Questions about cancer diagnosis

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anxiety out the roof
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Date Joined Aug 2010
Total Posts : 111
   Posted 9/30/2010 4:52 AM (GMT -6)   
I was diagnosed with 1 of 12 cores having cancer with a gleason score of 6. How much of a hurry should I be in to have threatment for it ?

An38
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   Posted 9/30/2010 5:11 AM (GMT -6)   
You shouldn't be in a hurry - the most important thing of all is to research research research. This will give you a clear understanding of where you stand, the options available to you and most importantly what questions to ask doctor/s you consult.

In addition it would be good to get an expert pathologist (eg Bostwick) look at your biopsy slides to determine whether the results you have are accurate. The run of the mill pathologist that looks at most biopsies often has not seen even a fraction of the slides that an expert would have seen and you really want your decisions to be based on an expert reading of your biopsy slides.

Hope this helps, I know how distressing being diagnosed with PC is and that is really another reason to wait a while till you have got over the shock. PC is a slow growing cancer and month or two or three or five is unlikley to change anything.

An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg margins, seminal vesicles, extraprostatic extension. Multifocal, with involvement in the peripheral, apex, fibro-muscular and transitional zones.

tatt2man
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   Posted 9/30/2010 5:14 AM (GMT -6)   
ANX:
-hopefully you asked this same question to your doctor who gave you the results....
I would not be in a "hurry" - I would research what is the best option for YOU ( and you alone) whether that be AS , or treatment or surgery...
-any chance of a "free PSA" reading to help fine tune where you are at now?
-you will be getting a lot of opinions and recommendations -
-remember - we are not doctors, not G*D, just other men on this journey called PCa.

hugs
BRONSON
Age: 55 -gay with spouse, Steve - live in Peteborough, Ontario, Canada
PSA: 10/06/2009 - 3.86
Biopsy: 10/16/2009- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/2009
Pathology: pT3a- gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
Post Surgery-PSA: April 8, 2010 - 0.05 -I am in the ZERO CLUB
Sept 23, 2010 -0.05 - again -hoorah !

BobCape
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Date Joined Jun 2010
Total Posts : 416
   Posted 9/30/2010 5:20 AM (GMT -6)   
A 6 is obviously MUCH better than a 7, 8, or 9. So the initial reading looks like you have a somewhat less agressive form of a cancer that typically is very slow growing to begin with. That said, you will read here that Gleason scores often increase after the prostate is removed and sent to pathology and they have a chance to give it a good look. Also, 1 in 12 cores sounds good, is good, but remember, they took 12 needle shots at a  much larger object... it is very easy to have underestimated the volume of pca, simply due to odds.
 
Mine went from 3+4 Gleason 7 with 3 of 12 cores testiing positive to
4+3 Gleason 7 with 75% involvement after they were able to look at it.
 
IF you have to have this dreaded disease, sounds like your initial results are
about as good as one can hope for. I hope it stays that way.
 
There is no rush, per se. But obviously you want to get as munch information
and knowledge as you can, and dont put anything off just to put it off.
 
Wishing you all the best.

ChrisR
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   Posted 9/30/2010 5:39 AM (GMT -6)   
I waited 6 months to have surgery and stayed a Gleason 6.
Dx 42
Gleason 6 (tertiary score 0)

open RP 10/08 Johns Hopkins

pT2 Organ confined Gleason 6

PSA
10/15/2009 <.1
10/15/2010 <0.03
10/15/2011 -

anxiety out the roof
Regular Member


Date Joined Aug 2010
Total Posts : 111
   Posted 9/30/2010 6:02 AM (GMT -6)   
ChrisR -- I only live 1.5 hours from Johns Hopkins. I was thinking of going there for a second opinion. Which doc did you see at Hopkins?

English Alf
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Date Joined Oct 2009
Total Posts : 2215
   Posted 9/30/2010 8:23 AM (GMT -6)   
Anxiety
You seem to be someone who has more than enough time to address your PCa slowly and have a good old think about what to do next and when.
However the Gleason score on its own doesn't ever paint the full picture.
Other relevant questions are:
What is your PSA?
What has your PSA been? ie how rapidly has it gone up (or not)
Did a DRE find any lumps?
How big is your prostate? (the ultra-sound done with the biopsy should have estimated the volume - this is relevant as twelve cores will take samples from less of the gland the bigger the gland is.)
etc
These may be questions for your uro if you don't already know the answers yourself. But 1 out of 12 and a 3+3 is a better place to start from than has been the case for everyone.

