Prostate Cancer and Gleason Score or Group Video
Pertinent to those interested in urology, a central example in the article is prostatic adenocarcinoma. One simple answer to this question is that to a small extent, a subgroup of prostatic lesions has already been reclassified as not cancer: In current practice, needle biopsy or radical prostatectomy specimens with an overall Gleason score GS of 5 or less are now quite rare in current Gleason 6 della prostata.
This shift is due in part to modern updates to the Gleason 6 della prostata grading system , under which many Gleason 6 della prostata now reach thresholds for GS6 or above. However, at least some lesions previously considered adenocarcinoma with a low overall GS would now be categorized as atypical adenomatous hyperplasia or adenosis in the era of immunohistochemistry for markers of prostatic basal cells. Nonetheless, the current and more controversial debate surrounds whether some or all?
Arguments against removing the cancer designation from some prostatic adenocarcinomas:. These similarities are not limited exclusively to the microscopic appearance but also include a number of immunohistochemical and molecular features, as summarized in a recent article addressing this question . Therefore, no pathologic features are as yet defined that ideally predict whether Gleason pattern 3 glands in a biopsy specimen represent a pure GS6 tumor or a component of higher-grade tumor in which the high-grade component is not represented.
Not surprisingly, it is not unusual for tumors Gleason 6 della prostata GS6 on needle biopsy to be upgraded to GS7 at radical prostatectomy , particularly when a high tumor volume is present in the needle Gleason 6 della prostata.
Gleason pattern 3 glands from a GS7 tumor, identical to those of a GS6 tumor. To compare to other cancers with low risk of aggressive behavior, Gleason 6 della prostata cell carcinoma and squamous cell carcinoma of the skin similarly show locally infiltrative properties, supporting their classification as carcinomas by a classical pathologic definition. In the same way, Gleason pattern 3 glands exhibit infiltrative growth by extending between benign glands, invading nerves, and sometimes extending outside of the prostate.
This small GS6 adenocarcinoma was an incidental finding in a radical cystoprostatectomy specimen for bladder cancer but surprisingly extended into periprostatic fat via this focus of perineural invasion.
Supporting removal of the cancer designation from some prostatic adenocarcinomas:. A valid argument of Gleason 6 della prostata NCI Viewpoint is that a neoplasm should have Gleason 6 della prostata substantive rate of progression and patient death if it is to be considered a cancer.
Likewise, others have questioned whether low-volume GS6 tumors fulfill other molecular and pathogeneti c hallmarks of cancer, such as unlimited replicative potential and other features . In general, benign and malignant neoplasms can Gleason 6 della prostata regarded as having some prototypical gross and microscopic pathologic Gleason 6 della prostata, such as a circumscribed vs infiltrative growth and homogeneous vs pleomorphic Gleason 6 della prostata population.
However, differentiating benign from malignant lesions also relies heavily on parameters specific to the organ involved. Clear cell renal cell carcinoma, another genitourinary tract tumor, often does not possess these prototypical features of malignancy. However, based on known behavior of these tumors, their status as a malignancy is not in doubt. Conversely, renal oncocytoma is a benign neoplasm that shares some of these general features a round mass composed of a homogeneous population of renal tubular cells.
Occasionally oncocytomas appear infiltrative by extending into the perinephric fat or renal vein, yet their status as benign is also not the subject of debate. If some prostate cancers do not have a substantial likelihood of resulting in progression and death, they may not meet an important criterion for a diagnosis of cancer, despite Gleason 6 della prostata other features, such as infiltration of tissues, invasion of nerves, and loss Gleason 6 della prostata the basal cell layer are characteristic of a malignant neoplasm.
If based on tumor volume, it would be difficult to conceptualize that a small amount of GS6 glands would be regarded as a benign lesion, whereas a large amount of identical glands would represent a malignant lesion. Alternatively, the presence of Gleason pattern 4 could used as the point of differentiation GS7 or above.
In the endometrium, a disorganized proliferation of crowded glands with some cytologic features of cancer is regarded as complex atypical hyperplasia. Diagnosis of adenocarcinoma is then reserved for proliferations with a confluent growth of these glands, similar to the threshold for recognizing a component of cribriform glands as Gleason pattern 4.
A limitation to such an approach, however, is that a substantial fraction of patients with a needle biopsy GS6 are upgraded to GS7 at radical prostatectomy, as discussed above. Likewise, the ability to treat and monitor GS6 adenocarcinoma nonsurgically is not quite analogous to that of endometrial hyperplasia. Higher magnification of image 2 shows Gleason pattern 3 glands invading a nerve with ganglion cells. Its status as a risk factor for a future cancer even remains debated. However, would recognizing the status of these lesions as at least premalignant neoplasms be more appropriate?
Likely a typographical error in the Viewpoint is that the authors also cite reclassification of urothelial papilloma as papillary urothelial neoplasm of low malignant potential .
Gleason 6 della prostata J Surg Pathol. Gleason score 6 adenocarcinoma: should it be labeled as cancer? J Clin Oncol. Cancer statistics, CA Cancer J Clin. Do low-grade and low-volume prostate cancers bear the hallmarks of malignancy? Lancet Oncol. Please note that all submitted comments will be reviewed by the BJUI Web Team before they are considered for publishing on the site.
