Defination of high risk PC

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duke68
Regular Member


Date Joined Mar 2007
Total Posts : 242
   Posted 3/23/2011 9:53 AM (GMT -6)   
Hi,

Here are the guide lines that identify "high risk".

Dana-Farber. Boston

- Clinical Tumor Category T1b, T1c, T2a and PSA greater than (>) 10 or Gleason
score equal or greater than 4+3=7 or PSA velocity > 2.0 ng/ml per year and also
eligible patients with tumor category T2c, T3a, T3b, or T4 as per 2002 AJCC
guidelines. Any minor tertiary grade of Gleason 5; Biopsy Proven or Radiographic
(erMRI Seminal Vesicle Invasion); Gleason = or > 3+4=7 with 50% or more cores
positive

This Information is important when making treatment decisions

Best Wishes to all
Gerry
age 68 diag. oct 2006 G8 T2b psa 11.7
4 of 8 cores 20% 30% 60% 100%
rrp dec 2006 G9 4+5 m+ sv+ ece after 6 weeks psa 0.6 second opinion Dana-Farber pT3b 4+4 + T5 = G9
Rt 35 sessions to lymph nodes and prostrate 4-2007
3/2007 cab 6 months lupron + casodex.
psa <0.1 from june 2007 to march 2010
psa 6/10 0.3 9/10 0.6 12/10 2.5 :(

Dana- Farber Phase 2 trial Avastin Lupron and casodex

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/23/2011 10:13 AM (GMT -6)   
Gee, I had 4 of those factors at my time of treatment.
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 2/11 1.24
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 9/10,

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3738
   Posted 3/23/2011 10:29 AM (GMT -6)   
So did I, and I was well aware of my "High Risk" status...

Many men try to minimize the extent of their PC and that attitude alone can put them at high risk...Just my opinion...

When my U-doc called with my original biopsy report, it seems so long ago, 9 months, and said: "Well Bob, I have some bad news, you have prostate cancer..And some more bad news, it's Gleason 9....That was a rough day...
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

JNF
Veteran Member


Date Joined Dec 2010
Total Posts : 3744
   Posted 3/23/2011 1:29 PM (GMT -6)   
I, too, am high risk and my urologist, rad-onc, and med-onc all separately explained it to me and what we needed to do.   They did not need to scare me, only cover things with great clarity.
 
My brother's brother-in-law, however, related to me that his urologist downplayed the risk as his PSA was low, but he was G9.   In the last 8 years he has had the prostate removed, SRT, two rounds of ADT and still has rising PSA.   He is just now coming to realize what being high risk is all about.   It took him awhile to get over the shock that surgery failed as he had been told it went well and there would be nothing to ever worry about.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/23/2011 2:47 PM (GMT -6)   
JNF:

Sounds like that relative was given very bad advice by his urologist, sounds like he was promising everything and the moon, there is nothing casual or low risk about a Gleason 9 case.

David
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 2/11 1.24
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 9/10,

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/23/2011 8:29 PM (GMT -6)   
count me in. What Me Worry turn
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 3/23/2011 8:37 PM (GMT -6)   
I have read several places that a G9 prostate cancer reduces life expectancy by 6-8 years. That sounds pretty high risk to me.

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 + IMRT on Novalis, 45 gy, 3/2010 + ADT3 (Lupron + Casodex+Avodart)

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; 3/25/2011-- 0.005

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3732
   Posted 3/23/2011 8:38 PM (GMT -6)   
I'm 4 out of 5. (I never got a tertiary score so I might even have a flush) Do I get extra credit for having PSA above 20 and having my velocity be 2.0/ month?
There wasn't much argument about whether or not I was high risk.
Jeff

duke68
Regular Member


Date Joined Mar 2007
Total Posts : 242
   Posted 3/23/2011 9:29 PM (GMT -6)   
Hi

Yes you also need a PSA > 10

Don't understand G6 with some 4s. That looks like 3+4=7?

