define aggressive pc

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twotall
Regular Member


Date Joined Nov 2009
Total Posts : 38
   Posted 11/20/2010 8:54 PM (GMT -6)   
I have made it to my third <.04 PSA test which reduced the stress until the 12 month one comes around.  Sure would like to find the stress "off" switch before each test.  I have been watching (do a lot of watching and not much posting) some of the posts about different levels of PSA and gleason scores.  I fall into the group of both high PSA and gleason scores (PSA 20 + and gleason 8).  I have read that the gleason 8,9, and 10 are all about the same aggressive level.  I think of that term everytime I have a PSA test.  Before it was determined that I had cancer, a doctor told me that if it was cancer it was very likely to have already spread due to the high PSA level. 
 
If this is true, and gleason 8 being an "aggressive" cancer, I have wondered how long it would take to show its face again with a increasing PSA level.  How does this "aggressive" compare to the aggressive of other cancers?  Or even to the aggressiveness of the gleason 6 and 7 cancers.  Sorry for the long ramble, just get to thinking about the numbers, odds and such things.  I am happy about my psa so far but am having trouble getting that aggressive thing out of my mind.
 
Bob
 
 
59
PSA
.6 2007
9.4 Oct 2008
11 Oct 2008
12 core bio neg
16 July 2009
20 Sept 2009
all DREs normal
18 core bio gleason 6
Robotic Dec 2010
Up grade 4+4+8
contained, neg in all areas
stage T2b no mo
First 3 PSAs <.04

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/20/2010 11:17 PM (GMT -6)   
Bob,

Hopefully you have looked at some of the nomograms. Statistcally you still have a very good chance of not having a reoccurence. Better than 60% at least.

Your surgery numbers look good, and yoiur postop PSA's look great. Your dates are a little off I suspect, by maybe a year tho.

As a Geason 9, I empathize with the stress factor, but I can only say that it does get a little better with each test.

There is honestly no way to definitively say if or when the PC may come back, no matter what your Gleason is. If you look at the signatures on this forum, you will find a wide variety. But be careful to not take this group as a normal cross section. Most guys move on after a year, unless they have problems. So many of the guys here are the onbes who are battling problems.

I have just resigned myself to the fact that it can and may come back, and there is noithing I can do to stop it. So I am living my life to the fullest, and doing my best to not let it mess up my life by worrying myself sick over if, and when. When it does, it does, and I will deal with it then.

Welcome to the forum, and good luck on your journey. Looks like you are off to great start.
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
15 month PSA <.01

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3741
   Posted 11/20/2010 11:37 PM (GMT -6)   
Hello Bob..I'm another Gleason 9 ..Like Goodlife says, every case is different..Yes, we are all 'high-risk" compared to the G-6 and G7 guys..But they have their nightmares too..I have resigned myself to just playing it one day at a time..It's pretty much out of my hands now..

Yeah, G-8 and PSA20 are bad numbers but the pathology report looks very good and the PSA.04 looks even better...That first year at .04 means a lot..So maybe you got lucky...But the real moment of truth is that 3 year mark. Usually, if it did get out, it will show up by then. After that, the odds are WAY in your favor...

Did your doctors recommend any further treatment right away, or are they content just to monitor your PSA? Sometimes with high-risk patients they like to add radiation but with your clean margins, I guess you have escaped that..

Anyway, I guess you know, the longer you stay in the zero club the better. With any luck you are done...You are going to be FINE!!

Post Edited (Fairwind) : 11/20/2010 10:43:10 PM (GMT-7)


twotall
Regular Member


Date Joined Nov 2009
Total Posts : 38
   Posted 11/21/2010 12:42 AM (GMT -6)   
Hello and thanks for your replys.  Goodlife you are right, in the middle the night while trying to limit my sig. to the 400 limit I typed in Dec instead of Jan.  Thanks for catching that and for your advice.  I have checked several of the on line calculators, some indicated that the chance that the cancer would come back as high as 82 percent while others had better percentages.  Since we are all a bit different, in my mind I have sort of averaged the numbers out.
 
Fairwind, thanks for your thoughts also.  I have had the 2-3 year range in the back of my mind as a goal to shoot for.  It took my PSA about 2 years to reach the 20+ range so I figured that the odds were higher that it might come back sometime during that time frame. 
 
