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Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 7/13/2010 9:04 AM (GMT -6)   
Okay, it's time to go "All In"...

Has ANYONE here been diagnosed Gleason Nine at the time of their biopsy and are not, five years out, fighting for their lives on chemo and HT ???

What I'm REALLY asking is this: Is surgery and radiation a waste of time and money for those diagnosed with Gleason 9 & 10 cancers? Is their metastasis virtually guaranteed?

There are in fact a group of respected doctors and researchers who seem to think surgery and radiation is a waste of time for Gleason 9 people and subjecting them to these treatments just adds to their misery and does not prolong their lives....

So lets hear it from those who were Gleason 9 and five years out are members of the Zero PSA club!!

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3741
   Posted 7/13/2010 9:26 AM (GMT -6)   
Hey Fairwind,
If you don't get a response soon may I suggest you look at the yananow site (You are not alone now)
http://www.yananow.net/Chart-Gleasonu6.htm#8

You can sort the reports by Gleason score and check when the people were diagnosed. Then look at the latest update. There are not many more than 5 years but they are there. Check it out. "Dxxg Adxx" was Gleason 10 and is still around 19 years later. "Exxc Txxxxr" was Gleason 9 and is still around after 10 years.
Jeff
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.


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 7/13/2010 9:35 AM (GMT -6)   
I feel better already...:)
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..


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 7/13/2010 10:54 AM (GMT -6)   
Fairwind,
It depends on if the cancer is contained or not. With a Gleason 9 or 10 there is a much higher probability of the pc having escaped because the cancer is agressive. There is no way of telling 100%, but you can get closer. A PAP test can indicate micromets. A MRIS or Color Doppler can identify the tumor location. The location of the tumor is probability the most important indicator that surgery will or will not work. The Combidex, which is no longer available, was the best diagonostic tool available to see small amonts of PC in the Lymphnodes. Dr Myers talks about a certain blood test that can indicate pc cells in the blood stream. Using all this information plus information from nueral networks and partin tables you can come to a better decision as to if it is contained or not.
With high risk PC most oncologists would recommend a combination treatment, surgery or RT plus Hormone Therapy for a period of 24 months. This combination is the most effective as it addresses the tumor as well as any PC cells that may have escaped.
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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/13/2010 10:58 AM (GMT -6)   
Can't speak to 5 years, but I am 20 % there and off to a good start.  After a year, I am at .01.
 
Good surgeon is what I believe is the key to mine.  Would IGRT or Brachy and IGRT worked ?, maybe, but I don't know, nor will I ever.  I should have had positive margins, but the skill of my surgeon enabled him to cut around the EPE.
 
Every 3 months I watch to see if some of those aggressive little dogs have set up house somewhere else.  Only time will tell.
 
But so far, just living the Goodlife !
 
 
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


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 7/13/2010 12:43 PM (GMT -6)   
Fairwind, I also think that a Gleason 9 is so aggressive that systemic pca is just a matter of time, hopefully not short but hard to be optimistic. According to my path report,  my pca was contained etc. but within 6 months, the psa was going up again. If the RT I completed in June doesn't work, then I guess its on the HT at which point I think we are only talking about a few years of survival. In my opinion, a gleason 6 or 7 is another world compared to 8-10 gleasons.  Take care, the Old Sailor  

Dx 07/09 Age 67  -  28 core saturation biopsy w/5 positive  (2 gleason 8, 2 gleason 7, 1 gleason 6)
RRP 8/13/09 Mayo Clinic Jacksonville
Path report upgraded gleason to 4+5=9
Negative margins/extraprostatic extension/seminal vessicles/ lymph nodes but perineural invasion present.
Two month post surgery PSA 0.022
Five month post surgery PSA  0.081
Seven month post surgery PSA 0.190
Eight month post surgery PSA 0.217
Started 38 sessions IMRT at Mayo Jacksonville on 4/12/10,  completed 6/4/10.  Few side effects except urinary urgency and  frequency during the day and some rectal discomfort near the end of therapy. 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/13/2010 2:44 PM (GMT -6)   
Dr. Strum just had patient ask his advice on reviewing his PCa journey, sure blew my mind, patient had Gleason 9 scenario. Guess what he has recurrance from surgery....BUT...we are talking a 15 yrs. fighter on PCa, even Dr. Strum commended the guy on such a good journey.

