New grading system for prostate cancer (skala WHO 1-5)

New grading system for prostate cancer (skala WHO 1-5)

Nieprzeczytany postautor: zosia bluszcz » 04 lip 2015, 03:27

New grading system for prostate cancer makes for easy understanding

Jill Margo

30 June 2015

A new streamlined grading system for prostate cancer, which hopefully will give men a better grip on their disease, has been approved by the World Health Organisation.

It is intended to replace the traditional Gleason grading system over the next few years.

It is much simpler and is said to have more prognostic power. Its advocates say it will help men better understand the relationship between their cancer and their treatment options.

The original Gleason system was developed between 1966 and 1974. It was complex, with 25 potential scores.

In 2005 it was revised for the first time.

Now, the latest version divides prostate cancer into five groups, numbered simply from 1 to 5, in order of aggressiveness.

It was described at a recent meeting of the American Urological Association in New Orleans.

SYSTEM VALIDATED FROM 20,000 SAMPLES

Jonathan Epstein, a leading prostate pathologist from Johns Hopkins, told the meeting the system was validated through an analysis of surgically removed prostates and biopsy cores from more than 20,000 men.

This exercise took a decade and was conducted in the United States at the Cleveland Clinic, the Memorial Sloan Kettering Cancer Centre, Johns Hopkins Hospital and the University of Pittsburgh. The Karolinska Institute in Sweden was part of the project too.

Epstein says this new system provides more accurate stratification and will permit more rational and less-emotional decision making, which would help to reduce the overtreatment of indolent cancer.

While the current grading system has a scale from 2 to 10, the lowest score that is reported is 6.

"This leads to a logical yet incorrect assumption on the part of patients that the cancer is in the middle of the scale, compounding the fear of a cancer diagnosis and potentially contributing to the overtreatment of indolent cancer."

Anthony Lowe, associate professor and head of the Prostate Cancer Foundation of Australia welcomes the change saying, "the current grading system is not as good as men think it is in predicting their cancer outcome.

"The new system is supposed to have a better ability to differentiate indolent and aggressive cancer, to have more predictive power."


BASED ON INTERPRETATION OF TUMOUR ARCHITECTURE


Paul McKenzie, associate professor and spokesman for the Royal College of Pathologists of Australasia, says while there has been much discussion about the new system, the publication detailing it is still in press.

He says it arose from a consensus meeting held by the International Society of Urological Pathology in Chicago last year.

McKenzie explains that Gleason grading is based on the interpretation of the architecture of the tumour, on the pattern of the cells on a slide.

"A great deal more is known today compared [with] when the Gleason score was being developed. Some very low-grade cancers in the old system would not be regarded as malignant today. This is reflected in the virtual disappearance of scores under 6."

He says a current score of 6 or less would be equivalent to group 1 in the new system and would carry a low risk of rapid progression and spread.

McKenzie says the new system still incorporates the Gleason system, which is important for consistency in research.

WILL HAVE TO PROVE VALUE


He expects the new system will begin to be adopted from next year.

Ronnie Cohen, professor of pathology at University of Western Australia, reserves comment, saying the system will have to prove its value.

He notes there was a consensus revamp of the grading of bladder cancer, which was not based on outcomes. A more recent study questions this revamp and supports the original system.

"Consensus is not always fact," he says. "Further, even low-grade tumours are not without some risk of progression."

While grading describes the aggressiveness of a prostate cancer, it is not the only important determinant of treatment. Staging, which describes the extent of the spread of the cancer, is very important too.



http://www.afr.com/lifestyle/health/men ... 630-gi0ay3
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Toward a new prostate cancer grading system — step 1

Nieprzeczytany postautor: zosia bluszcz » 04 lip 2015, 07:48

Toward a new prostate cancer grading system — step 1 | THE "NEW" PROSTATE CANCER INFOLINK

In the most recent issue of AUA News, Dr. Jonathon Epstein of Johns Hopkins — unarguably one of the world’s leading prostate cancer pathologists — has laid out the general principles behind a new, validated, prostate cancer grading system that is designed and intended to replace the traditional Gleason grading system over the next few years.
The article on page 23 in the June issue of AUA News is a written summary of a presentation made by Dr. Epstein at the annual meeting of the American Urological Association (AUA) in New Orleans a few weeks ago. We had not reported on this before because we wanted readers to have access to a version of this information that clearly presented the new system in Dr. Epstein’s own words.
Basically, the new grading system will be used to divide localized prostate cancers into a series of five histopathological groups, numbered simply from 1 to 5. However, for at least a while, in Dr. Epstein’s words.

