A case of fast PC progression

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/30/2009 2:45 PM (GMT -6)   
Met another interesting couple at the rad clinic.  I realize that for most men, PC is slow moving, and most will die of something else other than PC, the stats are overwhelming.  I realize that if a man lives to be old enough, most will have traces of PC.  I think we all accept that as fact.
 
One of my concerns since being here a bit over a year, is that lots of remarks are made about "how much time a person has", and don't rush, etc. etc.  In most cases I believe that may be safe advice.  But look at this case I learned about today at the clinic.
 
Got this all from the guy's wife while he was being zapped.  He was age 67 when dx with PC, all she remembered was Gleason 7, Stage2, didnt remember his PSA.  He had open Surgery locally right away.  Within 6 months, had reoccurance.  He did the same 39 rounds of IMRT as salvage.  He seemed ok while waiting for the radiation to settle down and to get some new readings on PSA, but complained all the time about bone pain.
 
He is 69 now  (hate to say this, looked like 90), he is now Stage 4 and they are doing 10 treatments of Rad on him right now only as pain relief, as his wife said that it has metasisied to his hips and halfway up his spine.  Not sure who his uro or rad oncl are, weren't local names I was familiar with.  She said they are now giving him a year at best.
 
Point of the story, not all PC is slow.  If Zufas sees this post, I will give him credit for one of his tenents, that there are varieties within PC, and this must be one potent variant.  Felt so sorry for the wife, and for the man as well.
 
What I learned from my own URO and the Rad Oncologists I have met with, that any portion of Type 4 cancer cells in the mix can cause unpredicible results.  We have guys here that are Gleason 7 like me, both in 4+3 and 3+4 formats, some have done great years after.
 
I like what is getting to be a current line of thinking according to my uro, that any Gleason 7 should be treated as if it were an 8, to be on the safe side.  We sure need better testing, this is proof of that first hand.  Outside of a miracle, I don''t think this new brother I met is going to make it.
 
I repeat this story, just to be a learning tool, not to scare anyone.  Knowledge is strength, even if we don't like the news.
Just don't shoot the messenger.
 
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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


Arnie
Regular Member


Date Joined Aug 2009
Total Posts : 372
   Posted 10/30/2009 3:01 PM (GMT -6)   

Hey David..........so does your uro and likeminded professionals distinguish between treating all Gleason 7's as Gleason 8's, or should we apply the caveat of taking all path stats into consideration? For instance, I'm a 3+4, but with no positive margins, lymph node involvement etc. unlike some other brethren who are less fortunate path-wise. Just wondering if that differentiation was made, or should be made going forward.

                          Arnie in DE


Age 56 (biopsy & surgery)
PSA at Diagnosis-3.9
Biposy 8/19/08--4 of 12 cores positive; 5% involvement, Gleason 6 (3+3)
 
Surgery 1/26/09-DaVinci Robotic Prostatectomy at Presbyterian Medical Center/HUP-Phila, PA
Dr. David Lee
 
Pathology Report- Adenocarcinoma, no capsular involvement, seminal vesicles clear, lymph nodes clear, negative margins, Gleason 7 (3+4), Stage T2C, Prostate 61.8 grams, gland involvement 2-10%
 
Catheter removed after 8 days, totally dry at 3 months. ED issues continue, Viagra (via ADC) nightly (100mgs), VED use in earnest at 6 months. "Ball Park Frank" plumping at this point.
3 month PSA--<0.1
6 month PSA--<0.1


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 10/30/2009 3:11 PM (GMT -6)   
No shooting the messenger David, but the reality of your post sure brings palpatations to my 3 + 4 heart.

And, I know that my surgeon was concerned that my PSA was so low. Apparently low PSA can sometimes signal an aggressive cancer. I think he was relieved to find the Gleason in pathology after surgery wasn't higher than before --- that the cancer hadn't become more aggressive between the April 9 biopsy and the surgery on June 20, near 3 months later.

