i am back with my dad biopsy results

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laila374
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Date Joined Apr 2011
Total Posts : 78
   Posted 4/29/2011 2:46 PM (GMT -6)   
hi everyone, i posted last time to ask if my dad schould do a biopsy, and you advised me to ask him to go for it,
he got the result today, and he has prostate cancer, i am very very sad, the doctor said that he has to do a CT  scan for the bones to see if it didn`t spread,
 

Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 4/29/2011 2:55 PM (GMT -6)   
That truly is too bad, but can you share some of the info off of the biopsy report, i.e. Gleason score, staging, number cores positive, percentage of cancer in the positive cores, etc. Will help us understand what he is dealing with, and what treatment options would be suitable.

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 margin
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, 4/11 3.81
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

Sleepless09
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Date Joined Jul 2009
Total Posts : 1267
   Posted 4/29/2011 3:24 PM (GMT -6)   
Lalia --- the bad news is he has PCa, the good news is he knows about it and now it should be able to be treated.

'david in sc' has some good questions I hope you'll post the answers too.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Worried Guy
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   Posted 4/29/2011 4:42 PM (GMT -6)   
Laila,
Sorry for the bad news.
If you don't know what to look for in the biopsy report, check out our signatures. Most of us include the biopsy info. For example:
"4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%"
or
"Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3"
or
"Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg"
You need that info to help decide on the treatment.
Good luck,
Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

geezer99
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Total Posts : 990
   Posted 4/29/2011 10:28 PM (GMT -6)   
The standard medical practice after a positive biopsy seems to be a CT scan and a bone scan. In fact a huge percent of these come back negative and I suspect that this is just defensive medicine. My strong advice would be, don't worry about them.

When I went for my CT scan the nurse asked if I had any pain in my shoulder -- at that time I didn't but afterwards it hurt for three days. This is to say that these tests are scary but just stay calm. remember that PC is slow and that your dad has lots of good choices.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day
9 mo. PSA 0.00 -- 1 light pad/day ED remains
12 mo. PSA 0.00 -- still one light pad and ED
16 mo PSA 0.00 -- light pad just for security, ED still an issue

laila374
Regular Member


Date Joined Apr 2011
Total Posts : 78
   Posted 4/30/2011 6:46 AM (GMT -6)   
hi everyone, i couldn`t look for his biopsy result because we are not in the same place, but i call him this morning and he said that it is written stage4. what does mean, his PSA is 13, is that a bad news? did the cancer already spread to his bones and there is no hope to cure it? please help

laila374
Regular Member


Date Joined Apr 2011
Total Posts : 78
   Posted 4/30/2011 7:47 AM (GMT -6)   
this is what is written in his biopsy result:

it`s in frensh:
Biopsies prostatiques multiples: adénocarcinome prostatique grade 4 de gleason, score de gleason à 8 (4+4) aver prédominance du grade 4 (60%), occupant environ 42% du prélèvement analysé, avec infiltration périnerveuse fréquente, la capsule n'est pas individualisée

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 4/30/2011 9:36 AM (GMT -6)   
A clarification - Stage 4 is not the same measure as Gleason score. We were concerned when you said stage 4, as that means the cancer is out of the prostate and already in distant sites. That is not what I read here. The Bone and CT scans are looking for that.
 
The report, with my little bit of "newspaper" French, says he has Gleason 4+4=8 in 42% of the sample that was examined. There is not a mention in what you sent of the number of cores (other than the indication that there are multiple cores).
There is mention of PNI being found.
 
"la capsule n'est pas individualisée" isn't clear to me, but is telling us about the capsule itself, which is not something I've seen in standard biopsies (posted here).
 

