What Do a PSA and a Gleason Score Mean for Prostate Cancer Patients?

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Is every elevation on a prostate-specific antigen (PSA) test cancer-related? What does the Gleason Score reveal about disease behavior? Patient Power founder Andrew Schorr is joined by leading prostate cancer expert Dr. Maha Hussain, from the Robert H. Lurie Comprehensive Cancer Center of Northwestern University, to discuss the significance of PSA and the Gleason Score. Watch now to learn more.

This is a Patient Empowerment Network program produced by Patient Power in partnership with Robert H. Lurie Comprehensive Cancer Center of Northwestern University. We thank Astellas, Clovis Oncology and Pfizer for their support.

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Transcript

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

Andrew Schorr:

Hussain, when we say PSA, think prostate-specific antigen...

Dr. Hussain:                

...antigen.

Andrew Schorr:          

How is that important in triggering, oh, this person may have prostate cancer?

Dr. Hussain:                

Prostate-specific antigen is a blood test, and it’s a product of prostate cells. A normal prostate will actually have, what we call PSA, prostate-specific antigen, and because the cancer cells are a product of the normal prostate cells, they will, in the vast majority of times, retain the ability to make the PSA. 

Now, as you know, prostates can change in size over time, and when we do blood tests for the PSA, there are ranges from what we would consider normal range, and this normal range is—also has to be adapted by age, so someone who is, let’s say, 45 years old, normal range PSA for that person ought to be different than someone who was, say, 75 years old and that has to do with the size of the prostate and other factors. 

Because the cancer can make the PSA, an elevation in the PSA could be something that could be cancer related, but I want to point out to the men who are joining us on this session that there are other things that can make the PSA go up, including infections in the prostate, irritation, things of that sort, enlargement of the prostate, so not every elevated PSA is necessarily cancer related.

Andrew Schorr:          

Okay, he mentioned Gleason Score. What is a Gleason Score and why is that significant?

Dr. Hussain:                

The Gleason Score is named after the pathologist who came up with the grading system, Dr. Gleason, and this was intended to basically better characterize, how aggressive is the cancer? As you know, if you think of the prostate as sort of like a peach, it has both sides, and at the microscopic level, there is what we call glandular tissue. When cancer happens, there are different shades of grey in terms of, how aggressivedoes it look under the microscope, and the quantity of the worst cancer versus not-so-aggressive cancer does matter in terms of the prognosis and the forecast in terms of risk of relapse and so on. 

Dr. Gleason came up with a system whereby, under the microscope, the pathologist will look at the cancer that is present and characterize it by how aggressive it looks. The more it looks like the normal tissue, that’s the less aggressive, and the less it looks like the normal tissue, that makes it more aggressive, and because the prostate is a large organ, there could be the possibility of multiple areas that might have the cancer in it.

Essentially, what they do is try to come up with a lump sum sort of read that gives you the most predominant pattern that’s given a score, and then the lest predominant pattern that’s also—I’m sorry, the next most predominant pattern is also given a score, and those two numbers are added up, and that’s how we come up with the Gleason Score.

Andrew Schorr:          

Okay, and is that the…

Dr. Hussain:                

Historically, that goes—I’m sorry—from two to 10, and that means a person’s Gleason Score, again, historically, was two or it could be three, or it could be anywhere between that and 10. Then, recently, the pathologists have changed the way the grading system is, so now it really goes from one to five and it’s not the Gleason Score itself.  

Andrew Schorr:          

Dr. Hussain, is the Gleason Score—that is a result of doing those biopsies, did I get that right?

Dr. Hussain:                

Yeah, the Gleason Score is not the result of it, but it’s basicallythe product of a pathologist looking at the tissue that was removed by the biopsy, and obviously, what they do is, when the surgeons, urologists go in, they try to sample multiple areas in both lobes of the prostate.

Please remember the opinions expressed on Patient Power are not necessarily the views of our sponsors, contributors, partners or Patient Power. Our discussions are not a substitute for seeking medical advice or care from your own doctor. That’s how you’ll get care that’s most appropriate for you.

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Page last updated on January 22, 2019