I'm really puzzled.

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JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/8/2010 11:07 AM (GMT -6)   
Today I spend a couple of hours on this site, checking many, many signature, to see what your post surgery Gleason numbers were.
 
Am I the ONLY one with a path. report that says:
 
"GLEASON cannot be detected because of the hormone treatment" I had Casodex and Lupron 60 days before surgery.
 
Why can they NOT detect it and tell me the numbers?
Pre-op was 4+4=8. Post op. ?????
 
Could this be a 'sloppy' path. report?
 
Would I be out of line to ask to have another one done ? How long do they keep these anyway?
 
The reason why I'm SO concerned is that based on my path. report,  I recently had another Lupron shot (90 day) and I'm to start radiation soon. What if the other info is not accurate or not with complete information?
 
Also, I wont have the post-op. PSA for another 3 weeks.
 
My surgery doc. is amongst the best in Canada but everyone on this board seems to have a Gleason score but me. (almost feel lonely) LOL!
 
Jerry.
.
Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/8/2010 11:25 AM (GMT -6)   
I can only offer a tiny bit of info, as this is really outta my league/outta my direct experience.

However, I've read that one of the disadvantages of neoadjuvant androgen deprivation prior to RP is that the pathologic interpretation may be "obscured."

I saw a paper that says this: "Androgen deprivation therapy (ADT) produces distinct histopathologic changes in both neoplastic and nonneoplastic prostate tissue. A pathologist not familiar with these alterations may misinterpret the specimen, resulting in inappropriate tumor grading or missed tumor foci; thus, the urologist should convey to the pathologist any information regarding therapy that might cause histopathologic changes."

reference: http://emedicine.medscape.com/article/455994-overview

Sorry, I don't know enough in this space to say whether this is meaningful for you or not...but I thought it was close enough to share with you.

best wishes...

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/8/2010 11:29 AM (GMT -6)   
Just a guess, a friend of mine I posted on here whom did ADT3 for 13 months, quit and used only proscar for monitoring...had rebiopsies done within a few years later at different times and no cancer found in those biopsies(but was found originally before using ADT3), because of the hormone therapy. Does not mean 100% no cancer, but big remission atleast for quite a while. So, maybe they cannot detect anything or if they did it would be so skewed as to little or no real value...I don't know...this was a maybe.

Maybe some else has alot more to say on this. I believe the stem cells of the PCa are just something that is usually not going to be killed off and they regenerate at some point...theory I have heard elsewhere.
Youth is wasted on the Young-(W.C. Fields)


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/8/2010 6:27 PM (GMT -6)   
Casey 59: Thank you for the article. A little deep for me, but I printed it and hopefully after reading it a few times, I'll be able to ask my oncologist for another path. report.

Jerry.
.
Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 3/8/2010 6:42 PM (GMT -6)   
It would be my guess that as androgen therapy deprives the tumour cells of the testosterone they need to survive (well most of them anyway), which is reflected in the falling PSA as they are killed off, the physical appearance of tumour cells would also be markedly changed by that same therapy making the normal(?) appearance of grade 3 or 4 etc very difficult to differentiate.
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


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 3/8/2010 8:27 PM (GMT -6)   
JB,  I'm afraid my experience will only add to the confusion.  I started Eligard about two months prior to my surgery.  My post op path Gleason score was unchanged but the tumor volume was about twice that of the original biopsy.  My surgeon did not believe the Eligard had any impact.
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, All margins, SV and lymph nodes negative. 
Staged pT2c, Gleason score 5+3=8.  PSA <0.1 at 20 months, Jan. 4, 2010.


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 3/8/2010 11:01 PM (GMT -6)   

JB:  My path report said the same thing.  I had my surgery done at the University of Washington and then had a second opinion afterwards at M.D. Anderson.  Both institutions are about as good as you can get.  My surgeon at the U said that the Lupron ravaged the cancer so bad that there was no way to establish a Gleason score, M.D. Anderson agreed.  I guess that's good and bad, I know that Lupron works for me but there's always that question as to what my true Gleason was.  My path report from my biopsy had me at a Gleason 8 and then I got a second opinion that downgraded to a Gleason 7 but it was a 4+3=7 so not much difference.

I personally believe that a lot of guys on this sight split hairs over a lot of this stuff.  My PSA began to rise a year after surgery so it was time for me to do SRT, seemed pretty easy to me. 

I don't believe it will do you any good to try for a second opinion it's not that whoever did your path is no good it's just that its impossible to tell.  I'm not saying that everyone who does Lupron first can't have a true path report done but its obvious that you and I can't.  I moved on to the next bend in the trail.

