Oh good grief! Now I'm a G7.5...

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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/23/2009 10:43 AM (GMT -6)   
Jon Epstein, internationally known pathologist at Johns Hopkins, is calling for changes in the Gleason system grading our prostate cancer...It's an interesting read...

http://prostatecancerinfolink.net/2009/09/22/a-recommendation-to-re-think-gleason-grading


Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!

Post Edited (TC-LasVegas) : 9/23/2009 10:57:14 AM (GMT-6)


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 9/23/2009 10:51 AM (GMT -6)   
Hey! Don't scare us like that! I saw that number and said: "No! Not TC! "
Since I don't have any tertiary score I guess that means I can be a 7, 7.25 or 7.5. I'll have to ask for a tertiary after my next biopsy. Oh..., Nevermind...
DX Age 56. First routine PSA test on April 8th: 17.8.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
----------------------------------------------
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7 Tumor size: 2.5 x 1.8 cm location: both lobes and apex. No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Extraprostatic extension present; Perineural invasion: present, extensive
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
----------------------------------------------
Post Surgery Status:
Potency - 9/17 2 months, Still no activity
Incontinence - 8/20 4 full pads per day
. 9/7 3-4 full pads per day (I'm going to try cutting down on fluids. Bad idea. I know.)
9/17 2 months: Still 3 pads per day. At this rate I'll be fine in 2011.
Post Surgery PSA - 9/3 6 weeks - 0.05


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/23/2009 10:58 AM (GMT -6)   
Uh yea you're right...I changed the subject name. Sorry for that scare, but wait, dang, now I'm a 7.5 no tertiary needed...Yuk...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 9/23/2009 12:08 PM (GMT -6)   
Sounds kind of like high school when you could get an F+ or a D-. Both were bad news when you got home !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/23/2009 12:09 PM (GMT -6)   
I wish I could hide this report card...:-)

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 9/23/2009 1:09 PM (GMT -6)   
Tony is in trouble, ha ha
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  38 days, 9/14/9 - met 3rd rad. oncl., agreed to start radiation, does not rec. HT at this time, mapping on 9/21/9


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 9/23/2009 3:34 PM (GMT -6)   
Yeah... but he's still gorgeous! Lana
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. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable <.1 PSA since, specifically, June 2007-0.01, Oct 2007-0.02, April 2008-0.02: Oct 2008-0.03, Nov, 2008-0.02, April 2009-0.03. 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/23/2009 4:04 PM (GMT -6)   
It's a good time to point out that all Aussie's have great eyesight...at least in my opinion...lol

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


creed_three
Veteran Member


Date Joined Jan 2007
Total Posts : 762
   Posted 9/23/2009 5:06 PM (GMT -6)   
It helps to have 3 different pairs of glasses Tony! I could never manage multifocals. Lana
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. Open Radical Prostatectomy with nerve sparing April 2007. Gleeson 3 + 4 = 7.   Undetectable <.1 PSA since, specifically, June 2007-0.01, Oct 2007-0.02, April 2008-0.02: Oct 2008-0.03, Nov, 2008-0.02, April 2009-0.03. 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/23/2009 6:05 PM (GMT -6)   
Shhh...now is not a good time to mention glasses...lol...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 9/24/2009 9:31 AM (GMT -6)   
I like this better than what I was told. I had 3+4=7 with tertiary 5. My doc said to think like it was an 8. 7.25 is actually in improvement. Whoopee.

The problem with the tertiary numbers is that when you get into the data the actual number of cases is mighty small. (I read everything I could on this topic) They can study them as a group but have no precision when looking at age, primary treatment, etc. One doc I talked with just dismissed the whole question as unanswerable yet.

Like most others I'm going to have to learn the application of this in real time and not by looking at others results.
Diagnosed at 54
PSA 8.7
Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7
Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09
Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence
Pad free week 5
PSA 6/6/09 <0.1
PSA 9/10/09 <0.1


hangin-in
Regular Member


Date Joined Sep 2008
Total Posts : 78
   Posted 9/24/2009 11:00 AM (GMT -6)   
Thanks for the post. I always wondered if the tertiary score has any meaning.

Rising PSA 12/06=1.6 12/07=2.1 5/08=2.6
Biopsy 6/4/08 12 core 4 Positive 15%,15%,8%,3%
Diagnose @ Age 51 Gleason 3+3=6
Bone & Cat Scans Normal
Lapro Surgery 8/18/08 at Memorial Sloan Kettering
Pathology report stage T2c organ confined with positive apical margin Gleason 3+3 = 6 (with tertiary grade 4)
Catheter removed 8/26 - reinserted 8/29 - removed 9/2
No continence or potency problems from the get-go.
First post op PSA 10/2/08  < 0.05
2nd  post op PSA 12/30/08 < 0.05
3rd  post op PSA 3/30/09 < 0.01
4th  post op PSA 6/25/09  0.01


RacingOyster
Regular Member


Date Joined Aug 2009
Total Posts : 31
   Posted 9/24/2009 1:12 PM (GMT -6)   
Tony, thanks for the link. Among other things, the article says, "patients with truly organ-confined prostate cancer who receive an accurate pathologic evaluation of true Gleason score 6 (with no sign of tertiary Gleason pattern 4 or 5) can be told that their risk of progression after radical prostatectomy is very rare (of the order of 0.4 percent or 4 cases per 1,000)"
 
That made me feel pretty good about a 99.6% change of my being cancer free for the rest of my life.
 
Now if we could clear up the annoying side effects...

Living in the northern Atlanta suburbs.

Good health and no symptoms when my annual physical uncovered an elevated PSA.

Diagnosis at age 55: PSA 4.6 - positive biopsy 3 of 12 cores - Gleason 3+3=6.

Open Radical Retropubic Prostatectomy with bilateral lymphadenectomy on 6/18/2009.

Pathology report after surgery showed negative margins, cancer contained in capsule

(60 gram sample, Gleason 3+3=6, T2c N0 MX).

PSA at 4 weeks after surgery <0.1 (all other problems are minor considering being cancer-free).

Catheters required on-and-off for 34 days after surgery due to recurring urinary retention.

Anal fissure due to trauma to rectum from biopsy, surgery, and antibiotic-induced diarrhea.

Using 1 pad during the day for occasional stress incontinence, dry at night (12 weeks after surgery).

Taking 2.5 mg daily Cialis for ED with no joy so far.

 


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 9/26/2009 8:14 PM (GMT -6)   
I read this to.  The best thing is that if you are one of the 4 people that had biochemical failure, none of them ever developed systematic desease...So even if you recurr.. It still won't kill you.   I e-mailed Dr. Epstein about my path. report, because it did not have a tertiary score noted, and I wondered if it was overlooked. He said if I had one it would have been on my path. report.  I had RP by Partin at JH on 10/15/08.  He said the same thing to me that it is very rare at JH for people to have reccurence who are Gleason 6.  There overall 10 year survival rate is %87 no matter how advanced you are when you come throught the door. Remember though that this is a study of people JH operated on and their pathologist did all the readings.  Some pathologists may read Gleason 6 when it is actually 7.  I am not saying to worry if your procedure was done someplace else, but this is a JH patient experince....It is why I went there.... They are the only people I know publishing these kinds of results with Gleason 6 people...  Partin had a paper out for 2500 Gleason 6 patients they operated on and after 15 years only 5 people had recurrence.  None had systematic desease and 4 of the 5 had radiation and now have undecteable PSAs.  Again, that is why I went there.
 
 

Post Edited (ChrisR) : 9/26/2009 8:18:42 PM (GMT-6)

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