On the problem with "4" --- I know it can be bad, really bad, news, ---  but I wonder statistically how often this happens. Of course, for the guy who "4" is bad news for, it doesn't matter if it's 10 out of 100 or 1 out of 1,000. Nevertheless it would be interesting to know. And, I suppose, how that fit with "3" being a problem sometimes too.

One issue I struggle with is that I focus on this cancer because it is the one I know about while the fact may very well be that even with a "4" in my Gleason make up, I'm at less risk of dying from PCa than some other cancer that's cheerly growing away somewhere and which I know nothing about.

Thank heavens God created rum and some nice druggist in Atlanta created Coke.


Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  0.02
Oct 1st 09 -- dry at night, during day some stress issues, but better every week. 
Feel free to email me at:  sheldonprostate@yahoo.com    


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 10/30/2009 3:12 PM (GMT -6)   
All generalities are false!

I ran across someone the other day. Age 43. Stage 4 prostate cancer found because he had some long term back pain. His cancer didn't get there by being slow moving.

My cancer was 3+4=7 with tertiary 5. That 5 suggests to me that things were going to take off soon. Waiting would have gotten me what exactly?

I look at it this way. While this cancer can be relatively slow moving there is a threshold that once crossed cannot be undone. That is, there is a day where we go from curable care to palliative care and we don't know when that day is. All the post care PSA tests we do are to find out which side of that day we were on, so the doctors don't know either.

It is sort of like Wyatt Earp's advice on gunfights - "Take your time quickly..."
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


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 10/30/2009 3:15 PM (GMT -6)   
David,
That's what happened to my dad.

Sad...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/30/2009 3:25 PM (GMT -6)   
I am not personally advocating any particular action, just sharing a real life story, and what my circle of medical professionals think, again don't shoot the messenger. There has to be other factors, because you can have two men with almost exactly the same stats, and one reacts one way with PC, and the other goes 180 degrees the other way. We have advanced brothers here, that are holding their own and doing well years later. Still comes down to the fickled nature of PC in general.

Arnie, good question, best answered between your own particulars and your own medical team. I was originaly 4+3, and after pathology 3+4, but according to my Rad Oncl, acting more like a 8. But this is just my body I am talking about.

Sleepless, the point is one never knows, regardless of his own stats, wish researcher could come up with some exact way to know why some PC is hyper agressive, why others are moderately aggressive, and why some, despite high PSA and Gleasons, are slow as mollasses.
Its frustating to me as a patient to deal with something like this that has no rhyme or reason as we currently understand it.

STW, all generalatiies are not false by any means, but many are. I agree, with your stats, nothing more may ever come up with it in your life time. THe original point of my posting this true story and case, was that it doesn't always work the way we think, its isnt always slow moving, and each man still has to make his own choices along this difficult path.

If the money that could be saved by not treating indolent cases of PC could be used to research agressive pC, think of the inroads that could made and the lives that could be saved. Based on today's knowledge, the doctors/surgeons/hospitals,clinics get richer and richer by default
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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 10/30/2009 3:57 PM (GMT -6)   
Hi David,
 
 
Gleason 7 its so confusing or is it ?.  As you can see I am a Gleason 7 Guy like yourself.  The confusion comes in to play when we talk 3+4 or 4+3. 
When these two scores are broken down into their Gleason Differential, ie percentage of grades, there does not seem to be alot of difference to me.
My Gleason Differential is 60% grade 4 and 40% grade 3.  I really dont see alot of difference  if it was the other way around say 60% (3) and 40% (4). 
Unless the GD is vastly different like 90% (4) and 10% (3).
So surely all the guys like myself that are sitting around the mid range area, should all be branded as simply gleason 7. 
I would be interest to hear you thoughts, I just fail to see the big difference, when the percentages are so close.  So much emphases is placed on 3+4 and 4+3.
 
