Prostate Cancer Diagnosis and Prognosis: Histopathology
September 21, 2021Information
September 19, 2021
Yale Cancer Center
visit: http://www.yalecancercenter.org
email: canceranswers@yale.edu
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- 00:00Funding for Yale Cancer Answers
- 00:02is provided by Smilow Cancer
- 00:04Hospital and AstraZeneca.
- 00:08Welcome to Yale Cancer Answers with
- 00:10your host doctor Anees Chagpar.
- 00:12Yale Cancer Answers features the
- 00:14latest information on cancer care by
- 00:16welcoming oncologists and specialists
- 00:18who are on the forefront of the
- 00:20battle to fight cancer. This week,
- 00:22it's a conversation about prostate
- 00:24cancer with Doctor Peter Humphrey.
- 00:26Doctor Humphrey is a professor of
- 00:27pathology at Yale School of Medicine,
- 00:30where Doctor Chagpar is a professor
- 00:33of surgical oncology.
- 00:35Peter, maybe we can start off by you
- 00:36telling us a little bit about
- 00:38yourself and what you do.
- 00:40I'm a practicing surgical pathologist
- 00:42which basically means that I
- 00:45look at a glass slide under a
- 00:48microscope and render a diagnosis,
- 00:50often cancer diagnosis on tissues that
- 00:54we received from other physicians,
- 00:57including biopsies and and resections,
- 01:02and so microscopes have always interested me.
- 01:05Ever since I was very young and
- 01:08looked through a microscope at pond
- 01:10water when I was in elementary school,
- 01:13but it was actually taking
- 01:16care of a patient in medical school
- 01:18that really helped direct me into
- 01:21pathology and if I can give that story.
- 01:25I was a third year
- 01:29medical student and
- 01:29hadn't really decided on a specialty.
- 01:33And was considering a number
- 01:35of different specialties,
- 01:36including medicine and internal medicine.
- 01:38Pathology wasn't so
- 01:41high on the list until
- 01:45there was an occurrence with one
- 01:48patient and she was on the internal
- 01:51medicine ward and she had rib pain
- 01:55and the radiologists were able to
- 01:58identify a lesion in the rib and
- 02:01the differential diagnosis that
- 02:03we considered clinically and the
- 02:06radiologist considered was quite lengthy
- 02:09so it really took a biopsy which
- 02:13then went to surgical pathology and
- 02:16in order to establish the diagnosis,
- 02:18and so I I went down to surgical pathology.
- 02:21the laboratory where the attending
- 02:24surgical pathologist was looking,
- 02:26at slides with their resident
- 02:28on the service and I asked if they
- 02:31had seen the biopsy from this
- 02:33particular patient and he said he had,
- 02:36and then he pulled out the slide
- 02:39and went through it and in pretty
- 02:41short order said oh,
- 02:43this is metastatic cancer from
- 02:45the salivary gland,
- 02:46which was a diagnosis that was not
- 02:49really considered in this patient.
- 02:51It turns out she did have a history of
- 02:54salivary gland cancer 10 years prior
- 02:58so it occurred to me that this was
- 03:01the way to really help patients
- 03:04by helping render diagnosis.
- 03:08I find that fascinating, because certainly
- 03:10if you had a patient with rib pain,
- 03:13metastatic cancer from a salivary
- 03:15gland would not be top of the list.
- 03:18Did the pathologist know about the distant
- 03:21diagnosis of salivary gland cancer?
- 03:24I think this particular
- 03:26cancer was so distinctive that
- 03:28he was able to suspect salivary
- 03:31gland cancer right away.
- 03:33I'm not sure if he knew the history,
- 03:35but he was an excellent
- 03:37surgical pathologist and being
- 03:38an excellent surgical pathologist
- 03:40I'm sure he had asked the
- 03:42resident for the history first,
- 03:43as they examined the slide.