The new grading system, recently accepted by the [World Health Organization] will be used in conjunction with the Gleason system until it becomes widely accepted and practiced.
The basic premise is that all prostate cancers can be subdivided, histopathologically, into five categories described in the table below:


picture2.png

https://talkaboutprostatecancer.files.w ... cture2.png



Now this is all a little technical, and it is going to take a while for us all to get used to, but there are three important points that we will all need to understand as we start to adapt to this new prostate cancer grading system:

It gets rid of all the inherent complications of the existence of the Gleason scores from 1 + 1 = 2 to 3 + 2 = 5, none of which are currently reported any more anyway, but whose existence prejudices everyone’s thinking because the lowest reported Gleason score today is 3 + 3 = 6.

It deals effectively with the fact that Gleason 3 + 4 = 7 really is a different form of histology compared to Gleason 4 + 3 = 7.

It differentiates between cancers that are more like Gleason 4 + 4 = 8 and those that are more like Gleason 9s and 10s.


Thus, we will be able to return to a simpler system in which Grade 1 is the least aggressive grade and Grade 5 is the most aggressive grade and stop worrying about all the differences introduced by primary, secondary and tertiary patterns of cancer.

As Dr. Epstein explains in his article, this new system has been validated through a careful analysis of whole-gland pathological specimens and biopsy cores from tens of thousands of specimens at some of the world’s leading prostate cancer treatment and pathology centers.

In addition, the five new grade groups are clearly different in their outcomes (as assessed by risk for 5-year biochemical recurrence) when men with these grades are treated by radical prostatectomy.
Furthermore, cancers that are defined as Grade 1 according to the new system have no potential whatsoever for transition to metastatic disease.


http://prostatecancerinfolink.net/2015/ ... em-step-1/
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Re: New grading system for prostate cancer

Nieprzeczytany postautor: zosia bluszcz » 23 kwie 2016, 08:32

W Gold Coast (QLD), Australia, wlasnie zakonczyla sie doroczna konferencja Urological Society of Australia and New Zealand, do udzialu w ktorej zostal zaproszony Jonathan Epstein, profesor patologii, urologii i onkologii w Johns Hopkins University, Baltimore.
http://www.hopkinsmedicine.org/profiles ... an-epstein

Profesor Epstein wyglosil wyklad na temat nowej klasyfikacji raka prostaty, ktora stopniowo powinna wyprzec dwuskladnikowego Gleason'a okreslanego z biopsji. (Pisalam o tym juz w zeszlym roku - patrz poprzednie posty).
Zaproponowana przez patologow z Johns Hopkins, i zatwierdzona przez WHO, skala jest 5-cio stopniowa, im nizszy stopien klasyfikacji tym lepsze rokowania.
Nie ocenia sie juz z biopsji Gleasona od 2 do 5 (czyli 1+1, 1+2, 2+1, 2+2, 2+3, 3+2), o czym wydaja sie nie wiedziec polscy patolodzy (sic!).

Wg nowej klasyfikacji, wynik biopsji zapisany jako
Grade 1 = 96% - 97% szansy na wyleczenie
Grade 2 = 88% "
Grade 3 = 65%. "
Grade 4 = 50%. "
Grade 5 = 25% "



Ponizej audio oraz pelny transkrypt rozmowy jaka przeprowadzil z prof. Epstein'em reporter, ABC Health Report, Norman Swan.


A better way to test for severity in prostate cancer

Monday 18 April 2016 5:50PM

AUDIO
https://radio.abc.net.au/programitem/pg ... ?play=true



There's a particular way doctors rate how quickly prostate cancers grow. It's called a Gleason Score. There's just one problem—experts now believe it's significantly deficient.

Transcript


Norman Swan: One of the challenges when you're diagnosed with cancer is being sure what stage it's at. The staging can decide what treatment you should have and what your prospects are for survival and cure.

For most tumours it's a complicated process involving the size of the tumour, what it looks like under the microscope, the extent to which it's spread and increasingly what the genes in the cancer are showing.

Prostate cancer has been even messier but some clarity may be coming from a new staging system developed at Johns Hopkins University in Baltimore.

