Gleason scale and classification of prostate cancer
The Gleason scale helps determine the degree of aggressiveness of a malignant tumor in the prostate gland. When it was created, the results of a biopsy of the tissues of the affected organ of the genitourinary system were taken into account. The level of differentiation of cells, according to this classification system, allows you to determine the outcome of the development of cancer and select the optimal treatment option.
What is the Gleason Scale for?
The scale is based on a comparison of tumor cells and healthy cells
The main task of the Gleason score is to identify the degree of development of a malignant tumor and select the optimal treatment to stop its further growth.
An American scientist named Gleason worked on creating an effective technique. He did this work while studying carcinoma at different stages of development. During medical experiments, he introduced a scale for assessing the aggressiveness of cancer.
The method allows the oncologist to get a lot of valuable information about the current state of the patient who has been diagnosed with prostate cancer. With its help, the following data are evaluated:
The degree of maturity of malignant cells.
The growth rate of the neoplasm.
The presence of metastatic processes.
In a study on the Gleason score for progressive prostate cancer, the degree of difference between healthy and malignant cells is determined. A high level of differentiation indicates that they are almost identical to each other. A low degree is usually calculated with atypical cells that lead to metastases.
The scale allows you to get information about for what time period the cells changed in such parameters as shape and size. Also takes into account the ability of these elements to perform certain functions that are assigned to them.
The Gleason score for oncology determines not only the aggressiveness of a malignant neoplasm, but also the likely prognosis of treatment and data on the survival of a patient with such a diagnosis. All this information can be obtained in the course of a thorough study of tissues taken for testing by biopsy. Samples are obtained from different parts of the prostate gland.
Next, testing of 2 samples is required. Each is assigned a specific rating, which is selected on a five-point scale. A mark of 5 points indicates the aggressive development of a cancerous tumor.
The points obtained during the evaluation of the samples are summarized. But at the time of deciphering the results, it is not their total amount that is taken into account, but each mark individually.
The amount collected may indicate the possibility of the development of the oncological process. A high score indicates the spread of cancer cells outside the internal organ in which the tumor appeared.
The Gleason score, which is used in developing prostate cancer, assesses the effectiveness of treatment. The analysis of a tissue sample in this case is usually taken at the stage of diagnosis of the pathological process and in the middle of the course of therapy. Another test sample is taken after surgery if it was prescribed to a patient with a tumor in the prostate. Comparison of the results of the study provides the oncologist with the opportunity to determine the tendency of malignant neoplasms to further development. Based on these data, the course of treatment is adjusted if the initial treatment regimen does not give positive results.
Since, as a rule, several oncological foci are formed in prostate cancer, samples of the two largest tumors are studied to study the histological material. Cell changes in each (the degree of their differentiation) is evaluated on a scale of 1 to 5 points.
Sum of studies of two biopsy specimens (prostate tissue obtained by biopsy) and is index Gleason's prostate cancer. Thus, the minimum amount is 2 points - the maximum is 10.
For practical value, the following Gleason score indicators are interesting in determining prostate cancer.:
The Glisson index from 2 to 6 indicates a slowly growing type of prostate cancer (the tumor is not aggressive),
A Glisson scale of 7 units indicates the average tumor aggressiveness,
Glisson's scores of 8 to 10 indicate an aggressive type of prostate cancer, a high likelihood of early metastasis, and the rapid growth and spread of cancer.
TNM Prostate Cancer Classification
The classification of stages of cancer development was developed by P. Denoix (France) from 1943 to 1952, then it underwent a number of changes, and in 2002 an international decision was made to stop making changes until radical changes in the diagnosis and treatment of malignant tumors occur . The latest classification of the TNM system was supported by all national TNM committees, it is used all over the world, as it helps in research and interpretation of the results, as well as in the development of treatment algorithms. The TNM system is used to diagnose and determine the stage of prostate cancer.
Gleason scale: what is it and where is it used?
The Gleason score and international systematization of TNM are used to diagnose prostate cancer. The scale reveals the level of aggressiveness of malignant tumors. The examination is carried out as part of the histology.
The procedure involves the collection of pieces of prostate tissue, after which a laboratory study is performed. The degree of tumor malignancy is judged by the sum of the indicators of the two largest tumors.
It shows the following options:
the presence of metastases
tumor maturity level,
tumor growth rate,
degree of aggressiveness.
The reliability of the analysis results depends on how correctly the material is taken. If the fence was carried out professionally, then its effectiveness is high: deciphering the results using the Gleason table in detail will indicate the nature of cell transformation.
The Gleason score helps to identify the patient’s current state of health.
The biomaterial should be removed from more modified areas of the prostate gland. Puncture, in which one sample was taken from the affected area, and the second from a healthy area, is considered erroneous.
The diagnosis is made to the patient only after a set of measures. The results of the analysis will include TNM and Gleason score.
Gleason score decoding
Data for analysis is taken using a biopsy of the prostate gland.
A tumor of any degree is usually located in several foci. Prostate cancer at the developmental stage is diagnosed in the course of mandatory research activities, including Gleason analysis. It is customary to take several samples of the affected tissue in different places of the prostate at once. Usually, the largest foci are located in which cells of the 1st and 2nd levels are located.
For proper testing it is necessary to add together two indicators. We are talking about the gradation levels of each sample taken from a man.
TNM Prostate Cancer Classification
Also in the conclusions they write the diagnosis of prostate cancer by TNM system. T - from the Latin "tumor", the size of the tumor, N - an indicator of the involvement of lymph nodes in the oncological process, M - the presence or absence of metastases.
Thus, for example, the diagnosis of prostate cancer T1N0M0 speaks of the first stage of the disease, when the tumor is not palpable, does not manifest itself and was detected only with a prostate biopsy. The value of T3N1M1 indicates the stage when there are already affected lymph nodes and distant metastases.