All the best with your investigations
Alf
Born Jun ‘60
Apr 09 PSA 8.6
DRE neg
Biop 2 of 12 pos
Gleason 3+3
29 Jul 09 DaVinci AVL-NKI Amsterdam
6 Aug 09 Cath out
PostOp Gleason 3+4 Bladder neck & Left SVI -T3b
No perin’l No vasc invasion Clear margins
Dry at night
21 Sep 09 No pads daytime
17 Nov 09 PSA 0.1
17 Mar 10 PSA 0.4 sent to RT
13 Apr 10 CT
28 Apr 10 start RT 66Gy
11 Jun 10 end RT
Tired
BMs weird
14 Sep 10 PSA <0.1
Erections OK

NEIrish
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Date Joined Aug 2010
Total Posts : 245
   Posted 9/30/2010 8:40 AM (GMT -6)   
You could even get a second opinion on your slides since you do have some time - some insurance co. cover it. We had the slides sent from a NY lab to JHopkins, which verified the diagnosis, dang it.
Husband 60yrs., no symptms: PSA 10/04 2.73, 12/06 3.64, 5/09 3.9, 10/09 4.6, 1/10 5.0w/ free PSA 24
6 core biop 4/1/10 path rept: rt mid: adnocarc. G=3+3, 5% of core; R apx v. susp. minute ca, R base bnign w/ mod. atrophy, L side atrphy only; 2nd opnion JH confrmd
MRI - 15mm nodule
BiLatRP surg 7/6/10, path: T2c, nodes, sem.ves, extra caps. neg., adenoc both sides G=3+3 cntinent, Viagr-8/27 ED

Fairwind
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Date Joined Jul 2010
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   Posted 9/30/2010 8:51 AM (GMT -6)   
Alf's advise and comments are good..A second opinion, perhaps from a Medical Oncologist, can be helpful..Traveling to Hopkins could be worthwhile or it could not..Sometimes the cost of these visits and the "pick a number" aspect can outweigh the benefit..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP performed Sept 3 2010, pos margin, one pos vesicle nodes neg

Casey59
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   Posted 9/30/2010 9:01 AM (GMT -6)   
anxiety out the roof said...
I was diagnosed with 1 of 12 cores having cancer with a gleason score of 6. How much of a hurry should I be in to have threatment for it ?
 
Being in a hurry is strongly discouraged by the experts in prostate cancer.  I don't know the rest of your biopsy results (maybe it's posted elsewhere, but I didn't search), but you have the makings of being classified as "low risk" or "very low risk."
 
Good idea going to Johns Hopkins.
 
I have provided this link to other newcomers which is a web presentation by several well-known prostate cancer experts from Sloan-Kettering (another Comprehensive Cancer Center), including a surgeon, a radiation specialist, and an oncologist.  I really like what the surgeon, Dr Eastham, says to many patients, "Let's wait and see what this cancer does."
 
Hear it for your self at this site.  An excellent investment of your time at this point.

John T
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   Posted 9/30/2010 9:09 AM (GMT -6)   
Please read" Invasion Of the Prostate Snatchers" by Dr Mark Scholz and search this forum for recent discussions on Active surveillance. Men with diaganosed with G6 pc on their biopsy and treated 18 months later had the same results as if treated immediately. So you have at least 18 monhts to make a decision and more probability 3 or 4 years. Right now the biggest risk you have is in quickly deciding to get a treatment and permanent side affects for something that may never hurt you.
Depending on the % core positive, your psa density, and your PCA3 score you may be dealing with clinically insignificant cancer that will never hurt you. At worse you are dealing with a slowing growing cancer that can be easily treated and even if it does some how escape the capusul rarely leads to death. Please research and find out about the different types of PC as they are not alike and should not be treated alike; this is the mistake that most new patients make.
JohnT

