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For example, if the primary tumor grade was 2 and the secondary tumor grade was 3 but some cells were found to be grade 4, the Gleason score would be 2+4=6. This is a slight change from the pre-2005 Gleason system where the second number was the secondary grade (i.e., the grade of the second-most common cell line pattern).
Over treatment is most likely to occur when a low grade prostate cancer is detected, especially in an older man. Data from various sources suggest that in the PSA range where many men are undergoing prostate biopsy today (PSA 2-4 ng/ml), 15-25% will have prostate cancer detected, and 80-90% will be low grade. [20] [21]
In fact, the five-year survival rate for prostate cancer detected early is virtually 100%, Siddiqui says. The outlook for late-diagnosed patients, however, is not nearly as rosy.
There are several reasons why PIN is the most likely prostate cancer precursor. [3] PIN is more common in men with prostate cancer. High grade PIN can be found in 85 to 100% of radical prostatectomy specimens, [4] nearby or even in connection with prostate cancer. It tends to occur in the peripheral zone of the prostate.
For prostate cancer, cell morphology is graded based on the Gleason grading system. [ citation needed ] Of note, this system of describing tumors as "well-", "moderately-", and "poorly-" differentiated based on Gleason score of 2–4, 5–6, and 7–10, respectively, persists in SEER and other databases but is generally outdated.
In the United States there has been an increase in the 5-year relative survival rate between people diagnosed with cancer in 1975-1977 (48.9%) and people diagnosed with cancer in 2007-2013 (69.2%); these figures coincide with a 20% decrease in cancer mortality from 1950 to 2014. [8]
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