You are quite correct. Gleason scores are only ONE factor in the initial patient risk assessment. The other really important ones include: PSA level at the time of diagnosis; number of positive biopsy cores out of the total number taken; clinical stage of the cancer; and age of the patient. And we are just beginning to understand the significance of certain genetic and other more detailed fac tors.

D’Amico and colleagues, some years ago, were able to show that it was possible to accurately categorize patients with localized disease into three risk groups at the time of diagnosis (low risk, intermediate risk, and high risk), based on their Gleason score, their PSA level, and their clinical stage.

Do two cases with identical Gleason scores but with different PSA values (say 5.0 and 15.0) prior to a treatment give the same PSA recurrence probablity ?

I would think not.

Fuat INCE

The Duke study group did consider this, but they decided that the logistical complexity and the amount of time need to do this were “disproportionate compared to the potential advantages.”

In addition, although this is not evident from the abstract of the paper, Dr. Tsivian informed me that “we included a contemporary cohort to minimize variability in grading.” Pesumably this information appears in the full report on this study.

Finally, Dr. Tsivian believeds that, based on the current literature, “it seems that academic uro-pathologists (at least in the US) do not differ much in assigning Gleason scores” today.

And with respect to Oppenheimer’s opinion, please remember that these were patients who had been treated … not just low-risk patients who might or might not need treatment (dependent, for example, on their age and other factors).

Will Gleason grade 3 eventually go the way of Gleason grades 1 and 2?

Should we reconsider what Dr. Jonathan Oppenheimer had to say.