Prostate Cancer Patients’ Understanding of the Gleason Scoring System: Implications for Shared Decision-Making

Abstract

The Gleason scoring system is a key component of a prostate cancer diagnosis, since it indicates disease aggressiveness. It also serves as a risk communication tool that facilitates shared treatment decision-making. However, the system is highly complex and therefore difficult to communicate: factors which have been shown to undermine well-informed and high-quality shared treatment decision-making. To systematically explore prostate cancer patients' understanding of the Gleason scoring system (GSS), we assessed knowledge and perceived importance among men who had completed treatment (N = 50). Patients were administered a survey that assessed patient knowledge and patients' perceived importance of the GSS, as well as demographics, medical factors (e.g., Gleason score at diagnosis), and health literacy. Bivariate analyses were conducted to identify associations with patient knowledge and perceived importance of the GSS. The sample was generally well-educated (48% with a bachelor's degree or higher) and health literate (M = 12.9, SD = 2.2, range = 3-15). Despite this, patient knowledge of the GSS was low (M = 1.8, SD = 1.4, range = 1-4). Patients' understanding of the importance of the GSS was moderate (M = 2.8, SD = 1.0, range = 0-4) and was positively associated with GSS knowledge (p < .01). Additionally, GSS knowledge was negatively associated with years since biopsy (p < .05). Age and health literacy were positively associated with patients' perceived importance of the GSS (p < .05), but not with GSS knowledge. Patient knowledge is thus less than optimal and would benefit from enhanced communication to maximize shared treatment decision-making. Future studies are needed to explore the potential utility of a simplified Gleason grading system and improved patient-provider communication.

Prostate cancer grading, time to go back to the future

“…However, we question the cost–benefit ratio of the putative pedagogical advantage vs the confusion that has been caused by the plethora of new terms. It has been shown that there is indeed a need to explain the grading information to the patients as fewer than 50% in one study were found to have adequate understanding of the current nomenclature [16]. Yet, an increasing number of patients are well informed as they have access to a wealth of information on the Internet.…”

Immunohistochemical investigation of cytokine expression levels as biomarkers in transrectal ultrasound‑guided needle biopsy specimens of prostate adenocarcinoma

“…The final GS is obtained by summing of pattern-numbers of the primary and secondary tissue grade, ranging from 2 to 10 (16). GS quantifies pathological aggressiveness and is also one of the key factors in treatment decision-making, together with TNM staging, age and pre-treatment blood PSA levels (17). However, histological examination has several limitations, such as morphological mimics of prostate carcinoma, including adenosis (a non-cancerous condition), atypical adenomatous hyperplasia and very low-or high-grade carcinoma, which hinder the interpretation of tumour biopsy (13,18).…”

Survey of Radiation Oncologists to Assess Interest and Potential Use of a Genetic Test Predicting Susceptibility for the Development of Toxicities After Prostate Cancer Radiation Therapy

“… 1 Given the various treatment choices and risk to quality of life, treatment decisions for prostate cancer are challenging. 2 , 3 In recent years, decision making for prostate cancer treatment has shifted to account for its preference-sensitive nature, 4 which is informed by clinical parameters along with patient values and outcome goals. 3 Consequently, physicians and patients are encouraged to follow a shared decision-making paradigm.…”