Video: Gleason 3+4=7 and 4+3=7: What Is The Difference? | Ask a Prostate Expert, Mark Scholz, MD
Ask a Prostate Expert | Transcription
Alex: So, getting straight to the point, what is the major difference between 3+4 and 4+3? I know a lot of people are kind of thinking, "that's the same thing," does it really matter that those numbers are switched?
Dr. Scholz: So the staging system that the PCRI has developed is to help people understand that there are different types of prostate cancer and the different types that we talk about—the different colors and whatnot—are heavily dependent on what the Gleason score is and the Gleason is what the cancer cells look like under the microscope. So, they're assigned numbers, so, 3, 4, or 5. Three being low, five being high, and four sort of being in-between, but people can have, on their needle biopsies, more than one type and so the Gleason system addresses that problem by putting the more common type first, followed by a plus sign, and then the second most common type. So if it's a 3+4 that means that the 3 (the low-grade type) is the most common on the biopsy. If it's a 4+3, the order being different, then you're looking at the higher grade type being the most common. And the story, in terms of how prostate cancer behaves over time, is driven by the higher grade type, and so, in some sense, you almost ignore the lower-grade type.
So, if you look at the difference between 3+4 and 4+3 then it's just a matter of how aggressive the cancer is and how likely it is to spread. When we talk about cancer being aggressive, we're really worried about metastasis. So, the 3+4's—there's basically in the staging system that we have for Teal we talk about Low, Basic, and High Teal—so the Low-Teals are the ones that have very small amounts of 4 and those are favorable enough to consider active surveillance. The men that have more 4 than 3, they're going to be the High-Teals and they're gonna need combination treatment (short course of hormones, seed implant, radiation), and then the people that are in a 3+4 situation but they don't have very small amounts of 3 (but still less than 50%) those are the Basic-Teals and they can do a lot of different treatments. Their chances for metastases are very small, but not negligible, and so focal therapy, seed implants, different types of radiation, different types of hormone therapy all could be considered as a form of monotherapy. So, bottom line, 3+4 is a lower grade, less concerning process. 4+3 is becoming a more serious, consequential type of prostate cancer.
Alex: Okay, so what type of cure rates are you seeing with the 4+3? I mean, are they still on a pretty okay zone. I know a lot of people get really freaked out when I talk to them on the phone and they're realizing that they have that higher grade.
Dr. Scholz: Yeah, with modern therapy, combinations of, as I mentioned, seed implants, radiation, and 4 months of hormone treatment, cure rates will range from—in the most favorable 4+3 situations you can be up to 90-95% cure rates. And then, in the very unfavorable 4+3's, people with high PSAs, lots of needle biopsies positive, still, the cure rates are going to be pretty decent—probably in the 75-80% range.
Alex: If you have questions about anything that we've talked about today when it comes to seeds, our helpline can definitely assist you with that. So you can go ahead and head to our website, PCRI.ORG, and under "our services" you'll see helpline, and you can submit your question in email form or give us a phone call. We're here for you and it's honestly an honor to do it. So, thank you so much, Dr. Scholz, for just answering our questions once again. Again, if you would like to submit a question that you would like Dr. Scholz to answer, you can go ahead and put that in the comment box of this video, and we really appreciate your time, and we hope you have a great week.