You might be able to find it in archives, it is just in the last week or so on P2P replies that he does for free.

This should boost your thoughts!!! Hope the best for you Fairwind, I like your tenacity and researching and looking it all over. I plan on going to an UStoo meeting tonight in Troy, Michigan.


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

Post Edited (zufus) : 7/13/2010 1:47:27 PM (GMT-6)


Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 7/13/2010 6:15 PM (GMT -6)   
Here is one study on men with high Gleason scores who did a combination of brachytherapy + EBRT + HT.

There appears to be some hope there for high risk PCa.

http://www.ncbi.nlm.nih.gov/pubmed/19493260

Sancarlos
Age 66
PC diagnosed 7/2009
Stage: T2c
Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11.15.2010 + hormone therapy (lupron) + IMRT on Novalis (February-March, 2010), 45 gy.

PSA at time of diagnosis: 11.9
PSA 10/2009, 5.0
PSA 12/2009, 0.56
PSA 5/2010, 0.15

Post Edited (Sancarlos) : 7/13/2010 5:47:15 PM (GMT-6)


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2461
   Posted 7/13/2010 8:33 PM (GMT -6)   
Fairwind,
My biopsy indicated one node Gleason 8 and one Gleason9. I had Davinci surgery on Feb 2009. The pathology report was Gleason 8. So far I have been in the zero club after 15 months.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 7/13/2010 8:47 PM (GMT -6)   
Thank You San Carlos, that's interesting enough that everyone should see it..

BJU Int. 2009 Dec;104(11):1631-6. Epub 2009 Jun 2.
Outcomes for patients with high-grade prostate cancer treated with a combination of brachytherapy, external beam radiotherapy and hormonal therapy.

Stock RG, Cesaretti JA, Hall SJ, Stone NN.

Departments of Radiation Oncology and Urology, Mount Sinai School of Medicine, New York, NY 10029, USA. Richard.stock@mountsinai.org
Abstract

OBJECTIVE: To assess the outcomes for patients with Gleason score 8-10 prostate cancer treated with brachytherapy, external beam radiotherapy (EBRT) and hormonal therapy (HT). PATIENTS AND METHODS: In all, 181 patients with Gleason scores 8-10 prostate cancer were treated from 1994 to 2006 with a (103)Pd implant (prescription dose 100 Gy), 45 Gy of EBRT and 9 months of HT. The median (range) follow-up was 65 (24-150) months; freedom from biochemical failure (FBF) rates were calculated using the Phoenix definition. RESULTS: The 8-year actuarial FBF, freedom from distant metastases, prostate-cancer specific survival and overall survival were 73%, 80%, 87% and 79%, respectively. The pretreatment prostate-specific antigen (PSA) level significantly affected FBF, with 8-year rates of 72%, 82% and 58% for patients with PSA level of <or=10, >10-20 and >20 ng/mL, respectively (P = 0.006). The PSA level had no significant effect on rates of distant metastases. The Gleason score had the most significant affect on FBF in a multivariate analysis, and was the only factor to significantly affect rates of distant metastases; the 8-year FBF rates were 84%, 55% and 30% for scores of 8, 9 and 10, respectively (P = 0.003). The corresponding freedom from distant metastases and prostate-cancer specific survival rates were 86%, 76%, 30% (P < 0.001) and 92%, 80%, 62.5% (P = 0.003), respectively. CONCLUSIONS: The 8-year outcomes after this regimen showed favourable biochemical and distant control, as well disease-specific survival rates for patients with Gleason scores of 8-10. This treatment approach should be considered as a viable option for this subset of patients with high-risk disease.

