Understanding how the Gleason pattern score and grade group impact the outcome and treatment of prostate cancer

1. Gleason Score in Prostate Cancer

2. www.aboutcancer.com
http://aboutcancer.com/videos.htm
https://www.youtube.com/user/robertmillermd/playlists

3. How Serious is Prostate Cancer?
1. How advanced (stage based on the size
and location of the tumor and possible
spread to nodes or distant sites)
2. How much cancer (how high is the PSA
blood test)
3. How malignant or mutated are the
cancer cells (the grade or Gleason
Score)
Anatomy (where and how advanced)
and Biology (how dangerous are the
cells)

4. Gleason Grade (or Pattern): a number from 1 to 5 based on how mutated
the cells look under the microscope
Gleason Score: grading at least two areas of the tumor and adding the
numbers together, so score of 2 (1+1) to a maximum of 10 (5+5)
Grade Group: putting the Gleason grade and score into one of five
groups
Confused about Gleason?

5. Malignant Prostate Cells
All cancer starts as a normal cell that mutates and becomes
malignant

6. For years, the biology of cancer cells has been
estimated by Pathologists looking at the cells
under a microscope and describing how
mutated the cells look (called the grade)
compared to normal cells.
Eventually this will be replaced by genetic
analysis.
Traditional way to classify malignant
cells.

7. Prostate Cancer Cure Rate After Radical
Prostatectomy Based on Pathologic Grade
(i.e. how mutated the cancer cells appear)
Cure Rate after Surgery by Grade

9. Gleason Grade and Scoring System
From the biopsy, the pathologist grades the appearance of the cells. From
least serious (slow growing or Grade 1) to the fastest growing and most
dangerous or grade 5).
The first number is the most common pattern seen from 1 to 5

10. Gleason Grade and Scoring System
The second number is the next most common pattern seen. Then they add the
two numbers, to get the Gleason Score (e.g. 3+3 or 4+3, etc.)

11. Gleason Grade and Scoring System
So a 4+3 is more serious than 3+4 even though they both are Gleason 7.
(Since the first number represents the most common pattern).
So the slowest growing cancer has a score of 2 and the fastest (most
dangerous) is a score of 10.

12. 50
55
60
65
70
75
80
85
90
95
6 7 8
5 Year
Survival
10 Year
Survival
The higher the Gleason Score, the lower
the cure rates after surgery

13. 60
65
70
75
80
85
90
95
3+3 3+4 4+4 4+5 5+5
5 year cure rate radiation
radiation plus hormones
The higher the Gleason Score, the lower
the cure rates after radiation
Adding hormone
therapy (e.g. Lupron)
improves the
outcome with
radiation esp. for
High Gleason
cancers

14. Gleason Grade (or Pattern): a number from 1 to 5 based on how mutated
the cells look under the microscope
Gleason Score: grading at least two areas of the tumor and adding the
numbers together, so score of 2 (1+1) to a maximum of 10 (5+5)
Grade Group: putting the Gleason grade and score into one of five
groups
Confused about Gleason?

15. Gleason Pattern leads to Gleason Score and now Grade Group
Gleason Pattern Gleason Score Grade Group
3+3 6 1
3+4 7 2
4+3 7 3
4+4 (5+3) 8 4
4+5 or 5+5 9, 10 5

16. 0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
Group 1 Group 2 Group 3 Group 4 Group 5
Relapse Free Rate at 5 Years after
Surgery
Based on Grade Groups
Eur Urol 2016 Mar;69(3):428-35.
The larger the Group Number the more Serious the Cancer
The larger the group
number, the lower the
cure rate

17. The AJCC Prognostic Groups now includes Grade Group
Need to know the
grade group to
complete the
stage

18. The NCCN Risk Groups also are
also based on the Gleason Grade
Group.
The more high risk, the more
important is treatment.

19. Knowing the Gleason Score Prior to Treatment
1.Will predict the risk that the cancer has
already spread (to other structures of lymph
nodes)
2.Will predict the risk of a relapse (either PSA
relapse or actual spread to bone)
3.Will predict the risk of ever dying of prostate
cancer

20. aboutcancer.com/medical_calculators
You can go on line and plug in the PSA or
Gleason and see what the likelihood of
spread or relapse would be

21. Assuming a 60 yo man with 3 + biopsies and a PSA of 6
Estimated Probability of the Results of Surgery Based on Gleason
Gleason Score 3+3 4+3 4+4
Organ confined disease 40% 24% 17%
Extra capsular spread 60% 74% 81%
Lymph Node spread 3% 15% 27%
Seminal Vesicle invasion 3% 12% 23%
Using the Gleason Score to Predict the Outcome of Surgery

22. http://urology.jhu.edu/prostate/resources3.php
Calculate the risk of a PSA relapse by 10 Years for T2a Patient
Gleason PSA 4-10 PSA 10-20 PSA
>20
6 2% 13% 25%
7 (3+4) 4% 21% 35%
7 (4+3) 8% 26% 47%
8-10 37% 37% 61%

23. Calculate the Risk of a Relapse (PSA recurrence) after surgery and the
Risk of Dying of Prostate Cancer
Assume 60 yo man, PSA 10, path only extra-capsular extension)
Gleason Relapse Rate by 10 Years Dying of Prostate Cancer by
15 Years
3+3 13% 1%
3+4 24% 2%
4+3 53% 3%
4+4 71% 8%

24. Calculate the Risk of a Relapse (PSA recurrence) after surgery and the
Risk of Dying of Prostate Cancer
Assume 60 yo man, PSA 25, path only extra-capsular extension)
Gleason Relapse Rate by 10 Years Dying of Prostate Cancer by
15 Years
3+3 21% (13%) 1%
3+4 37% (24%) 2%
4+3 66% (53%) 3%
4+4 80% (71%) 8%

25. Calculate the Risk of a Relapse (PSA recurrence) after surgery and the
Risk of Dying of Prostate Cancer
Assume 60 yo man, PSA 25, path: extra-capsular extension, also
seminal vesicle invasion and lymph node spread
Gleason Dying of Prostate Cancer by 15 Years
3+3 2% (1%)
3+4 7% (2%)
4+3 12% (3%)
4+4 36% (8%)

26. Genomic test evaluates the activity of genes in
the tumor that are shown to be involved in the
development and progression of prostate cancer.

27. Decipher Biopsy

29. Development and
Validation of a Novel
Integrated Clinical-
Genomic Risk Group
Classification for
Localized Prostate Cancer
New scoring system
that combined the
NNCN with Decipher
Score
Spratt Journal of Clinical
Oncology 36, no. 6, 2018

30. Development and
Validation of a Novel
Integrated Clinical-
Genomic Risk Group
Classification for
Localized Prostate Cancer
New scoring system
that combined the
NNCN with Decipher
Score
Spratt Journal of Clinical
Oncology 36, no. 6, 2018

31. Risk of Prostate Specific Mortality
using Combined System
10 Year Risk of Mortality
Low Risk
2%
Intermediate 10.7%
High Risk
27.3%
Spratt Journal of Clinical
Oncology 36, no. 6, 2018

32. How Serious is Prostate Cancer?
1. How advanced (stage based on the size
and location of the tumor and possible
spread to nodes or distant sites)
2. How much cancer (how high is the PSA
blood test)
3. How malignant or mutated are the
cancer cells (the grade or Gleason
Score) or the Genetic Analysis
(Genomics)
Anatomy (where and how advanced)
and Biology (how dangerous are the
cells)
Cancer Genetics

33. www.aboutcancer.com
http://aboutcancer.com/videos.htm
https://www.youtube.com/user/robertmillermd/playlists