Gleasons become worse with time?

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Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 2/16/2009 6:04 PM (GMT -6)   
May be a dumb question but does anyone know if Gleason grades worsen the longer PCa goes undiagnosed?  For instance, currently I'm a 4+3.  When my cancer first started, was I a 2+2, then a 3+2, etc.?  I've asked the question to my MDs but they have a way avioding direct answers. 
 
Tony
Age at diagnosis 61  5'8" 260 lbs.
Resides in SW Florida
12/07 PSA 2.6  12/08 PSA 4.0
Biopsy 1/09 - 6 of 8 nodes positive 
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason
Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineual invasion is present 
DRE small nodule on right - Prostate 22.6 cc's
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/16/2009 6:46 PM (GMT -6)   
Tony, I will make a stab here. How do you know that at first you were a 2+2? Until they did you first biopsy, there would be no way of knowing what Gleason score was suspected. Depending on how many cores were found with cancer, there could be more than one Gleason score. I.E., on my 3rd and final biopsy, some of my cores were 3+4 = 7, and some were 4+3=7, both 7's, but in reality can mean two different things. After a person has surgery, open or robotic, to remove the entire prostate, plus usually lymph nodes, seminal vessels, etc, then they do a post surgery pathology job. When that comes back, since they should have all the material removed from inside you, the results can either be the same, or downgraded to a lower gleason (rarer in my opinion), or upgraded to a higher number (which I have seen more cases in that direction). To go back to your question, the only way to know anything about your Gleason, is either through a biopsy (or several), or post surgical pathology after you have had an operation. That would be the general rule.

The 2+2 confuses me, as I have never heard of that as being a PCa dx. Again, not a doctor, could be wrong. Even a 3+2 or a 2+3 is unusual. Most PCa dx seem to be a 3+3 or a 6. The biopsy, at best, and depending on how many cores they take, is at best, an estimate of what they think is going on inside you.

You stats do concern me, particualy your right side with the 4 of 4 positive, 40% cancer , and a gleason 4+3. If this ends up being the case after treatment, then it definitely needs to be dealt with sooner rather than later, and no, not steering you into any particular treatment.

Hope this info helped, and if I am wrong, please someone correct me.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/16/2009 8:32 PM (GMT -6)   
Which answer would you like to hear? This is PCa, it usually is totally inconsistent, beyond normal rational analysis and thinking on almost every parameter you can mention. It is a wild world in effect.

S.W.A.G.~ the scientific wild ass guess is let's look at a what is PCa? Well it is said that there is atleast 18-19 variant types of PCa....so which one(s) are we talking about? Next out of those some of them are way different than the type most of us are diagnosed with, i.e. like squamous cell, signet ring or small cell and a few other 'radical' types (for lack of a better term) and they can be super aggressive in comparison.

Next parameter that probably has alot to do with 'possible' up staging/changing of Gleason pathology, is plodity analysis of the PCa cells DNA structures, i.e. how is it built. Three types exist and the first one is the closest to normal cell structures, called Diploid and has double stranded DNA and is the easiest to control with hormone therapies etc. it is said..thus (likely clue this is the safer of the 3), second one is aneuploid which has multiple stranded DNA's(repsonds not as well to hormone therapies) and third was tetraploid(or something like that...from memory right now..no quoting) and it has wild DNA structures and would be the worst prognostically. So the crazier the PCa cells DNA structures, the more wild it is.

This is why some pathologists offer "plodity" testings for additional $350 or such, Jon Epstein is not doing plodity analysis for whatever reasons, but among the experts on pathology, the other guys I mentioned in a posting, apparently all do ploidity. I am sure there are other reasons and parameters and maybe Tony or someone else can throw in some more information on this. Not saying I had the answer for you, but you can see how complex PCa can become.
It is possible to have low Gleason scores under 5 or 6, although it is somewhat uncommon and could be reviewed to make sure it was correct and not under graded, heard this from Bostwick himself at PCa support group.

"Youth is wasted on the Young"  (W.C. Fields....ah yes)


 

Post Edited (zufus) : 2/16/2009 6:42:35 PM (GMT-7)


Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 2/16/2009 10:38 PM (GMT -6)   
David:

I'm concerned, too. I'm scheduled for open RRP on 3/10 at MSK by their Urology Chief of Surgery, James Eastham. I was musing the other day, wondering if Gleason scores degraded over time, thus the post.

Hope you and the Z-man are doing well - thanks for the responses.

Tony
Age at diagnosis 61  5'8" 260 lbs.
Resides in SW Florida
12/07 PSA 2.6  12/08 PSA 4.0
Biopsy 1/09 - 6 of 8 nodes positive 
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason
Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineual invasion is present 
DRE small nodule on right - Prostate 22.6 cc's
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/16/2009 10:49 PM (GMT -6)   
3/10 will be here before you know it, Tony, you will feel better once you are on the other side of your surgery, and then you can see your post surgical pathology report, and let's all hope its good and contained. Then at least you will be on healing and recovery. Between now and then, I would enjoy all the regular things that you like to do, prepare the best you can for surgery and post surgery. Time will pass soon enough. We will all be here for you on the other side, and hoping all the best things for you. Just my personal observation and experience only, nothing special medically speaking, but I think with your known stats, height, weight, etc, the open is a good choice for surgery, and with a good surgeon like that, I feel he will have the best opportunity to do a good job on you. You should do well.

David in sC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 2/17/2009 9:12 AM (GMT -6)   
Godfather, You are in wonderful hands with Dr. Eastham, and you will come through with flying colors. Plus, having a daughter in law as a nurse, you will probably sail through all of the appointments!! Good luck to you. Diane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Hip replacement total success..pain gone!!
PSA .7 2/10/09


Godfather
Regular Member


Date Joined Jan 2009
Total Posts : 64
   Posted 2/17/2009 10:32 AM (GMT -6)   
Thanks for the note, Diane. Hope you and Pete are doing well.

Tz
Age at diagnosis 61  5'8" 260 lbs.
Resides in SW Florida
12/07 PSA 2.6  12/08 PSA 4.0
Biopsy 1/09 - 6 of 8 nodes positive 
Left - 2 of 4 positive, 2% involved, 4+3=7 Gleason
Right - 4 of 4 positive, 40% involved, 4+3=7 Gleason
Perineual invasion is present 
DRE small nodule on right - Prostate 22.6 cc's
 

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