- 03:46Yeah, it's just absolutely fascinating,
- 03:50but now you've kind of transitioned
- 03:52still looking at cancers,
- 03:54but now you're into the world
- 03:56of genitourinary pathology,
- 03:58tell us a little bit more about how
- 04:01your interests transitioned to that.
- 04:07In residency a big
- 04:10part of pathology residency,
- 04:12which is pretty broad based,
- 04:13we rotate through a number of different
- 04:17services, subspecialty services and
- 04:20those services work with specific
- 04:22clinicians and it's disease
- 04:25focused and usually organ site
- 04:29focused. For example,
- 04:32as a genitourinary pathologist,
- 04:34I interact very closely with the
- 04:38urologist and medical oncologist
- 04:40to treat urological cancers as well
- 04:43as radiologist and interventional
- 04:45radiologists to deal with these
- 04:47type of cancers and specifically
- 04:49for the genitourinary system,
- 04:51this is just an introduction.
- 04:53We basically address cancers that arise in
- 04:57the prostate and testis and bladder and
- 05:01kidney, so it turns out when you are
- 05:06in formative years,
- 05:08one should never underestimate
- 05:10how a single patient or a physician
- 05:14can impact the development of
- 05:18the individuals who are young and
- 05:20deciding in medical school or pathology.
- 05:25So I was a first year resident and
- 05:28I rotated through the VA hospital
- 05:31which was right across from Duke
- 05:33University Hospital,
- 05:34which is where I did my residency.
- 05:37And there was a fascinating rotation,
- 05:39and another excellent surgical
- 05:41pathologist was the attending there,
- 05:44and we saw quite a lot of prostate cancer.
- 05:48And at the VA hospital,
- 05:51this was several decades ago,
- 05:55dating myself a number of decades ago,
- 05:58there was not much known about
- 06:00prostate cancer,
- 06:01and treatments were relatively limited,
- 06:04so it seemed to me that this was
- 06:06an area where
- 06:07there is much to be learned about diagnosis
- 06:10and prognosis as well as treatment of
- 06:13that particular cancer.
- 06:15So that's really how I became
- 06:17interested as a first year
- 06:19pathology resident in
- 06:21genitourinary cancers,
- 06:22and specifically prostate cancer
- 06:24Let's dive a little
- 06:26bit more into prostate cancer.
- 06:28I think that so much of again,
- 06:31what we do is really dictated by
- 06:34the biopsies that we take.
- 06:36So if somebody has
- 06:38a mass in the prostate or an enlarged
- 06:42prostate, even more globally,
- 06:43sometimes a biopsy will be done,
- 06:46and that'll be sent to the
- 06:48pathologist and it's really up to
- 06:50you to try to figure out is this
- 06:53cancer or is this something benign?
- 06:56And if it's cancer,
- 06:57how bad of a cancer is it which
- 07:00really dictates
- 07:02is this something that we treat at all,
- 07:05or something that we simply watch?
- 07:09How do you make those decisions?
- 07:11How do you make that differentiation from
- 07:15benign to malignant and within malignant,
- 07:18the different grades of prostate cancer?
- 07:21So it's really quite a long
- 07:24educational process to be able to
- 07:27diagnose benign versus malignant,
- 07:29and it turns out that what's so fascinating
- 07:31is that every single biopsy is different,
- 07:34even if we render an
- 07:36umbrella diagnosis of benign tissue.
- 07:38For example, the lining tissue of the prostate.
- 07:41There could be a number of
- 07:43benign mimicker's in there,
- 07:45meaning benign tissue looking
- 07:46like cancer under the microscope,
- 07:49but it's not, and we have
- 07:55a differential diagnosis.
- 07:56We consider a number of different
- 07:57benign entities before deciding
- 07:59on a malignant diagnosis,
- 08:00because that's such a huge step
- 08:02to take for us and for the patient
- 08:05and the patient's treating physician.
- 08:09So that's what I particularly enjoy,
- 08:14that diagnostic work and it
- 08:16can be arduous sometimes.