One of the people responsible is Professor of Pathology, Urology and Oncology at Hopkins, Jonathan Epstein who's in Queensland as we speak to present his findings on the Gold Coast at the annual conference of the Urological Society of Australia and New Zealand.

Jonathan Epstein, welcome to Australia and the Health Report.

Jonathan Epstein: Thank you.

Norman Swan: It is complicated with prostate cancer, it's called the Gleason system, take us…we've only got a few minutes but just take us through what the Gleason system is and what the problem is.

Jonathan Epstein: The Gleason system was developed by a pathologist Donald Gleason in 1967 through 1973. It's a complicated system where you add the most common pattern and the least most common pattern seen under the microscope together to result in a score. The score ranges from 2 to 10, 2 being good tumours, 10 being very aggressive tumours which often kill patients. But it gets even more complicated because, for example, you could have a 7, and that 7 could be either mostly 3 which is good, plus a pattern 4 which is not as good, or mostly 4 which is, again, aggressive and a lesser amount of pattern 3.

Norman Swan: So we just need to explain that little bit more because when they do multiple biopsies in the gland, one might be, oh, that biopsy looks pretty good and the tissue is quite calm but this one looks really nasty, and you kind of add up the nasty bits versus the calm bits and come to a score.

Jonathan Epstein: Correct. And again, the score based on what Gleason did way back in the '60s and '70s was 2 to 10. But what has changed in recent times is that we no longer grade 2 through 5. We start pretty much the grading system at 6. So if you are a person who gets a biopsy and you have the best possible tumour present under the microscope we would give it a 6, which is out of kilter and patients are confused because the score theoretically goes from 2 to 10 but they are given a 6.

Norman Swan:
And then if you get a 7, it could be a good 7 or a bad 7, as you just alluded to before.

Jonathan Epstein: Correct, a 7 could be anything from an 88% cure rate down to about a 65% cure rate.

Norman Swan:
And I read a paper recently where if you present the same prostate tissue to different pathologists, they come up with scarily different conclusions.

Jonathan Epstein: Yes, it is a problem. There are some grades that under the microscope are classic and pretty much most pathologists should be in agreement, but a lot depends on the expertise of the pathologist, and there are some areas where because the grading system has changed over time, some pathologists may not be quite up to speed in what is the current way of grading it and may be grading it incorrectly based on current approaches.

Norman Swan:
So what have you done?

Jonathan Epstein:
So basically I'm an unusual pathologist in that most pathologists don't talk to patients, I talk to several patients a day.

Norman Swan:
Most pathologists don't talk.

Jonathan Epstein: Correct. So I talk to several patients a day because they have their cases sent to me based on finding me on the internet or in layperson's books et cetera. And I would find that they did have this apprehension that they were considering for example undergoing watchful waiting for good prostate cancer but they were given a Gleason 6 out of 10 and that scared them. Or they, again, were given a 7 out of 10, thought it was a death sentence, when in fact most of them had a potentially excellent prognosis.

So I basically thought to say if we were just coming up with a system right today, forgetting what was done in the '60s and '70s, what would be the simplest grading system that we could have that would be intuitive for patients with prostate cancer and came up with a 1 through 5, 1 being good, 5 being bad, and again, very understandable and gets rid of all the confusion that we have with the 3+4 versus 4+3, or a scale that goes from 6 to 10.

Norman Swan: So it sounds simple but is there a complexity behind it?

Jonathan Epstein: No, it's actually quite simple for pathologists, it's still based on the current approach to Gleason, so most pathologists can deal with it. I think like anything else in time, changes in medicine take years sometimes to go into effect. So what is currently being recommended is that in pathology reports we report the Gleason system but then side-by-side we give the new grading system 1 through 5. And the hope over a period of time is that eventually Gleason will be dropped and we will have a simple 1 through 5 grading system for prostate cancer.

Norman Swan: So take us through 1 to 5 and tell us what the outcomes are for each of the scores.

Jonathan Epstein: So if you have a grade 1 you literally have no chance of that tumour ever spreading outside the prostate. And if your prostate comes out and it's a pure grade 1, you are 100% cured. If you have a grade 1 on biopsy, there's always an issue with prostate and sampling that they may miss some higher grade or worse tumour, but even then with that inherent sampling problem, if you have a grade 1 biopsy, you have a 96% to 97% cure rate. A grade 2, you have an 88% cure rate. Grade 3 drops to about 65%. Grade 4 around 50%. And grade 5 around 25% cure rate.

