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rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 204
   Posted 4/23/2010 8:28 AM (GMT -6)   
Morning All,
 
My husband finally picked up his records from the uro. and I have a question that I'm think  I know the answer to, but  I need some advice.  His biopsy had 5 of 10 cores positive-all one side- percentages; 25%, 44%, 50%, 55%, 57%. All were scored 3+3=6. Also in his records it said his prostate volume was 23.1-don't have a clue what that means.  My question is this: does the high(it seems to me) percentages of cancer in the samples mean the the cancer is large and we should consider treatment as soon as we can schedule it or am I panicking.  We have an appt. with Dr. Vip Patel 5/26 to discuss surgery as an option.  I really could use some advice -until I saw those % numbers I was quite calm and collected but now I'm worried. 
 
In advance, let me say thank you all for being here for me and all the other newbies! Don't know what I'd do without this site.
 
Renee
 
 
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%
Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
Appointment with Dr. Patel, Global Robotics May 26,10
 
 


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/23/2010 8:55 AM (GMT -6)   

Good morning, Renee.  I hope I can provide some helpful responses.

Prostate size is reported in "cc's" (cubic centimeters).  During the biopsy, the doctor uses an ultrasound to get several dimensions of the prostate, then uses a complex 3-dimensional formula based on the typical shape of a prostate to calcuate an estimated volume.  23.1 would be a fairly normal sized prostate...which is about the size of a walnut.

The aggressiveness of the samples found in the biopsy, as indicated by the Gleason score, is low, which is a positive factor; although one always has to keep in mind that a biopsy is simply a sampling.  Each sample represents only about 0.1% of the prostate. 

With the number of cores positive for cancer, and the percentages of cancer in those cores, you husband would not be a good candidate for Active Surveillence, which defers treatment for a little or a long time (or forever).  An aggressive treatment would be appropriate, but that doesn't mean that it need to be rushed-into tomorrow.  Prostate cancer is different from other cancers and is generally slow growing.  With the understanding that aggressive treatment would be appropriate, one should move deliberately, but not rush, into a treatment decision.

With surgery, the experience of the surgeon is generally considered to be the most important factor to consider.  There is a well documented "learning curve" in the surgical proceedures to remove the prostate, and you would want to find a surgeon who has performed many hundreds of prostatectomies.

I hope this answers the questions you raised.  Please don't feel the need to panic, but do help your husband to move forward deliberately with an examination of treatment options.

best wishes...


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1785
   Posted 4/23/2010 9:07 AM (GMT -6)   
Renee, I too am the wife of a PCa man so I know how you're feeling. Each time you think you have a handle on the situation, you learn something else that sets you back. Believe me, your situation is not unusual and has been shared by many here.

I believe that the percentages indicate the percentage of cells that were abnormal - e.g., were cancerous. The good news is that your husband's cancer is restricted to only one lobe of his prostate - my husband had the same situation. With all 5 samples taken from that side coming back positive, it would seem that the cancer goes from the apex to the base (top to bottom) on that side. Some of the percentages are a bit on the high side but not alarmingly so (in my opinion).

But, there are 2 pieces of good news here: a Gleason 3+3 (which means the cancer cells are considered somewhat aggressive and the fact that his prostate seems to be a normal size (23.1 ccs is an estimate of the gland volume based on the sonogram) indicating that the cancer cells have not caused the prostate to enlarge.

Have you actually spoken with the urologist to discuss the biopsy report? When we met with ours, he drew us diagrams of where he took the samples and which ones came back positive. That helped us understand the anatomy of the disease. He also provided us with my husband's clinical stage - t1c (which is probably one of the most common). If you and your husband choose surgery, the surgical pathology report will be much more accurate in staging your husband's disease. Again, should surgery be your husband's treatment option, do not be surprised if his Gleason score and stage are upgraded - this too is quite common.

Did the biopsy report state any other findings such as perineural invasion (this is a common finding) or high grade PIN? If neither of these is noted on the report, that's also good news. However, mention of them should not be a cause for alarm since PI and PIN are also very common findings on biopsy. Perineural invasion means that cancer cells were found along the nerves running through the gland (not to be confused with the nerve bundles exterior to the gland). PIN is a kind of pre-cancerous condition, and are thought to be potentially cancerous down the road (like some those colon polyps that pop up on a colonoscopy).

All scary stuff but, believe me, you can and will get through this. Keep us posted on how things are going.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24124
   Posted 4/23/2010 9:38 AM (GMT -6)   
Renee

I agree with the other's so far, even thought its a Gleason 6 at biopsy, the higher % of cancer in the cores would require treatment at some point, but no need to panic or rush or take the first deal. With a fairly small prostate size like his, his options should be full, including surgery, either robotic or open, Seed Radiation or Conventional Radiation, etc.

Besides meeting with his uro or uro/surgeon, definitely needs to be accessed by a good radiation oncologist.

This is the right t ime to ask lots of questions, read the right books, and get some good medical opinions.

