3 months of hormone therapy (NHT) was followed by Pd-103 implant to the . But combined with their Gleason score and maybe someday with a diagnostic MRI men should be able to figure out whether their cancer is advanced enough to warrant treatment, or to monitor it to make sure it isnt turning more aggressive, Bill-Axelson said. Big whoop. Other ways that this Gleason score may be listed in your report are Gleason 7/10, Gleason 7 (3+4), or combined Gleason grade of 7. Yes there are side effects noted in this article, but they are manageable. Grades 2 through 4 have features in between these extremes. A score of 7 means the cancer is intermediate, and a higher . Scoring a 7 means that the primary score (largest section of the tumor) scored a 3 or 4. I discussed this with my GP and was reassured that in my case, this delay was unlikely to cause any problems, but of course it added to my stress. For individuals with known prostate cancer this is no longer relevant. Vicini FA, Ziaja EL, Kestin LL, Brabbins DS, Stromberg JS, Gonzalez JA, Martinez AA. Most cases of prostatitis reported on biopsy are not caused by infection and do not need to be treated. Grades 2 through 4 have features in between these extremes. It is imperative to mention that the lifetime risk of developing prostate malignancy is 14% (1). In addition to the Gleason score, you may also have been given a cancer staging and you'll probably have a recent PSA figure already. With all due respect your comment is absurd. He determines the least aggressive glands and gives a score of 1-5, then he looks for more aggressive glands or cells and gives a score of 1-5. Stage 4 doesnt have to be a death sentence. I took part in stampede trial receiving chemo, zometa and hormone therapy. However, other factors also contribute to determining the stage of prostate cancer, including: The Gleason Score is very important in predicting the behavior of a prostate cancer. We all have to the once so why prolong the agony? For instance, if the Gleason Score is written as 3+4=7, it means most of the tumor is grade 3 and the next largest section of the tumor is grade 4, together they make up the total Gleason Score. Read Also: Wife Gives Husband Prostate Massage. There is no simple answer. Scores of 8 or higher describe cancers that are likely to spread more rapidly, these cancers are often referred to as poorly differentiated or high grade. The first number assigned is the grade that is most common in the tumor. My husband is 63 and was just diagnosed with aggressive prostate cancer. Kibel, the Brigham and Womens urologist, said the Swedish study has been central to our understanding of how we manage prostate cancer, for decades, and confirms that many patients benefit from aggressive treatment. Is a Gleason score of 9 a death sentence? You could also call our specialist nurse team for some advice; you can telephone them on 0808 800 4040. This does not include deaths and injuries from other procedures, medical mistakes, increased suicide rate, ADT therapy complications, heart attracts, etc, caused by screening and treatments. 2018-08-17. GS can be obtained by adding the primary Gleason pattern (GP) and secondary GP. This is eminently suitable for surgery, which willprobably cure it, although you may need follow radiotherapy at some future point. To reduce the risk of over-or-under scoring, multiple biopsies are usually taken from different areas within the prostate. A Gleason score of 7 is considered medium-grade cancer and Gleason 8 and above is high-grade cancer. When this is found on a biopsy, it means that there is a higher chance that the cancer has spread outside the prostate. The objective of this study was to compare the survival outcomes of Gleason score 3+4 and 4+3 based on data from the Surveillance, Epidemiology, and End Results cancer registry database, and to investigate independent prognosis-associated factors and . Focal atrophy can sometimes look like prostate cancer under the microscope. Whether this difference remains in the setting of appropriately used adjuvant RT after RP, and the effect of possible delay in test She cut out all, and I mean ALL sugar, and took a mixture of baking soda and maple syrup, daily for 2 months. I was given a 10-day notice, and rushed into getting the Radical Prostatomy done by my urologist, Christopher Campbell Hoag who partners with other urologist in a clinic located in North Vancouver, British Columbia, Canada. Epub 2013 Nov 12. I was not allowed a second opinion because there was no time left due to the fact that my cancer had already metasitazied into distant organs and bones but I had no symptoms, no pains or no blood in my urine or semen. The lower the Grade Group, the less likely the cancer is to grow and spread. Low risk: PSA <10 ng/mL, Gleason score < 6 and clinical stage T1c or T2a The studys take-home message is: If you live a long time, youre likely to live longer if you get treated than if you dont, according