Video: What Does Gleason 9 & 10 Mean? | Ask a Prostate Expert, Mark Scholz, MD
Ask a Prostate Expert, Mark Scholz, MD | Transcription
Alex: So our first question is regarding Gleason 9 and 10. So we get, as you know, hundreds of inquiries regarding Gleason score, and a lot of people get extremely concerned that once they see that higher number of Gleason 9 and 10 that it really means that they're in an extremely, you know, ridiculous situation. They don't know what to do and they are kind of thinking that it's more in the end game, but in a sense, Gleason 9 or 10, if it's caught early, could be a different story. So could you speak to that?
Dr. Scholz: Yeah, so we're always trying to figure out with newly diagnosed prostate cancers—it's where the Gleason score is most important—and what's the chance that it's spread outside the prostate. And the patients that have Gleason 9 and 10s versus the patients that have Gleason 8s or Gleason 7s (think of those as sort of the intermediate, intermediate to high, and high-risk prostate cancers). The patients that have 9 and 10 are going to be a little higher risk for some early microscopic spread and there's just no compromising in selecting treatment. You want to use aggressive systemic hormones, seed implants, standard IMRT to the prostate to ensure you get a good cure rate. It's not that different from Gleason 8. It is a little bit higher risk of metastatic disease, and so a thorough, careful approach to treatment is necessary, but it's not a reason to get all overwrought. I have dozens, hundreds, of patients that have had Gleason 9 that are 10 years out, have been cured, and it's not that difficult to cure with appropriate therapy. In my opinion, it's not a very good situation to use surgery because the relapse rates will be high after surgery, but with a combination of seed implants and radiation the cure rates are going to generally be good—I mean, assuming that the PSA is not 60 or there's, you know, not already established metastatic disease somewhere. But for your typical patient that has a biopsy and it's Gleason 9, they should be looking to be cured.
Alex: That's really good news.
Dr. Scholz: Mm-hmm
Alex: That's awesome.
Dr. Scholz: Yeah.
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