t-dog
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Date Joined Dec 2009
Total Posts : 154
   Posted 9/30/2010 9:20 AM (GMT -6)   
heres alittle food for thought for you, my pos. core count was also very low and a 6, we did our research made a plan and then went to it, my repair was 4 months from diag to fix. the final path report showed the tumor was right at the edge of the prostate and not down in the center, much more waiting could have been ugly if it had gotten loose. i am quite thankful we didnt mess around with this too long. made it thru the surgery fine, all is working well and my life is really quite the same as before just with out the mess, hehe. good luck to you.
Dx at 50 in 12/09 Merry Christmas its cancer....
3 of 12 positive, right side only, psa at dx 2.6 free%14
gleason 3+3=6
routine physical, no symptoms
Da Vinci performed Feb 2k10 by Dr Marc Milsten [hes got mad skills]
99% continent from cath out, mr happy fully functional at 2 weeks out!
path showed same gleeson with no other blips other than one slight margin, organ confined 20% right, 5%left, 34grams
Hernia repair Mar 2k10, hernia was side effect of the surgery
30 day psa 0.03- 90 day psa 0.01

ChrisR
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   Posted 9/30/2010 10:16 AM (GMT -6)   
I had open RRP by dr. Partin. They have a 99.6% cure rate for organ confined G6 people and no death or distant metastsis with up to 22 years follow up. I would go there for my surgery and get a second opinion on everything from them. I would not even waste my time going any place else. I can send you the contact info.

I know everyone is different but I have no ED issues and am full continent.

Also calm down. If you are G6 I know it's tough but G6 prostate cancer is curable.

That is what Johns Hopkins said. They used the word "cure"

Post Edited (ChrisR) : 9/30/2010 3:06:57 PM (GMT-6)


F8
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Date Joined Feb 2010
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   Posted 9/30/2010 12:06 PM (GMT -6)   

did you ever mention your age?  younger guys tend to get a more aggressive cancer.

ed


age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Jazzman1
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Date Joined Sep 2010
Total Posts : 1160
   Posted 9/30/2010 12:27 PM (GMT -6)   
I was recently diagnosed as a Gleason 6. My urologist said that I didn't have to do anything right away, but I needed to act within about six months. Your mileage may vary.
 
That said, there are a few things that you omit from your post that could be pertinent:
  • What's your PSA? A PSA of four is a lot different than a PSA of 20.
  • What's the PSA velocity? In other words, how much has the PSA spiked up over time? Was it an abrupt increase, or a gradual one? Did it go from 3 to 3.5, or did it go from 3 to 20? Big difference.
  • How much cancer was in the positive core? Was it 10 percent, 20 percent, 80 percent? A high percentage may mean this is a more urgent matter.
  • How old are you?

It sounds on the surface like you're in good shape, but the above information will let you know just how good. Get a copy of your pathology report and your record of PSA scores. Get Patrick Walsh's 2007 book on prostate cancer and educate yourself. Get a second opinion. I recommend you talk to a general oncologist. If you know any of the nursing staff at your hospital (or know someone who knows one), find out who the best surgeons and radiation docs are. They'll know. You've certainly got time to do all that.

Going to Johns Hopkins is a great idea. Experience is huge when it comes to this stuff, especially surgery. You want a doc who deals with prostate cancer every day, not occasionally. There are some real superstars at Johns Hopkins, including Walsh. You might check their website as an information resource.

Don't get panicked into a hasty decision, and don't blow this off either. The odds are excellent that if you educate yourself, get an excellent and well experienced doc, and choose a course of treatment within a few months, you'll be fine. Good luck.

 


Age 55

PSA:
8/09 2.69
7/10 4.00
8/10 4.11

Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C
Gleason 6

Post Edited (Jazzman1) : 9/30/2010 12:38:08 PM (GMT-6)


ChrisR
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   Posted 9/30/2010 3:10 PM (GMT -6)   
I was 42 at diagnosis. At 38 my PSA was 2.4. So I am sure I had it at 33 or younger. Everything I have read and been told I'd that PCa is not more aggressive in younger people. That was old data from the pre PSA time.

compiler
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Total Posts : 7204
   Posted 9/30/2010 3:57 PM (GMT -6)   
Anxiety:
 
I know you were hoping for something better, but if you are going to get PC I doubt if you could get a better report. But please post the rest of the pathology.
 
Also, as has been mentioned, get a second opinion. I got one from Jon Epstein at Hopkins. He is one of the heavy hitters.
 
Mel

anxiety out the roof
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Date Joined Aug 2010
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   Posted 9/30/2010 4:20 PM (GMT -6)   
ChrisR said...
I had open RRP by dr. Partin. They have a 99.6% cure rate for organ confined G6 people and no death or distant metastsis with up to 22 years follow up. I would go there for my surgery and get a second opinion on everything from them. I would not even waste my time going any place else. I can send you the contact info.