 
................Cheers Kev
Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason Score 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c
Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week.
ED- taking Meds- Its been 9 mnths now getting some action ! yah
PSA 1/09  .03
PSA 2/09  .03
PSA 5/09  .03
PSA 9/09  .03
"Everyday in Everyway I get better"


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 10/30/2009 3:58 PM (GMT -6)   
As a gleason 9 prostate cancer fighter the reality of the situation is always close at hand. I often wonder when the cancer will rear its ugly head back up. I think I will do all my living now and just wear out instead of letting cancer wipe me out.
Thanks for sharing this story, i to remember the days in radiation oncology. There were some sad situations in there. I often think of a wonderful young lady that had oral cancer and had her tongue removed. Her throat radiation was terrible, but somehow she fought back and is still doing good and even learning to speak without a tongue. I had her come to my last event and give her story.
Oh well sorry to ramble on.

peace to all
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

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
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11

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%


rework
New Member


Date Joined Jan 2009
Total Posts : 9
   Posted 10/30/2009 5:01 PM (GMT -6)   
"Nothard" posted the attached article which has a lot of bearing on this discussion. My PC was found almost by accident. I had a turp and the biopsy was positive for PC. As is stated in the article, my cancer was very aggressive, has escaped the capsule, but not the margin. If I had not had the surgery, I am convinced that I would have had serious problems in the next couple of years. My PSA had not changed and was rather low, but my cancer was aggressive. Reading the article and relating it to my personal situation--it matches up pretty well.

http://www.prostate-online.com/gleason7.html
Age 61
TURP in March, 2008
Biopsy from that procedure showed positive for cancer
Radical Prosatectomy on July 15, 2008
Gleason- - 7
Cather for 15 days
Pull-ups and/or pads for about 30 days
4 PSA's since then; all undetectable
1-year PSA on August 10--undetectable


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 10/30/2009 5:11 PM (GMT -6)   
The sad fact is that we can only tell how a tumor reacts over time and not at any particular point in time if we have only one reference point.
From studies on watchful waiting we know that 3% of Gleason 6 progress very rapidily, within one year, and death with in 3 years. Others never progress.
G7's are a mixed bag a lot depends on the tumor location, if it on the edge of the capsule or by the seminal vesicles it can progress rapidily. If it's fully contained within the prostate you can go a long time. It's when PC excapes the capsule that it becomes deadly. I figure I had my G4+3 for 14 or 15 years from the time it could have been detected. My doctor said I could easily go another 10 years before it caused serious problems.
Again we have to remind ourselves that PC is very individual and tumors act differently. They only way to truely know is to monitor it over time and this stragety is only effective for the really low grade guys. Anyone with an intermediate or high risk PC must get treated.
JT

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/30/2009 7:21 PM (GMT -6)   
JohnT, yours was a good answer, and does had to the difficulty of sometimes knowing exactly what to do. The real example I posted today might be an extreme the other way around in the percentage game, but he is still a real person with a real wife, and it broke my heart to hear her tell his journey.

Dale, you know first hand in the PC fight for yourself, and you have been a tough fighter for a long time, and I hope it stays that way for you for a very, very long time.

Nothard, not to add confusion to this discussion, but even among drs, there is debate on Gleason 7. One school says the 3+4 vs 4+3 makes no difference, others feel strongly that it does. My uro doesnt put much value, he views both versions as moderately serious, but all 3 radiation oncologists I met with felt strongly that the 4+3 is a much more dangerous beast. My own said, it wasnt so much the percentage difference in the mix between the 3 and 4, but the agressive nature of 4's in general.

rework - I agree with you, that is how I felt about my own situation with my PSA velocity issues

squirm, it is sad about your dad, I am sorry.
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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 789
   Posted 10/30/2009 8:12 PM (GMT -6)   
Well guess I am in "the 7 club, as I have posted previously, after all my treatments, the old PSA will not go down, can't understand it, my pathology was not too bad, and no sign of spread, the theory now is that the remaining microscopic cells are in my system somewhere, and can not be detected until mets happen, have been told by Oncologist that "wherever they are" they are growing very very slowly, feel like a walking time bomb, but what can I do except get on with life? I guess all of us that are in this position can only keep going, I think for me HT will be next.

Hang in there David, every day is one less.