I think as men our solution to a problem is to dive in and fix it.  I am very much that way and find myself flustrated because there is not a thing that I can do to fix or prevent the problem.  I have to say that the two things have kept me from worring myself to death is the Rock called Christ and having this forum to follow.  I check it at least 4-5 times a week and appreciate your words of encouragement.
 
Bob
59
PSA
.6 2007
9.4 Oct 2008
11 Oct 2008
12 core bio neg
16 July 2009
20 Sept 2009
all DREs normal
18 core bio gleason 6
Robotic Jan 2010
Up grade 4+4+8
contained, neg in all areas
stage T2b no mo
April <.04
July <.04
Oct <.04

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 11/21/2010 6:25 AM (GMT -6)   
Excellent post and thanks for writing. It seems as though we are seeing several of the higher gleasons starting to post and ask questions and that is a good thing. I too am a gleason 9 however unlike many (call me strange) I do not worry to much about the cancer anymore. I live life to the absolute fullest every single day. Between work, running, swimming, biking, reading, family, and church there just isn't much time to think about the cancer. I say this only to say that staying busy for me is great therapy and increases my sense of purpose. I decided early on that cancer was not going to have any control over me. It may come back someday and probably will and when and if it does I hope I can keep doing what I am doing.
Our gleasons are aggressive on yes but hey so are we so lets get up, get out, and win this battle.

peace to all
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
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.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
PSA July 22nd of 2010 is .71
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%

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 11/21/2010 6:39 AM (GMT -6)   
twotall said...
I think as men our solution to a problem is to dive in and fix it.  I am very much that way and find myself flustrated because there is not a thing that I can do to fix or prevent the problem... 
I'm the same way...gimme a hammer.  Hang in there, Bob.  Look at it this way:  There is nothing to go fix...!  You've got a lot of things in your favor.  No positive margins, no seminal vesicle involvement, no lymph node involvement, and no detectable PSA 9-months after surgery.  All very good signs...nothing within your control to go fix. 
 
That being said, there are things within your control which will help you beat-down cancer cells in your body--prostate cancer cells which might be remaining, or other types of cancer cells.  Diet, exercise and stress reduction are tactics for fighting PC and improving overall health to fight any cancer, and the leading experts who specialize in prostate cancer all include these in their recovery programs because of their demonstrated benefit.  You will find a mix of information out there in the internet, but it's fairly easy to sort through the unreliable, sketchy information to find the actions that you can latch on to.
 
Continue to go to the Rock.  'Tis the season to help others...find things to do to help take your mind off the prolem that you don't have.
 
 
-Peace

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 11/21/2010 8:24 AM (GMT -6)   
I'm a gleason 8 and only got 1 year before BCR. If and when it PCa returns you just move on to the next stage of treatment. I intend to go the intermittant HT route that Dale is on and I am looking forward to enjoying my family and life in general for many years. Although, unlike Dale I am looking forward to retirement and doing some traveling. Best of luck and my years of those undetectable PSA's. BB
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 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.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 11/21/2010 1:03 PM (GMT -6)   
Hello Bob,
I'm a Gleason 8 like yourself. My pathology report was worse than yours (I had EPE) but my PSA was lower. So far, my latest PSA at 21 months post surgery was .005. My cancer may come back but the longer my PSA stays undetectable the better my chances. I still get PSA anxiety before every test but it seems to be less every time. Think positive.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18 months) undetectable
Latest PSA test (21 months) .005

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 11/21/2010 1:49 PM (GMT -6)   
Bob,  I'm also a G8 and made it 2 1/2 yrs. before I had a little rise.   Ironically, after 2 yrs. of <0.1, I wasn't very concerned before my last test.  I feel pretty much like BB Fan - take it one step at a time and do what you have to when the time comes.  I also believe age may make a difference.  I'm 74 now and my outlook and  priorities may be  different than the younger men such as Alf, Dale or Galileo.
 
