Please explain

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dogyluver
Regular Member


Date Joined Sep 2009
Total Posts : 35
   Posted 9/10/2009 5:45 AM (GMT -6)   
rolleyes I 'm totally new to this and confused. Could someone please explain to me what the info on my signature means?
The dotors say that it's good, I need a more detailed explaination in English.
Thanks,
Pam
April 09 PSA 3.2
May 09 DRE enlarged prostate
July 09 PSA 5.2
July 09 Biopsy 5 out of 12 malignant
Gleason score: Primary 3, Seconary 4 Total 7
August 24, 2009
Radical Open Prostatectomy Andocarcinoma of the prostate
% of 4 and/or 5: 1-25%
% of 3    76-90%
Androgen deprivation effect: Negative
Apical involvement: Positive
Apical marginal involvement: Negative
Extraprostatic extension (EPE): Negative
Margin: Negative
Bladder Neck Shave: Negative
 
Areas of involvement: Right and Left lateral, posterolateral and posterior and left anterior apex and mid prostate
Principle area of involvement: Right and left lateral, posterolateral and posterior apex and mid prostate
Focality: Multifocal
Volume: Medium(100 Sq mm)
Ejaculatory Duct: Negative
Seminal vesicles involvment (SVI): Negative
Vas deferens N/A
High Grade PIN: Positive
Neuroendocrine differentiation: Negative
 
Pathologic Stage: pT2c NO MX


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 9/10/2009 5:56 AM (GMT -6)   
If I read this correctly, it says that
- margins are negative
- tumor confined to prostate
- limph nodes are negative
- the tumor involves both sides of prostate including the apex
- there are changes to normal tissues that are pre-cancerous (PIN)

The one thing confusing is the Gleason score. It says 4 and/or 5. It would be important to find out which. My assumption would be that it is 4, making it G7.

Overall, a pretty good report.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 9/10/2009 6:21 AM (GMT -6)   
Your Dr is working for you, if they will not take the time to sit with you and in plain english explain

every number on your report, well then you should be looking for a Dr that cares more for their patient

If they are to busy ask to speak to an associate or NP, someone at the practice has to be able to speak with you, support during this process is paramount
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/10/2009 6:22 AM (GMT -6)   
A pretty clean report, decent staging , I would call it a 3+4 Gleason 7, which is better than a 4+3 Gleason 7 IMO. If it is that clean, he shouldn't have much likelyhood for reaccurance anytime soon, other than the quirkiness of all Gleason 7 cases.

I hope the best long term for your husband, he needs a good healing period, to be able to walk and build up his strength again, and to have time to deal with any incontinence and ED issues as they come along.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 9/10/2009 7:11 AM (GMT -6)   
Hello Pam:
 
I believe David and Geebra are correct, i.e. this looks like a pretty good report.  However, MrGimpy is absolutely correct.  Your doctor OWES you a complete and timely explanation about everything in the report.  You should INSIST on getting all of your questions answered to your satisfaction. 
 
Tudpock
Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 9/1/09.  6 month PSA  1.4 and my docs are "delighted"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/10/2009 8:49 AM (GMT -6)   
I agree with Tudpock's sentiment to the tee. Mr. Gimpy, you need to insist and be pro-active about making your doctor spend the time with you to explain your reports/tests and questions, until you understand. Don't be bullied or feeling sorry for the doctor because he/she is busy or over booked. When you are with your doctor, it is your time, your situation. Write your questions down, so you don't feel intimidated or toungue tied. If you don't understand an answer, ask the question a different way, keep at it and don't leave the room until you are satisfied. Might make the next patient on his/her list wait a bit ,but so what.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20%, Contained in capsule, 1 pos margin
2009 PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/09 met 2 rad. oncl, 7/09 cath #6 - blockage, 8/09 2nd corr surgery, 8/9 cath #7 - out after 38 days


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 9/10/2009 10:08 AM (GMT -6)   
Pam,

I WHOLE HEARTEDLY agree with the sentiments of everyone that says you have to hold your Dr. accountable and responsible to answer all of your questions and provide you with a complete and thorough understanding of everything you want to know. EVERYTHING.

I have been learning this lesson continually the last 5 years since my wife was diagnosed with cancer and it has certainly has held me in good stead as I began my own journey.

Patients have a responsibility to participate in the management of their care and treatment and it has become expected that they will demand that their Dr.s will be held to a higher standard. Gone are the days where we just do what the Dr. says and not ask why or what will happen. In my own case, my wife is here today because we did not blindly follow the diagnosing Dr.s recommendation for treatment without first becoming informed ourselves. The Dr.s method was old school and did not take advantage of the latest developments in therapy plans, treatments, and drugs. Nuff said on that.

So ask the tough questions, demand the answers and inform the Dr. you will accept nothing less. After all it is your lives he messing with, not his own.

David in SC,

Reading your post about the Gleason Scores, I remembered something I had seen previously. It was in the patient guide to da Vinci, Prostatectomy, from the University of California at San Francisco (http://urology.ucsf.edu/patientGuides/pdf/uroOnc/Radical_Prostectomy.pdf) I found it in the section of "Understanding the post surgery pathology report".

I am pasting that one passage here;

Cancers with both primary and secondary grades of 1 to 3 (sums of 2 to 6) tend to have a better
outcome (lower chance of recurrence), compared to cancers of higher grades. Cancers with grades of 4 and 5 (sum of 7 to 10), tend to have a higher chance of recurrence. A word of caution about Gleason sum 7 cancers (3+4 or 4+3): Gleason grade 3+4 cancers are associated with a lower risk of recurrence compared to grade 4+3 cancers. Over the years pathology grading practices have changed so that Gleason grades 1 and 2 have become very uncommon. Today Gleason grade 3 is usually the lowest grade assigned, and a Gleason 3+3 (Gleason sum 6) is the most common low-grade tumor.

Pam, our prayers and blessings are with you,

Sonny
60 years old
PSA November 2007 3.0
PSA May 2009 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
<5%, 90%, 40%
Gleason Score (3+4) 7 in all positive cores
CT Organ Scan - negative
Nuclear Bone Scan - Negative

Surgery set for September 17th, 2009 with Dr. Mani Menon at the Henry Ford Medical Center in Detroit.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 9/10/2009 3:35 PM (GMT -6)   
Greetings, Pam.  Let me agree with my friends on both counts.  It seems to be a decent report and cause for optimism.  However, the primary person that needs to explain this to you and your husband is your doc.  Mine always spends as much time as I want with him and answers all my silly questions and does it with a smile on his face.  He should be your primary source - we are glad to weigh in but he is your medical professional.  Trust you both continue to do well.  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me

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