is diagnosed with a G3+4 or perhaps a G4+3 (or whatever) but the lab also spots a tiny number of pattern 5s - in this case, the biopsy result would be given as G3+4 (tertiary 5) and the approach of the medical staff will take that tertiary 5 into account because of the risk of it replicating quickly.
If you had been diagnosed earlier, you might have been told (wrongly) that you were a G7 because that was all they could see in the samples, but you would have had some 5s in there already.
There are other things that can cause the Gleason grade to appear to change over time. In rare cases, a man can develop a second prostate cancer unrelated to the first (for example, in the left side of the gland having already had RT to the right side) and, because this is unrelated to the first cancer, it can have a completely different Gleason pattern. Also (fortunately even more rarely), the first diagnosis is of adenocarcinoma but the man then develops (or already has but it was not picked up in the biopsy) a rare type such as small cell or mucinous PCa with a different Gleason grade. A few years ago, we had a member here diagnosed with adenocarcinoma in his prostate but small cell PCa in his bones
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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