Norman Swan: And how have you verified that? Because one of the problems with any sort of testing is knowing how valid it is.

Jonathan Epstein: Yes, so initially I did this study in 2013 just based on patients from Johns Hopkins, and then basically I realised that this was going to be something that we could potentially sell to the rest of the world to use, it needed to be verified with other institutions and larger groups of patients. So I gathered together a multi-institutional study, including institutions from outside the United States, over 20,000 patients, and we verified it. And what we used as the outcome because that was what was available was the risk of being cured biochemically, meaning you take out your prostate and the PSA never goes up.

Norman Swan: The PSA test, whilst it might be unreliable as a screening test, it's a very reliable way of following somebody after they've had cancer.

Jonathan Epstein: Correct. Once you take out the prostate you don't have a source of PSA, so it's a very sensitive means of saying has your cancer come back. And then subsequently there's more recently been several studies showing a new grading system that correlates with death due to prostate cancer as well with longer follow-ups, so that has been very satisfying as well.

Norman Swan: Does it change treatments?

Jonathan Epstein: In general it changes patients' perception of what cancer they have, which can affect treatment. So if you are trying to recommend a patient to undergo active surveillance or synonymously watchful waiting and they have a Gleason 3+3 equals 6, many of them will feel uncomfortable doing so because 6 doesn't sound such low-grade. So it's a perception. Whereas if you tell them they have a grade 1, the lowest grade possible, the hope is that those patients will go on active surveillance, feel more comfortable doing so, and stay the course.

Similarly if you tell somebody they have a 3+4 equals 7, I've talked to patients who feel they think it's almost a death sentence and 7 is closer to 10 that it is to 2, when in fact they have an 88% cure rate and some of them may also be candidates for watchful waiting if they are older and have some comorbidity. If we tell them they have a grade 2 out of 5, again that's hopefully something we can tell them, that they may have a tumour that we don't have to be as aggressive with.

Norman Swan: So for consumers in Australia, are pathologists in Australia doing it?

Jonathan Epstein: Yes, so the Royal College of Pathology in Australia and New Zealand has accepted it, and the World Health Organisation just came out in 2016 has accepted it. So it's starting, it's probably starting more in some of the major academic institutions, and will take time to probably filter out to the communities, but it should hopefully be prevalent in a few years in Australia as well.

Norman Swan: Jonathan, thanks for joining us.

Jonathan Epstein: I appreciate it very much.

Norman Swan: Jonathan Epstein, who is Professor of Pathology, Urology and Oncology at Johns Hopkins University Medical School in Baltimore.

I'm Norman Swan, this has been the Health Report.

Guests

Dr Jonathan Epstein
Professor, Departments of Pathology, Urology, and Oncology at Johns Hopkins


http://www.abc.net.au/radionational/pro ... transcript
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Re: New grading system for prostate cancer

Nieprzeczytany postautor: zosia bluszcz » 05 mar 2017, 09:58

NewGradingSystem WHO 2016.pdf
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Re: New grading system for prostate cancer (skala WHO)

Nieprzeczytany postautor: wlobo135 » 06 mar 2017, 00:02

"Ściąga" z nowego systemu klasyfikacji CaP <= Ta sciaga byla i jest w moim poscie z 23 kwietnia 2016 :) zb

Grade Group 1 (Gleason score ≤6) => 96% - 97% szansy na wyleczenie
Grade Group 2 (Gleason score 3+4=7) => 88% szansy na wyleczenie
Grade Group 3 (Gleason score 4+3=7) => 65% szansy na wyleczenie
Grade Group 4 (Gleason score 8) 50% => 50% szansy na wyleczenie
Grade Group 5 (Gleason scores 9-10) => 25% szansy na wyleczenie


(system was validated through an analysis of surgically removed prostates and biopsy cores from more than 20,000 men)



Uwaga:
Pamietac nalezy, ze analizowano glownie wyniki pacjentow amerykanskich.
Biorac pod uwage, ze polskie biopsje sa nagminnie zle pobierane I jeszcze gorzej opisywane nadwislanski pacjent powinien podchodzic do tych wynikow i prognoz z duza rezerwa.
zb
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Re: New grading system for prostate cancer (skala WHO)

