37. GLEASON GRADING It is important to recognize Gleason pattern 4 tumor because tumors with this pattern have a significantly worse prognosis than those with pure Gleason pattern 3 ( McNeal et al, 1990 ). Tumors with Gleason score 4 + 3 = 7 have a worse prognosis than those with Gleason score 3 + 4 = 7 ( Chan et al, 2000 ) GS Gleason’s Pattern Histo. Grade Differentiation 10 yr Progression (%) 2, 3, 4 1, 2 I Well <25 5, 6, 7 3 II Mod. 50 8, 9, 10 4, 5 III Poorly 75
90. Very high : T3b-T4 <10yr >10yr Expectant m/m or RT or RP±PLND RP±PLND or RT Androgen ablation or RT+Androgen ablation Any T, N1 Any T, Any N, M1 Androgen ablation Androgen ablation or RT+Androgen ablation Relapse risk Expected survival Initial T/t LOW : T1, T2a GS 2-6 PSA< 10 <10yr Intermediate : T2b, T2c GS 7 PSA-10-20 Expectant m/m or RT or RP±PLND High : T3a GS 8-10 PSA>20 >10yr Expectant m/m or RT Androgen ablation +RT or RT or RP±PLND
Unenhanced CT scan in 78-year-old man with prostate cancer, Gleason score of 34 at biopsy, PSA level of 21 ng/mL, and palpable tumor shows enlarged prostate with evidence of gross tumor ECE (arrow) along left posterolateral margin of the gland.