PMID: 19493260 [PubMed - indexed for MEDLINE]
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..


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 7/13/2010 9:26 PM (GMT -6)   
Fairwind, I am a gleason 8. I had a BCR after one year. Tumor was conained in th prostate. Walsh states in his book that BCR after apparently successful surgery is 50%. Not much you can do if you are a gleason 8-10 but hope for the best. Now if you have radiation your chance for a cure is maybe 30%. Is sucks. My Uro tells me that if radiation has no positive impact that I will have 5-7 years. In reality it may be more like 3-5, but who knows. We are all on our own road. I've got to say that it's a bit depressing. I am starting SRT in 2 weeks and I'm not sure if the effort is worth it. BB
Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
psa May 10  .50

Aril 10 MRI and Bone Scan show lesion on lower spine, false positive. 
 
Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/13/2010 10:37 PM (GMT -6)   
BB,

I know it sucks, and I know what the numbers, percentages, and stats say, but go for the SRT, its still your last curative shot and slowing down or eliminating the PC that remains. I hated to do it too, but knew the same thing, and with a Gleason 8 - I would strongly reccomend you go for it while there is still a chance it might help.

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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, 7/2 - Caths #18 & #19


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7082
   Posted 7/13/2010 11:29 PM (GMT -6)   
I had DaVinci (10/09) with a post-op path of 4+5.
Went as soon as practical to IGRT (04/10).
ED was complete after surgery, remains conplete.
Incontinence has gone from 1 pad a day before radiation to 3 a day after.
So far I've kept an undetectable from Bostwick. Latest PSA was 6/24 - next 7/27.

Igor
New Member


Date Joined Jul 2010
Total Posts : 10
   Posted 7/14/2010 10:54 AM (GMT -6)   
Dear Fairwind:

My local urologist in Connecticut gave me a biopsy Gleason result of 4+4=8 in one core and 3+3=6 in another out of 12 samples in April, 2010. I went for a second opinion at Sloan Kettering in NYC and the biopsy which previously showed 8 came back as 3+4= 7. I had a robotic prostatectomy in June, 2010 and am awaiting my 6 week PSA. The pathology report confirmed the 3+4=7 Gleason Score and no spread outside the prostate capsule.

It is worthwhile for me to get a second opinion and would suggest the same.

Igor

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 7/14/2010 11:26 AM (GMT -6)   
Igor said...
Dear Fairwind:

The pathology report confirmed the 3+4=7 Gleason Score and no spread outside the prostate capsule.

It is worthwhile for me to get a second opinion and would suggest the same.

Igor


I was not aware that the pathology report could tell if the cancer has spread outside the prostate capsule? Is that really possible?

Sancarlos
Age 66
PC diagnosed 7/2009
Stage: T2c
Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11.15.2010 + hormone therapy (lupron) + IMRT on Novalis (February-March, 2010), 45 gy.

PSA at time of diagnosis: 11.9
PSA 10/2009, 5.0
PSA 12/2009, 0.56
PSA 5/2010, 0.15


Igor
New Member


Date Joined Jul 2010
Total Posts : 10
   Posted 7/14/2010 11:44 AM (GMT -6)   
Dear Sancarlos:

I received a copy of the pathology report. It detected no spread outside of prostate as follows:

Capsule: tumor confined to prostate
Seminal vesicles: not involved
Bladder neck: not involved
Surgical margins: free of tumor
Staging: pT2b (confined to the prostate & capsule)
Left pelvic lymph nodes: not involved
Right pelvic lymph nodes: not involved

My understanding is there could be a microscopic spread elsewhere. I believe PSA tests in the future will detect whether there actually was spread elsewhere.