to Dr. Anthony DAmico, chief of genitourinary radiation oncology at the Dana-Farber Cancer Institute and a professor at Harvard Medical School, both in Boston. For RT patients, 71 patients (82%) received hormone therapy (median duration 6 months). But be honest,I prefer NHS. Overtreatment is an issue because radical prostatectomy and similar therapies often cause side effects, Bill-Axelson said, most commonly erectile dysfunction and urinary leakage. Similarly, Gleason scores of 9 or 10 have a worse prognosis than Gleason score 8. The results do not affect your diagnosis, although they might affect your treatment options. Doctors use the cancer of the prostate risk assessment (CAPRA) nomogram to help them predict the risk that prostate cancer will spread, predict the risk of dying from prostate cancer and make treatment decisions. And live a short and miserable life after treatment. These include the clinical stage of the cancer, the prostate-specific antigen (PSA) level, and the appearance of the prostate cancer cells under the microscope (the Gleason score). When the needle is pulled out it removes a small cylinder of prostate tissue called a core. I just turned 50 when I underwent the infamous Radical Prostatomy, and I am now 56. Mammogram is an inappropriate comparator for radical prostatectomy. my husband is only in his 50s. How much of each core is made up of cancer, Whether cancer was found in both sides of the prostate, Whether the cancer has spread outside the prostate. If your husband's PSA is below 10 and/or the cancer stage is T1x or T2x then the prognosis is good to excellent. The prognosis for prostate cancer, as with any cancer, depends on how advanced the cancer has become, according to established stage designations. Whether you want to learn about treatment options, get advice on coping with side effects, or have questions about health insurance, were here to help. This series of Frequently Asked Questions (FAQs) was developed by the Association of Directors of Anatomic and Surgical Pathology to help patients and their families better understand what their pathology report means. . Then what would you do, go for adjuvant radiotherapy which no guaranteed result of extension, but guaranteed further side effects. This is called the Gleason system. In patients with HRPC, higher baseline PSA levels and greater PSA velocity predicts higher-risk for metastatic disease and shorter overall survival. Prolaris Score of 3.7, that is 39 percent of the high risk have a lowered . Time by the end of April is the worse. Stage 3 prostate cancer. The .gov means its official. New Prostate Cancer Grading System: The new prostate grading system is an extension of the current Gleason grading scale for determining the stage of prostate cancer. . Awaiting appointment in a week, breast lump. I dated this lady and knew her intimately, so this is not 3rd hand info for me. Unauthorized use of these marks is strictly prohibited. Most cases of prostatitis reported on biopsy are not caused by infection and do not need to be treated. The Gleason score is 7 to 8. We will all die anyway, have faith in God. My question is. I had a Gleason score of 7 out of 10 - the higher the Gleason score . If a tumor is all the same grade (for example, grade 3), then the Gleason score is reported as 3+3=6. Dont Miss: How Do You Treat An Enlarged Prostate. They will very likely be overtreated if they are treated immediately.. February 2020 in Prostate Cancer #1. Not a death sentence, however, research is required so the best choice of treatments can be determined. Keywords: However, since Dr. Gleasons original classification, pathologists almost never assign scores 2-5, and Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer. Researchers evaluated a total of 639 men (mean age, 65.83 years) with clinical T1-T4, N0M0 biopsy Gleason score 9-10 prostate cancer. Prostate biopsies are tissue samples from different areas of the prostate. 2005 Mar 1;61(3):714-24. doi: 10.1016/j.ijrobp.2004.06.018. She is alive and doing well. He said that if he could go back in time he would never have gone the route he did. Urology 11 years experience. Epub 2016 May 29. According to his diagnosis, I was given no more than 6 months , or as long as between 3 to 5 years to live because of my End Stage 4 Prostate Cancer. This is not actually the case at all. Prostate Conditions Education Council 2023, 7208 S. Tucson Way, Suite 230 Centennial, CO 80112. The area of cancer cells in the prostate will also be graded. Theoretically, Gleason scores range from 2-10. Other ways that this Gleason score may be listed in your report are Gleason 7/10, Gleason 7 , or combined Gleason grade of 7. Regardless, the ultimate interpretation needs to be through the lens of the patients values. Grade Group 3 = Gleason 4+3=7. I really have no will to go through the whole surgery/recovery only to hate my life more than I do now. Read more on EBRT under prostate cancer treatments. It