Carlos

Diagnosed 2/2008 at age 71, PSA 9.1, G8 (5+3), stage T1c.
Robotic surgery 5/2008, LFPF at 6 wks.,nerves spared, stg. pT2c, N0, MX, R0, G8 (5+3)
PSA .12 at 2.5 years. All prior tests <0.1.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 11/21/2010 1:53 PM (GMT -6)   
My hat has always been off to you Gleason 8 or 9 brothers. You have a second sword hanging over your head, in addition to the normal sword of PSA anixety. I am glad that there are several in your group, that despite your Gleasons and not so great pathology, are holding your own and doing well. I hope for each of you, it can stay that way for a long, long time to come.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

rob2
Veteran Member


Date Joined Apr 2008
Total Posts : 1131
   Posted 11/21/2010 4:22 PM (GMT -6)   
I'm a Gleason 8 and PSA was under 4 at diagnosis. My PSA has always come in <.04 for the past 2.5 years. I have been told by members here is the < means that is as low as the machine is calabrated. I have not had my PSA tested by a machine that goes less than .04. I tried at my general practictioners office and the PSA came back < .04 as well.
 
Age 48 at diagnosis
occupation accountant
PSA increased from 2.6 to 3.5 in one year
biopsy march 2008 - cancer present gleason 7
Robotic Surgery May 9, 2008 - houston, tx
Pathology report -gleason 8, clear margins
22 month  PSA <.04
continent at 10 weeks (no pads!)
ED is still an issue

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 11/21/2010 7:18 PM (GMT -6)   
Bob,  You asked how prostate cancer compared to other agressive cancers.  In and earlier post Bob Cape provided a link to an article  that does just that.  It compares post surgery PCa survival times to several of the most aggressive cancers.  This is a link to his post: http://www.healingwell.com/community/default.aspx?f=35&m=1930419.  The linked article is very informative.
 
Carlos

BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 11/21/2010 7:37 PM (GMT -6)   
Wow Carlos... I had forgotten about making that post.
Since my psa has jumped of late, and I was looking for glimmers of hope, thanks for reminding that all is not lost.
 
Bob.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3741
   Posted 11/21/2010 7:52 PM (GMT -6)   
I noticed one error. He claims only 3% die from PC..My calculator says 15%

Maybe you should post that link in a couple of the other threads where new people are pretty worried about their future, barry's daughter for one..I gotta go..

twotall
Regular Member


Date Joined Nov 2009
Total Posts : 38
   Posted 11/21/2010 8:05 PM (GMT -6)   

I wish to thank everyone for taking the time to reply to my questions.  Just knowing that there are others that can relate and understand is a very big help.  There have been quite a few sleepless nights in the last year when I would log on to this forum and find answers to some of my questions.

Sounds like there are more folks in the gleason 8-9 club than I had thought which just makes for a bigger, better support group!

Carlos, thanks for the link to the other cancer information.  This helps put things in a different prespective as many with other types of cancer have far more to worry about than we do.  I have a little knowledge of this as my father lasted 2 months after being told he had pancreatic cancer and my sister is a 4 year surviver of breast cancer.

As I read somewhere on this forum: "The day that we are born we also start to die".  As this is true for all of us, what we do with the precious time in between is what really counts.

Bob


59
PSA
.6 2007
9.4 Oct 2008
11 Oct 2008
12 core bio neg
16 July 2009
20 Sept 2009
all DREs normal
18 core bio gleason 6
Robotic Jan 2010
Up grade 4+4+8
contained, neg in all areas
stage T2b no mo
April <.04
July <.04
Oct <.04

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/21/2010 10:18 PM (GMT -6)   
Twotall.

I was wonderig if maybe you misread the nomogram. 82 % chance of re-occurence sounds very high. Are you sure it wasn't the opposite ? Maybe the higher Gleason makes it do that, bit I am doubtful.

I have always understood the the chance of non-reoccurence in 10 years is more like 60 to 70 %.
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
15 month PSA <.01

twotall
Regular Member


Date Joined Nov 2009
Total Posts : 38
   Posted 11/22/2010 11:21 PM (GMT -6)   
Goodlife,
 
I have double checked the site where I got the 82% information.  When I was first told that I had a very small amout ot gleason 6 upon biopsy, I went into major panic mode and checked everything I could find on the subject.  Once I determined that gleason 6 was the "friendly" cancer I settled down a bit.  After surgery the 6 changed to 8 and the panic really hit big time.  I checked everything that mentioned anything to do with high PSA or gleason 8.  One of those sites was prostatecalculator.org.  This site has what is called a PSA recurrance calculator.  I just entered my information and it said that I now have a 6% chance that the PSA would not increase.  ???  I had never heard of a PSA recurrance calculator and it gave much different figures than others I have looked at.
 
