WHICH IS WORSE

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Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 11/3/2009 9:59 PM (GMT -6)   
Pca group had a discussion on which was better (or worse) following prostate surgery, a gleason 6 that had escaped the capsule or had positive margins or a gleason 8-10 which had not escaped and all other markers negative.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 11/3/2009 10:03 PM (GMT -6)   
And what was the prevailing opinion of the group?
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 sess/72 gys cath #8 33 days, 11/2- SP Cath #9 in place


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 11/3/2009 10:46 PM (GMT -6)   
Of the 8 men, it was 4 each way.  I think the higher grade without complications is better.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/3/2009 11:09 PM (GMT -6)   
Sailor,
In the surface it would point to the higher grade that was contained in the prostate. But that's not always the case and all of the men were right in the group.

Fpr example consider this: A Gleason 10 T2C, versus, a Gleason 6 (3+3) T3a. I would rather be the G6 guy in these scenarios. The Gleason 10 would likely come back wreaking serious havec. The G6 guy could be brought to full remission and even if it came back, it would be far more manageable.

If you use the calculator below from Memorial Sloan Kettering, you will see that the G6 guy with positive margins and extraprostatic extension has better ten year results than a G10 guy cleanly removed.

http://www.mskcc.org/applications/nomograms/prostate/PostRadicalProstatectomy.aspx

But if you change the G6 guy to positive lymph nodes and positive seminal vesicle invasion, then that's different. The G10 guy does better. But I still caution, The G6 guy will have slowly advancing disease for many many years. If the G10 relapses, it likely won't be good. G9's and G 8's are not much better off. There are even Gleason 7 cases that are contained that just act aggressively.

I would need more information to say either way. Now you have 4 guys one way, 4 another, and one on the fence...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)
Hormone Therapy May '07 to September '09 ~ Currently off.
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (October 7, 2009): <0.1

My journey is at: www.caringbridge.org/visit/tonycrispino

My InfoLink page is at Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!

Post Edited (TC-LasVegas) : 11/3/2009 9:12:50 PM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 11/3/2009 11:48 PM (GMT -6)   
Tony,
I think you hit the nail on the head. An agressive PC is usually always more dangerous.
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

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