Please help me think this through.
My post-op pathology report said I had four tumors (all contained). The largest was a 3 + 3. The second largest was a 4 + 3. The other two were very tiny and were 3 + 3.
M. D. Anderson told me only that I was 4 + 3 and should enter that on any post-op nomograms. I only found out about
the four tumors, their sizes, and their Gleason scores when I paid the extra fee to get a copy of my path report.
You probably see where I am going with this ... if my four tumors were all one tumor, it would be a Gleason 3 + 4 because the majority of my malignant tissue was grade 3 and the rest was grade 4. [Let's put aside all issues about
the subjectivity of Gleason scores and potential institutional incentives to report a 4 rather than a 3. Let's also put aside issues like the
location of the tumors in the prostate.]
Why shouldn't I consider myself a 3 + 4, or actually an ex-3 + 4? It makes a big difference in terms of prognosis. Is there a fault in my logic?
And yes, I have asked this of my doctor (actually, his PA, since I can't get to my doctor) only to be told, "You're a 4 + 3, that's it."
Thanks in advance.
No family history of PC. PSA reading in 2000 was around 3.0 . Annual PSA readings gradually rose; no one said anything to me until my PSA reached 4.0 in September 2007, at which point my internist advised me to see a urologist.
Urologist advised a repeat PSA reading in six months = 4.0 . Diagnosed May 2008 at age 56 as a result of 12 core biopsy. Biopsy report by Bostwick Laboratories = Gleason 3 + 3.
Interviewed two urologists - the one who did the biopsy and another - the latter had the biopsy slides re-examined = Gleason 3 + 3.
Then went to M. D. Anderson Cancer Center in Houston in July 2008 and met with a urologist and a radiologist. Biopsy slides re-examined yet again, this time by MDA's internal pathology department = Gleason 3 + 4.
Chose da Vinci surgery over proton beam therapy; surgery performed at M. D. Anderson Cancer Center on August 15, 2008. Post-operative pathology report = four tumors, carcinoma contained in prostate, clean (negative) margins, lymph nodes clear, seminal vesicles clear. Gleason = 4 + 3.
Minor temporary incontinence; current extent of ED uncertain due to lack of sexual partner; refused treatments for ED as being pointless under the circumstances.
November 2008 = <0.1 ["undetectable"]
June 2009 = <0.1
December 2009 = <0.1