All 34 samples had cancer. Thats a large tumor burden

Best wishes
Gerry
age 72 diag 68 Oct 2006 G8 T2b psa 11.7
4 of 8 cores 20% 30% 60% 100%
rrp Dec 2006 G9 4+5 m+ sv+ ece after 6 weeks psa 0.6 second opinion Dana-Farber pT3b 4+4 + T5 = G9
3/2007 ADT2 6 months lupron + casodex
4/2007 SRt 35 sessions to lymph nodes and prostrate. Psa <0.1 from June 2007 to March 2010
Psa 6/10 0.3 9/10 0.6 12/10 2.5 :(
Dana- Farber Phase 2 trial Avastin ADT2
3/11 psa 0.02

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3738
   Posted 3/23/2011 9:44 PM (GMT -6)   
I can remember sitting around the campfire as kids in our late teens and early 20's, half in the bag, bragging and lying to each other...One guy said he read someplace we all could expect to live to be 65....We all laughed..We will be lucky to make it to 40 somebody said, the way we live.. Half my high school class is already gone...

So at 68, every day I can get out of bed and make my own coffee is a BONUS day, happy to have it and I try to make good use out of it..I can't do much about my PSA number anymore, it's a wait and see game now, so why spend what's left of your life worrying about it??

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 5815
   Posted 3/23/2011 11:49 PM (GMT -6)   
Amen to that Fairwind. Thats one of my favorite things to do also, small pleasures,really aren't that small are they. Just as I wrote this post, no lie, I mean seconds ago, my wife asked if she should throw away the rest of the coffee, and if I was going to make some in the morning. Know thats a small thing but ,Im enjoying it immensly. Have a great
morning.
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 3/24/2011 11:39 AM (GMT -6)   
I can't seem to win anything good.
T3b, 3+5=7 with tertiary 5.
However, I believe once your PSA rises after surgery that high, medium, low risk is a mute point. shakehead
Meeting with the radiation oncologist April 5 for that next step discussion.

Post Edited (STW) : 3/24/2011 11:43:46 AM (GMT-6)


Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 3/24/2011 3:22 PM (GMT -6)   
Fairwind,

If you had told me when I was 25 that I would live to be 66, and worried about prostate cancer, I am sure I would have laughed you out of the room.

And to add a bit of humor (black) to the discussion we still have the choice of decreasing our chances of dying of prostate cancer by increasing other morbidity factors. Let's take up riding motorcycles or hang gliding, take up smoking again, eat a lot of rich food and gain weight, give up our exercise programs, etc.

Sancarlos




Fairwind said...
I can remember sitting around the campfire as kids in our late teens and early 20's, half in the bag, bragging and lying to each other...One guy said he read someplace we all could expect to live to be 65....We all laughed..We will be lucky to make it to 40 somebody said, the way we live.. Half my high school class is already gone...

So at 68, every day I can get out of bed and make my own coffee is a BONUS day, happy to have it and I try to make good use out of it..I can't do much about my PSA number anymore, it's a wait and see game now, so why spend what's left of your life worrying about it??

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 + IMRT on Novalis, 45 gy, 3/2010 + ADT3 (Lupron + Casodex+Avodart)

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; 3/25/2011-- 0.005

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 3/25/2011 2:43 PM (GMT -6)   

The D’Amico Risk Classification is perhaps the most widely used tool among urologists/surgeons in predicting (clinically, before treatment) the risk of recurrence after primary treatment.  Other nomograms or other online predictive tools are sometimes referenced to patients, but many urologists quote the D’Amico Risk Classification to patients off the top of their heads. 

 

Dr Anthony D’Amico is Chair of the Division of Genitourinary Radiation Oncology at Dana-Farber Cancer Center (Brigham & Women’s Hospital), and professor of Radiation Oncology at Harvard Medical School, and is an internationally recognized expert in prostate cancer treatment.  The D’Amico Risk Classification has been recently validated by Drs. Han and Partin at Johns Hopkins, and more recently by Mayo Clinic.

 

 

Below is the overall risk stratification of this system:   LINK

Low risk:
PSA < 10ng/ml and Gleason < 6 and
The percentage of involved cores is < 50% or
Intermediate risk with only 1 positive core

Intermediate risk:
Gleason score of 7 or PSA of 10-20
Low risk with > 50% of positive cores or
High risk and only 1 positive core

High risk:
Gleason > 8 or PSA > 20 and more than 1 positive core
Or intermediate risk and more than 50% positive cores

When there is a conflict in the Gleason score and PSA risk group, the worse factor wins and determines the risk category assignment. For example, a patient with a low Gleason Score of 6 combined with a PSA of 25 ng/ml is considered high risk. The exception to this would be, say, if there is only one positive core out of all of the ones sampled, in which case the risk category goes down to intermediate risk.

 

 

 

 


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