The value of T2NxMx, for example, only indicates a suspicion of involvement of the lymph nodes in the process and a suspicion of metastasis.
For questions about treating prostate cancer with any Gleason index in Germany:
Table of Prostate Cancer Stages by TNM Classification
T - primary tumor
TX - insufficient data to evaluate the primary tumor.
T0 - the primary tumor is not determined.
T1 - the tumor is not clinically manifested, not palpated and not visualized by special methods.
• T1a - the tumor is accidentally detected by histological examination and makes up less than 5% of the resected tissue.
• T1b - the tumor is accidentally detected by histological examination and makes up more than 5% of the resected tissue.
• T1s - the tumor is diagnosed using needle biopsy of the prostate (produced in connection with a high level of PSA).
T2 - the tumor is limited to the prostate gland or spreads into the capsule.
• T2a - the tumor affects half of one lobe or less.
• T2b - the tumor affects more than half of one lobe, but not both lobes.
• T2c - the tumor affects both lobes.
T3 - the tumor extends beyond the capsule of the prostate gland.
• T3a - the tumor extends beyond the capsule (single or double-sided).
• T3b - the tumor spreads to the seminal vesicle.
T4 - an immiscible tumor or tumor spreading to adjacent tissues and organs, but not to the seminal vesicles: the neck of the bladder, the external sphincter, the rectum, the muscle that raises the anus, and / or the pelvic wall.
With the amount of 2-4
Grade 2 is obtained by healthy cells that are not affected by pathological processes of a malignant nature.
Another transcript has a mark of 3-4 points. It is obtained by tissue taken for research, which indicate the development of a malignant neoplasm. At this stage, pathology has a first degree of development. The cells detected during the diagnosis are not much different from healthy ones. The tumor itself is not aggressive. No metastases and lymph nodes are observed.
Malignant neoplasm of this type is characterized by slow growth and development. This process in most patients takes several years.
If a man got such a result on the Gleason score, he should start to be regularly examined by an oncologist. A urologist consultation is also advisable. To prevent the progression of cancer in the prostate, the patient is prescribed a course of hormonal drugs that suppress the production of androgens.
Oncological pathologies can affect any organs and tissues in the human body. Cancerous diseases are diagnosed all over the world and take the second place in mortality of patients (the first place belongs to cardiovascular pathologies).
Prostate oncology is a fairly common pathology in men. It occurs in the secretory epithelium of the organ and takes 3rd place in the oncological group, and the first places belong to the cancer of the stomach and lungs.
Tumor formation of the prostate develops and proceeds slowly, but metastases may appear in the early stages. Often the disease develops over several years without any manifestations, and only in the later stages can cancer be suspected.
Prostate oncology develops due to elevated testosterone levels. It determines the growth of the tumor, the risk of developing metastases and their entry to other organs.
At the beginning of its development, cancer spreads exclusively to the prostate, but in the process of growth it affects the lymph nodes, the spine, rarely oncology affects the lungs, liver and even soft tissues.
Classification of prostate cancer according to the juite-whitemore system
The second most commonly used classification of prostate cancer is the Juith-Whitemore system, which also aims to determine the size of the tumor, damage to the lymph nodes and the presence of a metastatic process. This system uses the letters A, B, C, and D. Division into sub-stages is indicated by numbers from 0 to 3.
Table of stages of prostate cancer according to the classification of Juite-Whitemore
For treatment of prostate cancer with any Gleason score in Germany:
MD, medical psychologist, is currently the head of the international service of the Dortmund Center for Medicine and Health.
Diagnosis and treatment of prostate cancer in Germany
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N - regional lymph nodes.
In relation to the prostate, the regional lymph nodes are the pelvic nodes, which are located below the bifurcation of the common iliac arteries. Category N does not depend on the side of localization of regional metastases.
Nx - insufficient data to assess regional lymph nodes.
N0 - metastases in regional lymph nodes are absent.
N1 - There are metastases in the regional lymph nodes.
Symptoms of a prostate tumor
At the beginning of the development of oncology of the prostate, a man is unlikely to notice any changes in his condition. It is possible to understand that a pathological process occurs in the body when the tumor begins to grow, press on the bladder and adjacent organs.
Cancer progression is extremely slow. Prostate oncology can be at stages 1 and 2 for 10 years or more. Since there are no symptoms of the disease in the initial stages, pathology can only be determined by passing a blood test and examining the pelvic organs.
The tumor process is characterized by the following symptoms:
the presence of blood impurities in the urine,
urinary incontinence, rapid and difficult urination,
pain in the pubic area and in the pelvic bones,
swelling of the lower extremities,
weight loss and appetite,
Growing, prostate cancer begins to involve other organs in the pathological process, so signs of abnormalities in the body can be localized in different places.
The above symptoms are also characteristic of other diseases of the prostate, so do not immediately panic. The main way to diagnose cancer early is to visit a specialist regularly.
Therefore, if there are such signs, it is better to consult a doctor immediately.
Only a specialist will be able to correctly diagnose a pathology, be it cancer or another disease.
Data with the sum of 5-6
An amount of 5 points indicates that the patient develops a grade 2 tumor in the prostate gland. During the study, the specialist notes noticeable differences between healthy and diseased cells.
An oncological neoplasm with a mark of 5 points is characterized by a low level of aggressiveness. For him, an invasive character is characteristic of this period.
A neoplasm at 5 points on the Gleason scale is characterized by slow growth. The development of the tumor at certain points may stop for a while. This phenomenon is observed during periods when the immune system is activated and begins to fight pathology.
The prognosis of treatment for stage 2 cancer in most cases is favorable. This is because at this moment the person has no metastases, and the cancer itself lends itself well to adequate therapy.
