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Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 3/4/2009 11:54 PM (GMT -6)   
Can anyone please tell me, does it matter what gleason score you are if the cancer is localized and there are no extraprostatic extentions or pos margins.  ie is there a major disadvantage having a gleason 7 (4+3) rather than a gleason 6.  I am aware of the different grades and aggressions, but providing the surgeon gets it all out, are there any after effect
differences between the two.  For that matter would it matter if it was gleason 9, provding it was caught before leaving the capsule ?

Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 3/5/2009 12:18 AM (GMT -6)   
Statistics show that a 4+3 tends to behave more toward and 8 and a 3+4 is more toward a 6. The higher the Gleason, the higher the risk of recurrence. Keep in mind that it's a science and not 100% reliable. One day maybe this will change. Science is getting better all the time.

As for confined..there's plenty who have done very well with high Gleasons and recurrences sometimes happen with low scores. Negative nodes, margins and such certainly put the odds in a man's favor no matter what his Gleason happens to be though. Good luck and be well.

swim
 


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 3/5/2009 12:44 AM (GMT -6)   
My husband's biopsy showed a 4 + 3 = 7, then post-op pathology showed the majority 3 + 4 = 7. We hoped for a 6 given his age,  but were thankful it was contained, and fine since then. We also don't read statistics or other age/stage predictors which is unusual I am finding here, but we just feel lucky it was addressed and removed.  The fact it was a Gleeson 7 determined his choice of treatment however. We also plan on outliving any statistics we haven't read for gleeson 7's! wink We hope there are no disadvantages if it was caught and treated early compared to a 6. Good luck.
Creed_three
Husband 51 yrs (49 years at diagnosis)
PSA (2002) 2.1.  PSA (2006) 3.5.  1 x (5%) core of 12 positive at biopsy. 11 cores negative. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable PSA since Surgery (< 0.1) specifically,  
June 2007: 0.01; Oct 2007: 0.02; April 2008: 0.02: October 2008: 0.03: November, 2008 (repeat PSA with instructions to lab to calibrate carefully) = 0.02.
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 3/5/2009 1:02 AM (GMT -6)   

Hi Rookey,

Welcome to HealingWell.  The is a great site for getting patient insight.  The members do care and will share.  Gleason is not a lone predictor of disease containment.  Though I can say a person with Gleason 10 is not safe from relapse regardless of containment.  In fact nobody is.  But if you are concerned about the chances of relapse or spread, the link below is a great tool.  It's from Memorial Sloan Kettering in NYC.  They also have a post surgery tool as well.  The link below is for pretreatment.  Have a look at it and play around with the numbers and you will see some intersting stuff.

http://www.mskcc.org/applications/nomograms/prostate/PreTreatment.aspx

Peace and again, welcome.
 
Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 3/5/2009 9:05 AM (GMT -6)   
I too, had a 4+3 gleason 7 before surgery, I was afraid it might be upgraded to a 8 or higher after surgery. It wasn't. The final pathology was a 3+4 gleason 7. Yes, they are both 7's, but the 3+4 is less agressive then a 4+3, because a 4+3 is made up of more type 4 cancer cells. My was supposedly contained fully, no evidence of escape anywhere. But have read enough, that with any gleason 7, you have to keep on guard and keep your eyes open. I have only had my 3 months psa, and it was good. I will be nervous as I wait for 6 mos, 9 mos, and 12 months. I will be much happier and relieved if I am still pulling a zero at year 2. This is the part of PC that I hate, there's often not a cut and dry "Im ok and nothing is going to happen" period.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 6 month on 5/9
 
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/5/2009 11:50 AM (GMT -6)   

 

Decided to edit my prior words on this, short version 'containment' is basically somewhat an unknown in PCa, it might be and it might not be. Patient has to monitor and be alittle vigalent over time. Almost nothing with PCa is 100%, exceptions and inconsistencies are all over this disease.

 

 


 

Post Edited (zufus) : 3/6/2009 4:52:28 AM (GMT-7)


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 3/6/2009 8:07 PM (GMT -6)   
Rookey:

Read my stats. I think I am right in line with what you are asking about. My surgeon would say that surgery (by him) is a viable alternative for high risk patients. So far, I am living proof. I would assume other surgeons are achieving similar success.

My cancer was described to me as having bulged out, but not broken out. I acted fairly quickly and I am glad I did - BUT, and zufus is absolutely correct - almost nothing with PCa is 100%. It all seems to be shades of grey.

Good luck,
kcragman
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.
Feb 2009: PSA at 9 months was undetectable.


Ralph Alfalfa
Regular Member


Date Joined Nov 2008
Total Posts : 469
   Posted 3/6/2009 9:46 PM (GMT -6)   
Hello Rookey,
Just to throw this out there. I saw my Uro 3 weeks ago for 1st post-op visit and he downgraded my Gleason from a (4+3) 7, to a (3+4) 7. I asked him the difference and he said with the 1st, there is a 25% chance of recurrence. With the 2nd, it's less than 10%. Has anyone else heard this? If so , chime in and explain, please. I understand that the initial staging is more aggressive but what constitutes such parameters?
Thanks,
Bob
 AGE:57
 Dx: October,27(the day after my birthday)
 Psa 14.5
 Gleason:(4+3) 7 T1c
 Bone scan:Negative
 Cat scan: Negative
 Biopsy: 4 of 12 positive, left side, pre-cancerous on the right.
 Confined to prostate.
 DaVinci scheduled for Jan. 19, 2009.Dr. Scott Montgomery, KC Urology,
Shawnee Mission Med. Center. Kansas


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 3/7/2009 1:04 PM (GMT -6)   
The gleason score indicates the agressiveness of the cancer. A gleason 4+3 acts like a gleason 8 and a 3+4 acts like a gleason 6. this indicates how fast a tumor will grow and the likelyhood that it will spread beyond the prostate. A gleason 6 has a high probability of being contained whereas higher gleasons have a higher probability of escaping into other parts of the body and also are associated with higher reoccurance rates. If you look at the nonograms and partin tables higher gleasons and PSAs are rated as more unfavorable outcomes.
JohnT

Modified by moderator ~ Tony Crispino

 John your signature is in space consumption overload again...Please look at your posts when done.  If you need help let me know

Post Edited By Moderator (TC-LasVegas) : 3/7/2009 12:52:56 PM (GMT-7)


spisam
Regular Member


Date Joined Jan 2009
Total Posts : 47
   Posted 3/7/2009 4:40 PM (GMT -6)   

I had robotic surgery on January 6, 2009. My pre op Gleason was 6 with one of 12 cores showing 10% cancer cells. The post op pathology with I posted here several weeks ago showed a Gleason 4+3=7 AND 40% of the prostate showing cancer. Fortunately it was contained and the margins are not affected. My 6 week PSA showed <0.1. The time between the biopsy and surgery was 6 months.

I now encourage men to look beyond the biopsy report because if the actual post op pathology showed an agressive cancer in me it could happen to others. Don't wait. Select a method of treatment and go for it. It could save your life.

Sam

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