Gleason Grade
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Introduction 

 Demographics

 Anatomy & Physiology

 Symptoms

 Who Should be Evaluated

 Prostate Examination

 Digital Rectal

 PSA

 Total vs. Free Ratio

How to Evaluate for PCa

 Consultation

 Total vs. Free PSA

 Trans Rectal Ultrasound

 Needle Biopsy

 Biopsy Results

What if the Biopsy is Positive?

PIN

 How is Pin Diagnosed?

 Does Pin Raise PSA?

 What does PIN mean?

 Treatment of PIN

PIN

 How is Pin Diagnosed?

 Does Pin Raise PSA?

 What does PIN mean?

 Treatment of PIN

Gleason Grade

Stage

 Stage A

 Stage B

 Stage C

 Stage D

Therapy Options

Surgery

 Radical Prostatectomy

 Standard Operation    

 Nerve Sparing Oper.

 Positive Margins

 Recurrence after Surgery

Radiation Therapy

 External Beam Therapy

 Interstitial Radiotherapy

 Brachytherapy or Seeds

 Rapid Interstitial Therapy

 Combined Therapy

 Neoadjuvant Therapy or

         Hormones + Radiation

Combined Therapy

Cryotherapy

Hormone Therapy 

 Hormonal Therapy

 Castration

 LHRH Inhibitors

 Total Androgen Blockade

 Neo Adjuvant Therapy or

    Hormones + Radiation

Observation

Late Stage Prostate Cancer

 Cycling antiandrogens

 Chemotherapy

 Cryotherapy

 Bony Metastases

   External Beam Radiation

   Strontium 89

   Bisphosphonates

   Immunotherapy

   Monoclonal Antibodies

   Alternate Medicine

Alternate Medicine

 PC-Spes

 

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Stephan L. Werner, M.D., F.A.C.S.

Grade or Gleason Grade

   When the pathologist looks at the biopsy he grades the cancer by comparing the appearance of the cancer cells to the appearance of normal prostate tissue.   The grades go from Grade 1, almost normal, to Grade 5, very abnormal.  

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    The Pathologist then adds the results from the two greatest areas of cancer and gives a report, for example, (3+2=5).  Therefore positive biopsies run from Gleason grade 2, which has a relatively good prognosis, to Gleason grade 10, which does not.  The vast majority of prostate cancers are Gleason grade 6 -7, or moderate. It is virtually impossible to make a diagnosis of Grades 2 to 4 on needle biopsy.  The lowest grade reported on needle biopsy is (2+3)=5. Epstein:AmJlSurgPath: 24(4) 477-78 2000

PIN[click to view] Prostate Intraepithelial Neoplasia

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Rev: 04/02

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Werner - Francis Urology Associates llc - Mid Atlantic Urology Associates llc

Greenbelt - Bowie - Laurel     Maryland

(301) 441-8900               Fax (301) 982 0453

7500 Hanover Parkway   Suite 206    Greenbelt, MD   20770

e-mail: wfurology@gmail.com

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Rev:03/08