Causes of development and methods of treatment of prostate cancer
Despite the development of medicine and constant research of a disease such as cancer, it is still not possible to identify the cause of prostate cancer.
PSA level in prostate adenoma
Currently, it is known that the development of pathology is due to hormonal disruptions and the presence of following factors:
alcohol and smoking
various diseases of the prostate gland.
As for the treatment of cancer, the main methods of treating prostate cancer are radiotherapy, hormonal treatment, and cryotherapy. Chemotherapy familiar to most patients with this diagnosis is prescribed extremely rarely.
M - distant metastases.
MX - to determine the presence of distant metastases is not possible.
M0 - There are no signs of distant metastases.
M1 - there are distant metastases.
• M1a - damage to non-regional lymph nodes.
• M1b - there is bone damage.
• M1c - there are other localizations of distant metastases (lungs, liver, etc.).
Score 7 points
This stage of the disease requires surgical intervention.
If during the diagnosis 7 points were obtained, it means that the patient develops a tumor-like neoplasm of a malignant nature of a moderate degree. This indicator indicates the presence of atypical cells that have significant differences from elements that are not susceptible to the disease.
The lack of timely therapy at this stage of development of prostate cancer in men leads to metastasis. Cancer cells go beyond the prostate and begin to spread actively throughout the body, affecting healthy tissues of internal organs.
To limit the tumor, you must completely remove it. Chemotherapy or radiation will also be needed to suppress the remaining malignant cells.
Gleason Classification of Prostate Cancer
As a basis for creating his scale, Donald Gleason took changes in the structure of the prostate. According to the classification, a more differentiated cell structure determines the most positive prognosis.
For example, 1 point indicates that prostate cancer is slightly aggressive. The low-differentiated cell structure indicates the rapid and intensive development of the disease. In this case, the Gleason score is 5 points.
Prostate cancer may have more than 1 foci of inflammation. In this case, the analysis is taken from several of the largest tumors. When summing up the data, they summarize and get a total score on the Gleason scale.
The following are specific values of the Gleason score, which indicate the nature of the development of prostate cancer:
2 to 6 points - the disease is slow,
7 points - the average degree of development of oncology,
8 points - An aggressive and rapidly developing cancer process, in which there is a high probability of the formation of metastases.
Indicators with an amount of 8 points
If during the test a mark of 8 points was set, the patient expects an unfavorable prognosis. Malignant neoplasms in this case are characterized by rapid growth. Metastases begin to penetrate the lymph nodes, thereby disrupting their function. Further spread of cancer cells to organs located in the vicinity of the prostate gland is not ruled out.
Surgical intervention with this development of prostate cancer prevents the patient from achieving remission.
Classification of Prostate Cancer by the TNM System (TNM)
The medical report of the attending physician describes the nature of prostate cancer using the TNM index.
This abbreviation is deciphered as follows:
T is the size of the tumor,
N is the degree of involvement of the lymph nodes in the pathological process,
M - the presence of metastases.
The interpretation of the classification of prostate cancer according to the TNM system can be considered with specific examples.
Value T1N0M0 says that the disease has just begun its development, it still does not have characteristic signs and is detected randomly when passing a prostate biopsy.
Designation T3N1M1 indicates the presence of distant metastases and the development of cancer in the lymph nodes.
Index T2NxMx means that the lymph nodes are affected, and metastases have begun active development.
Gleason 9 Data
The combination of scores, which gives a total of 9, indicates an aggressive tumor. With this course of the disease, malignant cells infect the soft tissues. In them, their active growth and development begins.
With 9 points, a high probability of death. The treatment that is offered to the patient under such circumstances is not aimed at recovery, but prolongation of the patient’s life for at least several years.
Gleason Scale Sum 10
The Gleason classification of prostate cancer according to the TNM system ends with a mark of 10 points. It is put at the worst prognosis for the patient. The probability of improving the patient's condition with this course of the disease is no more than 10%.
At the last stage of the development of a cancerous tumor in the prostate, doctors do not prescribe surgery, since it makes no sense. For men with such a diagnosis, therapeutic measures are selected that can at least slightly reduce the severity of painful symptoms in order to improve the quality of their life.
The reliability of the results
The accuracy of the data directly depends on the experience and qualifications of the doctor who knows where to take the samples from.
To correctly set the grade on the Gleason score, a specialist must be sure of the reliability of his results during the histological examination. It directly depends on whether the material was taken correctly for further tests.
Professionally conducted collection of materials for analysis allows you to achieve high information content from the test on the Gleason scale. Thanks to this, the oncologist will be able to correctly interpret the results.
Puncture is objectively considered erroneous if one of the samples was taken from a healthy site and the other from the affected area. Diagnosis will give an unreliable result, because of which the moment of timely assistance to a man with prostate cancer will be missed.
With the Gleason score, it is easier for oncologists to determine the degree of development of an oncological disease in a man who affects the prostate gland. With its help, the dynamics of the progression of cancer or the growth of malignant cells is also traced. That is why this diagnostic method must be used in case of suspected oncology.
Classification of cancer according to the degree of development of the disease
When there is a suspicion of oncology of the prostate, the patient is prescribed a full examination, after which the specialist assigns the TNM category to prostate cancer, and also differentiates it according to the Gleason score.
The classification of prostate cancer extends to all stages.
In other words, the Gleason score has values related to the asymptomatic degrees of development of prostate oncology.
In order to determine the presence of a malignant neoplasm, a man needs the following laboratory tests:
PSA blood test
Ultrasound of the prostate gland,
CT or MRI of the prostate and neighboring organs.
A biopsy is the main method by which the doctor can make an accurate diagnosis. This analysis determines the degree of development of oncology and the activity of cancer cells.
