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texannie
New Member


Date Joined Sep 2009
Total Posts : 4
   Posted 9/29/2009 5:21 PM (GMT -6)   
My 80 year old father just got the results from his biopsy and has asked for my help in understanding them. (i am not a medical profession, just know how to look for info on the internet)
He has Prostatic Adenocarcinoma in 5 of the 12 areas. Gleason score of 7.
In 2 areas he has high grade PIN
1 area has minute focus of atypical glands strongly suspicsious for carcinoma
Perineural Invasion is present
Diagnostic summary is Prostatic Adenocarcinoma
 
So what do we do with this info?
Thanks.

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 9/29/2009 6:02 PM (GMT -6)   

Sorry to hear the news about your dad.  The biopsy results are moderate, yet do show some spread.  I'm sure some other people will comment in more detail.  A lot depends upon your Dad's general health.  If he is youthful and robust he probaby has many good years ahead of him.  In that case, the doctors will probably suggest some kind of radiation treatment.  On the other hand if he is aging badly and has other major health issues, the doctors might suggest that he do nothing.  By that I mean that they would continue to observe his condition, but not have any active treatment.

If his biopsy showed less spread and a lower Gleason score, I am sure that due to his age they would do nothing.  Many prostate cancers are relatively slow growing, so older people can often ignore them.  Your dad's doctors will, I am sure, let you know what they are thinking and what they suggest.  I am familiar with a two friends in good health who were older (75-85) who had to overrule their doctors and demand treatment. 


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


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 9/29/2009 6:06 PM (GMT -6)   
Texannie,
This is a bit of a shock to you, but I gotta tell you, there is lots that will keep him going for years to come. He is probably not a candidate for surgery with his age. There are several treatments. Is is NOT in a terrible place at all. Radiation, hormone therapy may be offered and will help him a lot and also help with side affects. If not those treatments, there are still more. Your doctor will walk you through it all. Welcome to the boards!
Paul
46 at Diagnosis.
Father died of Pca 4/07 at 86.
10/07 PSA 5.06 (Biopsy 11/07 1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC www.roboticoncology.com
Saved both nerve bundles.
Path Report: Stage T2cNxMx
-Gleason (3+3)6
Pad free on March 14 - (10 weeks.) Never a problem since.
ED - at one year, ED is fine with viagra.
One year PSA - undectable!

ED Website: www.FrankTalk.org - frank discussions of Erectile Dysfunction - check it out.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/29/2009 6:28 PM (GMT -6)   
For an 80 year old man, we wish that the PC weren't there but the diagnosis is not all that bad. My dad at 76 did hormone therapy. He died at 80 of an unrelated stroke. So, essentially, the PC didn't matter
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


texannie
New Member


Date Joined Sep 2009
Total Posts : 4
   Posted 9/29/2009 6:30 PM (GMT -6)   
Thank you so much for all your words of encouragement!! I realy appreciate them. I am 51, but still 'daddy's little girl'. ;)
Most of the research I have read said that if you have a 10-15 year life expectancy to do active surrveillance and maybe hormones. His dad lived to be 85 (leukemia) his paternal grandmother lived to be 101! He's in pretty good health. He swims 1/4 mile everyday, but does have high bp (on meds) and some back/hip problems.
Obviously, talking about alot of his symptoms with his daughter can be rather uncomfortable so he hasn't gone into alot of detail on them. I am not sure how many doctors he saw. He did say his PSA was 5 last year and 7 this. (does that sound right?)
how do you know if it's spread? that would be to the lymph nodes outside of the prostate, correct? or are we talking about within the prostate itself?
from my reading the questions he needs to ask his doctor
*Is it contained or has it spread
*What's the activity level? (slow growing or high grade)
*Recomendations/options
*Side effects
*

what other questions should he ask?

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/29/2009 6:48 PM (GMT -6)   
hello texannie,

sorry your father has pc. glad you found us on the net, great place to be. if he were 50, not 80, a more agressive approach might be in order. the old school thinking would be not to do surgery at his age, but other men his age have had good results with surgery. it also might be in his best interest to practice Active Surveilence, and of course, there are several radiation based options. he definitely should be talking to a good surgeon and a good radiation oncologist for starters. his general health is definitely a factor in how he could be treated.

please keep us posted.

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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/29/2009 6:50 PM (GMT -6)   
Hello Tex!,
Typically I'd save that hello for one of the guys, but a daddies little girl is worthy as well...lol...Welcome to HealingWell. This is a great site for just why you called on us. What is the life expectancy on your fathers side of the family? If he is healthy and has a reason to believe his life expectancy is beyond ten years then those numbers you posted would likely need an intervention of some sort. Surgery is not out of the question, but radiation might be a better approach. Either brachytherapy or IMRT would do a great job of controlling the disease and might be less uncomfortable for your dad.

In any case, watchful waiting is best if he does not have great health or other life threatening conditions like CAD or COPD as examples.

We welcome you and look forward to your father being around quite a long time...

Peace,

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) : 9/30/2009 12:28:49 AM (GMT-6)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 9/29/2009 7:08 PM (GMT -6)   

Annie,

From what you have said your dad is in the intermediate risk catagory. He could go a number of years before the cancer would affect him. Either radiation or hormone therapy would be the recommended treatment, but they both come with some side affects that would affect his quality of life immediately but could extend his life to it's normal course. In his case it would be a personal choice.