I know everyone is different but I have no ED issues and am full continent.

Also calm down. If you are G6 I know it's tough but G6 prostate cancer is curable.

That is what Johns Hopkins said. They used the word "cure"
thanks Chrisr- I would appreciate you sending the contact info. thanks in advance

anxiety out the roof
Regular Member


Date Joined Aug 2010
Total Posts : 111
   Posted 9/30/2010 4:23 PM (GMT -6)   
all I know so far is that 1 core in 12 was G6 with 10% being cancerous. Another area had minor cell disruption. My score was 3+3=6. i am 61 years old and in good shape. I go to the gym 2-3 times a week for cardio. I have lost 12 lbs and now am in the slightly overweight class.

Post Edited (anxiety out the roof) : 9/30/2010 5:04:26 PM (GMT-6)


Fairwind
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   Posted 9/30/2010 5:22 PM (GMT -6)   
What was your last PSA ??

anxiety out the roof
Regular Member


Date Joined Aug 2010
Total Posts : 111
   Posted 9/30/2010 5:27 PM (GMT -6)   
last psa was 3.8.

ChrisR
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   Posted 9/30/2010 5:49 PM (GMT -6)   
I will get you his information. At 61 with G6 you are probably going to hear a lot of people to argue that you don't need treated at all. G6 prostate cancer is usually very unaggressive. I mean we are talking more then 20 years to advanced desease.
Dx 42
Gleason 6 (tertiary score 0)

open RP 10/08 Johns Hopkins

pT2 Organ confined Gleason 6

PSA
10/15/2009 <.1
10/15/2010 <0.03
10/15/2011 -

Jazzman1
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   Posted 9/30/2010 7:37 PM (GMT -6)   
I know you're freaked out, but try not to be. At G6 with one core positive and a 3.8 PSA, you're well poised for a cure.

Get your butt down to Johns Hopkins and let one of their hotshots fix you up. Nobody ever wants to go through this, but chances are excellent that you'll be just fine. A lot of guys here would trade their prognosis for yours in a heartbeat.
Age 55

PSA:
8/09 2.69
7/10 4.00
8/10 4.11

Biopsy 8/10
Three of 14 cores positive: 10%, 60% & 80%
Stage T1C
Gleason 6

FLBeachgal
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Date Joined Mar 2010
Total Posts : 46
   Posted 9/30/2010 9:00 PM (GMT -6)   
We had a totally different experience than most with G6:
 
Hubby age 65 at diagnosis
2/09 - PSA 2.8
3/09 - Small nodule felt on DRE
3/09 - 12 core biopsy - 2 positive cores, both 20%, G6
5/09 - Consult with head of GU Oncology at Moffitt Cancer Center, Tampa FL
           Biopsy slides reviewed and initial findings confirmed
           Advised that cancer was very small and slow-growing
           Advised that he should be fine with AS for at least 5 years
8/09 - Consult with Dr Vip Patel re: DaVinci RP  
11/09-DaVinci RP by Dr. Patel at FL Hospital Celebration
           Pathology pT3a, Gleason 5+3 (8), positive margins, extracapsular extension
1/10 - PSA .1
3/10 - PSA .1
5/10 - PSA .2
6/10 - PSA .3, Began RT x 40 treatments, hormone therapy x 2 years
9/10 - RT completed, next PSA & hormone injection 11/10
 
We were told after we got the shocking pathology report that hubby was one of the unfortunate few whose cancer was extremely aggressive, unlike most men with similar initial findings. 
 
Not trying to discourage you at all - just wanted you to know that not everyone with a Gleason 6 can be assured that they have plenty of time to make a decision on treatment.  Our best wishes to you.............
 
Margie 

Fairwind
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   Posted 9/30/2010 9:21 PM (GMT -6)   
That's the big problem with Active Surveillance. In many cases, you don't know what you are watching..I don't think a 12 core biopsy is enough to safely put someone on AS. One must undergo an extensive series of expensive scans and tests to be SURE it's a small localized Gleason 6...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
age 61: 5.2
age 64: 7.5, DRE "Abnormal"
age 65: 8.5, " normal", biopsy, 12 core, negative...
age 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
age 67 4.5 DRE "normal"
age 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP performed Sept 3 2010, pos margin, one pos vesicle nodes neg
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