Good luck

David  


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/9/2010 9:23 AM (GMT -6)   
Thank you, David. So there are at least two of us without knowing what our post surgery gleason might have been.

I guess we can say: so what ? Although I'm back on Lupron, I'm a bit concerned they plan to start radiation so soon after surgery, without even waiting for the first PSA.

Jerry.
.
Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 3/9/2010 12:39 PM (GMT -6)   
Sorry but I had Lupron 3 months prior to surgery and the lab didn't seem to have any problem with determining a Gleason score. If the Lupron toned it down a notch or five then the tertiary 5 cells they found will really cause me to worry.
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


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 3/9/2010 1:43 PM (GMT -6)   
Hi Jerry,

First, if you put my PCa knowledge on a scale with all of the others on the site, the rest would be standing on top of me.

However, I live a rich fantasy life, and I'm not modest, so I make this comment.

While it's all very nice to have a Gleason after surgery, and is the reason I went with surgery rather than HIFU, now that I'm out the other side I've come to realize what I'd been told before, understood, but didn't internalize. Before treatment the Gleason is a critical number. After surgery, it's history --- the only number that matters is your PSA in three months, then six months, then ....... well, you get the picture.

My post surgery Gleason was 3 + 4 and it could be 2 + 2 or 4 + 4 and not a thing would be different. The only number anyone is interested in is the PSA. Either alll the 3+4 went away in a little da Vinci bag, or it didn't, and the only way to know is watching the PSA. There may be statistical inferences to be drawn from a Gleason post surgery, but even if the suggestion is you're 99% cured, or likely to have it back, the reality is for you as an individual it's 100%. Either you're in the 99% or the 1% and the only way you're going to know is by the post op PSA.

I too would be fussed if I didn't have a post op Gleason, but in reality, I'm not sure it's of any particular value.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02  
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
Feel free to email me at:  sheldonprostate@yahoo.com    


JB71
Regular Member


Date Joined Nov 2009
Total Posts : 206
   Posted 3/10/2010 10:27 AM (GMT -6)   
Thank you Sleepless.
 
Your response is exactly what I needed. Feel much better now about the missing Gleason numbers but you are right, it's out the door, in the garbage can with the prostate.
 
It's the PSA that's going to count for the rest of my life.

Jerry.
.


Age, only 71.
 
July 2009, PSA 9.1, free ratio 0.16
September GLEASON 4+4=8, T2A
Prostate 44cc.
 
Calcium: 2.46  (range: 2.20 - 2.65 mmol/L)
25 Hydroxy Vitamin D: 102 (range: sufficiency:
76 - 250 nmol/L)
 
Bone Scan: Negative
CT Scan scheduled for Dec. 1st. Negative.
 
Started Casodex 50mg. on Nov. 6, first pill of 30.
Got Lupron 22.5mg ( 90 day ) on  November 19.
 
No real side effects as of Dec. 15 except dry skin and hair but getting quite 'porky' in the belt area even though now I go to the gym, three times a week. Also I dont have a need to shave anymore so now I can save my 'shaving' allowance and direct it to my stash of Depends !
 
Christmas Day got my first hot flashes. Thanks Santa!
 
Open surgery scheduled for Jan. 22 by Dr. J. Chen
 
Open surgery done on Jan. 20th. by Dr. J. Chin at London's University Hospital.
 
Cath removel scheduled for Feb. 8th. Yes, I know,
that will be 19 days. Dr. is out of country until then.
====================================
Pathology Report:
 
Gleason Score: cannot be determined due to hormone therapy effects. ???????
 
Extraprostatic Extension:
present, left radial, multifocal
present, left basal, multifocal
 
Resection Margins:
Apical: involved by invasive carcinoma, multifocal
Bladder Neck: involved by invasive carcinoma, unifocal on left side.Other: non-tumoural prostatic present at resection margin.
 
Perineural Invasion: present.
Seminal Vesicle Invasion: absent
Lymphovascular Invasion: absent
Lymph Node Status: no malignancy in regional lymph nodes
 
Additional path. findings:
high grade prostatic intraepithelial neoplasia
 
Pathology Stage: yp T3a NO MX
==================================
Radialogist appointment was on Friday Feb. 26 with Dr. Glenn Bauman in London.
 
Got another Lupron 90 day shot today and he wants to start IMRT soon. CT Scan plus measure scheduled in about 3 weeks. ( march 20)
 
First PSA test since surgery on March 25th.
 
Next appointment with the surgery Doc is April 13.
 
.

Post Edited (JB71) : 3/10/2010 8:34:00 AM (GMT-7)

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