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Page 3 of 12  When doctors lower the boom on men with these words, “You’ve got prostate cancer,” they also tell them a figure known as their “Gleason” score, which indicates the aggressiveness of their tumors. For example, my Gleason score was a “6,” which stands for moderately aggressive.
Using the Gleason score as a guide, doctors and patients then decide how aggressively to treat the cancer. But could adding an extra step to the Gleason test improve treatment? Yes, and such changes may help predict the risk of the cancer coming back, says Dr. Abhijit A. Patel, a radiation oncologist at Brigham and Women's Hospital and the Dana Farber Cancer in Boston. Many studies have confirmed the significance of the Gleason score with respect to recurrence and death following treatment for prostate cancer. The higher the Gleason score, such as from 8 to 10, the higher your chances of the highly aggressive and most dangerous cancer coming back in spades.
A third 'disorder' A Gleason test involves a urologist taking a biopsy of the prostate and sending the samples off to a pathologist, who then looks at everything under a microscope to determine if cancer is present. If the answer is “yes,” then the pathologist looks at the level of “disorder” displayed by the cancer cells, ranking them from 1 for less disorderly to 5 for more disorderly. The patient will get two rankings, which, when added together, is his Gleason score, which runs from 2 to 10. In Patel’s study, researchers looked for a third pattern of “disorder” in biopsy samples from 2,370 men with prostate cancer. Men with Gleason scores 7 plus the disorderly third pattern suffered a more rapid increase in prostate-specific antigen (PSA) levels in the blood. What’s more, their PSA began rising five years after treatment, called "PSA failure," suggesting that their cancer had come back, compared to seven years for men with the same Gleason score but no third disorder. In fact, the failure time for men with a Gleason score of 7 and the third disorderly pattern was the same as for men whose cancers registered Gleason scores of 8 or greater—the most dangerous kinds of prostate tumors. Thwarting testosterone? The men with rapid PSA increases should probably receive surgery and more aggressive treatment to fight their disease, such as hormonal therapy to thwart testosterone, the male hormone believed to spur the growth of prostate cancer, Patel says. But in the latest Journal of the American Medical Association, Patel adds that nobody has studied whether more aggressive treatment for men with the disorderly third pattern would improve their outcomes. Benign or malignant conditions in a man’s prostate can make his PSA rise, but rapid increases mean the chances for prostate cancer are much higher. After treatment, a rise in PSA also may mean the cancer has returned. While the PSA test signals to doctors that something is fishy with a man's prostate, only a biopsy can diagnose cancer. Spreading the cancer further? But Dr. David Berman, a pathology, urology and oncology expert at Johns Hopkins University’s medical school, says adding hormone suppression therapy to prostate cancer treatment might bring its own set of dangers. Berman says in October’s Cancer Research that lab studies indicate hormone suppression could boost the protein nestin, which promotes movement of prostate cancer cells to other parts of the body, although the danger is far from proven. Such treatment—called androgen deprivation therapy—is often given to men with advanced prostate cancer, not as a cure but to slow the growth of the tumor doctors can’t remove through surgery. “We’re far from recommending that all androgen deprivation therapy be discontinued,” Berman said. “It’s extremely effective in the short-term. It’s an important arsenal in the fight against prostate cancer.”
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