Oncology classification helps doctors determine the stage of development of the disease, as well as prescribe the appropriate treatment.
Prostate biopsy: how to do a prostate puncture
The classification of prostate cancer is made up of TNM values and Gleason score.
The initial stage of a cancer can have the following characteristics:
The neoplasm is not visualized with ultrasound, palpation is not palpable. The tumor is detected randomly during surgery. Ultimately, such a tumor is defined as follows: T1N0M0 and 6 points on the Gleason score.
A tumor is easily felt rectally or can be seen on one side during an ultrasound scan. Cancerous processes do not go beyond the prostate and do not give metastases. In this case, the characteristic is as follows: T2aN0M0 and 6 points on the Gleason score.
The second stage of cancer has several substages.
Stage called 2A has one of the following characteristics:
The tumor is not visible on the ultrasound scan, is not determined rectally, it can only be seen during surgery or through a biopsy. This sub-stage has an index T1N0M0 and 7 points on the Gleason score.
The substage can have the same indicators as in the previous example, but on the Gleason scale it can have a value of 6 or less.
The neoplasm is palpable, it can be seen on an ultrasound scan, but the tumor still does not give metastases. Index is equal T2bN0M0, on the Gleason scale - 7.
Stage 2B may be characterized by the following data:
The tumor is clearly visible during ultrasound, is clearly palpable during palpation and spread to 2 sides of the organ, does not give metastases. Index is equal T2cN0M0 with any Gleason score.
An ultrasound neoplasm can be seen or not, palpated or not, palpable, and the process does not extend beyond the prostate. No metastases are found in the lymph nodes and other organs. Index available T2N0M0 with any value on the Gleason scale.
Index is equal T2N0M0, Gleason score is 8 or higher.
The third stage is characterized by the following indicators:
Tumor processes extend beyond the prostate, but do not affect the lymph nodes and other tissues and organs. Any value on the Gleason scale, the index is T3N0M0.
The fourth stage can be characterized by one of the following options:
The tumor grows beyond the prostate, affects neighboring tissues and organs. Seminal vesicles are not involved in the process. No metastases, the lymph nodes are healthy. Gleason score can be any, index - T4N0M0.
The neoplasm goes beyond the body. Metastases enter the nearest lymph nodes, but other organs are not damaged. Any value on the Gleason scale, the index is TN1M0.
Diagnosed with metastases, the cancer process grows beyond the prostate, it is possible damage to the lymph nodes and other organs. Characterized by any Gleason score and index TNM1.
Thus, thanks to the Gleason score, modern scientists can describe in detail the malignant neoplasm in the prostate gland and find the right treatment.
Gleason scale and classification of prostate cancer
Gleason, an American scientist, proposed using a scale to assess prostate cancer: the degree of malignancy (aggressiveness) of cells in prostate carcinoma.
Gleason's indicator has predictive value.
The more differentiated the cells, the more favorable the prognosis for prostate cancer.
1 point corresponds to the highest degree of differentiation (non-aggressive prostate cancer).
At 5 points on the Gleason score, the lowest grade (highly aggressive prostate cancer).
What is required to determine the index?
The classification of prostate cancer is carried out as a result of tissue collection in several areas of malignant formation.
The result of the study is evaluated on a scale of five points:
1 point - homogeneity of the cell structure is not broken, slight changes in the nuclei are observed,
2 points - an increase in the distance between the cells of the prostate is determined, the stroma is visualized,
3 points - cells have an uneven structure, the stroma between them disappears,
4 points - the number of atypical summers exceeds normal,
5 points - accumulation of undifferentiated fibrous tissue was found in the biomaterial.
The classification of prostate cancer according to the THM system and the Gleason score are closely related. TNM is used to indicate the stage of the disease. The oncologist is guided by both indicators.
Another rating system, called Jewet-Whitemore, is also used. It allows you to identify the stage of progression of the cancer process. The index shows the location of the tumor. The result is evaluated in conjunction with other research methods.
Only a doctor can carry out calculations based on the results of the study.
How is cancer evaluated on a scale
To identify the nature of the tumor on a scale, it is necessary to fix the indicators of the largest foci. For this, a prostate biopsy is performed. Depending on the sum of the obtained indicators, the final diagnosis is made. An indicator of less than 2 points indicates the absence of oncology. Everything above indicates the presence of a malignant formation.
In 65% of cases, with an indicator of 2 to 6 points, the tumor is considered local. In this case, it cannot be diagnosed with MRI. An indicator of more than 8 points indicates an extensive proliferation of malignant cells.
Gleason score: for prostate cancer, classification
The Gleason score helps determine the degree of neglect of prostate cancer and predict the further development of the disease. It got its name, thanks to the histologist Donald Gleeson. Assessment is based on histological examination.
High indicators on the Gleason score indicate an unfavorable prognosis, low indicators indicate highly differentiated types of the tumor. The main analysis criteria are: the structure of the tumor formation and the nature of the transformation.
To confirm the final diagnosis using a combination of different studies.
• low-grade Gleason score (less malignant tumors) with a Gleason score of ≤ 6 points.
• intermediate Gleason score (medium-malignant tumors) with a Gleason score of 7 points.
• high-grade Gleason score (severely malignant tumors) with a Gleason score of 8 to a maximum of 10 points.
For example, take Gleason's sum, which is 5 points, this will mean that the 2 largest or malignant tumors have 2 and 3 points. That is, these are less malignant tumors.
The importance of estimating the prevalence of a malignant process
Differential diagnosis of prostate cancer makes it possible to assess the degree of spread of the malignant process. The data obtained play a crucial role in choosing a treatment method and predicting the further course of the disease.
The classification of prostate cancer is presented by various specialists who have been involved in this issue. Differentiation of cancer cells is carried out on the Gleason scale. The lower the value obtained, the more favorable the outcome.