As a group, we are here for you all the way

david in sc
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 4/23/2010 10:29 AM (GMT -6)   
Added later...

Most newcomers are hungry for reliable information. Personally, I find information on the internet has value, but should be used cautiously. Therefore, I recommend the book titled "Guide to Surviving Prostate Cancer", by Dr Patrick Walsh. You can readily find this via online booksellers, and could have it delivered by Monday. It is an outstanding resource for all phases of this journey, and is written by one of the world's leading prostate surgeons.

best wishes...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24124
   Posted 4/23/2010 10:41 AM (GMT -6)   
A great book recomendation. I had read it cover to cover several times, even before I had my PC dx. Lot of good general info from one of the best. I still use it as a reference work.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3699
   Posted 4/23/2010 10:48 AM (GMT -6)   
The number and % of positive cores is a strong indicator of outcome, along with other factors.
The Prostate Cancer Research Institute Web site has some tools you can download. You input the number and % of each core and its location and it will calculate tumor volume and various other probabilities of outcomes. I would share this with your doctor on your next visit.
Also I would strongly recommend getting a 2nd opinion on biopsy slides from Epstien at John Hopkins before you decide enything. Make sure your doctors uses Partin Tables and Artificial Neural Networks and explains the results to you in a way you can understand. All of these are useful tools in eliminating treatments that have little chance of working.
Don't count on your doctor to supply you with all the information you need. As Casey recommended read Walsh's book, but also read "Primer on Prostate Cancer" by Dr Strum as it comes at PC from a completely different angle than Walsh.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 204
   Posted 4/23/2010 5:09 PM (GMT -6)   
David, Sephie, John T. and Casey,

Thanks for taking time to help. I have been reading a lot and will get both the books (Strum and Walsh) that you suggested. I have read Dr. Marks book but the more the merrier. My husband's uro has basically told us nothing except that he has pc-gleason6. We asked for his records and I have been trying to decipher them . Never thought I was going to have to figure out how to cure my husband's pc ! At least I've got help-thanks again.

Renee
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%
Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
Appointment with Dr. Patel, Global Robotics May 26,10
 
 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1251
   Posted 4/23/2010 11:56 PM (GMT -6)   
Renee ---- Loved your line: " Never thought I was going to have to figure out how to cure my husband's pc !"

It's an excellent way of looking at & understanding what you're facing. This cancer does require decisions and they are not easy decisions because you need to be well informed. The good news is that when you are well informed, making the right decision will be easier.

While I second the motion to read the books mentioned, above all you need to get a second read on the slides by a pathologist with lots of experience reading prostate tissue. As you'll learn the pathology is the basis on which all decisions must be made and you need to know exactly where your husband is at.

Please keep us informed.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 
 
  


rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 204
   Posted 4/24/2010 1:01 PM (GMT -6)   
Sheldon-how exactly do I go about getting the slides read by a different pathologist? Do I ask my husband's uro or do we do that ourselves? As to my line, when I told my husband that, he said "As long as you don't try to operate- I'd hate to see you try to learn to do that online!" And Ohio, thanks-I'll order the book asap. Thanks, guys.
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%
Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
Appointment with Dr. Patel, Global Robotics May 26,10
 
 


FLBeachgal
Regular Member


Date Joined Mar 2010
Total Posts : 35
   Posted 4/24/2010 4:50 PM (GMT -6)   
Hi rhb47,
My hubby's slides traveled about the state a couple of times before his surgery.  First from here in Vero Beach to Moffitt Cancer Center where he had his first 2nd opinion, and then from there over to FL Hospital Celebration where he had his surgery by Dr. Patel last November. 
 
As I recall, we had to fax consent/release forms each time, but there was never any problem with having them traveling about in a timely fashion!  I imagine some of the guys on this board who sent only their slides off for second opinions either arranged for the consultations themselves or had their physicians start the process.......I'm sure they will chime in with some more good information.
 
Another good resource in addition to this great discussion board is the local "Man to Man" prostate cancer support group.  The local group here in Vero Beach meets the last Tuesday of each month (next week!) and includes quite a large group of guys who range from newly diagnosed to many years post diagnosis.  My hubby has found the group to be quite informative and enjoys talking with others who are going through the same thing as he is.  A local radiation oncologist was the speaker last month.  Hubby's working with a newly diagnosed guy who is going to have surgery by Dr. Patel next month, and is telling him what to expect, etc.....   Why he won't get on this computer and participate in this great discussion board is beyond me!!
 
 

rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 204
   Posted 4/24/2010 5:11 PM (GMT -6)   
Hi FlBeachgal,

Sounds like we have a lot in common-we live in Vero Beach also. We've got an appt. with Dr. Patel next month. I'll let my husband know about the meetings-like your husband , he's interested in what I tell him about the forum, just can't be bothered either.

Renee
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%
Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
Appointment with Dr. Patel, Global Robotics May 26,10
 
 

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