Comments may take up to 48 hours to go live. If you have made a comment which has not appeared live after this time and you wish to discuss this matter Gleason 6 della prostata, please contact us. Is Gleason 6 really cancer? Rate this article:. David Bouchier-Hayes August 16, at am. As we are seeing with patients on Active Surveillance, a 'pussycat' Gleason 6 not infrequently becomes a much more worrisome tumour as discussed extremely well in the blog on repeat biopsy.
Until our methods of diagnosis are more accurate, this will always remain our stumbling point. Perhaps it is time to redefine Gleason 6 della prostata 1 and 2, so that they can be diagnosed on a needle biopsy. This large jump in potential lethality inherently feels incorrect to me. Although not based on epidemiological studies, I dread the day that I have to tell a patient that he has metastatic prostate cancer, and needs chemical castration, having told him a number of years earlier that the Gleason 6 disease I found was not defined as cancer any more, and he had nothing to worry about!
Jeremy Grummet August 17, Gleason 6 della prostata pm. Technically speaking, Gleason 6 is cancer. We are currently faced with the potential of losing PSA testing as a means of finding aggressive prostate cancers while still curable. The strongest argument against PSA testing is the gross overtreatment of harmless low risk disease that has gone on and continues to go on. So if a way of stopping this overtreatment is to re-label Gleason 6 as benign disease, or preferably as Gleason 6 della prostata, then I am strongly in favour.
Concerns over upgrading at radical prostatectomy are overstated. There are indeed upgrades to high risk disease also, which are truly concerning. But these are a result of inadequate biopsy, rather than the finding of Gleason 6 on biopsy. Our biopsy techniques clearly need refinement, which is now occurring through multiparametric MRI and transperineal biopsy - refinements that are likely to become standard of care in the years ahead.
So I'd argue that if you can't find Gleason 7 or higher on a biopsy unless it's clearly high volume Gleason 6don't undertake curative treatment. If you're still worried your patient is harbouring something sinister, get an MRI with an expert radiologist and do a transperineal biopsy.
Better still, do this first and save your patient the inaccuracies of a standard TRUS biopsy, along with the risk of septicaemia - far more life-threatening than Gleason 6 disease!
In calling Gleason 6 pre-malignant, I would argue that we are far more likely to succeed in undertaking active surveillance in the vast majority of these low risk patients. If we do, we strengthen the argument to continue PSA testing, so that we can continue to find and treat those men who do truly have harmful disease. Sorry DBH, I disagree! Andrew Ryan drandrewryan August 19, at am. As a pathologist, I would strongly argue for sticking with clear objective disease terminology.
At the risk of sounding dogmatic, I believe invasion is cancer. Maybe it is the complete lack of any intervention that is the problem in low grade prostate cancer. Don't get me wrong, I'm all for improved risk stratification in prostate cancer but I believe the bulk of the work needs to be done in the pre-biopsy and post-biopsy stages with improved patient selection, more accurate sampling techniques, better risk stratification and improved patient and population education.
Amrith Rao August 19, at pm. Dr Williamson should be congratulated for initiating this debate. I would like to raise a few queries that may further fuel the debate.
What is the inter- and intra- observer variation with regards to Gleason 6 cancers? We do know from the older series that radical prostatectomies was performed and indeed external beam radiotherapy were delivered for Gleason 1 and 2 cancers. According to the current consensus, was it really cancer that was treated?! The reason why I raise this is whether we may be discussing in a decade's time that we treated Gl 3 cancer that would be branded not cancerous?! I strongly support the views of Dr Ryan about the medico-legal implications of re-branding the terminology.
What is important is the need for better counselling skills by the physicians in reassuring the patient. Warm Regards. Ronald E. Wheeler, M. December 15, at pm. The suggestion that a Gleason Score GS of 6 is not a cancer would be a dramatic setback to a profession where progress has been limited in recent decades. Making such a change while inappropriate in my professional Gleason 6 della prostata, would also confuse the non-medical unwitting public at large.
Presently men with a GS Gleason 6 della prostata 6 have a chance to avoid significant side effects by avoiding caustic radiation or radical surgery while learning to live with prostate cancer much like patients live with Diabetes. It is well noted that dietary and nutritional lifestyle changes assist an active surveillance AS or chronic disease management CDM protocol benefitting the patient.
On the other hand, many men with a GS of 6 have significant cancer where a progressively rising Prostate Specific Antigen PSA value signals a much more aggressive cancer than that predicted by the designation of a GS 6. These are cancers that should be treated as they put patient lives in jeopardy. Michael Barry, M. Unfortunately a biopsy based diagnosis without adequate imaging cannot identify the population who should be able to avoid definitive Gleason 6 della prostata by virtue of minimal disease.
To be sure, biopsies often miss cancer altogether even with a rising PSA. Therefore, a GS 6 cancer should not lose its cancer identity or designation but moreover magnetic resonance imaging MRI is the only way to state unequivocally the extent of disease allowing men improved confidence in avoiding unnecessary treatment while protecting quality of life altering issues like impotency and incontinence commonly experienced when aggressive treatments like radiation and radical prostatectomy are performed.
We owe to our patients to avoid unnecessary confusion in an otherwise contentious discussion arena. Changing the cancer nomenclature does just that; so therefore it should be avoided. Respectfully submitted. David Berman March 23, at pm. Outstanding review by Dr.