Cancer Categories TNM System
The TNM system for assessing the prevalence of pathology allows you to make a forecast based on three indicators:
T is the magnitude of the malignant neoplasm,
N - the spread of the malignant process to the lymph nodes,
M - metastases.
There is a table describing all the possible conditions for prostate cancer.
The tumor does not extend beyond the prostate. It is palpated and / or an elevated PSA level is detected.
B0 - the tumor within the prostate, not palpable, the level of PSA is increased.
IN 1 - a single tumor node in one lobe of the prostate.
IN 2 - extensive tumor growth in one or both prostate lobes.
In this category, the size and dynamics of the increase in malignant neoplasms in the tissues of the organ are described in detail.
Category T describes the size of the primary tumor
The first values of the table evaluate the very fact of the presence of a tumor or the risks of its occurrence in the prostate.
Tx - the beginning of the development of the pathological process. At this stage, it is impossible to assess the size of the tumor and the pathological processes occurring in the prostate.
The next stage is T0. The tumor, as such, is not detected by any examination, including MRI. Such marking means the absence of a visible neoplasm.
If the doctor writes in the Tis patient's card, this means a small size of the malignant neoplasm. The tumor is limited to the tissues of the prostate gland and does not go beyond the limits of the examined organ.
Further classification of prostate cancer in this category allows us to estimate the size of the tumor and the percentage of the affected and healthy tissue in the prostate gland.
T1 - the size of the malignant neoplasm does not exceed 20 mm in diameter. As a rule, cancer at this stage is asymptomatic. Perhaps the accidental detection of the pathological process during a routine examination, ultrasound or finger examination with a proctologist.
Marking T1a means that the tumor has grown no more than 5% of the total volume of the glandular tissue of the prostate.
When more than 5% of tissues are affected, prostate cancer is labeled as T1b.
During a biopsy, cancer cells are detected with 100% accuracy. In this case, the cancer is labeled as T1c.
Starting with the T2 marking, doctors talk about a rapidly progressive malignant process with a risk of damage to surrounding tissues and lymph nodes located in the groin.
T2 means an increase in the malignant neoplasm to 50 mm in diameter, however, the tumor does not extend beyond the prostate.
T2a - prostate lobes are less than half affected.
T2b marking is used for lesions of more than half of the lobes.
T2c - this is how lesions of two lobes of the prostate by malignant cells are indicated.
Marker T3 means large tumor sizes (diameter exceeds 50 mm) and the spread of the pathological process to the capsule of the organ.
T3a and T3b means the spread of the tumor beyond the capsule (T3a) and the defeat of seminal vesicles (T3b).
Category N: lymph node assessment
The absence of damage to the lymphatic system by malignant cells is referred to as Nx. The same reduction applies if there is insufficient data to assess the state of the lymphatic system against the background of progressive cancer. The next category is N0. This value is used when there is a proven absence of lymph node damage. When single metastases appear in the lymph nodes, the category N1 is assigned.
N2 means multiple lesions in the lymph nodes, which can merge to form large tumors. With the spread of the pathological process to the regional nodes of the lymphatic system with the inability to remove them, cancer is classified as N3.
The scale assesses the degree of development of the tumor itself and damage to other tissues
The tumor gives metastases to regional lymph nodes or to distant organs and tissues (lungs, liver, bones, stomach, etc.).
D0 - metastases detected clinically, while PSA levels increase.
D1 - regional lymph nodes are affected.
D2 - distant lymph nodes, organs and tissues are affected.
D3 - metastases after treatment.
Category M - assessment of the spread of metastases
About the absence of metastases Mx (insufficient data to assess the condition) and M0 (the absence of pathology in other organs confirmed by laboratory methods).
Single foci of metastasis are defined as M1. The spread of the process of cancer metastasis to non-regional lymph nodes is designated as M1a.
Bone metastases (limb bones, hip joints) are indicated by the marking M1b. The extreme degree of metastasis of the malignant process to large organs is M1c.
The cancer classification of TNM prostate oncology is in many ways similar to the diagnosis of the spread of pathology in the Juite-Whitemore system.
DAmico classification of prognostic risk factors
According to this classification, the probability of cancer progression in the initial stages to clinical symptoms and / or death, as well as the risk of relapse after local treatment of cancer, is looked at. According to the classification of prostate cancer, Damiko patients are assigned to one of the groups of disease progression: low, medium or high. The following indicators are taken to evaluate:
- classification of cancer according to the TNM system, namely the indicator T - the prevalence of the primary tumor,
- the degree of prostate cancer on the Gleason score,
- level of prostate-specific antigen in the blood (PSA).
The Gleason score involves examining tissue and assessing the degree of progression of changes in prostate cells. Tissue cells, due to the development of oncology in prostate cancer, are classified by degree or stage of malignancy.
To assess the risks of prostate cancer, according to Gleason, material for histological analysis is taken from large lesions. The degree of malignancy of the cells is determined by scores from 1 (minimal changes) to 5 (aggressive malignant process, with a tendency to rapid progression).
Since two separate sections of prostate tissue are used for evaluation, the minimum value is two points, and the maximum is ten.
The Gleason index for prostate cancer up to 6 indicates a slow progression of the malignant process.
If the Gleason score for prostate cancer is 7 units - we are talking about medium-aggressive cancer. A score of more than 7 points means the most dangerous form of cancer, with a tendency to rapid progression and rapid development of metastasis.
Gleason's scale for prostate cancer allows you to make an accurate prognosis for recovery, regardless of the stage of tumor development. Based on the data determined by the Gleason score, a decision is made on the methods of treatment of pathology.
With this scale, histological analysis results are evaluated.