Nieprzeczytany postautor: irq » 06 mar 2017, 15:05

zb pisze:
Uwaga:
Pamietac nalezy, ze analizowano glownie wyniki pacjentow amerykanskich.
Biorac pod uwage, ze polskie biopsje sa nagminnie zle pobierane I jeszcze gorzej opisywane nadwislanski pacjent powinien podchodzic do tych wynikow i prognoz z duza rezerwa.
zb

O ile dobrze zrozumiałem ten tekst, przyjmuje on za bazę prognostyczną, w zakresie Grade Group 1-4, wyniki histopatologii pooperacyjnej, nie biopsji. Wyjątkiem jest prognozowanie na podstawie Grade Group 5 również z biopsji, poprzedzającej RP lub RT. Więc może jednak te prognozy nie są aż tak bardzo nieprzydatne?
Ur. 1962. PSA przed: 2012: 1,795, 2013: 1,867, 2014: 2,504, 2015-03: 4,69 2015-04: 3,74, 2015-09: 4,32, 2015-10: 4,36, 2016-01: 6,15, 2016-02 MRI: niejednoznaczne, 2016-03 Biopsja: T1c, Gleason 7 - 8 (4+3) - (4+4), 2016-04 TK: czysto, 2016-05 LPR: pT2c N0, Gleason 3+4=7; węzły chłonne czyste, pęcherzyki nasienne czyste, linie cięcia czyste, trzymanie moczu: 100,00%, potencja: 0,00% PSA po: 2016-08 - 2017-08 : < 0,003; 2017-11: 0,007; 2017-12 < 0,003; 2018-02: 0,005; 2018-05: 0,006; 2018-08: 0,004; 2018-11: 0,006; 2019-02: 0,004; 2019-05: < 0,003; 2019-08: 0,004; 2019-12: 0,004; 2020-03: 0,005; 2020-09: 0,004; 2021-05: 0,004; 2022-01: 0,005; 2023-01: 0,005 Geny: mutacja BRCA2
5km: 00:21:00; 10km: 00:43:16 !!!; 21,098km: 01:35:45 !!;
Mój wątek: viewtopic.php?f=2&t=2365
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Re: New grading system for prostate cancer (skala WHO 1-5)

Nieprzeczytany postautor: bela71 » 06 mar 2017, 20:47

Jedna poprawka: "wyleczenie" w statystyce oznacza pzeżycie 5 lat bez wznowy.
Tata ur.1936 Od 2005 leczenie BPH, PSA przy finasterydzie oscylujące między 5 a 11(!).
Po odstawieniu Proscaru VII.2012 PSA 20,81ng/ml, biopsja GL 4+3, zatarta torebka, scyntygrafia czysto. cT3NxM0 Gleason 7 (4+3)
X.2015 Apo-Flutam (1mc), Diphereline co 3m-ce, zmieniona po roku na Eligard 45. 4.XII.12 PSA 1,15.
XII.2012-I.2013 RT 65 Gy IGRT w 25 frakcjach (Wieliszew).
PSA 21.II.13 - 0,089; 25.IV.13 - 0,076; VI.13 - 0,067; IX.13 - 0,065; XII.13 - 0,044,(testosteron 0,035); III.2014 - 0,057, (T<0,025 od tego momentu); V.14 - 0,021; IX.14 - 0,016; XI.14 - 0,009; I.2015 - 0,01; IV.15 - 0,011 KONIEC HT VIII.15 PSA - 0,008; XI.15 PSA 0,010, T 0,14; II 2016 PSA 0,025, T 0,4; V 2016 PSA 0,017, T 0,68; VIII 2016 PSA 0,021, T 0,9; XI 2016 PSA 0,016, T 0,966; III 2017 PSA 0,003[?], T 1,38; IX 2017 PSA 0,035 T 1,63; XI 2017 PSA 0,051, T 1,79; I 2018 PSA 0,06, T 2,13; II 18 PSA 0,06, T 1,84; IV 18 PSA 0,05 T 1,88; XII 18 PSA 0,05, T 1,57; III 2019 PSA 0.07, T 1,75; V 19 PSA 0.08, T 1,66

3.12.15 – Kolonoskopia i APC zmian naczyniowych (angiodysplazja odbytnicy po RT); 2016 2 serie czopków łagodzących podkrwawianie; 29.05.2017 - ponowna koagulacja laserowa niewielkich zmian naczyniowych w odbycie - zaobserwowana znaczna poprawa stanu śluzówki jelita w porównaniu do 2015
Wątek: http://rak-prostaty.pl/viewtopic.php?f=2&t=2137
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