Gleason score progression

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 12/22/2009 3:54 PM (GMT -6)   
Something maybe you all can shed some light on.

Somebody here will report a Gleason score of 6 and the comment "that means it is slow growing" will be made. Unless I'm wrong, everyone starts will a Gleason that is effectively 0 and somewhere along the way cells get out of kilter and eventually they'll be diagnosed with a 6 or a 7 or an 8....

Won't everyone with an 8 have had a 6 at some point? And couldn't any 6 today be a 7 tomorrow as cells get a bit more whacked?

I had some tertiary 5 in mine which one doctor said was insignificant and another said that my 3+4=7 should be treated like an 8. (Lets just flip my lucky quarter while we're at it.) Last year I may have been 3+4=7 with no 5 and the year before than I might have been a 6.

So, since only change is constant why do we soften a 6 when we know it won't change to a 5?

Just curious.
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/22/2009 4:45 PM (GMT -6)   
Not necessarily, many men are Dxed with small tumors that are G8 and these may never have been a G6 or were a G6 for only a very short period of time. Younger men are usually DXed with a higher gleason grade, so obviously these have had very little time to progress from a G6. A G6 may progress, but it usually takes many years and a large % never progress and stay a low grade G6 forever, This is supported by the fact that only 2% of G6 patients ever die of pc regardless of their age at DX. If G6's were a normal progresssion to a higher Gleason, then the death rate would be significantly higher. The vast majority of DXed patients are G6 in the current area of PC testing.
Pc is either agressive, which means it progresses and spreads very rapidly or it is non agressive which means it grows slowly and will never progress to a higher gleason.
It is believed by many that the upgrade in Gleason from a pathology after surgery is mainly due to a missampling of the initial biopsy and not because of progression.
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 : 25393
   Posted 12/22/2009 4:49 PM (GMT -6)   
Totally agree with John's answer above. The key, and the great unknown is whether the cancer is agressive variety or not, that alone will determine the ultimate gleason progression through the life of the cancer.

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
Post SRT PSA:
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 12/22/2009 6:19 PM (GMT -6)   
<<Younger men are usually DXed with a higher gleason grade>>


JohnT - is there medical evidence to demonstrate that? I am not doubting what you say -- just wondering whether in fact a higher percentage of men who are diagnosed at a younger age are diagnosed with higher Gleason grade tumors.
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/22/2009 8:16 PM (GMT -6)   
Medved,
I read it in a couple of places, but can't give you a reference.
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 : 25393
   Posted 12/22/2009 8:27 PM (GMT -6)   
The same appears true for women with breast cancer. My rad. dr. said that often the most agressive strands of breast cancer are found in the younger women at dx.
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
Post SRT PSA:
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


t-dog
Regular Member


Date Joined Dec 2009
Total Posts : 154
   Posted 12/22/2009 9:58 PM (GMT -6)   
John, i`ve reread your post several times and it sounds like anyone with a gleason 6 really doesnt have much to worry about. The 2% number is so miniscule why would we put our body thru the cure when the problem isnt going to kill us? I`m trying to gather all this info in and this one has me confused again. Thoughts anyone? Thanks Tim