Regards Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept.
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)
PSA 11th March 09 0.5
PSA 3rd August 09 0.6
next PSA January 2010 (I am now 69)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/30/2009 8:19 PM (GMT -6)   
Mal, your attitude is the correct one to have, instead of worrying about the ones that got away, and not really knowing what one's exit plan is going to be in this world, we have to live and enjoy what we can.

My pathology was pretty decent on paper, but the cells have plans of their own, and I am hoping that 72 gys of salvage radiation will knock the living sh** out whats left. At least that is the game plan
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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 10/30/2009 9:20 PM (GMT -6)   
Mal,
Did your doctor say anything about hitting the PC with HT now that the population is small and eaiser to kill?
JT

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


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 789
   Posted 10/30/2009 10:00 PM (GMT -6)   
Hi JT, seeing him again on January 27th, think he is seeing what the January PSA brings, I had an interim PSA from my GP last week, came in at 0.68 (different Lab) so guess it looks like on the way to .7 will see what happens in January, meantime lot's of competition bowls to play this summer...lol

David hope the RT blows the little horrors to bits!

regards Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept.
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)
PSA 11th March 09 0.5
PSA 3rd August 09 0.6
next PSA January 2010 (I am now 69)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 10/31/2009 7:20 AM (GMT -6)   
Hey Purg and brothers of PCa world, as Dr. Strum has pointed out in his book(s) going back 8yrs or more ago. There are "tigers and *****cats" in the PCa variety types, the problem is many of the docs don't know which type you have and  therefore how do you treat it? therefore the logic that follows by various doctors and protocols. You can see the real world data and results, like in the case you mentioned. Bottom line there is a place for every treatment and non-treatment in the real PCa, the problem is knowing what are you dealing with and what do you personally do?

Here are some links to "small cell" PCa one of the more bizarre variants of PCa, that can go undetected by some pathologist and if you read this, it is possible to have a mix of small cell and so called normal variants of PCa together.

www.turkjcancer.or/pdf/pdf_TJC_68.pdf
www.prostate-cancer.org/education/highrisk/smalcell.html
www.annclinlabsci.org/cgi/content/abstract/26/6/487

Not saying this to scare anyone that they have small cell, it is quite rare in comparison to the majority, but they are supposedly around 12-14 variant types of PCa and some do not respond well to hormone therapies and other drugs, while some others have reasonable controll. The whole world of PCa is full of inconsistencies, grey areas and less than definitive known parameters and lacking in the perfection in assessment of the patients disease type-level-aggression, etc. We are put into a scenario whereby since diagnosed with this, we are supposed to chose a modality based upon this and one man's assessment of a protocol that could maybe work for a cure. Is this PCa world more like a jungle, twilight zone, well you decide.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/31/2009 8:38 AM (GMT -6)   
Zufas, that's why I invoked your name in my original post, this poor man and his wife are an example of something out of the ordinary with his PC, not at all saying its an everyday case and everyone should be afraid for themselves. Just a real living case. She did say there were no known cases of PC in his family, and his general health was good prior to the cancer.

Wish there were a sure way to dx within the dx, to help someone with the bizzare out of control variants.

Thanks for your assistance

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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 10/31/2009 8:46 AM (GMT -6)   
It is something we will always have to monitor. I was a gleason 8 and my doctor looked at me and said start enjoying life. I had clean nodes and everything in prostate so far. I still go in every 6 months. Once I found out I had pc, I wanted it out of me asap. I am not advocating surgery but it was the best road for me to follow - mental/emotionally was a big factor.
 
Age 49
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
12 month  PSA <.04 (low as the machine will go)
continent at 10 weeks (no pads!)
ED is still an issue but getting better


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 10/31/2009 8:51 AM (GMT -6)   
 
Hi All,
 
Very interesting conversation and I guess I am going through a lot of the same thing what to do with a Gleason 8 and a rising PSA.  I finally had the Cath removed yesterday in Orlando that was a result of the surgery to remove surgical clips that migrated to my bladder neck and form stones.    That now out of the way and the burning and urgency gone I can concentrate on my rising PSA.  I am a Gleason 8 but my Path report was excellent organ confined stage t2a surgial margins and lymph nodes clear.   So why is my PSA rising?  My surgeon feels the PSA is wrong and wants another test done on Nov 16th if another rise he feels it is not a local recurrance but cells that got out prior to surgery.  The two radiation Oncologist I have spoken too both feel it could be local and that I should do radiation.  My surgeon's PA told me yesterday to go with my gut.  I told her I would like a little more professsional advice then my gut?  Do I do radation or not?
 
