Biopsy Scoring Gives Better Prognosis Indication
Reported October 3, 2007
ORLANDO, Fla. (Ivanhoe Newswire) — New research uncovers a more effective way to predict risk of prostate cancer recurrence.
Of the more than 218,000 American men diagnosed with prostate cancer this year, most will undergo a biopsy to determine their Gleason score — a number from two to 10 reflecting how likely it is the cancer will grow and spread quickly. But adding another element, known as a tertiary pattern, may give doctors a better indication of how the disease will progress.
Following a prostate biopsy, pathologists compare the two most prevalent cell patterns of the specimen biopsy. Each is assigned a score of one to five, five being the most aggressive. Those two scores are combined to give a Gleason score. The Gleason scoring system does not incorporate a third cell pattern, but it is widely believed that more than two patterns can and do occur. Because of this, many pathologists use a third pattern, the tertiary pattern, in their analysis of tumors.
Now, researchers from Brigham and Womens Hospital say the addition of that third pattern is a valuable tool. Abhijit A. Patel, M.D., Ph.D., radiation oncologist at Brigham and Womens Hospital and lead author of the study tells Ivanhoe, This is not a new test. Its just a way to interpret the existing test.
Dr. Patel says between 2 percent and 5 percent of prostate biopsies return with this aggressive tertiary component. Tertiary grade-five scores have a similar prognosis to Gleason scores of eight to 10, the most advanced and aggressive Gleason scores. Results show men who had a Gleason score of seven and tertiary grade-five disease had a significantly shorter time to PSA failure than men who had the same Gleason score of seven without tertiary grade-five disease.
Since weve now shown that it has prognostic significance, patients, if they do have this minor component of grade-five disease should likely be treated with more aggressive therapy, Dr. Patel tells Ivanhoe.
SOURCE: Ivanhoe interview with Abhijit A. Patel, M.D., Ph.D.; The Journal of the American Medical Association, 2007;298:1517-1524