Gleason Score; What Does it Mean When it Comes to Prostate Cancer?

The Gleason score plays a major role in helping patients who have been diagnosed with prostate cancer determine their outlook and treatment plan.

After a doctor diagnoses prostate cancer, a biopsy of the cancer cells in the prostate will be done. The Gleason score is then used by the doctor to help explain the results, determine how aggressive the cancer is and to plan the best course of treatment.

What is a Gleason score?

The Gleason score is a grading system devised in the 1960s by a pathologist called Donald Gleason and it measures the progress of a cancer call from normal to tumorous.

Five decades ago Mr. Gleason discovered that cancerous cells fall into five different patterns; these patterns change from normal cells to tumorous cells. He determined that these patterns they could be scored on a scale of 1 to 5.

Low Gleason scores

Cells that score a 1 or 2 look similar to normal cells and are considered to be low-grade tumor cells.

High Gleason scores

Cells that score closest to 5 are considered high-grade. These have mutated so much that, in comparison to the low grade cells, they have mutated so much that they no longer look like normal cells.

How is the Gleason score worked out?

The results of a biopsy are used to determine the Gleason score. During a biopsy, the doctor takes tissue samples from different areas of the prostate. Because cancer is not always present in all parts of the prostate, several samples are taken.

Using a microscope to examine the samples, the doctor finds the two areas that have the most cancer cells and assigns the Gleason score to each of these separate areas. Each sample area is given a score of between 1 and 5. The scores are added together to give a combined score, often referred to as the Gleason sum. In most cases, the Gleason score is based on the two areas described above that make up most of the cancerous tissue. However, there are some exceptions to the way scores are worked out.

When a biopsy sample has either a great deal of high-grade cancer cells or shows three different types of grades, the Gleason score is then modified to reflect the prediction of how aggressive the cancer will be.

What do the results mean?

When a doctor tells a patient their Gleason score, it will be between 2 and 10. Although it is not always the case, generally the higher the score, the more aggressive the cancer tends to be. Typically, lower scores indicate less aggressive cancers.

In most cases, scores range between 6 and 10. When biopsy samples score 1 or 2 they are generally not used because they are not usually the predominant areas of cancer.

A Gleason score of 6 is usually the lowest score possible. Prostate cancer with a score of 6 is generally described as well-differentiated or low-grade. This indicates that the cancer is more likely to grow and spread slowly.

Scores between 8 and 10 are referred to as poorly differentiated or high-grade, and in these cases, the cancer is predicted to spread and grow quickly.

In some cases, a patient may receive multiple Gleason scores because the grade may vary between samples within the same tumor or between two or more tumors. In these instances, the doctor is likely to use the highest score as the guide for treatment.

UroNav Fusion Biopsy System Improves Prostate Cancer Detection and Treatment

A high-tech MRI-ultrasound imaging system can result in fewer biopsies and better treatment decisions for prostate cancer patients. Dr. Robert Gaertner and Dr. Christopher Knoedler are experts in the UroNav® fusion biopsy system and have this technology available for their patients.

UroNav is a unique technology that fuses images from magnetic resonance imaging (MRI) with ultrasound to create a detailed, 3-D view of the prostate. When physicians use this improved view, it helps them perform biopsies with much higher precision, and increases prostate cancer detection.

Many prostate cancer specialists feel that UroNav revolutionizes how they diagnose prostate cancer and make treatment decisions. Before UroNav was available, when prostate cancer was suspected due to results of a PSA blood test or digital rectal exam, a physician performed a prostate biopsy which typically involved sticking a needle into 12 different areas of the prostate. This traditional method can miss a tumor. Because of this fact, physicians were led to falsely conclude that either the patient didn’t have cancer, or they were forced to perform one or more additional biopsies to find the suspected tumor.

When this new fusion biopsy system is used, the patient undergoes a MRI exam before undergoing a biopsy. The MRI is used to detect and pinpoint lesions in the prostate that may be cancerous. The MR image is fused with ultrasound imaging in real time during the actual biopsy. The system employs GPS-type technology to let the doctor guide the biopsy needle directly to the exact lesions detected by the MRI, leading to significantly fewer needle biopsies.

This technology when compared with traditional biopsy techniques that randomly sample the prostate, is a vast improvement. It is instrumental in helping physicians detect hard-to-find and often aggressive prostate cancers and can help provide greater certainty regarding the extent and aggressiveness of the disease. In many cases it makes it possible for patients to avoid multiple and unnecessary repeat prostate biopsies.