- 08:18Sometimes it's very straightforward
- 08:20that a particular biopsy is benign
- 08:23and sometimes straightforward that
- 08:25it's malignant, but other times
- 08:27there are benign conditions under
- 08:30the microscope that look like cancer
- 08:32and cancer that can look benign.
- 08:34So we've been fortunate in this area
- 08:37to have some tools to help us and
- 08:40those include antibodies that can
- 08:42help us recognize specific cells under
- 08:45the microscope and in certain cases
- 08:47that can be relayed to us,
- 08:50but it still requires judgment and
- 08:53having formed a differential diagnosis
- 08:56or consideration of what's possible
- 08:58before we order those tests.
- 09:00On that issue,
- 09:02so once having established a
- 09:04diagnosis of malignancy,
- 09:06then the next step is to decide and this
- 09:09is so important for prostate cancer,
- 09:11how aggressive is it?
- 09:13Because it turns out most men who
- 09:16have prostate cancer will die
- 09:18with it rather than of it.
- 09:20So there are a large number of
- 09:23prostate cancers that can grow
- 09:25very slowly and may not affect
- 09:27the man during his lifetime,
- 09:29yet it turns out that
- 09:31prostate cancer is the second most
- 09:34lethal cancer amongst American men
- 09:37by total numbers
- 09:38trailing only lung cancer.
- 09:41So those are the cancers we want
- 09:43to specifically separate out from
- 09:45the more slowly growing ones.
- 09:47And we do that under the microscope
- 09:49using a very powerful approach
- 09:52that is grade, as you suggest.
- 09:55So what is grade?
- 09:57It's basically the way the cells
- 09:59grow within the prostate once
- 10:01we've identified them as cancer cells,
- 10:04so we can look under the microscope
- 10:06and in their patterns
- 10:07there are specific patterns that
- 10:10are known to correlate with the
- 10:13outcome for the patient,
- 10:14and so we have various tiers,
- 10:17various numbers we can apply
- 10:20and the most simple one that we
- 10:22use right now is grade group and
- 10:24that ranges from one to five.
- 10:26One being the best outcome,
- 10:29and those patients are managed
- 10:31very differently from
- 10:32those who have a grade group
- 10:35five out of five,
- 10:36but there's everything in between,
- 10:38so it's really a spectrum.
- 10:39And therein lies again
- 10:41judgment as far as deciphering as you note,
- 10:46the detective work deciphering
- 10:48out the patterns that can help
- 10:51us assign a grade that
- 10:53indicates aggressiveness of
- 10:55that prostate cancer.
- 10:58One of the questions
- 11:00that I think always comes up is
- 11:02that it seems to be a little bit
- 11:04of art and a little bit of science.
- 11:06Looking at these patterns
- 11:09and trying to decipher is this
- 11:12lower grade?
- 11:13Is this a higher grade?
- 11:15How much of it is art,
- 11:18and how much of it is science
- 11:21and how sure are you at any given
- 11:24time of your diagnosis being correct?
- 11:27Interpretation of slides
- 11:30under the microscope is most definitely
- 11:34both art and science, so there's
- 11:37much experience that one must have
- 11:39in order to recognize these patterns.
- 11:42The science part is that we can use
- 11:45antibodies to help identify specific cells.
- 11:48The grading part remains, though,
- 11:50very much art and pattern recognition
- 11:53going forward in the future,
- 11:54and this has already started.
- 11:56We have tools that can help us recognize
- 11:59patterns even better and more quantitatively,
- 12:02and that's through the use of artificial
- 12:06intelligence and machine learning.
- 12:08So all of that work has just started,
- 12:10but already I've had the opportunity
- 12:12to work in on a couple different
- 12:15projects and it turns out that the
- 12:18computer with specific algorithms
- 12:20can identify,
- 12:21can diagnose and grade prostate
- 12:23cancers just as well as a number
- 12:26of us who specialize in sub
- 12:28specializing in that particular area.
- 12:31I can't wait to learn more about that,
- 12:33but first we need to take a
- 12:35short break for medical minute.