Post Edited (142) : 4/30/2011 9:54:39 PM (GMT-6)


laila374
Regular Member


Date Joined Apr 2011
Total Posts : 78
   Posted 4/30/2011 1:08 PM (GMT -6)   
can we know from the Gleason score the stage of the cancer and if it has spread????

logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 4/30/2011 1:17 PM (GMT -6)   
Thank you 142 I dont know french but i picked that up. I getting PNI not PIN, but not sure.
Laila, how old is your Dad, it helps us help you. OK I will tell you what I think. The gleason grad is high=more aggressive, the volume sounds high in the sample, remember the volume is of the small core taken out not of the whole prostate. IT is NOT any kind of direct corralation. I had 2 cores with 70% plus smaller % in other cores. When the whole bugga was snatched, total volume of cancer was was 9%. anybody out there , help with translation?
Bottom line Laila, While not an early catch, it is not as bad as it could be IMO. The psa is high but under the 20 that alot of medicos will not do bone scan, cause not necassary. It might not be curable,but could be, which in pca, is not the same as terminal. Many, many people live a long, long time, with " incurable " Pca and die of old age from other causes. 80% of 80 year old men have been found to have PCA at autopsy. At its most aggresive it is a lot slower than most cancers, arguably the slowest. Thanks for inviting us into your life, keep us in formed.
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

logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 4/30/2011 1:26 PM (GMT -6)   
The only way you can tell if it has spread is with diagnostic tests that can pinpoint it, but these have there own difficulties or with the prostate being snatched and examined. There are people, who based on pathology, should be spreading and are not, and who shouldn't be spreading , who are. Remember it is a slow growing disease, there is more life than death in PCA patients, trust me on that one. Keep your faith and hope, its real!
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

142
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Date Joined Jan 2010
Total Posts : 7084
   Posted 4/30/2011 1:29 PM (GMT -6)   
The Gleason score "rates" the cells on a scale of 1 (normal cells) to 5 (the most aggressive).
 
Mine were also 4+4 in the biopsy, then seen in the post-op pathology as 4+5.
 
Simply, unless a more exotic scan is done, it is almost impossible to tell if the cancer is limited to the prostate unless surgery is done. Many others here can address the specific tests. I went straight to surgery and adjuvant radiation.
 
Bone scans and CT scans will find cancer if it has become well established, but with a PSA of 13, that is not very likely. It is really hard to evaluate, even after surgery, which is hard for all of us to deal with.
 
"Stages" of the cancer are expressed with the TNM system, which, until you have surgery, metastasis, or some advanced scans, won't be more than a T2a, T2b, or T2c. I've posted the chart here, but will have to search for the link.
 
(adding link to Tony's post linking to a pdf doc which explains the system)
 
 

Post Edited (142) : 4/30/2011 12:33:22 PM (GMT-6)


logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 4/30/2011 1:30 PM (GMT -6)   
PS. Buy, read study Patrick Washes book on prostate cancer, dont know exact title , google. I will answer all your questions. Keep asking us tho....
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

logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 4/30/2011 3:21 PM (GMT -6)   
Was that a freudian dress Logo? re walshes book I should be it. What would we do with out the unconscious, be unconscious, I guess.
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

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 4/30/2011 10:56 PM (GMT -6)   
Logo,
 
Yes, it should have been PNI. I corrected that in the post.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 4/30/2011 11:13 PM (GMT -6)   
Thats cool, I didn't e know you could do that, I always end up making a new post with correction. couldn't figure the capsule thing tho.
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

laila374
Regular Member


Date Joined Apr 2011
Total Posts : 78
   Posted 5/1/2011 6:34 AM (GMT -6)   
i really appreciate your interest and helpful answers.
My father is 57, the doctor didn`t give him too much information about his situation, he just asked him to do a bones scan to see whitch treatment will be best for him, i don`t know in whitch satge is the cancer and if there is any chance to treat it.

laila374
Regular Member


Date Joined Apr 2011
Total Posts : 78
   Posted 5/1/2011 8:26 AM (GMT -6)   
how can we know the satge of the cancer?

142
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Date Joined Jan 2010
Total Posts : 7084
   Posted 5/1/2011 9:00 AM (GMT -6)   
The stage is not simple to define yet.
 
T1 is found by "accident" of sorts - surgery for BPH, for example. It can not yet be seen on imaging tests or by DRE. Perhaps it is found simply because of biopsy due to a PSA alone.
 
If the DRE showed something not right, it would be T2, with the a, b, or c meaning which lobe(s) are involved.
 
