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  When a man is diagnosed with prostate cancer, his first question is almost always: "How bad is it? When a man is diagnosed with Gleason 7 disease, the answer is a little tricky. This is because not all Gleason 7 cancers are alike. In fact, the differences can be great.

The Gleason system (see this story) is based on a score — the sum of the two most common patterns that the pathologist sees under the microscope. The equation, "2 + 2 = 4," for example, would signal a very mild, slow-growing form of cancer, and one that is rarely diagnosed today. On the other hand, "5 + 5 = 10" would represent much more aggressive disease. The first number in the equation represents the predominant type of cancer. In the case of Gleason 7, this can go two ways: "3 + 4 = 7," or "4 + 3 = 7."

"Tumors with a Gleason score of 4 + 3 are more aggressive and predictive of advanced disease at the time of surgery, compared to Gleason 3 + 4 tumors," explains Mark L. Gonzalgo, M.D., Ph.D., assistant professor of urology and oncology. In a recent study, published in the journal Urology, Gonzalgo and urologists Alan W. Partin, M.D., Ph.D., and Patrick C. Walsh, M.D., investigated the relationship between a man?s biopsy Gleason score, the Gleason score in the entire prostate (the specimen removed during radical prostatectomy) and the recurrence of PSA among men who were diagnosed with Gleason 7 cancer in a needle biopsy.

"The good news is that the vast majority — 75 percent — of these men turned out to have the less aggressive type of Gleason 7 cancer," Gonzalgo says. "Their Gleason score determined after surgery remained the same, or turned out to be less aggressive." For men diagnosed with the more aggressive form (Gleason 4 + 3), the news was also reassuring: Almost half were found to have less aggressive disease (3 + 4, or less) in their prostates at the time of surgery.

Not all Gleason 7 cancers are
alike. Fortunately, most men
have the less aggressive type.

"What this means," Gonzalgo continues, "is that nearly half of all men diagnosed with the more aggressive type of prostate cancer on needle biopsy are actually found to have less aggressive disease. These men are also more likely to have more favorable outcomes after surgery. In the majority of cases, prompt diagnosis and treatment will lead to a cure." In futher laboratory research, Gonzalgo and colleagues are also studying molecular markers that may help identify men who have a higher risk of having more aggressive prostate cancer.

http://urology.jhu.edu/newsletter/prostate_cancer_discovery_96.php

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