- 12:37Please stay tuned to learn more about
- 12:40prostate cancer diagnosis and prognosis
- 12:41with my guest doctor Peter Humphrey.
- 12:44Funding for Yale Cancer Answers
- 12:46comes from AstraZeneca, dedicated
- 12:48to advancing options and providing
- 12:50hope for people living with cancer.
- 12:53More information at
- 12:56astrazeneca-us.com.
- 12:58The American Cancer Society
- 13:00estimates that nearly 150,000 people
- 13:02in the US will be diagnosed with
- 13:05colorectal cancer this year alone.
- 13:07When detected early, colorectal
- 13:09cancer is easily treated and highly
- 13:11curable and men and women over
- 13:13the age of 45 should have regular
- 13:15colonoscopies to screen for the disease.
- 13:18Patients with colorectal cancer
- 13:19have more hope than ever before,
- 13:21thanks to increased access to advanced
- 13:24therapies and specialized care.
- 13:26Clinical trials are currently
- 13:28underway at federally designated
- 13:30Comprehensive Cancer Centers.
- 13:31Such as Yale Cancer Center and
- 13:33at Smilow Cancer Hospital to
- 13:35test innovative new treatments
- 13:37for colorectal cancer. Tumor
- 13:39gene analysis has helped improve
- 13:41management of colorectal cancer
- 13:43by identifying the patients most
- 13:45likely to benefit from chemotherapy
- 13:48and newer targeted agents,
- 13:49resulting in more patient specific treatment.
- 13:52More information is available at
- 13:55yalecancercenter.org. You're listening
- 13:57to Connecticut Public Radio.
- 13:59Welcome back to Yale Cancer Answers.
- 14:02This is doctor Anees Chagpar and I'm joined
- 14:04tonight by my guest doctor Peter Humphrey.
- 14:07We're talking about prostate
- 14:08cancer diagnosis and prognosis,
- 14:10and right before the break we were
- 14:13talking about this magic that
- 14:16happens in the pathology lab.
- 14:18At least, it seems like magic to those of
- 14:20us who send them biopsies and magically
- 14:23get back a diagnosis that we then
- 14:25use to treat our patients and Doctor
- 14:27Humphrey was telling us that this is
- 14:29in part art,
- 14:30but it is in part science and
- 14:33that you're able to use antibodies
- 14:36and so on to help you in making
- 14:39that diagnosis and right
- 14:42before the break you started to talk
- 14:45Doctor Humphrey about artificial
- 14:47intelligence and how this might actually
- 14:51help us in making a diagnosis now,
- 14:55so that the computers might
- 14:57be able to make a diagnosis
- 14:59almost as well as an experienced pathologist.
- 15:02Tell us a little bit more about that.
- 15:05So we are in the very early pilot stage
- 15:09I would say as far as
- 15:12development of this tool,
- 15:14but I think it will be an important
- 15:16tool that can assist the pathologist
- 15:18and actually artificial intelligence
- 15:20is being developed in many
- 15:22branches of medicine and
- 15:24radiology too, so it turns out
- 15:26that those parts of medicine that
- 15:28deal with diagnostic images like
- 15:31radiology and pathology are areas
- 15:33where there could be great benefit.
- 15:35From more standardization, I would say,
- 15:39and perhaps even quantitation,
- 15:42using computer assisted methods,
- 15:45so that's already happening and
- 15:46actually happening very quickly
- 15:48as far as the research into this.
- 15:50And the use of computers and
- 15:53artificial intelligence.
- 15:55To develop algorithms, ways in which
- 15:59the computer can diagnose and
- 16:02even grade prostate cancer.
- 16:05So I've been fortunate enough to have
- 16:07been involved in a couple of these
- 16:09research studies and a number of us
- 16:11from around the world who
- 16:13are interested in prostate cancer
- 16:15and are genitourinary pathologists,
- 16:17and we've looked at hundreds of slides,
- 16:19all online,
- 16:20so these are all images diagnosable
- 16:23on our computer.