One option could be to go on hormone therapy and see how it affects him as everyone reacts differently. If it is too much he could stop. My cousin and my neighbor have both been on HT for 10 and 12 years and both are doing just fine with few side affects one is in his mid 80's and the other in his late 70's.

JohnT


64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/29/2009 7:09 PM (GMT -6)   
Easy guys,
The center of attention in this thread is the lady and her father. At least it should be. Please let the peace prevail.

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!


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 9/29/2009 7:11 PM (GMT -6)   
Tex,
You have already received a lot of advice. My Dad, was diagnosed with prostate cancer in his early eighties. The doctors didn't think that he was a candidate for surgery and chose to do nothing. He died at the age of 89 but not because of PC. If your Dad is strong and healthy he may chose to get treated. He has several treatment options depending on how much side effects he can tolerate. Getting opinions from oncologist, urologist and radiation professionals will be the next step.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
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 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/29/2009 7:13 PM (GMT -6)   
Tony, I don't appreciate getting flamed on the side, and what is my crime? Because I have time on my hands, I am a writer, and because I care? Feel I am owed an apology. Can't believe someone writing to a new friend here, would take advantage to flame a fellow poster, cleverly disguised or not.

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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 9/29/2009 8:11 PM (GMT -6)   
Your dad is lucky to have you on his side. You should look at the permanent links at the top of the threads list for suggestions about books and other good sources.

You report your dad’s Gleason score and you should ask if it is 3+4 (better) or 4+3 (not quite as good.)

His PSA level is moderate – definitely the right time to do a biopsy but nowhere near time to be greatly worried.

I sympathize with what seems to be his reticence to discuss details of his health. My father’s first response to all questions about his health was “I’m fine, just fine.” I know that a lot of us here have started talking much more to our children because we realize how important it is for them to understand a disease which may affect either themselves or their husbands. I hope your father can see the importance of passing information on to you.

Side effects are difficult to predict, but quality of life is important. For my dad, on hormone therapy, the biggest issue was night sweats, he would wake up in the morning with his pajamas wet and also the sheets and sometimes the blankets. He would strip the bed, throw everything in the wash and get on with his day. So it is not just the effects, but how you deal with them.

This response is rather rambling, but be encouraged. We are here for and with you and your dad
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads


texannie
New Member


Date Joined Sep 2009
Total Posts : 4
   Posted 9/29/2009 8:55 PM (GMT -6)   
Now boys..let's all play nice! ;) LOL

Thank you all so much for your kinds words. I know the internet is a wonderful place for info, but it's also scary! I am feeling much more encouraged. I does seem odd to 'do nothing' to treat cancer, but I understand better now why.

As to your question Geezer99
Right Lateral Base Gleason score 7 (4+3) 3mm
Left Medial Base Gleason score 7 (4+3) 7mm
Left Medial Mid Gleason score 7 (3+4) 3 mm
Left Lateral Base Gleason score 7 (3+4) <1mm and 10mm
Left Lateral Mid Gleason score 7 (4+3) 7.5 mm and 8 mm

does that change things?
 
 

Post Edited (texannie) : 9/29/2009 7:59:25 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 9/29/2009 9:05 PM (GMT -6)   
Annie, I watch over my 82 year mother the way you do your father, so I can understand the worry and concerns you are having. Makes me feel better that you are helping him and learning all you can.

The "doing nothing" is just a manner of speaking, in the method of Active Surveilence, the patient still needs to have regular PSA tests, possible additional biopsies if needed, and be prepared to start an active treatment if needed.

The thing that concerns me the most out of your father's stats, is the number of Gleason 7 (4+3), and the Gleason 7 cores in general. The "4" component of those mixes is definitely a more agressive progression of cancer cells. Gleason 7 cases can be hard to predict, and if anything, they tend to act more agressive, as opposed to less agressive.

Now if your dad lived to be a 100, him being 80 would live him a lot of time for the cancer to progress, but on the other hand, would also give him a chance at standard primary treatment methods.

The scary part, can't be helped. It comes with a diagnosis of any kind of cancer. But as anyone will testify here, the best way to overcome the scary and fearful part, is to gain knowledge ,as you are attempting to do.

I hope only the best for you and your father. What you will see here, as far as treatment, or even non-treatment, we tend to support each other fully in our decisions. We are in this together.

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% cancer, 1 pos margin
Post Surgery  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, 8/9 2nd corr surgery, 8/9 cath #7 - out  38 days, 9/14/9 - met 3rd rad. oncl.agree to start radiation, mapping on 9/21/9, 9/24 - mtg with uro/surg, 9/29- pre-op, 10/1 - 3rd corr. surgery - suprapubic cath/hard dialation, 10/5 - first treatment IMRT.


texannie
New Member


Date Joined Sep 2009
Total Posts : 4
   Posted 9/29/2009 9:21 PM (GMT -6)   
Thanks David.
I am going to send this link to my dad and hopefully he might come here. He hasn't quite figured out how you can make some wonderful friendships with people you have never met. I have been going to a mom's board for over 17 years so i 'get it'.
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