Confused about some terms

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compiler
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Date Joined Nov 2009
Total Posts : 7197
   Posted 12/10/2009 10:47 PM (GMT -6)   
Can someone elaborate on:
 
Aggressive Cancer
Advanced Cancer
Intermediate Cancer
 
These terms are bandied about and it gets confusing.
 
For example, I am a Gleason 4+3. Some books refer to this as Intermediate, but later in the book it is clearly lumped in with advanced cancers. Is it aggressive? Am I correct that you really don't know, even after a post surgery pathology? You only know when HT fails? If not, at what point can one determine that it is aggressive (surely not at biopsy?).
 
There is much talk here about the typical run-of-the-mill PC. You get it, get treatment,  and you are fine. But do you know if this is the case with a Gleason 4+3? What about a 3+4?
 
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.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 12/10/2009 11:19 PM (GMT -6)   
Comp,
This is my understanding. Advanced is reference to the stage of the tumour i.e. early stage would would be confined to the gland while advanced would involve substantial escape from the prostate from local escape to metastases. Intermediate and aggressive refers to the likelihood of the tumour spreading and the speed that it may spread at. While Gleason scores are used reflect how much the various cells within the tumour have changed and are likely to escape if untreated the score does not play any part after escape. Grade 3 cells have changed a little and are more likely to stay put. Grade 4 are markedly more likely to escape the gland and spread while grade 5 present the greatest danger of spreading. As the grade of the altered cells increases usually so does the speed with which they multiply. The more grade 4 within the prostate then mathmatically the more likely are the chances it has escaped (this is why 4+3=7 is worse than 3+4=7). Aggressiveness can also be checked by what is known as a DNA Ploidy Analysis.........cell aneuploidy changes seem to correspond with aggressiveness. You can have the biopsy specimens analyzed for ploidy: there is a little reading here:

www.specialtylabs.com/books/display.asp?id=512

Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm

Post Edited (BillyMac) : 12/10/2009 10:27:52 PM (GMT-7)


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/11/2009 8:17 AM (GMT -6)   
Mel, putting in my two cents here.

My understanding is that both aggressive and intermediate are related to the Gleason score. Advanced is related to the stage of the disease.

For instance, a Gleason 7 is considered intermediate, while 8 and up is aggressive.

Stage II is considered local, stage III is locally advanced and stage IV is advanced.

That's my understanding but am looking for others to weigh in.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


John T
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Date Joined Nov 2008
Total Posts : 4188
   Posted 12/11/2009 11:28 AM (GMT -6)   
Mel,

Agressiveness indicates the rate at which the cancer will grow. Some G6s are agressive, most are not.
G8 and above are usually agressive. Intermediate cancers, G7, are a mixed bag. Some grow faster than others. You can determine how fast a cancer is growing by it's psa doubling time and it's gleason score.
Advanced cancer is cancer that has matastized to other parts of the body.
Obviously the faster a cancer grows the more dangerose it is and more likely to escape the prostate and become advanced.
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


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2211
   Posted 12/11/2009 11:53 AM (GMT -6)   
Mel
John T's reply is spot on.



And your query almost addresses THE main concerns of people with PCa:

What is it?

How big is it?

Where is it?

What's it doing?

What's it going to do? and

When's it going to do it?



And I think all of us would be rather content to know the definitive answer to those questions.



Alfred

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/11/2009 12:29 PM (GMT -6)   
Is this PCa? (just kidding of course it is)...John T and others all good on this thread, going to mention one of the exceptions regarding psa numbers (and I know you know this John).

There are so many exceptions with PCa on anything that it is 'unreal' (twilight zone).
The exception concerning Psa numbers (this is why additional tests like PAP, pryilinks and onco-doc parameters measuring stuff is important).....there are some "rarer" PCa's that do not give off much Psa....thus one could think they are "safe" and found totally the opposite and such patients are occasionally out there...fortunately for most of us patients it is on the rarer side. Usually this kind of thing is made more likely with odd ball variants PCa's, higher gleason scores, worst DNA plodities (tetraploid). This is stranger than fiction on PCa issues.

Billymac, Sephie, John T, English Alf- kudos for answering this question. Brother Mel- this is not intended to scare you which you don't need, but you probably would rather know something about this beast from all angles, than not know it and find out later, this is why we ask lots of questions and always will on this stuff. Don't rush into anything you got some time or you could even take casodex(you can ask these docs their opinions on that) to control the PCa while you make up mind....not mentioned alot by some docs, it is another choice which has been used by some others.
 
CHECK THIS OUT TERRY HERBERTS CHARTED PSA'S DAILY FOR 28 DAYS:(psa fluctuates alot)
(this is just a learning tool for us to look at to know how crazy it can fluctuate, thanks to Terry H.-pioneer in having guts to monitor and do W.W. for probably too many years, but he is in the brotherhood now as fighting this dragon, too)

Post Edited (zufus) : 12/11/2009 11:51:39 AM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 12/11/2009 3:59 PM (GMT -6)   
Zufus,
You are right on. Most doctors are not skilled enough to recognize agressive vs non agressive and surely don't know anything about how to recognize a varient.
I went from BPH, to low risk, to high risk advanced, to intermediate risk contained, all depending on what data was looked at. I'm all for getting a 2nd opinion from a doctor that specializes in PC and get as many tests as you can to confirm the DX. I'm convinced that only about 10% or less of the doctors currently treating PC know what data to collect and how to properly analyze it.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/11/2009 7:41 PM (GMT -6)   
Good question,
All three responses are somewhat conflicting and that's because these terms are not specific terms, but rather more layman. I think Sephie calls it well to what I would understand they mean. Here's mine:

Sephie said: "My understanding is that both aggressive and intermediate are related to the Gleason score. Advanced is related to the stage of the disease."

I agree, but they can mean more.

1> Many use the the term "Advanced Prostate Cancer" to mean that prostate cancer has escaped the prostate capsule. The term advanced is sometimes subdivided between "locally advanced" and "metastatic" as John has stated for staging purposes. Some clinicians term seminal vesicle invasion as locally metastatic and believe that any metastatic prostate cancer is advanced prostate cancer.

2> Aggressive cancer in clinical pathology, is used to describe grade 4 or 5 cells using the "Gleason Grade" method. But also, "aggressive cancer" can be used to describe any cancer that does not respond to therapy. Hormone-Refractory cancer, for example, is aggressive regardless of "Gleason Grade", "Gleason Sum", or stage, though it is seldom not stage IV. Also G8, G9, and G10 are termed as "high risk" but you could call them aggressive also because they contain grade 4 or 5 cells. I would also believe that if any cancer is in remission, then it is not being aggressive until it ceases to be in remission.

3> Intermediate Cancer is even more layman and has less uses. When determining risk, the term "intermediate risk" when used describing the "Gleason Sum" means Gleason 7. Usually the terms that would go along with it are "low risk", "moderate risk" and "high risk". Intermediate would be between moderate and high. However, an intermediate risk cancer like G7 can be a very aggressive cancer.

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/12/2009 12:00:15 AM (GMT-7)

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