is a challenge that many men have overcome and you are one of . When it affects the entire prostate gland it is called diffuse atrophy. One of the major problems with the Gleason score is that some scores can be made up in different ways. For comparison, 233 women in their 60s would need to get a mammogram to prevent one of those woman from dying of breast cancer, according to a 2012 study. I would say that radical prostatectomy is aggressive treatment and that anyone who is diagnosed with prostate should seriously consider it. I was diagnosed through high PSA and the usual digit test. . However, since Dr. Gleason's original classification, pathologists almost never assign scores 2-5, and Gleason scores assigned will range from 6 to 10, with 6 being the lowest grade cancer. Cancer Information, Answers, and Hope. We couldnt do what we do without our volunteers and donors. HHS Vulnerability Disclosure, Help Bookshelf My husband has aggressively prostate cancer and he isnt going to do anything about it. Finding any of these is not important if prostate cancer is also present. . I was stupid enough to buy into his diagnosis and planned treatment (I didnt know that Radical Prostatomy was for localized cancer only, and not for curative purposes of metastasized cancer that had already spread). Lori63 Member Posts: 9. EBRT is effective in painful bone lesions in advanced prostate cancer patients but not an ideal option if there are multiple lesions at different sites. Plenty of men with Gleason 8 to 10 disease actually do well after treatment. Based on latest statistics, age-adjusted mortality rate due to prostate malignancy is 21.4 per 100,000. Cancer grade: When the pathologist looks at prostate cancer cells, the most common type of cells will get a grade of 3 to 5. 1997 Mar-Apr;3(2):78-87. Here are the possible Gleason scores with pattern 4, in order from least aggressive to most aggressive: Gleason 3+4. . Half of the men had their prostates removed to get rid of the cancer, and half were put on watchful waiting, a now-discredited approach that essentially amounted to doing nothing. Because I'm so desperate I've checked out recently even prices in private hospitals nearby.My wife is trying to force me for earlier operation,even in private clinic. From 1992 to 2013 . Exclusive analysis of biotech, pharma, and the life sciences. Bethesda, MD 20894, Web Policies This stage also has three . When this is found on a biopsy, it means there is a higher chance that the cancer has spread outside the prostate. Before A relative survival rate compares people with the same type and stage of cancer to people in the overall population. Excepting older age for RT patients (median 73 vs. 62 years), the groups were well balanced. 1999 Jul;54(1):111-7. doi: 10.1016/s0090-4295(99)00219-8. Gleason scoring combines two numbers and can range from 2 (nonaggressive cancer) to 10 (very aggressive cancer), though the lower part of the range isn't used as often. Men with a result of 7 on a test called the Gleason score, who are today considered at intermediate risk, should be treated, and should not wait to see if their tumors become more dangerous, D . Copyright 2015 Elsevier Inc. All rights reserved. My life after the Radical Prostatomy has been a living hell complete loss of interest in life due to urinary incontinence, impotence, and infertility. Together, were making a difference and you can, too. Because the grade may vary within the same tumor or between different tumors, different samples (cores) taken from your prostate may have different Gleason scores. This is not actually the case at all. Read the sad truth about prostate cancer over testing and treatment dangers and exploitation for profit by predatory doctors that no one will tell you about, even after its too late. Recommended Reading: Where To Go For Prostate Exam. Of the factors related to prostate cancer that doctors take into consideration when deciding on treatment, Gleason score is probably the most important one. 18 Several studies have tried to address this problem by subdividing Gleason score 7 into Gleason score 3 4 7 and Gleason score 4 3 7. Unable to load your collection due to an error, Unable to load your delegates due to an error. Because I saw a very good friend of mine go through the prostatectomy and radiation treatment, I took another route. The Gleason Score on a biopsy usually reflects the cancer's true grade. Since prostate tumors are often made up of cancerous cells that have different grades, two grades are assigned for each patient. However about 1.3 to 3.5 deaths per 1,000 from prostate blind biopsies [5]. Posted 3 years ago. Metastatic prostate Cancer Stage 4 Gleason 8. Each day, well check to see if new items have been published to the topics youre subscribed to, and well send you one email with all of the new items from that day. There is a perception among a lot of patients especially when they get diagnosed that having a high Gleason