Interesting data on PCa-DNA-ploidity from Uro-Cor posted by Dr. Strum

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

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 6/22/2010 7:31 AM (GMT -6)   
There is much evidence that the ploidity of the DNA of PCa cells do effect ones response to hormone therapies and prognosis's of disease, the worse the ploidity gets, away from normal cell DNA strands that are similar to diploid (two sets of chromosomes matched), others get into uneven sets and randomish like chaos thus aneuploid and it used to be mentioned a third worst level was named teteraploid (spelling) or such, perhaps that has been dropped and leaving the two categories presently seen in this data collected from Uro-Cor. It is best to be found with diploid cells, you can pay expert pathologists like Bostwick, Oppenheimer and a few others an additional fee to have this done, Dr. Epstein does not apparently believe alot in the value of ploidity and does not offer it  (not making any judgement on him either).
 
Gleason Score vs Probability of Diploid vs Aneuploid

GS         Diploid        Aneuploid        # Biopsies Evaluated

2-5        85%            15%                    564
6            62%            38%                   15,999
7            33%            67%                   12,768
8            22%            78%                   4,433
9-10      13%            87%                   2,167

See Insights, Vol 4, No.1 Jan 2001, page 4, table 2.
Data from UroCor, Inc.

Dr. Strum had this in reference to a patient on P2P question/answers thing from prostate-pointers.org ,  which was just replied to on the internet and so I thought others should atleast ponder these collected datas on PCa, it is very significant that high gleasons are associated with riskier level of ploidity analysis and those same patients have usually more issues with control of the disease via drug therapies or perhaps any therapy. Why ploidity is not done as standard practice on biopsies is in my mind, stupid. We spend a fortune on unneeded ct and bone scans on low stats patients, which costs alot of money and is a complete waste of resources (as per Dr. Strum mentioning the same). But don't have money for say a few hundred more bucks for ploidity analysis???? 
 
I would have thought in my own mind that Gleason 6's in general were higher percentages of diploid status, maybe  85-95% and herein shows 62% in a rather decent patient sampling, interesting.  May not surprise me though, as PCa is just so unpredictable to know where a patient stands, even some low stats patients fail cures (maybe not that many?) This may help to explain why and also who knows if your PCa type is properly identified to begin with, 18 variants types of PCa have been found...I doubt the average pathologist knows what he is looking at compared to the leading experts in this (that is my own thoughts).  I think the variants thing is swept under the rug, you might ask your uro-doc how many variants of PCa are there or what is ploidity analysis (gulp...probably unaware), or are there some weird variants of PCa and if so, can you name a few of them????  (like: small cell, signet ring, squamous cell and such). Uro-doc should atleast know some of them  like maybe, small cell  PCa which does have a terrible prognosis in general.
 
Chow- cool
Youth is wasted on the Young-(W.C. Fields)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/22/2010 8:43 AM (GMT -6)   
didn't understand your chart/data, can you translate it down a level for me, using a Gleason 7 as the example. trying to understand what it signifies. i know my uro at least knows about the small cell PC, as we discussed that over a year ago, beyond that, give me an example of some more variants, and i will quiz him next time we meet.

good info here, unfortanately went over this guys head, like the roof, lol, ok, lame 1950s poor humor attempt.

david
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 6/22/2010 9:33 AM (GMT -6)   
I noticed this data was created in 2001.  Not many people realize this, but in 2005 there was a change to the Gleason grading system.
 
See this article.
 
Since 2005 it is a lot harder to be a Gleason 6 then before.  If you look at the chart Gleason 6 looks more like  Gleason 5 used to.  Thus some of you guys who are Gleason 7 today may have been Gleason 6 before 2005.  Read the whole article, but it appears that Johns Hopkins has adopted this and I believe many others.  This would shift the DNA polity results.


Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010

Post Edited (ChrisR) : 6/22/2010 11:31:05 AM (GMT-6)


el perro
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 6/22/2010 12:12 PM (GMT -6)   
Thanks for the link. I always assumed the Gleason scale was the same today as when it was first introduced; interesting to know it was 'tightened up' on the 3's in 2005. Appears to add another layer of uncertainty to the outcome statistics for Gleason 6 and 7 in studies started pre-2005.
Dx 11/2008, Gleason 3+3
Active surveillance for now


ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 831
   Posted 6/22/2010 12:29 PM (GMT -6)   
I think it makes the Gleason 6 people have a much better prognosis.  According to J.H. if you have organ confined Gleason 6 you are basically cured by surgery alone.  They have a 99.6% cure rate for RRP Gleason 6.  The other .4% after 22 years did not even develope metastatic desease...This has still ruined what's left of my life...
Dx 42
Gleason 6 (tertiary score 0)
OPEN RP 10/08  Johns Hopkins
pT2 Organ confined Gleason 6
PSA Undetectable as of 10/15/09
Next PSA 10/15/2010


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 6/22/2010 3:23 PM (GMT -6)   
Chris,
If you have a gleason 6 you have an excellent chance of being cured by just about anything. If you do nothing you only have about a 2.4% chance of dieing. There is a huge difference between agressive and non-agressive PC.
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 6/22/2010 7:33 PM (GMT -6)   
David the basic idea on this is to understand risk factors as to ploidity pointing towards higher (or lower) risk with Aneuploid level=higher (the DNA strands are not well differentiated(definable) or in a pairs as in normal type cell structures with the pairs of chromosomes (normal cells 23 pairs=46 chromosomes matched up), this level they are more chaotic and unevenedly paired, etc.). Means ones disease risk is higher as to becoming refractory (refractive) on drug therapys (they stop working perhaps sooner), and controlling of the PCa. So, as you look at the high Gleason scores 9,10's the odds for having the better type of diploid type cell structures are low, also you see more patients dealing with high risk scenarios. It may be useful to know such information up front or when dealing with some of the excellent onco-docs, whom look at this type of information and could perhaps find it useful in forming their strategies for protocols on patients(they do things uro-docs never heard of) and this is why patients seek them out. Don't freak out on this information or let it scare you, was intended as educational useage and demonstration.
Youth is wasted on the Young-(W.C. Fields)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/22/2010 7:53 PM (GMT -6)   
thanks for the explanation. doesnt scare or freak mean, was just trying to understand in simpler terms what you meant with the info. that helped it clear up greatly from my original reading.
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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 6/23/2010 9:16 AM (GMT -6)   
I have seen ploidy analyses in three categories: Diploid (normal), tetraploid (double), and aneuploid (abnormal numbered). This Strum article mentions only two. What happened to the tetraploid? Or might the aneuploid be re-named "non-diploid"?

Post Edited (tarhoosier) : 6/23/2010 8:19:35 AM (GMT-6)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 6/23/2010 11:50 AM (GMT -6)   
tarhoosier- The info comes from Uro-Cor and was mentioned by Dr. Strum, as for the tetraploid missing, I am not sure if they now classify ploidy (ploidity analysis) into just 2 levels??? Or maybe in Uro-Cor's information wasn't deemed noteworthy to post it, for whatever reasons, who knows?

They might have dropped the tetraploid of which I remember (unless CRS got to me again), this was the worst form and chaotic random DNA structures that don't even resemble anything normal. Anyway we wish to have diploid if analyzed. Oppenheimer has an abstract called Ploidy 101 on his website, it helps with somemore information on this discussion, interesting to see what Dr. Grignon says about it(therein) as some of it is his work, he is a Michigan pathologists and one on Dr. Strums list of the A-list of promenient pathology guys. Just by chance my uro doc did something right and sent my pathology to this guy.


Youth is wasted on the Young-(W.C. Fields)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/23/2010 4:39 PM (GMT -6)   
Special Notation to Ohio State:

Why don't you come out to "chat time" this evening, and chill out with some of the guys and girls, its a good outlet. You don't have to even talk about PC, though we often do. You can talk about anyting you wish or interests you. The group on the chat switches interests and subjects often. Just a good time to chill out with the brethren, since we can't just meet up at a local bar or pub and shoot the breeze. You would be most welcomed.

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, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
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 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17

New Topic Post Reply Printable Version
Forum Information
Currently it is Monday, September 24, 2018 6:06 PM (GMT -6)
There are a total of 3,006,226 posts in 329,318 threads.
View Active Threads


Who's Online
This forum has 161825 registered members. Please welcome our newest member, TheRayf.
319 Guest(s), 5 Registered Member(s) are currently online.  Details
swimmer2, GreekGuy94, InTheShop, mitchden4, oregonhay