Biopsies guided by MRI/ultrasound fusion will also enable physicians and patients to opt for active surveillance, instead of surgery when appropriate. When patients are put under active surveillance, they hold off on having surgery or radiation and instead undergo periodic digital rectal exams, PSA tests and ultrasounds to see whether the cancer is growing.

Surgery Seen as Superior to Radiation Therapy in Younger Men with High-risk Prostate Cancer, Study Finds

A recent study concluded that men under age 60 with high-risk prostate cancer who underwent radical prostatectomy; or surgery to remove all or part of the prostate; as an initial treatment, showed significantly improved overall survival at four years than those given radiation therapy.

Researchers used the National Cancer Database to analyze 16,944 high-risk prostate cancer patients, age 59 or younger, who had Gleason scores of 8 to 10 with no metastasis or nodal involvement. The study included data collected between 2004 and 2013.

Of the study population, 12,155 men had radical prostatectomy, and 4,789 had external beam radiation therapy (EBRT) — alone or in combination with brachytherapy — as a first therapy. In 82.5 percent of radiation-treated patients, hormone therapy was also used. Post-operative radiation therapy was given 17.2% of those who had a radical prostatectomy.

After a median 50-month follow-up, statistical modeling was used to determine differences in overall survival between the two groups, and found a significant 48 percent improvement in those who underwent surgery. The estimated survival rate at eight years was also higher in this group, 85.1 percent versus 74.9 percent, respectively.

“When a younger man has high-risk prostate cancer, it generally makes sense to choose surgery over radiation,” a prostate cancer surgeon and urologic oncologist said in a recent press release. “Radical prostatectomy has many advantages over radiation which include shorter recovery times, less pain, and from what this study is showing, the prostate cancer is removed with a higher cancer control and survival rate.”

The findings were presented at the 2017 American Society of Clinical Oncology Annual Meeting, which took place in Chicago in early June. The study was published in the Journal of Clinical Oncology, under the title “Survival impact of initial local therapy selection for men under 60 with high risk prostate cancer.”

It concluded: “Compared to RT [radiation therapy], initial treatment of men under 60 with high risk PCa [high-risk prostate cancer] with RP [radical prostatectomy] results in a large, statistically significant improvement in overall survival that remains consistent over time and remains significant in a multivariable model adjusting for known prognostic variables.”

Shortcomings noted by the study’s researchers included its retrospective nature as a database analysis, and a lack of cancer-specific survival information.

Social Media Is Helping To Support People Diagnosed With Cancer

The digital age has changed the way we live, the way we work and now it has also changed the way we view cancer. In addition to offering a world of information, the internet can offer hope, solace and support to cancer patients.

On Twitter, clicking a hashtag like #prostatecancer can instantly return thousands of people who are going through prostate cancer. It can also lead patients to helpful information about the latest treatments or clinical trials.

There are also Facebook groups that offer a safe haven for patients to share some of the thoughts and fears that they might not feel comfortable sharing with their family, friends, or even doctors.

Support groups whether in-person or online can also serve as passive places to read and digest other people’s experiences with cancer. Many patients benefit in the feeling that they are “not alone”.

A columnist for the Lymphoma News Today shared a story online about how the fellow lymphoma sufferers she met online have become her closest friends; so much so that they served as bridesmaids in her wedding. She told about how the strength she drew from online support helped her through the darkest times. She said that in her experience, social media became her safe haven.

In addition, blogs, YouTube channels, and Instagram accounts allow users to reach out to others with cancer in faraway places. Many patients report that they have made lasting friendships that endure way beyond their final rounds of chemotherapy or final cancer treatments. Social media has made a huge impact; becoming the 24-hour support group patients need. Patients are comforted when they can reach out and touch and be touched by people who truly understand what life with cancer is like.

Social media also empowers cancer sufferers to share their knowledge and empower themselves and others. Sharing knowledge through online outlets helps patients make informed decisions and be more proactive about their treatments. Today’s patients often bring up new treatment ideas with their doctor; vs. the not so distant past where they were more likely to wait for their doctor’s suggestions.

No increase for the risk of prostate cancer for men who undergo a vasectomy according to Mayo Clinic Study

According to Mayo Clinic researchers in a study published in July of 2017, published in the journal JAMA Internal Medicine, there is no association between vasectomy and any form of prostate cancer. The researchers who published the story were from the main Mayo Clinic in Rochester Minnesota.

