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Does 3 + 4 and 4 + 3 Always Equal 7? (October 2003)
Not quite - when the
issue is the influence of Gleason scores on treatment outcome. In the
prostate cancer world when adding Gleason grades to arrive at the Gleason
score, it is more like 3 + 4 = 7- and 4 + 3 = 7+. Practitioners in
prostate cancer know this. However, it was very clearly set out by a group
at MCKCC in "The Prognostic Significance of Gleason Grade in Patients
Treated with Permanent Prostate Brachytherapy" (Int J Rad Onc Biol Phys
Vol.56, pp.749-754, 2003). They studied 1029 T1/T2 PC cases with Gleason
sums 6, 7, 8 with a median F/U of 46 months. Failure was set (ASTRO
definition) at the midpoint between the posttreatment nadir and the first
of three consecutive PSA rises. Results at 7 years: biochemical freedom
from relapse for GG 3 + 3 was 81.8%; for GG 3 + 4, 78.4%; for GG 4 + 3,
56%; and for GG 4 + 4, 50.7%. Similar findings for outcome post RP have
been published. Herman, Kattan, Scardino, AM J Surg Pathol 2001,
25(5):657-660, reported the findings from their study of RP in 832 cases.
Although the primary Gleason grade 4 lost independent significance when
collated with the available information regarding tumor volume, surgical
margins, and the status of seminal vesicles, extracapsular extension, and
lymph nodes, none the less, the primary Gleason grade 4 remained
significantly correlated with the other predictors of progression.
Bottom Line:
When reported by excellent pathologists, major Gleason pattern 4 carries
adverse prognostic significance.
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