Jonathan I. Epstein, professor of pathology, oncology and urology at the Johns Hopkins University School of Medicine and researcher at the Kimmel Cancer Center, admits that he is an unusual pathologist since he actually speaks living patients. Over the years, many men diagnosed with prostate cancer (PCa) have discovered his media research and asked for advice. "A man called me in tears recently," recalls Dr. Epstein. "He said he had PCa, and his wife had just been diagnosed with a severe brain tumor, and she would die within six months to a year." He was scared His own cancer would kill him before he could take care of his wife.
At first glance, the man's anxiety seemed reasonable: the 2-1
But Dr. Epstein knew something most patients and many doctors do not know. In practice, the lowest Gleason score everyone receives today is a 6. "This leads to a logical but incorrect assumption of many patients," Dr. Epstein, "that your cancer is in the middle of the scale, the lowest note should be the lowest number, not somewhere in the middle."
While numerical evaluation is not the only problem with the Gleason system, says Dr The numbers also do not necessarily reflect a patient's actual prognosis, for example, some traditional 6s and 7s are slow-growing tumors that are unlikely to cause harm for years, while others are much more aggressive and prone to rapid metastasis.
Hoping to distinguish the turtles from the tigers, Dr. Epstein and his team analyzed data from 7,000 live PCa patients in 2013, taking 20,000 tissue samples from the prostate through surgery and another 5,000 prostate biopsies from men treated by radiation Based on this, they proposed a new, simplified and more accurate rating system, Prostatatu rated more from the least aggressive (grade 1) to the most aggressive (grade 5). Its new approach has since proved so accurate that it was introduced in 2016 by the World Health Organization as the new global standard. In the US, its use is now prescribed alongside the traditional Gleason rating and will likely become our stand-alone standard in the years to come.
Changes in tumor classification may seem like but like a ho-hum development, but not experienced cancer patients and the patients being counseled by them. "The first and foremost change in PCa treatment is not actually in the treatment per se, ," says Otis W. Brawley, MD, FACP, Chief Medical Officer of the American Cancer Society. "It's about determining who needs a treatment . In the past 5 or 6 years, the number of men diagnosed with PCa has increased dramatically and has not been aggressively treated. "Thanks to the system of Dr. med. He adds Epstein, Men with Grade 1 Cancer – and even Cancer Some older men in grade 2 can now embrace this watchful waiting without feeling like it's a crazy gamble.
Further confirmation in this regard emerged from the ProtecT study, which compared ten-year survival of men whose local PCa was either surgically treated with radiation or simply active surveillance. The results, published in New England Journal of Medicine in 2016, found that all three treatments caused the same, very low PCa death rates.
For men like the one Dr. Tears, such evidence-based insurance can be a godsend. In further questioning, Dr. Epstein states that the man's 7 was 3 + 4 = 7, as opposed to 4 + 3 = 7 – one of Gleason's many confusing subtleties. "I explained," Epstein says, "that we now refer to it as Grade 2 of 5, a very good cancer with a cure rate of almost 90 percent, I said it will not kill you quickly – most likely it will not kill you at all No question, you'll be there to look after your wife. "