Wondering about historical diagnosis...is that geeky enough?

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Veteran Member

Date Joined Jul 2006
Total Posts : 686
   Posted 5/8/2009 9:16 PM (GMT -6)   
While waiting to tee off at the local CC today I had a talk with an old friend who is a retired urologist.  He noted that I was looking well and that my 30 month trip from prostate surgery seemed to be successful. His experience is interesting in that in his day he performed almost exclusively pereneal surgery and had little feed back as to the success. He has been retired for over two decades.
When I reminded him that I had been diagnosed with a Gleason 8, he remembered that he once had a patient with a Gleason 19.  I don't know if he "mis-remembered", or if the Gleason system once showed  a higher degree of involvment.  Does anyone know what changes we have seen in the explanation of Gleason and other prostate cancer diagnosis.
PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Very Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8 with no extension or invasion
no long term continence problems
Post surgery PSA continues to be "undetectable"
One side nerves spared
Bi-Mix for ED 
born in 1941

Veteran Member

Date Joined Feb 2008
Total Posts : 655
   Posted 5/9/2009 9:05 AM (GMT -6)   
Greetings, Lifeguyd.  The only thing I could figure would be that they added the scores of both lobes.  So if he was 4 + 5 on one lobe and 5 + 5 on the other lobe it would be a total of 19.  I know my doctor said that post surgery one lobe was 3 + 3 and the other was 4 + 3 and they quoted the one that was highest.  Who knows?  I guess we can just be grateful to be doing well.  David

Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me

Veteran Member

Date Joined Feb 2008
Total Posts : 1858
   Posted 5/9/2009 7:58 PM (GMT -6)   
I should tend to think that your playing partner has "mis-remembered'". As your link explains, part of Gleason's intention was to quantify the risk of prostate cancer spreading by giving the appearance of the prostate cells a number according to how much they had changed from the norm . The more they had changed the more aggressive they were and thus more likely to spread from the confines of the prostate. 1 was more or less normal while 5 was very abnormal in appearance. The score was made up by adding the number given to the two most predominate grade of cells in the prostate biopsy plug. If your friend was correct in his recollection then having a 3+3 in both lobes would have resulted in a Gleason score of 12 which would appear to give a worse prognosis than having a 5+4 (9) in one lobe. Clearly this is not the case.
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)
PSA February 09 <0.01

Post Edited (BillyMac) : 5/9/2009 7:06:07 PM (GMT-6)

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 5/10/2009 5:33 AM (GMT -6)   
Donald Gleason created the current pathological staging system in the late 60's. It is and has always been scaled from 2 to 10. Your friend is probably confusing PSA from Gleason. In the early seventies many doctors did not know the Gleason system, so it is possible he never knew the system.

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  

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