3+4=7 or 4+3=7 its still 7

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 5/13/2009 12:25 AM (GMT -6)   
Some interesting reading I have just come across, for us 4+3=7 guys, seems theres not alot
of difference between 3+4=7 and 4+3=7, according to this doc.  Just thought I would share it with you all................cheers Nothard
 
http://www.prostate-online.com/gleason7.html
Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason 4+3=7
Stage T2c
Three small foci total volume 10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week (unbelievable)
ED- taking Meds/ No results yet/still "NotHard"
PSA 28/1/09 0.03
PSA 24/2/09 0.03
"Everyday in Everyway I get better"


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/13/2009 7:48 AM (GMT -6)   
Nothard,

I have read the arguments on the 3+4 vs 4+3 debate ever since I was first dx. with PC with a Gleason 7.

My dr. feels strongly that most 3+4 act more like a Gleason 6, which is a good thing, because the largest component is type 3 cells, and generally less aggressive. Whereby a 4+3 is made up mostly of type 4 cells, which are typically very agressive, and 4+3 Gleason 7's often act more like Gleaon 8/9s. This is not an uncommon opinion on the subject.

In general, a 7 is very unpredictabel, some feel that watching and waiting with any variant of a Gleason 7 is a risky business, as there is such a razor thin line between containment in the prostate and escape.

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, 5/9 .10 doubled in 3 months, new test in six weeks, then possibly off for salvage radiation
 
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 5/13/2009 11:25 AM (GMT -6)   
Interesting article. Thanks for sharing.
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/13/2009 3:32 PM (GMT -6)   
They say 4+3 is worse, but any grade 4 disease is not good. In fact after my surgery my surgeon said it was worse, but my oncologist says he treats all G7's the same.

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!


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 5/13/2009 4:46 PM (GMT -6)   
Greetings, Nothard.  As a 4+3=7 guy, it's always good to hear it might not be quite as problematic as we thought.  Thanks for passing along a good article.  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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/13/2009 4:58 PM (GMT -6)   
Unfortunately, David,
That's not what the article is saying. Any cancer with grade 4 tissue is more dangerous is the point. So a 3+4 is just as likely to be aggressive as a 4+3 is what the doctor is saying. And both are much worse than a 3+3. I can understand that, too. I was thinking why would it matter if the grade 4 tissue was present it can be aggressive. he is confirming this.

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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/13/2009 5:54 PM (GMT -6)   
My gut feeling is that the prognosis and outcome are a matter of volume. As grade 4 cells carry a higher risk of escaping the prostate via local spread or micro-metastases then the higher volume of grade 4 cells that are present then the greater is the probability that escape will occur . I should not think that a Gleason 7 comprised of grade 4 cells @ 55% and grade 3 @ 45% would be a whole lot different to Gleason 7 comprised of 55% grade 3 and 45% grade 4. But a Gleason of 7 with 90% grade 4 and 10% grade 3 (also a 7) would more than likely be a whole different animal to 90% grade 3 and 10% grade 4 (same 7 score).
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)
PSA February 09 <0.01


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 5/13/2009 6:23 PM (GMT -6)   

BillyMac-  I think you have hit the nail on the head.  Would it not be a good idea then to grade some gleasons as to its percentage of stage 4 eg 7.1 would equal 10% grade 4 and 7.2 would equal 20% grade 4 etc etc right up to 7.9 and then of course Gleason 8.  Hey we might be on to something here, I would like to call it the "NotHard Score".

Come on fella's, you got to have a laugh turn ...............Cheers "Nothard"


Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason 4+3=7
Stage T2c
Three small foci total volume 10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week (unbelievable)
ED- taking Meds/ No results yet/still "NotHard"
PSA 28/1/09 0.03
PSA 24/2/09 0.03
"Everyday in Everyway I get better"


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 5/13/2009 6:25 PM (GMT -6)   
Great discussion and one worth following. I like Tony's observation and I got the same thing from it. Bottom line is a grade 4 cell is not something to play around with. I also think Bill had a great way of describing volume. You guys are smart and it goes to show how great this forum is. Love you all

peace and grace
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 5/13/2009 6:27 PM (GMT -6)   
Also the article seems to point to the size of the tumor itself. So a 5 cc Gleason 7 tumor may be more dangerous than 3 cc Gleason 7 regardless of whether it is 3+4 or 4+3.
Age: 67
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09
Surgeon: Dr. Randy Fagin, Austin TX.
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
seminal vesicles clean
Lymph nodes: not dissected
1st PSA test 4/7/09 result <0.1


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 5/13/2009 6:36 PM (GMT -6)   

Ed C....Good point, my pathology says total estimated 3d volume tumor size 0.98cm3 (which was the total of three foci) that seems very small to me.  I never was good with maths, but isnt that the same as 0.98 cc ?

Would be interesting for members to share tumor sizes, see if there is a pattern forming.


Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason 4+3=7
Stage T2c
Three small foci total volume 10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week (unbelievable)
ED- taking Meds/ No results yet/still "NotHard"
PSA 28/1/09 0.03
PSA 24/2/09 0.03
"Everyday in Everyway I get better"


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/13/2009 6:47 PM (GMT -6)   
BillyMac, your post smoothed out the point I was trying to make in mine, I don't think I expressed myself as well on this one, but doctor is adamant about the difference between 4+3 and 3+4, and of course, it has everything to do with the volume of the 4 cells vs the volume of the 3 cells.
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, 5/9 .10 doubled in 3 months, new test in six weeks, then possibly off for salvage radiation
 
 

New Topic Post Reply Printable Version
Forum Information
Currently it is Saturday, September 22, 2018 9:41 AM (GMT -6)
There are a total of 3,005,663 posts in 329,249 threads.
View Active Threads


Who's Online
This forum has 161795 registered members. Please welcome our newest member, jjakefamily.
238 Guest(s), 5 Registered Member(s) are currently online.  Details
George_, jjakefamily, InTheShop, andwes, Pixie415