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 12/22/2009 10:48 PM (GMT -6)   
Tdog,
Let me clearify: low risk G6 is small tumor (less than 3 cores and less than 50% core involved), PSA under 10. PSA doubling time >3 years. No nodule detected. This type of low risk PC has very little chance of killing you.
If you have a detectable nodule, a high psa, or a doubling time <3 years there is a good chance of the PC progressing into a harmful pc over a number of years. and you need treatment.
There is a subset of G6 which are varients that are very dangerous; they progress very rapidily, in 6 months, even if treated. These are the 2% that are usually fatal.
Even when G6 tumors escape the capsul they grow very slowly and are easily controlled by HT.
Basically 70% of G6 tumors will show no signs of progression; around 30% do progress, either by a rising psa or move to a G7. These are easily treated with any local cure at the same 95% rate. The ones that have escaped the capsul are controlled by HT, so there are very few fatalities.
It is important to verify that you have low risk and not just an undersampled biopsy. A color doppler Ultrasound does a good job as well as having a psa history of at least two years with at least 8 data points. This will uncover any undersampling of the original biopsy.
I didn't mean to overly simplfy this in my previous post.
Most people with G6 tumors don't have a lot to worry about. the cure rates for all treatment options are in the mid 90%; the cure rates for community hospitals vs major cancer centers are in the mid 90%. I don't think that this is a coinsidence; It's much more related to the PC's agressiveness than the treatment or skill of the doctor. This is not true of the more advanced PCs. The small 5% of G6 that aren't cured are controlled with HT. So the 2% fatality rate makes sense.
The message that I was trying to convey is tht G6 tumors have a low fatality rate because many don't progress and the ones that do are easily treatable. Not that you shouldn't treat those G6s that don't fall into a low risk catagory or ones that show signs of progression.
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


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 12/22/2009 11:01 PM (GMT -6)   
Regarding the notion that younger men tend to be diagnosed with higher-grade tumors, here's one study that appears to disagree:

http://www3.interscience.wiley.com/journal/112722853/abstract

Of course, this is just one study, and there may well be others that reach the opposite conclusion.

If you look around enough, you can find all sorts of studies -- to support just about any proposition you want to find support for. For example, as a guy whose father died of prostate cancer, here's one study I like, which finds that, among the younger-diagnosed crowd, guys with a family history of p ca tend to have better differentiated (lower grade) tumors than guys without family history. (Again, I am pretty confident you could find studies that reach the opposite conclusion):

http://www.drcatalona.com/showarticle.asp?pubid=130
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 12/23/2009 5:31 AM (GMT -6)   
Another problem is the difference between Gleason scores after biopsies and Gleason scores after post-op pathology.


While the more advanced scans can tell you more and more these days, it's only from examining the whole prostate under a microscope after its removal that a lab can see the complete picture, so the Catch 22 is that you have to have surgery to have certainty with the numbers.



While my biopsy said 3+3 my post op Gleason was 3+4 (and the biopsy also missed the seminal vesicle invasion) so while I still cannot know what my future may bring, I am very glad to have had the operation even if it means that I got worse numbers.




As I was aged 48 at diagnosis I had already reasoned that there were simply far too many years for that 6 to become a 7 and then an 8 anyway even if it was a slow growing tumour.



And I hate to think that had the biospsy needles been a little to one side or the other then they could have come back with a 5 when I was actually a 7, so were I to have a nasty PCa in me, then I could have found myself having a repeat biospy in 2010 only to find that it had suddenly jumped to an 8.



I think that at diagnosis all you can do is assess the risk (of things getting worse) rather than know all the answers.



Statistically you are not likely to get PCa in the first place, but once you have it you then have to ignore those statistics and move on to the next set.



Statisically we are likely to be in the 95% group where PCa is not fatal, but we are only human and I think most of us will find it impossible to ignore the possibility that we might be in the other 5%.



Once you find you are Gleason 7 you have to ignore the stats for Gleason 6 and so on.



There is a lot of information/data/stats out there and it's important to manage it all to pick the relevant stuff.



Meanwhile



Happy Christmas to all



Alfred
New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, September 21, 2018 12:41 PM (GMT -6)
There are a total of 3,005,461 posts in 329,227 threads.
View Active Threads


Who's Online
This forum has 161775 registered members. Please welcome our newest member, Rawle.
297 Guest(s), 16 Registered Member(s) are currently online.  Details
SoMuchFun, Mind body spirit, Froggy88, Kent M., xpeetzax, oceanfisher58, aidanw20, sadiecat, cosa35, Indigo69, InTheShop, Gmike, quincy, FLBeachgal, fiddlecanoe, dsrouillard