Jerry1  turn
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  3+3= 6 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
6/12/09 new gleason score of 4=4
Developed stone in bladder may require surgery
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/31/2009 9:08 AM (GMT -6)   
Rob, I think you are doing great so far, especially as a Gleason 8, sounds like you are on the good side of the percentages and I hope it stays that way for you for a long time. At your young age, most doctors would feel that surgery as your primary treatment would give you your best shot.

Jerry, nice to see your update. Glad you got rid of some of other problems you were dealing with. Most drs want to see 3 consecutive rises in your PSA before pushing the next step. You being a confirmed Gleason 8, my gut feeling (not telling you to do anything here, you have your doctors for that), but if it were me, I would already be thinking about SRT. If you do have reoccarance going on, or about to be, the one thing I learned from 3 radiation oncologists, is that the sooner your hit it with radiation, the better the odds, this is assuming it is local. I know you have a lot of tough thinking ahead. My own rad oncol finally convinced me after much troublesome delay on my part, is why wait to watch it get worse? That logic finally won me over. Best to you, brother
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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


brainsurgeon
Regular Member


Date Joined Jul 2009
Total Posts : 137
   Posted 10/31/2009 9:09 AM (GMT -6)   
We must remember that "grades" such as Gleason Scores are purely subjective to a large degree. You don't just stick a biopsy specimen into a machine that reads its qualities objectively. The biopsy tissue is merely a tiny peek at the whole tumor. Tumors are often times made up of a variety of cell types and grades. People are different. Some cancers, such as breast, are notorious for variance in behavior. I once took a cerebral metastatic breast tumor out of a woman 22 years after her breast lesion and 17 years after a lung metastatic lesion removal. Some folks just "live" with their cancer better than others. It has to be something with the body's immune system, but I don't know what.
70 years old USA citizen
Prostatic carcinoma dxed June 2009 by PSA (7.0) and then Bx
PSAs yearly since 2001 ranged 1.52 to 7.0
Neg. CT and BS
4 of 8 biopsies positive (all right side) Gleason Score 3+4=7
Robotic assisted total prostatectomy and node excision July 2009 in Luzern, Switzerland by Dr. Mattei in the Kantonsspital
pT2c G3 pN0 (0/14)
Catheter out in 5 days (home in 3 days)
No incontinence
Potency: beginning tumescence??? at 3 weeks post-op. Still happens at 3 months PO
3month PSA less than 0.01


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 312
   Posted 10/31/2009 12:16 PM (GMT -6)   
Good discussion.

I am glad that brainsurgeon reminds us of what we all know - that Gleason scores are very, very subjective.

For example, we have a well-known cancer care center here in Houston that many people believe frequently hand out Gleason scores that are significantly higher than when the same slides are examined by others. Certainly true in my case and with several other men with whom I have spoken.

Maybe they feel it makes their statistics look better - a survival for X years of a 3 + 3 is not as impressive as a survival for X years of a 3 + 4 or 4+ 3, for example.

Zen9

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 10/31/2009 12:18 PM (GMT -6)   
Zen,

Quite true. The subjective nature makes still another cloudy matter when discussing and dealing with PC
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: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 10/31/2009 4:09 PM (GMT -6)   
Dont forget that for individual results, Gleason is just one part of Pca, we need to through,
Stage, PSA, Tumor volume, Age etc, to come up with our true destiny.................Kev
Age 51yrs
DX 11/11/08
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason Score 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c
Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week.
ED- taking Meds- Its been 9 mnths now getting some action ! yah
PSA 1/09  .03
PSA 2/09  .03
PSA 5/09  .03
PSA 9/09  .03
"Everyday in Everyway I get better"

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