Alan Partin Tables or Nomograms
Partin’s chart is a scale that takes into account mathematical models calculated on the basis of the PSA level, Gleason score and the clinical stage of prostate cancer according to the TNM system classification, namely the T indicator is the prevalence of the primary tumor. Partin's chart allows predicting the further progression of the disease. Nomograms were compiled based on a study of data on men who received prostate cancer treatment. Based on these data, tables were compiled that are divided:
- The degree of prostate cancer from T1s to T2s.
- According to the level of PSA in the blood, the following categories are distinguished from 0 to 10 ng / ml, and more than 10.0 ng / ml.
- Gleason score points are divided into 3 categories from 2 to 4, from 5 to 6, or from 8 to 10.
This is how modified Partin nomograms look, by which you can determine the likelihood of further progression of prostate cancer.
What determines the quality of the examination
An essential role in the diagnosis of the disease is played by the speed of going to the doctor. In order to detect the pathological process in time, it is necessary to regularly visit the urologist. Also, do not ignore the symptoms characteristic of oncology.
impaired urination function,
pain in the perineum,
blood impurities in the urine,
burning in the urethra while visiting the toilet,
general deterioration of well-being.
In conjunction with a histological examination, other diagnostic procedures are also performed. The diagnosis is made on the basis of a combination of different techniques. Equally important is the delivery of analysis for a specific antigen, which is called PSA.
An antigen is a protein substance produced in the prostate gland. The norm is considered an indicator of 4ng / ml. If the result of the analysis is in the range from 4 to 10 ng / ml, there is a small chance of malignancy.
An indicator above 10 ng / ml in 50% of cases indicates the presence of a pathological process in the body. Since elevated PSA does not always indicate the development of cancer, a Gleason study provides a complete picture of the situation.
The reliability of diagnostic tests largely depends on whether the biopsy is performed correctly.
Histological examination is carried out under the supervision of ultrasound monitoring. The procedure is performed on an outpatient basis. A probe is inserted through the rectal opening, and then a special needle is used to extract pieces of tissue.
In medical institutions that are not equipped with modern equipment, a transrectal biopsy is performed manually. The tissue is taken with a syringe, at the end of which is a long needle.
Manual diagnostic is considered more painful. Due to the unreliable identification of the affected area, it often gives incorrect results. Especially if the disease is at the initial stage and the tumor has small volumes.
Cancer is a serious disease that requires timely diagnosis. It depends on her the further development of events. If the disease is detected at an early stage, the probability of a successful recovery is significantly increased. The Gleason score plays an important role in the diagnosis. Therefore, a biopsy is mandatory.
This system classifies prostate cancer by degrees. Each degree has subcategories that allow a more complete assessment of the pathology.
Grade A describes the initial or pre-asymptomatic stage of prostate cancer. It has two subcategories:
A1 means the absence of a malignant process in the cells,
A2 - slow progression of the disease, minor cell damage.
The localization of a malignant tumor only in the prostate gland is indicated by degree B. It, in turn, is divided into three subcategories:
B0 - a neoplasm is found in the tissues of the prostate, but with rectal palpation imperceptibly, the diagnosis is carried out by increasing the level of PSA,
B1 - the tumor affects 1 lobe of the prostate,
B2 - a tumor is found in two lobules, but does not go beyond them.
Grade C is the spread of the malignant process outside the affected organ. Subcategory C1 describes the spread of the tumor beyond the capsule of the organ, C2 - damage to the tissues of the urethra and bladder by malignant cells. At stage C2, there is a violation of urination due to the fact that the tumor blocks the urethra. Usually, it is at this stage that bright symptoms appear that allow you to accurately diagnose.
The onset of metastasis describes grade D.
With the appearance of single metastases, a sharp increase in the prostate-specific antigen in the patient’s blood (PSA) occurs, which is described by the D0 subcategory. When regional lymph nodes are affected, cancer is classified in the D1 subcategory.
D2 means the spread of the process of metastasis to bone tissue, tissues of internal organs and large nodes of the lymphatic system. Relapse after treatment and the progression of the metastasis process is indicated by subcategory D3.
The above classifications are the most common and are used universally. For the diagnosis of cancer, apply:
determination of the PSA level,
digital examination of the prostate,
magnetic resonance imaging.
After confirming the fact of the presence of a tumor, material is taken for further examination (biopsy). During the analysis, it is possible to determine the aggressiveness of malignant cells and make an initial prognosis. In the future, the success of treatment will depend on the chosen technique, the age of the patient and the presence of concomitant diseases. It is important to remember that only timely detection of pathology will increase the chances of a full recovery. Since cancer in the early stages proceeds covertly, it is recommended that all men older than 50 years of age undergo an examination of the prostate gland.
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Let's take a closer look at how to use Partin tables. For example, a patient has a PSA level of 3.1 ng / ml, the sum on the Gleason score 3 + 4 = 7, the clinical stage of T2a (the tumor is palpated and affects less than half of one lobe). In the second table, in the PSA value, we are looking for a range from 2.6-4.0 ng / ml, points on the Gleason scale 3 + 4 = 7. We look at the intersection and on the 4 lines we see the percentage of progression: the probability of developing a tumor limited by the prostate is 50% (from 43 to 57%), growth beyond the prostate is 41% (from 35 to 48%), damage to the seminal vesicles is 7% (from 3 to 12%), spread to the lymph nodes 2% (from 0 to 4%).
To facilitate the obtaining of data from Partin tables, there are computer programs where you only need to enter the initial data.
In addition to Partin's tables, there are Cattan nomograms that can predict the results of treatment of prostate cancer and make a prognosis for life expectancy.
Using the classification to indicate the stages of prostate cancer helps oncologists determine the tactics of treatment (combination of methods or monotherapy: hormone therapy for prostate cancer, chemotherapy, radiation therapy, surgery), to make a prediction of the progression of the disease and the life expectancy of the patient. In addition, a single classification helps to process conclusions from different studies, which in turn leads to the accumulation of experience and improvement of existing methods of treatment and diagnosis of prostate cancer.