Igor

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 7/14/2010 12:14 PM (GMT -6)   
Sancarlos....pathology after surgery is normally where you find any capsular penatration that has occurred. It can be found also on the initial biopsy if by chance the needle hits the extension. Very rare, but can happen that way. It can also be found with the various scans or based on the amount of psa, dre and other factors the uro may feel that the cancer has already excaped the capsule. The capsule is only a membrane so cancer can move past that membrane quite easily.

Looks like you are doing great so far from you signature. For advanced cancer that is fantastic.
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


Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 7/14/2010 12:15 PM (GMT -6)   
Igor said...
Dear Sancarlos:

I received a copy of the pathology report. It detected no spread outside of prostate as follows:

Capsule: tumor confined to prostate
Seminal vesicles: not involved
Bladder neck: not involved
Surgical margins: free of tumor
Staging: pT2b (confined to the prostate & capsule)
Left pelvic lymph nodes: not involved
Right pelvic lymph nodes: not involved

My understanding is there could be a microscopic spread elsewhere. I believe PSA tests in the future will detect whether there actually was spread elsewhere.

Igor


Sorry for the misunderstanding. I had assumed that the pathology report you were talking about was from the second opinion of the biopsy.

Sancarlos
Age 66
PC diagnosed 7/2009
Stage: T2c
Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11.15.2010 + hormone therapy (lupron) + IMRT on Novalis (February-March, 2010), 45 gy.

PSA at time of diagnosis: 11.9
PSA 10/2009, 5.0
PSA 12/2009, 0.56
PSA 5/2010, 0.15


English Alf
Veteran Member


Date Joined Oct 2009
Total Posts : 2218
   Posted 7/14/2010 1:17 PM (GMT -6)   
I think a guy's age has to be considered in terms of this gleason 8-10 aspect.
Some prostate cancers grow fast but PCa is known for being a slow growing cancer in the majority of cases. Thus if someone is aged 70 and has a Gleason of 9 at diagnosis I think it is more likely that they have already lived for several years with PCa that has progressed perhaps quite slowly from nothing to Gleason 6, 7, 8, then to 9, than that they have suddenly be confronted with an agressive cancer. So the number of years after diagnosis is not going to be as long as the number of years that the cancer has been there.

If I only get as far as 68 then I will have made it 20 years from dx, but I could just as easily have not gone to the doc till I was 68 and then had next to no time after dx, but still had the cancer for 20 years.

Not an easy isssue, but in my case I have to assume that from where I actually am that had I not had treatment that I might not have been going to make it to 58, but that becasue I have had treatment I might be going to make it to 78.

Alf
Age at Dx 48 No Family history of Prostate Cancer
Married 25 years, and I cannot thank my wife enough for her support.
April 2009: PSA 8.6 DRE: negative. Tumour in 2 out of 12 cores. Gleason 3+3.
RALP (nerve-sparing) at AVL-NKI Hospital Amsterdam on 29th July 2009. Stay 1 night.
Partial erections on while catheter still in. Catheter out on 6th Aug 2009.
Dry at night after catheter came out
Post-op Gleason 3+4. Tumour mainly in left near neck of bladder.
Left Seminal Vesicle invaded, (=T3b!)
no perineraul invasion, no vascular invasion. clear margins,
Erection 100% on 15th Aug 2009, but lots of leaking of urine
Stopped wearing pads on 21st Sept 2009
Pre-op style intercourse on 24th Oct 2009 !! No use of tablets, jabs, VED etc. but...
Nov 17th 2009 PSA = 0.1
Can still get erections okay, and almost no leaking of urine, but since December 2009 I don't have orgasms, instead I just have intense pain in place where prostate used to be.
Mar 17th 2010 PSA = 0.4!!! referred to radiation therapist
April 13th 2010 CT scan.
April 28th 2010 Started Radiation Therapy (66Gy - 33 sessions)
June 11th 2010 finished RT - main side effect tiredness, but also the occasional small leak
June 27th My 50th Birthday - feeling better but still not 100% okay


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 7/14/2010 1:26 PM (GMT -6)   
Fairwind:  Here is a study that actually is pretty positive about the more aggressive PCa. 
 