In the past, studies about the association between vasectomy and prostate cancer have shown conflicting results.

A number of studies in the late 1980s and in the early 1990s suggested an association between vasectomy and the risk of prostate cancer. In recent years, some studies have reported an association and some have not; all this discrepancy has contributed to the debate over whether there is indeed a link.

The Mayo Clinic researchers conducted a comprehensive review of previous studies and did a meta-analysis to determine if a vasectomy is associated with any form of prostate cancer, including high-risk prostate cancer, advanced prostate cancer, and lethal prostate cancer. A meta-analysis covers the combined findings of multiple studies.

Several types of research, including cohort, case-control and cross-sectional studies were covered by the study.

The definition of a cohort study is one that covers people who share a common characteristic or experience in a particular period. A case-control study compares two groups whose disease outcomes are different to try to find a reason for the difference. A cross-sectional study looks at information about a population at a point in time.

The Mayo Clinic analysis included 16 cohort, 33 case-control, and four cross-sectional studies. Together, the 53 studies covered almost 14.7 million patients.

The researchers wrote: “Of these, seven cohort studies (44%), 26 case-control studies (79%), and all four cross-sectional studies were deemed to have a moderate to high risk” of biased findings.

When the team focused on studies they considered to have a low risk of bias, they found a week association between vasectomy and prostate cancer in seven cohort studies. They also found an insignificant association between the two elements in six case-control studies.

“The association between vasectomy and prostate cancer was stronger when studies with moderate to high risk of bias were included,” the team wrote.

Overall, the findings supported the notion that there is no association between vasectomy and high-grade, advanced-stage, or fatal prostate cancer.

The study concluded: “Although patients should be appropriately counseled, concerns about the risk of prostate cancer should not preclude clinicians from offering vasectomy to couples seeking long-term contraception.”

The How’s and Why’s of Prostate Cancer Recurrence

Why and how does prostate cancer return? It’s important to face your fears and learn the facts.

With an overall five-year survival rate of close to 98 percent, prostate cancer is considered one of the most “curable” forms of cancer. However, many men continue to have the fear that their cancer persists long after the cancer itself may be gone. It is human nature to wonder “What if it comes back?” Some research studies done have estimated that as many as 70 percent of cancer patients are plagued with anxiety over a relapse. Patients should discuss these feelings, deal with them, and have a conversation with their doctor about their risk level.

Risk Factors for Prostate Cancer Recurrence

Before patients start worrying they need to understand what their risk of recurring prostate cancer really is. According to the Prostate Cancer Foundation, about 90 percent of all prostate cancer cases are diagnosed in the local or regional stages, when the five-year survival rate is nearly 100 percent. The majority men will be cancer-free throughout that time and beyond. Around 20 to 30 percent of cases, the cancer will relapse after the five-year mark.

If prostate cancer does come back, it may return in (or close to) the site of the original cancer, which is called a local recurrence. The cancer may also show up in the bones or other distant places, which is called a metastasis.

Listed below are risk factors that can help determine if a man’s prostate cancer is likely to return:

• The stage of your cancer at diagnosis. The higher the stage of prostate cancer at diagnosis, the greater the likelihood of a recurrence.
• Where the cancer spread. If your prostate cancer spread to the lymph nodes, you may be at an increased risk of recurring prostate cancer.
• The tumor itself. The larger the tumor at diagnosis, the greater the risk of a prostate cancer recurrence.
• Your Gleason score. This system measures what type of cancer cells are in the tumor, and how aggressive they are. The higher the score, the greater the risk of prostate cancer recurrence.

At the time of the initial diagnosis there are also certain warning signs that the prostate cancer could recur. Doctors might find certain measures of aggressiveness during the biopsy that initially diagnoses prostate cancer, and these could indicate the likelihood of a recurrence. Very aggressive tumors have more tendency to recur.

If Prostate Cancer Returns There Are Treatment Options Available

The prostate cancer treatment that is best for you will depend on the treatment you first received to battle the cancer. Hormone therapy, radiation and chemotherapy are all options to treat recurring prostate cancer.

Dealing With Your Fear

Make sure to discuss your concerns about prostate cancer recurrence with your doctor. It’s important not to let fear and anxiety lead to depression and other emotional and mental health issues. Talking about your concerns and being educated on your risks and treatment options can help in preparing for what may happen.