Gleason scale for prostate cancer. Decryption
The incidence of prostate diseases in men is increasing with each new decade. This is due to the influence of various factors.
To simplify the understanding between doctors regarding a particular pathology of this organ, special classifications and scales have been developed.
One of the most commonly used is the Gleason scale, which is used in the oncological process in the parenchyma of this anatomical structure.
This scale was developed about forty years ago by an American scientist named Gleason. It was based on a large study, as a result of which a characteristic histological structure was developed for prostate carcinoma at its various stages.
Depending on the indicator, it is possible to determine how aggressively the process will develop and partially present a prognosis of curability and five-year patient survival. The malignancy of the process is judged by the sum of the points that the samples from the two largest tumors in the organ scored.
You may be interested in reading a general article on prostate cancer.Here you will learn about the types, stages, diagnosis and treatment of prostate cancer.
The type of cells in this situation is difficult to distinguish from normal parenchymal or muscle structures of the prostate. The tumor is considered the least aggressive, due to which metastases and damage to the lymph nodes are either not observed at all, or at the terminal stage of development.
The neoplasm is characterized by a very slow growth, which can be detected only over a long period of time, which is estimated in years. The only recommendation in the presence of such a pathology is a dynamic observation by an oncologist or urologist.
Cell structures in this situation are already significantly different from normal, but they are of the same type. The presence of an invasive nature of education growth is beginning to be traced, however, the aggressiveness index still remains low.
Very slow growth rates are observed, which are interspersed with its complete stop - this is due to the increasing or decreasing activity of the immune system. In the dynamics, which is determined by months, one can observe a slow increase in the level of prostate-specific antigen in the blood serum.
The presence of this pathology is often accompanied by a favorable prognosis, since metastases usually do not develop, and cancer can be treated well. Such patients are recommended to visit a urologist at least once every three months to monitor the condition.
Histological examination of a micropreparation determines the presence of atypical and minimally aggressive cells, the growth of which is characterized by an average degree of aggressiveness. The growth rate is already higher and tumor growth can be seen in dynamic observation for several weeks.
The ability to penetrate into surrounding tissues, lymphatic and blood vessels leads to the occurrence of metastases. The PSA level is growing already at a more noticeable pace, its rise has been taking place over a couple of weeks.
The prognosis of survival or cure for such patients is already unfavorable, but the tumor at this stage is still amenable to chemotherapy, and the possibility of radical excision of the organ significantly increases the chances of recovery. When identifying this type, the start of treatment is shown as soon as possible, which involves a complex effect on the pathological focus.
On a slice in a microscope, the presence of many atypical cells that can grow in the surrounding tissue is determined. The neoplasm is characterized by an extremely aggressive course, and the ability to rapidly grow into surrounding organs and blood vessels contributes to the early development of metastases in the brain, lungs and spine.
PSA levels are increasing constantly and quickly enough, which allows for early diagnosis. The prognosis can be favorable only if the disease is detected early and adequate complex therapy is used. Organ excision, chemotherapy, targeted exposure and radiation are used.
Healthy cells are practically not detected in the micropreparation, they are replaced by pathological elements. The tumor is characterized by extremely high aggressiveness and rapid infiltrative growth.
The early development of a large number of metastases significantly worsens the prognosis for life in such patients. There is an approximately twenty percent chance of recovery if the treatment is as comprehensive as possible.
Normal cells cannot be detected in the section; only atypical elements that occupy the entire field of vision can be detected; destruction may be present. The rapid defeat of all systems and organs leads to an extremely unfavorable prognosis for survival.
The occurrence of metastases is observed in the early stages of the development of the process. Often, such patients are not treatable and only palliative therapy is possible in relation to them.
The Gleason score is the most informative for both patients and doctors of any country with a graduation regarding the condition of this patient. It combines many parameters, including the degree of cell maturity, growth rate, aggressiveness, the presence of metastases. In accordance with it, you can determine the likelihood of recovery in each individual case.
Prostate cancer: stages, Gleason's scale, grades and why it is important
Prostate Cancer Stages
To choose the right treatment method, it is necessary to determine the stage of the disease. Prostate cancer is divided into four stages, depending on the extent of the tumor. Substages A, B and C are also distinguished in the second, third and fourth stages. The lower the stage number, the less cancer is spread throughout the body.
In addition to the stage, the patient’s age, the presence of other diseases, general physical condition, life expectancy and other factors also influence the choice of treatment method. We reviewed the stages of prostate cancer and the recommendations of the US National Cancer Institute on treatment methods for each of them.
When determining the stage of prostate cancer, consider:
1) the size of the tumor, 2) whether the cancer has spread to other tissues, organs and lymph nodes,
3) the level of PSA (prostate-specific antigen) in the blood. PSA is a protein produced by prostate cells. It is believed that the PSA level in a healthy man is 4 ng / mg. However, this indicator depends on many parameters and can change throughout life.
4) Gleason score. This scale is used to evaluate how badly the prostate tissue is affected. If under a microscope a tumor looks more like normal prostate tissue, it is given a score of 1. If it looks very affected, 5.
Since the tumor is often heterogeneous, two sections of the prostate are evaluated - the bulk of the tumor and the next in volume. After these values are added up and the Glisson sum is obtained, which can be from 2 to 10. Cancerous tissues of the prostate are those with a Glisson sum above 6.