- 16:24And then we tested the algorithm and then
- 16:30the algorithm was tested against our
- 16:33diagnosis in grade versus collections
- 16:35of pathologists who were
- 16:39not sub specialized in
- 16:41prostate cancer diagnosis and the
- 16:43computer was actually just as good
- 16:46as our diagnosis and grading.
- 16:49So what does this mean for the future?
- 16:52Well, there are actually a lot of challenges.
- 16:55There are several algorithms that
- 16:57have already been published.
- 16:58Methods that the computer uses,
- 17:01and there's a lot of standardization
- 17:04and validation that needs to occur
- 17:06so that a computer can use
- 17:08images from a particular laboratory
- 17:11and one particular hospital as far
- 17:14as the scanners they use to make
- 17:16those images and the way the slides
- 17:19are prepared that all of those
- 17:21factors can have a huge impact on the
- 17:23success or failure of the algorithms.
- 17:26My hope is that as far as standardization,
- 17:29it can be used as a tool to help
- 17:31hospitals where there may not be ready
- 17:34access to a genitourinary pathologist.
- 17:37And also I think for those of
- 17:38us who have high volumes
- 17:40and have a special sub specialized group
- 17:42of Geo pathologist as we do here at Yale,
- 17:45I think it might actually
- 17:47help us screen cases.
- 17:48So that the computer could actually help
- 17:51us identify through all these slides,
- 17:54identify the ones that need particular
- 17:57attention or standardized grading.
- 17:59So there may be,
- 18:00for example,
- 18:01a difference of opinion about the
- 18:03grade of a specific cancer and
- 18:06the way we currently address this,
- 18:07and this is very important actually
- 18:09when there's a difficult case,
- 18:10we'll have a consensus conference,
- 18:13meaning that up to seven of us
- 18:15who are sub specialized in
- 18:18genitourinary pathology at Yale will meet
- 18:19around the microscope or in this area,
- 18:22from our computers and look
- 18:24at the images together to try
- 18:26to agree on a particular grade.
- 18:28In a difficult case or where it's a
- 18:30borderline case between grades for example.
- 18:32So maybe the computer could also
- 18:35provide help in standardizing those.
- 18:38Those sorts of assessments when
- 18:40it's a difficult or borderline case,
- 18:43so it sounds like this is really exciting
- 18:47technology that might be able to provide
- 18:50a second opinion. But for right now,
- 18:53if you're a patient and you might not
- 18:57be at or near a large academic center,
- 19:00and you get a prostate biopsy,
- 19:03for example, how important is it for
- 19:05you to get a second opinion on that
- 19:09biopsy from another human pathologist
- 19:11if a computer isn't readily available?
- 19:14That's a really critical question,
- 19:17and I think it's important to
- 19:19know in discussions with your
- 19:22physician whether a genitourinary pathologist
- 19:25has reviewed the slides and it's
- 19:27true that around the country there
- 19:29are just varying degrees of practice
- 19:32and varying volumes of practice,
- 19:35and so at a smaller hospital,
- 19:37maybe only a few prostate biopsies might
- 19:39be seen over a long period of time,
- 19:42and particularly in those cases where the
- 19:45pathologists may not feel as comfortable,
- 19:47or the treating physician may not
- 19:50feel as as comfortable, it's
- 19:54I think a useful step to seek
- 19:56a second opinion,
- 19:57and we see slides for second opinions
- 20:00all the time here from everyone.
- 20:02Actually from patients from treating
- 20:05physicians and from pathologists themselves,
- 20:08and this is an important quality
- 20:10to all these second opinions.
- 20:12And again we very commonly almost
- 20:15on a daily basis share cases here at
- 20:18Yale amongst our group of seven genitourinary
- 20:21pathologists
- 20:23And so are these second opinions when
- 20:26you go and you have your
- 20:28slides reviewed by somebody else?