Your Job; How it Can Be Affected by Prostate Cancer

Many patients are very concerned about keeping their job after receiving a prostate cancer diagnosis.

It can require quite a bit of time away from work once a patient is undergoing prostate cancer treatment. Money and health insurance are two pressing concerns for any patient during prostate cancer treatment, so how it will affect your job is an important consideration.

Prostate Cancer Diagnosis; What About Missing Work?

Whether you have surgery, hormone therapy or radiation treatment to treat prostate cancer, there will be side effects of each that may require you to miss work. Most patients need time off to have surgery and recover (anywhere from a week to more than a month), and radiation treatment appointments for prostate cancer may cause you to miss work regularly for a long period.

It is important to consider the options your employer offers to allow time off to take care of your health.

• FMLA. The Family and Medical Leave Act is a federal law that allows you up to 12 weeks off work, unpaid, to take care of a health condition. There are conditions to such leave: Your employer must have 50 or more employees, and you must be a full-time employee. You are also required to have been employed by the company for at least one year before you can take FMLA. Ask your employer if you qualify.
• Disability pay. Your employer may offer short-term or long-term disability, or your state government may provide it. These programs allow you to receive a certain percentage of your pay if you are unable to work because of a health condition. Ask your employer if any disability pay is offered through your benefits. Disability insurance policies can be bought independently; ask an insurance agent or a financial planner.
There will also need to be time devoted to managing health care bills and the paperwork relating to your prostate cancer treatment for insurance purposes. You will want track doctor’s visits, hospital visits, treatment dates, and medications that you’ve taken and received. Develop a good filing system so you can. Develop a good system to file all paperwork from your health care providers and your insurer.

Co-Workers May Be Glad To Lend Their Support

You may find that co-workers are a great source of support during and after prostate cancer, and you should tell them as much or as little about your situation and prognosis as you are comfortable with.

Keeping Up With Your Work During Prostate Cancer Treatment

It is a good idea to try to keep up with your work as much as you are able to while you’re out, or during your intermittent time out of the office. Try to talk to colleagues about handling some of your work, and make sure that meetings and deadlines aren’t missed while you’re gone; if possible, see if someone else can cover for you. Many patients also try making a to-do list of everything that you’re working on, so that your manager and co-workers are kept up to date.

If you can investigate the work-related benefits available to you early after your diagnosis can provide peace of mind. If you can keep the communication lines open at work you’ll feel more comfortable knowing that people are there for you.

Prostate Cancer: Coping With the Disease By Using Relaxation Techniques

It’s been proven that simple relaxation techniques can actually help ease the stress and anxiety of prostate cancer diagnosis and treatment.

Patients who have received a diagnosis of prostate cancer can feel stress, anxiety and even depression. It may seem overwhelming to deal with a diagnosis of prostate cancer, the treatments for it, and the side effects. These feelings are perfectly normal. Learning to manage that stress is can be an important positive step to managing your condition.

According to a recent study, easing stress prior to prostate cancer surgery could help speed up both physical and psychological recovery. Researchers followed more than 150 men and found that those who underwent stress management sessions prior to their treatment experienced higher immunity and improved mental health months after the operation.

If you feel like your stress and anxiety are completely out of hand, by all means talk with your doctor. But there are some simple steps you can take to help you feel more calm.

Learn Some Techniques to Help You Relax

Four great ways for patients to learn to help themselves are through relaxation, breathing, medication, and guided imagery. The beauty of these tools is that they can help you get through almost any kind of stress over and above medical issues. Meditation can help center a person and give them balance and a calm feeling. Prostate cancer patients have many ways to teach their bodies to relax and release stress.

• Guided imagery. When you feel stressed or anxious, try creating a picture in your mind of peace and calmness.

• Relax your muscles. This is an exercise you can do just about anywhere. Focus on your body then tighten and release the muscles section by section. Once you experience how different each sensation feels, you can become more aware of a relaxed feeling. Many people start by relaxing their toes and work up to their head and neck.

• Breathe slowly and deeply. Take a long, slow, deep breath in through your nose. Breathe in until your chest and lungs are full of air. Hold it and then after a second or two, slowly breathe out.

• Meditation. This is another exercise that you can do just about anywhere. Even while resting, walking, receiving treatment, or simply sitting in your doctor’s office. Clear your mind of all thoughts to relieve stress.