score of 8, 9, or 10 is essentially a death sentence, regardless of how they get treated. Information about the cancers stage and other prognostic factors will help the doctor recommend a specific treatment plan. Any man over 50, anyone concerned about cancer in general, dangers from clinical trials, injuries and deaths from medical mistakes, should read this document. Widespread bone and lymph node mets. These tests are usually imaging studies and may include a bone scan, positron emission tomography scan or computed tomography scan. I agree. All of these terms mean the pathologist saw something in your biopsy that suggests cancer may be present, but they cannot be certain. The stage of the cancer is based on the results of the staging and diagnostic tests, including the PSA test and the Grade Group: The radioisotopes have been found to reduce the need for opioid painkillers in such patients. The finding of prostatitis on a biopsy of someone with prostate cancer does not affect their prognosis or the way the cancer is treated. Henry, The higher the Gleason Score, the more likely that the cancer will grow and spread quickly. The American Cancer Society offers programs and services to help you during and after cancer treatment. Clinical staging of prostate cancer is based on the pathology results, physical examination, PSA, and if appropriate, radiologic studies. There are many users on here with similar experiences and I hope someone will be along soon to help answer your questions. A Recursive Partitioning Analysis. https://www.youtube.com/watch?v=tYii98gcejA https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/prostate-cancer-screening1 https://medium.com/@drsadeghi/early-detection-disaster-4d4740ee5828. the percentage of biopsy samples that have cancer. A Gleason score of 8 or higher, accompanied by a PSA level of higher than 20 ng/ml and a more advanced tumor stage, signifies a high risk of advancing cancer. Use the menu to choose a different section to read in this guide. The cancer has not yet spread outside the prostate. These 2 grades are added to yield the Gleason score . The good news is that most prostate cancers are slow-growing and that with early detection and treatment, it can be cured. A prognosis depends on many factors, including: Dont Miss: Cryoablation Success Rate For Prostate Cancer. Of those who died, 70 percent died of something other than prostate cancer, the study found. A total of 559 men were consecutively treated with RP and pelvic lymph node dissection. Is Gleason 9 a death sentence? Accessibility At best, it postpones death by a year or two. Major factors in metastatic disease pointing to adverse prognosis at the time of diagnosis include : Extent of the disease, Gleason score of 8 to 10 and presence of bone pain are other important prognostic factors in metastatic prostate cancer. Heidenreich A, Bastian PJ, Bellmunt J, Bolla M, Joniau S, van der Kwast T, Mason M, Matveev V, Wiegel T, Zattoni F, Mottet N; European Association of Urology. Reporting from the frontiers of health and medicine, You've been selected! Careers. Beware, the ugly truth. Atypical adenomatous hyperplasia is another benign condition that can sometimes be seen on a prostate biopsy. PSA is 6.9,bones scan in last month shown that they're free of metastasis so far. Free information. His number is a 8 and on the Gleeson score its a 4. This system is designed to provide a simplified and more accurate grading stratification system than the current Gleason Score. The man that invented the PSA test, Dr. Richard Ablin now calls it: The Great Prostate Mistake, Hoax and a Profit-Driven Public Health Disaster. Plenty of men with Gleason 8 to 10 disease actually do well after treatment. A score of 7 suggests and intermediate risk for aggressive cancer. There is a perception among a lot of patients especially when they get diagnosed that having a high Gleason score of 8, 9, or 10 is essentially a "death sentence", regardless of how they get treated. Otherwise, is a Gleason score of 9 a death sentence? This is most often caused by hormones or radiation therapy to the prostate. The next question, and the primary subject of this point-counterpoint discussion, is whether to offer radical prostatectomy or radiation therapy. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy. I dont know what to do or who to turn to, I have to get away from this anguish, self loathing, and basically feeling hopeless and apathetic. The survival expectancy for men with Gleason 810 adenocarcinoma of the prostate treated with hormonal therapy was 68 years less than that for controls. In some cases, finding perineural invasion may affect treatment, so if your report mentions perineural invasion, you should discuss it with your doctor. Radiation is also an option, but can lead to some side effects. Grade Group (based on the Gleason score) is a measure of how likely the cancer is to grow and spread. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). These include the clinical stage of the cancer, the prostate-specific antigen (PSA) level, and the appearance of the prostate cancer cells under the microscope (the Gleason score). I also had a lady friend who was diagnosed with bone cancer and given 6 months to live. After 24 targeted biopsies from the 3T MRI, I had cancer in one core measuring 1mm in length (Gleason score 6) and Cancer in another core measuring 3mm in length (again Gleason score of 6. The Gleason Score ranges from 1-5 and describes how much the cancer from a biopsy looks like healthy tissue (lower score) or abnormal tissue (higher score). What Does it Mean? In high-risk cases, the prostate cancer tissue looks very different from normal tissue. For GS7 prostate cancer patients, RT is associated with superior disease-free survival at 5 years compared to RP alone, without difference in disease-specific survival. Atrophy is a term used to describe shrinkage of prostate tissue . Men with a result of 7 on a test called the Gleason score, who are today considered at intermediate risk, should be treated, and should not wait to see if their tumors become more dangerous, DAmico said. . The highest a Gleason score can be is 10. Gleason scores label the severity and stage of the prostate cancer. Increasing your knowledge by reviewing sections such as Coping with cancer, Choosing your treatment as well as other areas of the web site helps relieve the stress and helps make decisions clearer. If a tumor is all the same grade , then the Gleason score is reported as 3+3=6. High-grade prostatic intraepithelial neoplasia (or high-grade PIN) is a pre-cancer to the prostate. Federal government websites often end in .gov or .mil. Routine PSA screening can overdiagnose cancers that wont turn lethal. I expect the next diagnostic stages for your husband are an MRI scan and perhaps a bone scan. In Sweden today, 80 percent of men with newly diagnosed prostate cancer are not treated, but actively surveilled, to make sure their tumor is not becoming more dangerous, Bill-Axelson said. Finding any of these is not important if prostate cancer is also present. Henry, Im with you. In my case the actual Gleason score was 4+3 or a 7. Part II: Treatment of advanced, relapsing, and castration-resistant prostate cancer. Nearly 30 years after it began, a study of prostate cancer patients shows both that the disease will not cause harm to the majority of men who have it, and that aggressive treatment is warranted for men with an intermediate risk of spread. The questions and answers that follow are meant to help you understand medical language you might find in the pathology report from your prostate biopsy. The lowest Gleason grade is 1 and the highest is 5, so theoretically Gleason scores can range from 2 (1+1) to 10 (5+5). * To protect your identity do not use your full name. According to the study, those men who had a radical prostatectomy at the start of the study lived an average of 2.9 years longer than men who got no therapy. An official website of the United States government. The studys duration and insights into one of the most common forms of cancer make it arguably one of the most important publications of the year, said Dr. Adam Kibel, a professor of surgery at Harvard Medical School and chief of urology atBrigham and Womens Hospitalin Boston, who is not involved in the research. If so, have a word with your GP and ask whether you can be transfered to a hospital with a shorter waiting list. official website and that any information you provide is encrypted Your daily dose of news in health and medicine. The next section in this guide is Types of Treatment. In order to assess and stage the malignancy, several classification criteria are used such as gleason scoring, PSA levels etc. I'm waiting until end of April to have a radical prostectomis. The Kaplan-Meier method was used for disease control estimates. If the cancer cells and their growth patterns look very abnormal, a grade of 5 is assigned. Is a Gleason score of 9 a death sentence? If the cancer is almost entirely made up of cells with the same score, the grade for that area is counted twice to calculated the total Gleason Score. Improved biochemical outcome with adjuvant radiotherapy after radical prostatectomy for prostate cancer with poor pathologic features. Together they can be used to predict an individual's risk of prostate cancer recurrence. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less is grade 4, and they are added for a Gleason score of 7. For example, your tumor may be assigned a Gleason score of 7 if the two most common grades were 3 and 4. Subscribe to STAT+ for less than $2 per day, Unlimited access to essential biotech, medicine, and life sciences journalism, Subscribe to STAT+ for less than $2 per day, Unlimited access to the health care news and insights you need, Ahead of genome summit in London, questions linger about, Ahead of genome summit in London, questions linger about CRISPR baby scandal, Experts weigh in on potential health hazards posed by, Experts weigh in on potential health hazards posed by chemicals in Ohio train derailment, Why fentanyl is deadlier than heroin, in a single, Why fentanyl is deadlier than heroin, in a single photo, An mRNA vaccine for cancers associated with HPV shows, An mRNA vaccine for cancers associated with HPV shows promise in mice, Report: Obesity could cost the world over $4 trillion, Report: Obesity could cost the world over $4 trillion a year by 2035. It might (or might not) be felt by digital rectal exam or seen with imaging such as transrectal ultrasound [T1 or T2]. Gleason Score. Conclusion: This is not actually the case at all. According to his diagnosis, I was given no more than 6 months , or as long as between 3 to 5 years to live because of my End Stage 4 Prostate Cancer. These are special tests that the pathologist sometimes uses to help diagnose prostate cancer. DAmico also highlighted what he called a pretty striking statistic: that just eight men needed to undergo treatment to save one life, according to the study. Because grades 1 and 2 are not often used for biopsies, the lowest Gleason score of a cancer found on a prostate biopsy is 6. Gleason score 3 + 4 = 7 (grade group 2), and. A pathologist, the doctor trained in analyzing cells taken during a prostate biopsy, will provide two starting pointsthe cancers grade and Gleason score. Cancer-Fighting stage 4 Gleason 8. A prostate cancer survival guide by a patient and victim. Does prostate cancer screening put mens health and lives in danger? In some cases, inflammation may increase your PSA level, but it is not linked to prostate cancer. Undertaking aggressive treatment is a difficult decision for a person to make, particularly younger people, but the risks in not undertaking this form of treatment can be devastating. The first number signals the most voluminous where the second is the less volumious. Gleason 7 prostrate diagnosis. MeSH All of these are terms for things the pathologist might see under the microscope that are benign , but that sometimes can look like cancer. Today I am 65 and healthy. I'm not sure how it works in Scotland, but it's still worth having a chat with your GP. The usual cutoff is around 69 or 70, though the use of modern techniques is notching that upward slightly for men in good shape with a long life expectancy. It is estimated that nearly 23,000 protstate cancer diagnosis will be missed or delayed due to the COVID-19 pandemic. The PSA was still below 3 ng/ml. In this case, the term 'high-grade' refers to the PIN and not the cancer, so it has nothing to do with the Gleason score or how aggressive your cancer is. 2017 Apr;15(2):242-247. doi: 10.1016/j.clgc.2016.05.016. What are the treatment options for my stage of cancer? The finding of prostatitis on a biopsy of someone with cancer does not affect their prognosis or the way the cancer is treated. PSA 10 to 20 ng/ml, and. This grading system can be used to choose appropriate treatment options. The treatment is of more value in patients with multiple metastases . The 7 may come either from adding 3 + 4 or from adding 4 + 3. Please enable it to take advantage of the complete set of features! It's a shock to receive a cancer diagnosis, but a Gleason score of 7 is normally regarded as Medium risk and depending upon other factors is often curable. The median progression-free survival in patients with minimal disease is about 2 years and in extensive disease about 18 months. Gleason score: The two grades will be added together to get a Gleason score. Due to the size of the tumor, the doctor can feel it during the DRE. PSA relapse-free survival was inferior for RP versus RT (P < .0001), with 5-year rates of 55.4% versus 82.6%, respectively. Don't be shy posting here - there are people here who've gone and are going through this so don't feel you're alone. Most cells look very different from normal. 2023 American Cancer Society, Inc. All rights reserved. I think, no, I know, dying of prostate cancer is a hell of a lot easily than suffering from the unstoppable side effects of the treatment! Because prostate biopsies are tissue samples from different areas of the prostate, the Gleason score on biopsy usually reflects your cancers true grade. For example, if the 5-year relative survival rate for a specific stage of prostate cancer is 90%, it means that men who have that cancer are, on average, about 90% as likely as men who dont have that cancer to live for at least 5 years after being diagnosed. A PI-RADS 4 or 5 is equivalent to a Gleason 7 or more. Another problem with the Gleason grading system is that the Gleason scores are often divided into only 3 groups (6, 7, and 8-10). I was stupid enough to buy into his diagnosis and planned treatment (I didnt know that Radical Prostatomy was for localized cancer only, and not for curative purposes of metastasized cancer that had already spread).