- 20:30Or maybe the pathologists themselves sends
- 20:33it to another center to get reviewed
- 20:36if they're not quite sure
- 20:38about the diagnosis,
- 20:39is that covered by your insurance?
- 20:42Usually it is.
- 20:44So at least the cases that we
- 20:46receive here for second opinions.
- 20:50That's good to know.
- 20:52Is it ever the case where even
- 20:55if you go to a large academic
- 20:58center that it's worthwhile
- 20:59getting your slides reviewed by
- 21:01another large academic center?
- 21:03I mean, how much heterogeneity
- 21:06is there between experienced
- 21:08genitourinary pathologists for example?
- 21:11So since diagnosis
- 21:13and grading are still art,
- 21:15there can be differences of opinion amongst
- 21:19even expert and experienced genitourinary
- 21:22pathologists and these tend to be the
- 21:25rarer or more borderline cases.
- 21:28There's been a lot of research looking at
- 21:32variations or differences of opinion
- 21:35between pathologists and even between genitourinary
- 21:38pathologists,
- 21:39and even did a study where I looked
- 21:42at agreement with myself so I
- 21:45diagnosed and graded some slides and
- 21:48then came back sometime later
- 21:50to see if the diagnosis and grading
- 21:52were the same so the agreement is
- 21:54pretty good amongst genitourinary pathologists,
- 21:57but one should not hesitate in
- 21:59seeking a second opinion at another
- 22:02center with an established
- 22:04group of pathologists,
- 22:06but as we
- 22:08talk about that variability,
- 22:09all of these pathologists are looking
- 22:12at the same slides and I know that in
- 22:15other cancers we've talked on this show
- 22:17about this concept of
- 22:19heterogeneity that you might have a
- 22:22cancer that looks kind of different in
- 22:24one part than another and so I wonder,
- 22:28when you get these biopsies,
- 22:30we often
- 22:33send a core biopsy so
- 22:35a sampling of this tumor,
- 22:37how representative is that,
- 22:38and is it ever the case where
- 22:41you look at this and you
- 22:43kind of say
- 22:45I don't know that this is representative?
- 22:47We need to get more tissue or
- 22:49are you usually pretty happy
- 22:51with the sample that you get?
- 22:54So that's such a key question and
- 22:57really the practice of the biopsy
- 23:00as far as the prostate has changed so
- 23:04remarkably since when I was a resident.
- 23:06So back in the olden days,
- 23:08it was usually just one needle biopsy,
- 23:11digitally directed towards a palpable
- 23:13mass in the prostate by the examining
- 23:16physician and one single core was taken.
- 23:19So prostate cancer,
- 23:20heterogeneous concept of heterogeneity,
- 23:23and different areas of the prostate
- 23:25being actually of different grades
- 23:27and different aggressiveness
- 23:29is actually characteristic of
- 23:31prostate cancer and prostate
- 23:33cancer also tends to have multiple
- 23:35nodules within the same gland,
- 23:37so what's been a real advantage
- 23:39is medical advances in radiology,
- 23:41and there are expert radiologists here who have
- 23:45actually helped develop this technique,
- 23:47and that's a special type of MRI.
- 23:50Magnetic resonance imaging that's used
- 23:53with ultrasound to guide the
- 23:58needle placement within the prostate.
- 24:00So now rather than one needle core,
- 24:03we often receive anywhere from 20 to even
- 24:0830 individual needle cores per patient.
- 24:12And the reason is that the radiologist
- 24:14now can identify areas where they're
- 24:17suspicious of cancer and can specifically
- 24:20say based on their grading scheme,
- 24:22whether they think it's a lower
- 24:25risk or a higher risk case so
- 24:28I do feel good about the
- 24:32representation for most patients and when
- 24:35the patients have undergone this
- 24:38type of imaging by the radiologists.
- 24:43Even though multiple needle cores
- 24:44are placed in a single nodule,
- 24:46it's still possible that maybe
- 24:49a smaller high grade area was missed.
- 24:53Warning signs would be,
- 24:54what if the patient has a really high
- 24:57serum PSA prostate specific antigen level?
