Understanding the Gleason Score and Margins after surgery

[GeorgeWilson]

1. Is a Gleason Score (=8) the same from day one?
2. Would the margins after surgery differ base on how long you waited to have the surgery after it was first detected?
3. If there is no trace of cancer in the lymph nodes(after prostate was removed) then how long does the cancer  residue
   remains stay in the prostate area( before they spread to some other place) if the margins were positive? In other words;
   how long should you wait before seeking adjuvant therapy?  

[Ash Tewari, MD, M.Ch.]

Thank you for your question.

In addressing your inquiries, please restate question #1. It is not clear what you mean by "day one."

"Would the margins after surgery differ base on how long you waited to have the surgery after it was first detected?"
You would not expect a marked difference in the probability of positive surgical margins within 2-4 months after biopsy. There is one, or several, caveats. This would be hard to predict given the positive predictive value of biopsy and the discordance between imaging and final pathology. That is to say, given all the preoperative workup, it is often a challenge to correlate clinical findings with surgical realities.

"How long should you wait before seeking adjuvant therapy?"
Depending on the findings of surgical pathology, often times you would wait until PSA levels begin to rise consistently to start adjuvant therapy (assuming a negative surgical margin). The extent and location of a positive margin, the gleason grade, would determine if (after continence is regained) radiation is warranted.

Consultation with your urologist is essential to determine a followup regimen.

Ashutosh (Ash) K. Tewari, MD
www.cornellroboticprostate.org

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[GeorgeWilson]

After looking at the  definition of a Gleason score ; I do agree with you that question one was stated incorrectly and base on that ; it  should be ignored. Thank for you for your answers.