Gleason score and risk of death from prostate cancer
Posted Sep 28 2008 7:03pm
Based on a reanalysis of prostate cancer data from the Connecticut tumor registry, Albertsen writes in the World Journal of Urology that, “high risk prostate cancer is best identified by Gleason score 7-10.” However, he further concludes that there is no evidence to support the suggestion that “men with high-grade disease are less likely to benefit from radical surgery.”
One issue that this study therefore illuminates further is the problem of under-grading, previously discussed on this blog. Since something like 25-50 percent of men are understaged even at experienced academic centers like Duke University and the University of Miami, men cannot take it for granted that an initial biopsy-based Gleason score of 5 or 6 is accurate and that they are on the “safer” side of the Gleason grade divide. A significant proportion of those men will be upgraded to Gleason 7 or 8 post-surgery, which will then place them into the higher risk group.
According to Albertsen’s analysis of the Connecticut data, patients with rising PSA values after either surgery or radiation for localized disease have residual prostate cancer and are at very high risk of dying from prostate cancer within 10 years.