How These Relaxation Techniques Help Prostate Cancer Patients

There are physical health benefits that come as a result of alleviating stress. Reductions in stress can slow heart and breathing rates, lower blood pressure levels, reduce muscle tension, and increase blood flow in the muscles.

Patients who practice these relaxation methods are often:
• More energetic.
• Able to do more during the day.
• Experiencing less pain.
• Experiencing less anger.
• Better able to concentrate, problem-solve, and make decisions.

Prostate Cancer; When Watchful Waiting is the Answer

Patients are used to asking the question, “When do we starting treating it and what type of treatment will we use?”. But with prostate cancer in many cases the answer could be “We’re not going to treat it.” The “wait and see” approach may well be the right option for your prostate cancer.

Watchful Waiting/Active Surveillance

Also called “active surveillance” the term “watchful waiting” describes one way to “treat” prostate cancer. It is used to describe cases where the prostate cancer patient has opted to refuse surgery, radiation, hormone therapy, and any other medication to treat the prostate cancer. Instead of treatment doctors will rely on prostate-specific antigen (PSA) tests and digital rectal exams (DRE) to monitor disease progression. If and when one of these tests show that the cancer is progressing, at that time other more active treatment options may be considered.

Certain types of prostate cancer can be very slow to progress; some men who have it will never experience any symptoms or problems. Occasionally the disease can actually be less damaging than the treatment. Prostate cancer can be monitored regularly with frequent testing — about every six months — and without surgery or radiation. According to a large, long-term study of nearly 800 men with prostate cancer, the risk of dying from a “low-risk” tumor is similar whether you choose observation or treatment.

Are You a Good Candidate for Watchful Waiting?

Not all patients are good candidates for watchful waiting. Younger men or men who have aggressive prostate cancer are often recommended to take a more proactive approach to treatment, but older men who are concerned about side effects — commonly, impotence and incontinence —may want to consider watchful waiting.

The following are other factors that can indicate whether watchful waiting is a viable treatment method for a prostate cancer patient:

• Early stage diagnosis. The earlier the stage at diagnosis, the more time a prostate cancer patient may have in determining what treatment plan is best.
• Short life expectancy. If a man has a life expectancy of less than five years for other medical reasons he may opt for watchful waiting.
• Having another serious health condition. If a patient is struggling with another disease or health condition, they may not want to proceed with surgery or radiation for prostate cancer at the same time.
• Gleason score. When the cancer is not aggressive and is slow to progress, a man may have a low Gleason score. This patient may consider watchful waiting as an option.

Caring for a Partner With Prostate Cancer

How to Care for a Partner With Prostate Cancer

The whole world can seem to change in an instant when a you find out that your partner has been diagnosed with prostate cancer. Both of you will probably feel overwhelmed, and afraid. It will most likely be a confusing time for both of you.

The Best Thing to do is to Learn What to Expect

You both should take steps to educate yourself about the disease. In this case knowledge can certainly be power. There are many possible side effects of both the cancer and the types of treatments that you should be prepared for. These can include:

Infertility.
A man can be rendered infertile due to prostate cancer treatment, whether it be surgery or radiation therapy. For partners that want to have children after treatment, if is recommended to investigate options such as sperm banking pre-treatment.

Sex life changes.
It is common for men to experience erectile dysfunction (impotence) after treatment for prostate cancer. It may be temporary or permanent depending on the treatment.

Changes in urination/bowel issues.
Lack of control/urinary incontinence can be a common after prostate cancer treatment. Bowel issues such as diarrhea can be long-term effects of some kinds of radiation therapy.

Hormonal changes.
Numerous side effects can occur from the hormone therapy used to treat prostate cancer. These side effects can include weight gain, and muscle loss, fatigue, low sex drive, hot flashes, and brittle bones.

Subtle hormonal changes could be evident as well including memory and multi-tasking difficulties. For example, hormone deprivation therapy can potentially have some subtle, cognitive (thought process) effects in the men prescribed this treatment. The knowledge you can gain about the types of side effects that can occur, and what you can do about them, can empower you and help you and your partner know when/how to take action.

Prostate Cancer Caregiving: More Tips
Your partner will need you to be there to listen. Make sure to encourage him in his treatments by going to doctor’s appointments, treatment sessions, and tests. Make sure that he knows that you want to be a part of this process with him. You are the best person to encourage him to look forward to the life he can enjoy once his treatments are completed and successful.

You Are Important Too
Some find it helpful to join a group for caregivers of prostate cancer patients. It can be a good place to share your experiences with others.