What does it mean????

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woodysgirl
Regular Member


Date Joined Jul 2010
Total Posts : 32
   Posted 7/7/2010 1:22 PM (GMT -6)   
New here so please forgive if these questions have already been addressed.  My husband was diagnosed couple months ago and I am scared to death.  He is 55 years old; psa 26; no prior psa for compairison; biopsy positive in 4 of 12 samples with 2 cores positive at 40% one positive at 60% and one positive at 80%.  It seems that these are very high numbers from some of the postings here.  Also there is perineuro involvement in 2 of the cores but MRI and bone scan were negative for mets.  Does the percentage of involvement indicate the aggressivness of the cancer??  Also are there any reliable statistics on cure or recurrance based on perineuro involvement or the percentage of involvement?   Do these numbers mean anything in ultimate cure or recurrance numbers?  He has opted for radiation rather than surgery but has not begun yet.  I am so affraid that the high percentage of involvement is an indication that this is an aggressive cancer.  His gleason score was 7 (3+4 in 3 samples and 4+3 in 1 sample). 

rhb47
Regular Member


Date Joined Mar 2010
Total Posts : 208
   Posted 7/7/2010 2:06 PM (GMT -6)   
Hi Woodysgirl,
Welcome to the forum. My husband's samples were 25-57% and his Dr. told us that he had probably had the cancer for years. It may be the same with your husband. If that is the case, it shows how slowly pc grows. I wouldn't want to coment on cure or reoccurance as I'm certainly not capable of it, but would advise you read either Dr. Walsh or Dr. Strum's books on pc-having the knowledge you'll get from reading one of these books will probably alleviate a lot of your fears. I know I was scared in the beginning, but now feel very calm and positive about my husband's outcome. There are some really knowlegable people here who will soon pop in and I'll sure you'll get some good answers. My husband is having robotic surgery 8/9/10 and though we're not thrilled about it, we look at it as a bump in the road.

Renee
Husband diagnosed 3/10
Age 56, PSA 4.7, free 7.6%
Biopsy 5 of 10 cores positve-all right side-25% to 57%
Gleason 6
DaVinci surgery with Dr. Vip Patel scheduled 8/9/10
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 7/7/2010 3:08 PM (GMT -6)   
Your husband has two high risk factors, a psa over 10 and a grade 4 gleason; this would put him into a high risk catagory. Bone and CT scans won't show anything at this point, so you cannot rule out micro mets. The psa of 26 is very worrisome.
These are the things I would recommend:
Get a 2nd opinion on the biopsy slides from Epstien at John Hopkins and do a ploidy analysis.
Get a scan, either color doppler or MRIS to pinpint the tumor location and evaluate extra capsular extension.
Find a doctor that uses the partin tables, neuronetworks and have him explain them to you and what they indicate. You want a probability that the PC is organ confined. If there is a low probability of organ confined disease then surgery would most likely fail.
Get a PAP and a PCA3 test. These can indicate possible micromets and agressiveness.
After reviewing all of the above with a prostate specialist, most likely a medical oncologist, then a treatment plan based on his condidtions can be recommended. Until you get this information you are only guessing.
You are in a fight with PC now and if you want the best chance of winning you must determine everything about your enemy before you start fighting. Most battles are won before any fighting begins.
JohnT

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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/7/2010 3:46 PM (GMT -6)   
John has given it to you straight.

You can follow his advice, you can just decide to do what your current doctor is saying, or you can just give up.

This is a fight. You husband had been given some not so good test results. If you live near a major cancer center like Johns Hopkins, Cleveland Clinic, Mayo Clinic, U of M , etc., that is where you will find some people who routinely treat tough cases and will be able to help you on yours.

We have some guys here who have had a PSA in the 2 or 3 thousand range, and are still going strong. Don't despair, just get educated, and be very involved in the treatment decsions. Doctors are prone to advise what their specialty is.

Welcome to HW and good luck on your journey. You are amongst caring friends here at HW.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 7/7/2010 4:11 PM (GMT -6)   
Woodysgirl,
 
Please check-out the site below, and press the panic button, it certainly help me, when I was first diagnosed.  I am a 4+3 gleason 7, and doing great, as you can see by my stats.  Your husbands PSA is most probably the most worrying aspect, but please stay positive. 
The like below will show you many men, with high gleasons and PSA's far higher than your husbands, all doing well........................Cheers Kev
 
 
http://www.yananow.net/
Age 52yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4 Gleason Score 3+4=7 Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week. ED- okay with Meds.
PSA at 18mths no change remains 0.03
"Everyday in Everyway I get better"


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3895
   Posted 7/7/2010 4:12 PM (GMT -6)   
Don't get rushed into anything quickly..A couple of more weeks will not make any difference..Like your Doc said, he has had it for years...If the horse has left the barn, then radiation is the way to go..Be sure to investigate Brachytherapy (seeds) combined with IMRT which in many studies has proven to be the most effective looking out ten years, especially in high-risk cases. This method pushes the radiation dose up to the point where it's really effective..