To know if it is T3, there has to be either an advanced scan that shows the capsule wall to be broken, or evidence of that from the post-operation pathology.
 
To say T4, there has to be evidence that the cancer is into the bladder wall, pelvic muscles, or other tissue outside of the prostate.
 
(All this is in the chart I added the link for, and in several of the books we have mentioned. I am using the Cleveland Clinic Guide as well.)
If the pathologist who did the report uses the TNM system, the result will look like this: T1c N0 M0
 
If they do not use the TNM system, a urologist here in the US should be able to read a translation of the report and assign a stage.
 
My Biopsy report did not include a TNM value. I was told I was a T2a from the initial examination. My actual post-operation pathology was pT3a (the p means that it comes from pathology).
 
 
 

logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 5/1/2011 10:16 AM (GMT -6)   
The way you know the stage is to ask the Doctor, he is the one that determines that from the biopsy findings. He most assuredly has done that. This is called the clinical staging done before treatment, ie from the biopsy. When a patient elects surgery for treatment, there is a post op stage be cause they now have the prostate in the lab , they examine it and can determine a lot more about about the stage from it . With non surgical treatment i dont know how they determine a post treatment stage if they do it all. Listen Laila, whats going on here IMO, is your father is a distance away from you, he doesn't seem to be interested in learning about the disease and wants to trust the doc and go on about it. I think thats a wrong descion, but most patients do exactly that and go on to recover nicely. He, and I may be wrong here, is not being a self advocate and you are picking up that slack. Its done all the time and its a good thing you do that. If you do, then follow thru, get the book study it so you know. You are not the pateient , the doc is not going to have a consult with you, to be continued I stupidly did quick reply, standbuy and some of you ladies get in here on this pls.
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

logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 5/1/2011 10:34 AM (GMT -6)   
Hopefully the ladies will show up and share there experiences of being an advocate for the men in there lives who for whatever reason do not want to be or can not be. A doctor is not going to take the time to explain everythin to a 3rd party whatever the relationship. He may not even want to explain it to the pateint , " trust me sir ". You as an advocate then must find other avenues, which you have, in joining the forum. But we are not doctors and there are doctors that have this knowledge and will share it for the price of a book, buy it study it , We are trying to to answer the questions the best we can, you must help us by learning on your own from additional souces IMO the best is for your father to do this Im sure he has no cancer symyoms , other than shock depression which are real, but his involvement will lift him out of this. I t is probbably not as bad as either of you think. But I don't know.
reread all the posts and give out the information we are asking, the stats at the bottom of my post is a template for you to follow in anserwing these questions. Dear Laila this is not a scold, relax take it a step at a time and stay stong, this is probably harder for you than your father , he at least has a doc there he CAN ask wheter or not he does....
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

142
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Date Joined Jan 2010
Total Posts : 7084
   Posted 5/1/2011 11:43 AM (GMT -6)   
Logo,
 
You can either delete the extra post ( X button) or just edit out all the text -
 
 

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 5/1/2011 12:19 PM (GMT -6)   
Thanks 142, I gots to chill, this is frustrating me. she and her father are both in shock as we all were. Time and knowledge will help. Have a nice Sunday its still early morning here, just took a run, feel better about everything. Aloha
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

laila374
Regular Member


Date Joined Apr 2011
Total Posts : 78
   Posted 5/1/2011 12:30 PM (GMT -6)   
my father is not good at all with comptur, he is in a place where he can`t get too much information about PC, I felt so bad to know that he doesn`t know what to do or where to go, this is why i am trying to get help from you and anything you write to me i call him and say there is persons in your case and said that and that..

many thanks

mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 5/1/2011 1:37 PM (GMT -6)   
Hi Laila:
Where exactly is your father- Quebec? France? or in the US.
Many things can get lost or misunderstood in going from one language to another- you need to be careful in passing on advice.
You really need to talk to his doctor.
Good luck and stay in touch.
 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
Brachytherapy- May 19, 2009 -so far, so good.
 
  "There may come a day when the courage of men will fail, but it will not be this day."
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