I have also been playing with the Sloan Kettering calculator and like the odds there much better.  It shows a 79% chance of the cancer not coming back within 10 years.
 
Having looked at a bunch of these things I finally decided that everyone is different and just to try to take it one test at a time.   
 
Bob
 
59
PSA
.6 2007
9.4 Oct 2008
11 Oct 2008
12 core bio neg
16 July 2009
20 Sept 2009
all DREs normal
18 core bio gleason 6
Robotic Jan 2010
Up grade 4+4+8
contained, neg in all areas
stage T2b no mo
April <.04
July <.04
Oct <.04

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 11/23/2010 9:06 PM (GMT -6)   
Bob,
 
I am much more familiar with the SK nomograms, which are based on the thousands of cases they have seen.  I put more trust in their validity.
 
Besides, I like the numbers better.  Helps my state of mind.  I'm sticking with the nomograms until something else happens.
 
Good luck, and have a great holiday.
 
Goodlife

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 11/24/2010 6:42 AM (GMT -6)   
There are three important aspects to aggressive cancer, 1) PSA, 2) Velocity and 3) Gleason score. But remember there are exceptions to every thing we discuss here.

The PSA is usually an indicator of the tumor volume. Numbers below 4 or 5 suggest that the volume is fairly low and that is is mostly confined in the prostate. And a tumor contained in one lobe of the capsule is better than one that is in both lobes. A number higher than 10 or 20 or suggests that the tumor may be out of the prostate. Numbers over 50 or 100 indicate that the tumor is probably definitely out of the prostate.

Velocity relates to how fast the PSA is increasing. A PSA that doubles every year is a very aggressive cancer. Velocity is one of the most important numbers we look at following curative treatment. If velocity doubles in three or six months it is even more dangerous.

Gleason score relates to how differentiated the tumor cells are from normal prostate cells. A G5 or G6 tumor is barely differentiated from normal cells, whereas a G9 or G10 is highly differentiated. The importance of this is that a highly differentiated cell can divide and reproduce much easier outside of the prostate than one that is more like normal cells. This is why with G8, G9 and G10 PCa there is always a risk of micro mets in the body that won't show up even with the most sophisticated kind of testing.

All of these factors are important in determining what type of curative treatment one chooses. My urologist recommended a RP, but after studying the literature of nomograms and prostate calculators I determined that a RP was a very poor choice for me as there was such a high probability that the tumor was already out of the capsule. If that is the case a RP is a waste of time and of your life energy because the probability is that it will not get all of the PCa and you will then have to have salvage radiation and/or HT.

The problem with all of this is that the correlation between Gleason score and the ability of the tumor to survive outside of the prostate is not absolute. For some reason many G6 and G7 cancers find a hospitable environment outside of the capsule while a very few G8, G9 and G10s remain in the prostate. But you really never know with any PCa because there is always the danger of micro mets which can result in a return of the cancer, even many years out from treatment.

Another very important consideration for life expectancy in the event the PCa has escaped the prostate capsule and become systemic is how it reacts to androgen deprivation therapy (Hormone Therapy) over the long term. Most PCa is quite responsive to ADT at first, but after about three straight years on it about 50% of men will become refractory. Some men, on the other hand, have PCa which responds to ADT far longer, up to 10-15 years and perhaps even longer.

Sancarlos
Age 66, PC diagnosed 7/2009 at age 65
Stage: T2c, Gleason: 9 (4 + 5), 6 of 6 cores positive
Bone, CAT and MIR scans negative

Treatment: brachytherapy (103 palladium), 100 gy, 11/2009 + ADT3 (Lupron + Casodex+Avodart) + IMRT on Novalis, 45 gy, 3/2010.

PSA: 7/2009, At time of diagnosis -- 11.9
10/2009 -- 5.0
12/2009 -- 0.56
5/2010 -- 0.15
8/9/2010 -- 0.06
11/2010 -- 0.013

Post Edited (Sancarlos) : 11/24/2010 7:24:49 AM (GMT-7)

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