The technology used to administer radiation therapy is advancing very quickly. The Radio-Oncologist's skills must advance along with the equipment. So choose your treatment center carefully, you only get one shot at this...Read, Read, Read, Learn, Learn, Learn...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/8/2010 8:16 AM (GMT -6)   
Ploidy analysis you would pay extra for in pathology, may reveal if PCa is a variant and thus more aggressive, maybe $300-500 more. Dr. Bostwick and Oppenheimer do this and maybe less than a handful of others. You can still have it done as a review, second opinion on your slides and even after a long time span, the parafin wax seals these samples and they last.

Hope is eternal....my stats considerably worse than you posted, the good news is still around and currently in great shape due to overall treatments taken would be my guess. It is not the totally typical 'ride' taken by the majority patients, so maybe I am stupid as some likely believe, but alive and even playing soft rock music as a duet and enjoying things, far from disabled living. I am at year 8+ right now, which has amazed my sorry posterior to some degree, too. Fired a few docs along the way too. My story is found on yananow.net give me an email and will send you the direct link. Yeah I know it can change anytime, been aware of that all along. So I respond to others like yourself, now. While I still have that luxury.
 
Dx-2002  bpsa 46.6  total urinary blockage and in emergency room, 12/12 biopsies all PCa 75-95% values, gleason scores found 7,8,9's and in two about equal sets of them like that, ct and bone scan (useless) appear clear (meaningless and profittable for them). Protocols that follow not all typical types.
Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 7/8/2010 7:20:33 AM (GMT-6)


woodysgirl
Regular Member


Date Joined Jul 2010
Total Posts : 32
   Posted 7/8/2010 9:06 AM (GMT -6)   
Thanks for the input and support. I have looked at the yananow site, which along with this one, has provided more information on what to expect with various types treatment than the doctors have given. We are so far pleased with the medical staff, but feel we only get the upside. One thing of concern in reviewing other's stats is the lack of longevity. It appears most diagnosis have been within the 1-5 year point with few 10+ year histories. I know I should be thankful for every healthy day, but he's only 55 and I want 20-30 years at least. Do you get to a point where you don't worry about it every day? Thanks again

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/8/2010 9:23 AM (GMT -6)   
Welcome Woodysgirl

Worrying...probably for awhile...my wife still does to this day and it is perfectly normal. For me, no longer worry but stay aware which for me is a lot easier to deal with.

You have been given excellant advise so follow through with that and let us know how things go.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009     .06
                   6 month Apr 2009     .06
                   9 month Jul  2009     .08
                 12 month Oct 2009     .09 
                 18 month April 2010   .19


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 7/8/2010 10:55 AM (GMT -6)   
Hi Woody's girl.

Check out my stats. Woody and I are very similar. There is another guy here with similar stats. He and I have compared notes. I went surgical, he went radiation and HT. Both of us are healthy, active and expect to be on the top side of the grass for a long time.
My email is listed and I am willing to talk any time. Feel free to contact me.

Don't panic. You got great advice above.

Jeff

(Despite my screen name I'm not much of a worrier.)
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 3+4=7, 3+3=6. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day. Try controlling fluids.
12/11/09 5 months: 3 pads per day, 400-450ml/day
02/26/10 7 months: 3 pads but leak is now 320 ml (5 day avg.)
03/22/10 8 months: 3 pads per day, 280 ml/day (5 day avg.) PT says all muscles are tight and working properly. There must be another issue. Uro mtg 4/23.
5/22/10 10 months: 2 pads per day, 190 ml/day Scope on June 15 Short sphincter
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05, 4/14 9 months - 0.04 and <0.01 with ECLIA.

Post Edited (Worried Guy) : 7/8/2010 9:58:34 AM (GMT-6)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/8/2010 11:30 AM (GMT -6)   
With the new advances in PCa like Provenge which some people are lining up to get, limited supply and openings right now, it may work pretty well on normal PCa because their testings were done on refractive patients in trials, FDA just approved. Right now medicare is supposed to cover 80% of it I am hearing about, so the rest is still a big bill and insurance companies may cover this in total (some of them). Cost is around $93K, we have a guy in Florida whom got proactive and called and got an confirmation to get started with treatment within a few weeks you also have to currently meet their criteria guidelines (not just anybody can get it right now), we will all monitor his journey and effects if any.

The message is say you buy time like 5 yrs.+ with currently meds and protocols, this time frame Provenge could be refined, other companies in Canada and elsewhere have similar concepts right now for 're-engeering or cells' to go back in and change or kill PCa. They may have further advances for patients whom have been waiting decades for real new choices.
Youth is wasted on the Young-(W.C. Fields)

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