Can a 4+3=7 have a better prognosis than a 3+4=7

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BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/12/2008 12:30 AM (GMT -7)   
I thought I would put this out there to get others opinions. I may be wrong but I would have thought that that the grade of cells that may have escaped the prostate (when the margin is suspect) is as important as the Gleason score post surgery. I am particularly thinking along the lines of a Gleason Score of 7. Here we have either 4+3 or 3+4. In the case of the 4+3 the majority of the cells are the more aggressive grade 4 and at first view have a more serious prognosis. Vice versa for the 3+4. But, logic tells me that if the Gleason 4+3 had the grade 4 cells confined well within the prostate and grade 3 at the margin, this may in fact have a better prognosis than a 3+4 with the more numerous grade 3 well within the prostate and the lesser volume grade 4 at the possible margin. Additionally, in a 3+4 with the grade 4 confined within the prostate and the grade 3 at the surface, would this for all practical purposes be much the same as a 3+3 (with grade 3 cells at the surface). As I said, I have never seen a discussion on this point. Any ideas? I raise this because my original report post surgery did not mention the grade of the cells at area of focal extension while a second report made a point of mentioning it.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

Post Edited (BillyMac) : 10/12/2008 2:29:13 AM (GMT-6)


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 10/12/2008 9:21 AM (GMT -7)   
Bill,

The scores are set according to cell dominance. It is unlikely that the score will change if positioning is different. It may very well be that a less agressive tumor close to the margin is less likely to recurr. I don't think any Doc is willing to guess at such the notion. A pathologist may suggest the chances are lessened but, an Oncologist will still play it safe and say nothing.

So far you're doing well :>) Modified Citrus Pectin...Worth a look see if one is into such alternatives.

Stay well,

Swim
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/12/2008 9:46 AM (GMT -7)   
The finite answer is yes. Gleason is not the lone prognosticating factor. in addition to all you mention, tumor size and stage are also important in predicting outcome. A contained Gleason 9 has a better outlook than my Gleason 7, for example. Post operative Gleason merely tells us how aggressive the cells are, and how the disease may behave upon relapse.

In my case my prostate was 25% cancer by volume, 70% of that tumor was grade 4, and my cancer had spread locally to facia tissue, skelital muscle, and ther was SVI. i think everybody should know where they are with these things about their disease.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


John Bonneville
New Member


Date Joined Sep 2008
Total Posts : 15
   Posted 10/12/2008 10:30 PM (GMT -7)   
Bill whilst I agree with your logic I cannot but think it is somewhat academic. Why you may ask?? Well simply because what is happening inside our bodies at a microscopic cellular level is currently outside medical knowledge. Thus the medical profession use modeling, albeit tables, case histories, gleason levels, tumour staging, psa etc. Thus there is no hard and fast rule as to predicting disease free outcomes among paiients with the same criteria, a bit like russian roulette.

My own philosophy is very simple, enjoy today, because anything can happen tomorrow. Best leave the aetiology and prognosis to the experts methinks and even they disagree among themselves, so what hope have we got, LOL!!!!!
Diagnosed March 2007, Age 57
Positive DRE, 12 Core Biopsy, 6 cores positive PCa,
Gleason 7 (4+3), Stage T2B
Rx 9 months LHRH ADT Lucrin, Neo Adjuvant,
Gold Seed implants 2 weeks prior to EBRT
70gy 3D Conformal EBRT

PSA: Nov 2006 = 6.0 ng/ml
May 2007 = 5.9 ng/ml * 1st Lucrin IMI
Aug 2007 = 0.85 ng/ml* 2nd Lucrin IMI
Nov 2007 = 0.45 ng/ml * 3rd Lucrin IMI
Jan 2008 = 0.29 ng/ml * 8 weeks EBRT and TURP in May
June 2008 = 0.12 ng/ml
Sept 2008 = 0.14 ng/ml


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/15/2008 8:59 PM (GMT -7)   
swimom said...
Bill,

The scores are set according to cell dominance. It is unlikely that the score will change if positioning is different. It may very well be that a less agressive tumor close to the margin is less likely to recurr. I don't think any Doc is willing to guess at such the notion. A pathologist may suggest the chances are lessened but, an Oncologist will still play it safe and say nothing.

So far you're doing well :>) Modified Citrus Pectin...Worth a look see if one is into such alternatives.

Stay well,

Swim


Swim, I have been reading up on that Modified Citrus Pectin you mentioned the other day. There seems to be a good deal of positive information regarding its use and possible inhibiting of metastasis and it is a relatively inexpensive supplement. At first glance it does not seem to be readily available in Australian health food stores so I'm hoping that if I decide to add it to my diet (high probability) and bring it in from the US, the Australian Quarantine Service doesn't give me any grief.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

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