5) a grading group or prognostic group of a tumor. The grading group is determined by the value of the Glisson sum and ranged from 1 to 5. Group 1 = value on the Gleason scale 6 (or less) Group 2 = value on the Gleason score 3 + 4 = 7 Group 3 = value on the Gleason score 4 + 3 = 7 Group 4 = Gleason score 8 Group 5 = Gleason score 9-10
The smaller the grading group, the more likely the tumor will grow slowly and only within the prostate. A high grade group value (4-5) means an increased likelihood of rapid tumor growth and the formation of metastases.
In the first stage, the cancerous tumor is only in the prostate and does not spread to other tissues, organs and lymph nodes. Blood PSA is less than 10 ng / mg. The tumor belongs to the 1st grade group, that is, such a tumor is likely to grow very slowly and will not cause any symptoms.
The tumor in the first stage is difficult to detect during rectal examination. It is detected by a biopsy of the prostate, which is carried out at a high level of PSA in the blood, or in tissue samples removed from the prostate during other operations.
Standard treatment at the first stage may consist of the following methods: - Expectant tactics,
- Active surveillance. If the cancer begins to spread, hormone therapy may also be prescribed,
- Radical prostatectomy with pelvic lymphadenectomy, that is, removal of lymph nodes in the pelvic region. After surgery, radiation therapy can also be performed,
- External radiation therapy. After it, hormone therapy can be performed,
The tumor in the second stage is usually larger than in the first. It is also located only inside the prostate and does not spread to other tissues, organs and lymph nodes. At this stage, prostate cancer can be detected during a rectal examination.
The second stage is divided into groups depending on the degree of tumor development. Allocate IIA, IIB, and IIC groups.
At stage IIA: - a tumor may occupy less than half of one side of the prostate. The level of PSA in the blood is more than 10 ng / mg., But less than 20 ng / mg., Cancer belongs to 1 grade group. OR
- the tumor can occupy more than half of one side of the prostate or is found in both parts of the prostate gland. The PSA level is less than 20 ng / mg., Grade group - 1.
At stage IIB cancer can be spread in one or both parts of the prostate. Blood PSA levels below 20 ng / mg. Cancer is assigned to the 2nd grade group, that is, probably, it will not develop very quickly. The likelihood of metastases is also low.
On stage IIC cancer can be spread on both sides of the prostate. PSA levels are still below 20 ng / mg. Cancer belongs to 3 or 4 grades. Consequently, the likelihood of cancer spreading beyond the prostate gland is increased.
Standard treatment may include the following tactics:
- Expectant tactics,
- Active surveillance. If the cancer begins to spread, hormone therapy may be prescribed,
- Radical prostatectomy with pelvic lymphadenectomy, that is, removal of lymph nodes in the pelvic region. After surgery, radiation therapy can also be performed,
- External radiation therapy. After it, hormone therapy can be performed,
- Brachytherapy or internal radiation therapy with the introduction of radioactive particles,
- Clinical studies of cryosurgery, high-intensity ultrasound therapy, proton radiation therapy, photodynamic therapy. As well as studies of new types of treatment, for example, hormonal therapy, accompanied by radical prostatectomy.
At this stage, the cancer can spread beyond the prostate, but it still does not affect the lymph nodes of the body. The third stage, as well as the second, is divided into three groups: IIIA, IIIB, and IIIC.
At stage IIIA a cancerous tumor can be located on both sides of the prostate. Blood PSA levels reach a minimum of 20 ng / mg. Cancer can belong to either 1 or 4 grades. This means that the cancer can develop quite quickly, there is also a high probability that it will give metastases.
In stage IIIB the tumor can spread to the nearest organs - the seminal vesicles (glands that produce seminal fluid), the rectum, the bladder, but so far it does not affect the lymph nodes. Cancer belongs to 1-4 grade groups. Blood PSA levels can be any.
In stage IIIC, cancer can be located on one or both sides of the prostate and spread to nearby organs and tissues. Blood PSA levels can be any. At this stage, grade group 5 is assigned, which means fast tumor growth and a high probability of metastases.
Standard treatment in the third stage may include:
- External radiation therapy. After it, hormonal therapy can be recommended, - Hormone therapy. After which radiation therapy can be used, Radical prostatectomy. After surgery, radiation therapy can be applied,
- Active surveillance. If the cancer begins to spread, hormone therapy may be prescribed,
Treatments to control prostate cancer and reduce symptoms may include:
- External radiation therapy,
- Internal radiation therapy with the introduction of radioactive particles into the tumor, - Hormone therapy, - Transurethral removal of the prostate,
- Clinical studies of new types of radiation therapy and cryosurgery.
Cancer has already spread to nearby organs and lymph nodes. He could also touch bones. At this stage, the cancer causes symptoms that may include problems with urination and erection, blood in the urine and / or sperm, bone pain and severe weakness. Stage 4 treatment will help slow down tumor growth and reduce cancer symptoms.
The fourth stage is divided into two groups: IVA and IVB.
Stage IVA the cancer may be on one or both sides of the prostate. It spreads to the nearest lymph nodes. Cancer can also spread to nearby tissues and organs - seminal vesicles, bladder and intestines. The PSA level can be anything, the grading group too (from 1 to 5).
Stage IVB cancer spreads to other, more distant parts of the body. In addition to the bladder, intestines, liver, and nearby lymph nodes, it can also affect distant lymph nodes and bones.
Standard treatment may include:
- Hormone therapy, - Hormone therapy combined with chemotherapy,
- External radiation therapy. After it, hormonal therapy can be prescribed, - Alpha therapy,
- Expectant tactics, - Active observation. If the cancer begins to spread further, hormone therapy may be recommended.
- Clinical studies of radical prostatectomy combined with orchiectomy, that is, removal of the testicles.
Treatment to control cancer and reduce symptoms may include: - Transurethral removal (resection) of the prostate or TURP, - Radiation therapy.
Watch the video: Prostate Cancer: Gleason Score (February 2020).
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