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The move to include a tertiary grading is part of the move that is shifting Gleason Grades upwards. There is an interesting paper Gleason Grade Migration which says in part:
Pathologists may increasingly be swayed to incorporate a slight modification of the Gleason grading system itself. As initially described, pathologists were only supposed to include the two most common patterns in the Gleason score. However, there is increasing evidence suggesting that presence of a third (tertiary) Gleason grade higher than the primary or secondary component is important, and should be reported. Pathologists may want to include a small amount of high-grade cancer in the Gleason score. As described below, new recommendations will actually mandate this change. Although not part of the classic grading system, this reinterpretation may explain some measure of grade migration.
This 'migration' of Grades will make currently diagnosed PCa appear to be more aggressive than histoically diagnosed disease and makes comparison of outcomes more difficult. I recently read some other interesting material regarding more potential reasons for the migration, which are not mentioned in the paper. I am still investigating these and if I find anything of interest will post something in due course - but it may be some time, so don't hold your breath :- )
Thanks Terry...that article cleared up some of my questions. So if I understand it correctly, I had a predominant grade 3, secondary grade 4 and a small amount of grade 5....which ultimately gives me a 7+ or 8. I also understand this is up to the pathologists interpretation. I had my biopsy looked at by 3 pathologists, one gave me a 4+4 on the left side, the other two gave me a 3+4 on the left. All gave me a 3+3 on the right side. The tertiary came up only on the post surgery look at the prostate. Gee...maybe I'm finally getting this!!
Well, Ron, it certainly is a complex business!! But you're getting there.
I must say when I was diagnosed I found it difficult to understand how I could have Gleason Score of 5 or 6 or 7, depending on whose findings I believed - and of course now those would likely be 6 or 7 or 8!! So that's quite a range, especially when you consider I was staged from T1c through to T4 and my PSA was up and down.
Feed all those into one of the nomograms and you get a range of answers that says in effect "We really don't know what to say."
Good luck - don't worry too much about that little GG 5
