How important is Core Volume

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7213
   Posted 12/5/2009 11:51 AM (GMT -6)   
We hear about the Gleason score. But there is also the core volume.
 
For example, I have Gleason 4+3 which is not good at all, but it is in 5% of the core. Is that more optimistic?
 
Incidentally, my biopsy report seems to indicate the percentages in that the "4" is 60% and the "3" is 40%. That doesn't sound too bad.
 
But I'm not sure how significant the volume percentages are.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 12/5/2009 3:05 PM (GMT -6)   
Well, my first observation is that while Gleason score is in the nomograms because it has predictive value, core percentage is not. So the first answer is that if there is a connection it is not strong enough to pass the inclusion tests. This does not mean that a wise doctor might not see little truths that evade statistics. So, ask your doctor. Remember that this is why you are hiring him.
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
6 mo. PSA 0.00 -- 1 light pad/day


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/5/2009 9:32 PM (GMT -6)   
It is relavent in discussion on "indolent PCa" as they put 5%< in their definition (along with Gleason 3+3=6) in one scoring or such. Someone can post the web link data, to Brady-Urology of John Hopkins whom defined this new terminology in the PCa, "indolent PCa" (not a life threating PCa in other words). So percentage here is very meaningful, it seems.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/5/2009 10:11 PM (GMT -6)   
The % of cancer within a core itself, is more indicative of how much tumor volume may be cancerous. Since biopsies can be hit or miss, its still best estmate only. The Gleason Score within each core is definitely more a statement of how progressive the cancer cells are in the tumor.

Zufas, the <5% standard I believe is a good thing to note. As a general guideline, if one has one or two cores <5% with a Gleason six, most would accept that as a pretty low grade dx of PC, and probably indolent.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 12/6/2009 5:03 AM (GMT -6)   
Mel

Due to PC troubles I haven't been able to post since you were confirmed as a memebr of the club. So Welcome - though you are, as has been mentioned elsewhere, already a long time poster since you began your quest for knowledge when you just got worried about what was going on in your body.

This is not an easy journey, I even reached a point where I felt I needed a break from the info overload before by final choices and I went away with my wife, which helped as I cut myself off from the internet.

The % doesn't really matter at the biopsy stage, unless everything is very high. It's only at the post-op pathology that it tells you how big the tumour was in relation to the size of the prostate itself.

Biopsy really is hit-and-miss procedure unfortunately, hence it can return a false negative, as shown by guys posting here who can have several biopsies before a needle eventually hits a bit of tumour.

I suppose I was lucky that I had a small prostate and twelve needles first time so it would have been difficult to miss a tumour unless it was really small.

A needle might go right through the tumour in its biggest dimension and be almost 100% or just clip the edge and hardly pick up anything, or hit just healthy tissue between two big bits of tumour. We have to rely on the skill ofm the guy with the needle gun. And an biopsy isn't even really 3 dimensional either: remember that coming in from the rectum all the needles take cores in one direction. Imagine trying to work out how big a peach stone was by sticking six needles into a peach at spaced intervals from just one entry point on side of the peach.

And no test seems to cover what for me was a vital question namely is the tumour in me slow growing or agressive?

One of the parts of my decision making process was that I decided I had to take the safest option and consider that the tumour might be agressive and get rid of it.


If I'm right then "slow growing" prostate cancer means that it only doubles in size (volume) every five years - but nobody told me how fast aggressive tumours grow.

So what difference might it make?

While getting told about my post op pathology the doc took a life size drawing of a crosssection of the relevant bits of the male body and drew on it to show me where my tumour had been, how big it had been and what bits had been removed. (That made things a lot easier to understand than just getting a sheet of paper with numbers and Latin words on it)

One area of tumour was right by my bladder neck, so while not very big even if it had been slow growing then over five years it would have grown through everything and into the bladder right at the sphincter, which would clealry have given me more trouble that any incontinence I may still have now from the Da Vinci. The second area of tumour was in the seminal vesicles and over five years could have gone into the rectum and who knows where else.
But if my tumour was agressive then maybe we would have been talking one year before I was in a real mess.
And even if slow growing, I was only 48 at DX, so that would have given the tumour a lot of years for it to keep doubling in size. (And it could of course have decided to turn aggressive at any time without me knowing till it was far too late.)

And from the biopsy, neither I nor the surgeons klnew where the tumour was located, so I think I have been very lucky.

But nobody out there will be the same as me, everything in their bodies will be different shapes and sizes and in different locations. Some can have a quite a big tumour, but in the middle of their gland and miles from surrounding tissue. So my experience is unique and almost no help to you or anyone else other than to show how there are so many unknown factors to make the decision-making so very difficult for all of us.

May you continue to find help and assistance at HW

Alfred

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7213
   Posted 12/6/2009 3:20 PM (GMT -6)   
Alfred:
 
Thanks for your thoughtful reply and those of others. You said you couldn't post due to PC, so I hope things are going okay for you.
 
I realize I am asking questions that probably can't be answered, and we are dealing with probabilities.
 
I know I was asking questions before my biopsy that could only be answered after my biopsy. I am now asking questions before (probable) surgery that can only be answered after the surgery and pathology report. It's all part of the fear and neurosis pertaining to this darn disease.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 12/6/2009 5:14 PM (GMT -6)   
Mel,
Core volume of a biopsy is just an indication of tumor volume; but it is very often an inaccurrrate indication. Tumor volume is very important as well as tumor location. These can only be determined a couple of ways, 1. Surgery, then it's after the fact and does you little good. 2. Color Doppler Ultrasound. 3. MRIS with a Telsa 3 MRI.
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


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 663
   Posted 12/7/2009 3:23 PM (GMT -6)   

Mel,

It was my personal experience, and I believe from what I have been able to draw together from research, that it is not uncommon for the tumor status to change when the pathology department has the whole prostate in front of them to study. I saw all kinds of numbers. Frequently quoted was as much as 30 % of the time.  One source indicated even more often but it also included cases where the reassignment was reduced in severity from the original opinion.   I was a bumped two steps; I went from 3+3 to 4+3.  I feel like that pre-op Gleason status is kind of sneaky.  You’re told that it may change but I got to tell you I felt like I’d been kicked by an old Missouri Mule when I saw that 4+3 on my path report.  I’m not an expert on histology but to your question regarding tumor volume. It just makes since to me that the more tumor volume percentage as related to total prostate volume would not be the desirable side of the equation to be on.  Or simply stated…more is bad.?

Interesting stuff, we prostate people have to consider.

 

Jack

 


Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. 75% of one core.
da Vinci at Wash U, Barnes on 11/02/09
Pathology Changed Gleason to 4 + 3 = 7. Gleason 7 present in all 4 quadrants
All(4)periprostatic Lymph Nodes Negative, All(10)pelvic Lymph Nodes negative
Seminal Vesicles tumor free. No prostate extension


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2216
   Posted 12/7/2009 3:44 PM (GMT -6)   
Mel
Just to clarify: when I said "PC problems" I meant Personal Computer (especially Internet Explorer) problems, and they are just about sorted, or manageable.
 
My PCa problems are minor compared to many guys here.
 
Alfred
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