- 25:00Or what if this is radiologically
- 25:02a very aggressive looking lesion,
- 25:04but we don't see that under the microscope?
- 25:07Then I would worry about
- 25:10the needle maybe not sampling
- 25:12the worst of the cancer.
- 25:14Yeah, it goes back to that
- 25:15concept of being a bit of a
- 25:18detective that we talked about before
- 25:20the break and the fact that the
- 25:22pathologist is really a key part
- 25:25of this multidisciplinary team that
- 25:26you need to get information from.
- 25:29From the radiologist,
- 25:30from the surgeon.
- 25:32from the other physicians.
- 25:33who are involved
- 25:34in the case to kind of put all
- 25:37of the pieces together to make
- 25:38sure that it all makes sense.
- 25:40That's what I love about
- 25:43working here is working with so many
- 25:45bright and experienced physicians
- 25:47who are passionate about providing the
- 25:50highest level care and talking with
- 25:53them about what their perspective
- 25:56and view is on a specific patient.
- 25:59For example, if there
- 26:02is not a link made between pathology
- 26:06and what we see in the clinical setting
- 26:09that sort of correlation is
- 26:12clinicopathologic correlation and
- 26:13is so vital.
- 26:16Going back to that patient with pain in the rib.
- 26:19It was absolutely essential to know that
- 26:21the patient had a history of cancer
- 26:2310 years ago to establish firmly that
- 26:26cancer scene and what we would
- 26:28do is compare slides.
- 26:29That cancer in the rib biopsy
- 26:32was the same as the cancer in the
- 26:35salivary gland,
- 26:36so we do that commonly to look
- 26:38back at old slides to see if
- 26:40if cancer has come back and
- 26:42we think a cancer might
- 26:45have come back or spread so that
- 26:47comparison is a really important part
- 26:49of the detective work we do.
- 26:52And I think the other piece
- 26:54that's so important is that it's so
- 26:57critical in terms of what you do,
- 26:59especially in prostate cancer,
- 27:01to really nail down how
- 27:03aggressive this is because it is
- 27:05the difference these days between having
- 27:08more aggressive surgery
- 27:11or radiation versus watchful waiting.
- 27:14Tell us a little bit more about how your
- 27:18decisions impact treatment and prognosis?
- 27:21After establishing a
- 27:23diagnosis of prostate cancer,
- 27:25we assign the Gleason grade or score
- 27:28and that is a grade number we give
- 27:31for every single prostate cancer
- 27:34needle core in every case and a great
- 27:38group for that particular biopsy.
- 27:41So if a patient had 10 positive
- 27:43cores with cancer in each one,
- 27:45we would assign an individual
- 27:47grade to each one,
- 27:49and actually I just gave a
- 27:51lecture this morning to the pathology
- 27:53residents on grading and staging.
- 27:55So it is one of the most critical
- 27:59things we do because grade is such
- 28:02a dominant prognostic indicator for us.
- 28:06For the patients physician,
- 28:08for everyone,
- 28:09and the patient themselves.
- 28:13For example, a grade Group One in a patient
- 28:15with a lower PSA might consider
- 28:18along with their physician,
- 28:20the physician might consider active
- 28:23surveillance or careful monitoring of
- 28:25that cancer compared to a grade Group
- 28:275 where everyone would agree this
- 28:30patient definitely needs active therapy.
- 28:33Doctor Peter Humphrey is a professor of
- 28:35pathology at the Yale School of Medicine.
- 28:38If you have questions,
- 28:39the address is cancer answers at
- 28:41yale.edu and past editions of the
- 28:44program are available in audio and
- 28:46written form at Yale Cancer Center Org.
- 28:48We hope you'll join us next week to
- 28:50learn more about the fight against
- 28:52cancer here on Connecticut Public
- 28:54radio funding for Yale Cancer
- 28:56Answers is provided by Smilow
- 28:57Cancer Hospital and AstraZeneca.