 
I decided at the beginning of my journey that I'll fight until my last breath against PCa.  Get the SRT and plan your next move, hopefully you won't need it but it never hurts to plan ahead.
 
We're in it to win it!!!!!!!!!!
 
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.
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 7/14/2010 6:00 PM (GMT -6)   
I am a gleason 9 with lymph node involvement on both sides. I had a failed surgery and then went on HT and had 44 rounds of IMRT. I strongly suggest going with the radiation and HT, I do not believe in the do nothing approach. I am three outs and lead a very full filling life. I currently train for a triathlon, I work fulltime, and stay very busy doing whatever I want. Do not sit back and let this get you. Matter of fact take the approach that you are going to get it. We can live with cancer.
email me sometime and we can chat further.

thanks for the question

peace to you
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 7/14/2010 7:56 PM (GMT -6)   

Alf, I like your logic but in my case, my PSA was below 2.0 until I reached 65  so I don't think I had pca until my psa went to 4.5 in 09/08,  even then, a 10 core biopsy was negative in all cores.  I asked my Uro if pca starts out at say a 6 then morphs into a 7, 8, 9 etc.  He said they really don't know but he felt that if you have a gleason 8-10, it probably started out aggressively  therefore the poor prognosis of an 8-10 even if a good path report.

Heres how I see it based on research, reading etc:

      Gleason 6 - very good chance of cure

      Gleason 3+4 - good chance of cure     

      Gleason 4+3 - fair chance of cure

      Gleason 8-10 - Very little chance of cure,  pca almost always returns sooner or later and life expectancy at best is 10-12 years but probably less even with with RT and HT following primary treatment.

      I hate to be a pessimist and think the Uros should steer the higher gleasons to seeds or IMRT. Knowing what I know now, I would have gone that route but I didn't know I had a gleason 9 until prostate was removed.   Such is life.  The Old Sailor 

 

 

    


Dx 07/09 Age 67  -  28 core saturation biopsy w/5 positive  (2 gleason 8, 2 gleason 7, 1 gleason 6)
RRP 8/13/09 Mayo Clinic Jacksonville
Path report upgraded gleason to 4+5=9
Negative margins/extraprostatic extension/seminal vessicles/ lymph nodes but perineural invasion present.
Two month post surgery PSA 0.022
Five month post surgery PSA  0.081
Seven month post surgery PSA 0.190
Eight month post surgery PSA 0.217
Started 38 sessions IMRT at Mayo Jacksonville on 4/12/10,  completed 6/4/10.  Few side effects except urinary urgency and  frequency during the day and some rectal discomfort near the end of therapy. 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/14/2010 9:36 PM (GMT -6)   
Interesting studies showing that curative intent of treatment (surgery/radiation vs HT has a big impact on results.

www.actasurologicas.info/v32/n06/ENG/3206OR02.htm
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


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 7/14/2010 10:28 PM (GMT -6)   
Sailor, Goodlife, that was good stuff..

I am starting to lean more towards the Full Monty treatment of HT, seeds and IMRT as this combo seems to provide the best percentage that make it out past 10 years..150 Gy has got to be better than 80 when you are down to the River card...

But again, it all depends on who is compiling the figures...

And Sailor, don't open the scuttle valves just yet! SRT can be very effective at pulling the rabbit out of the hat and delivering a cure...Who is to say the surgery was a waste of time?
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..


Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 7/15/2010 12:50 AM (GMT -6)   
Fairwind-
Thank you for starting this thread and to all that posted information. I am going to take the time tomorrow to review all this helpful information. BF is G9 with invasion and mets. He opted for everything. Surgery, HT and IMRT. I hope it was the right things to do even though he is now second guessing the surgery. He is 7 mos out with a PSA of .02 and no uptake on bones on recent PET scan. Thank you all again for continued support and helpful information!
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.
pT3c N1 Mx
HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10

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