Any Gleason 8 or 9's out there?

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Devasted1
Regular Member


Date Joined Feb 2011
Total Posts : 494
   Posted 5/10/2011 11:30 AM (GMT -6)   
I just got my pathology back from my 4/27/11 RP and my Gleason Score got bumped from an eight to a nine. Cancer was found in my margins, seminal vessels and one peri-prostatic lymph node.
 
Has anyone who is out there on this site have a Gleason 8 or 9 and had a RP? If so, I would appreciate your experience, what your oncologists recommended for the next steps to take. after a RP.  I know I have to heal first before I start any future treatments. I would assume the most logical course would be to start HT in a couple of months along with IMRT, but I do not know. My surgeon is out of the country for another couple weeks so I have not had a chance to visit with him so I would appreciate any and all feedback, suggestions, experience with treatments, etc.
 
I know I have a much higher grade aggressive PC than most of you that post on this site, but there has to be a few on this site that have a similar high grade PC that can shed some insight for me. I have re-read Chapter 12 of Dr. Walsh's book on Advanced Prostate Cancer a couple of times since my RP and obviously thinking about the worst case, mortality, etc.
 
Thank you in advance for your comments.
Born July'`1959
DRE Positive
Biopsy 7 out of 12 Positive
Gleason 4+4 both sides
PSA Jan 2011 5.5
Diag. February 15, 2011
Participant in Provenge Study
RP April 27, 2011
Pathology: PC in 25% of Prostate
PC in the Margins
PC in the SeminalVessals
PC in a Peri Prostatic Lymph Node
Catheter in 13 Days

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/10/2011 11:42 AM (GMT -6)   
Admitedly, while that is not a good pathology report, the Gleason 8/9 guys here will be the first ones to tell you that its not a hopeless case or lost cause. There will be many things you can do to attack the cancer monster still, and some here, even with similar pathology, have been doing well for themselves. It may be more of a challenge, but there's lots of reason to be hopeful for you own case.

If you don't have one already, you definitely need to get referred to a great medical oncologist.

Good luck, and hanging in there, friend.

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

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 5/10/2011 11:46 AM (GMT -6)   
I am a G4+5. I have seminal vesticles and lymph nodes clear, but had EPE in multiple points, as well as multiple positive margins.
 
My pathology was such that I went straight to IGRT (no HT).
 
My IGRT thread is linked from my signature.
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 5/10/2011 11:51 AM (GMT -6)   
I am gleason 9 with distant lymph nodes positive. I had a surgery that was aborted due to the spread so I still have a prostate. I went through 2 years of ADT3 and now I am living life large. I bike, run, swim, and work 55 hours per week. The diagnosis is devastating of course however it is only a chapter in the book. It is up to you to write the finish. I chose to live. Feel free to write anytime as I will share all my experiences.

peace to you
Dale
I was 45 at diagnosis with PSA of 16.3
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. Scheduled to have a radical on July 11th, 2007, surgery was aborted when it was discovered it had spread to the lymph nodes.
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009.
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
PSA Sept of 2010 is .71
cancer in 4 of 6 cores
92%
80%
37%
28%

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 5/10/2011 11:54 AM (GMT -6)   
Yeah since 2002   G-7,8,9's two sets like that....would like to see them?

Post Edited (zufus) : 5/10/2011 2:05:18 PM (GMT-6)


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 5/10/2011 12:05 PM (GMT -6)   
Hello Devastated...Yeah, I remember that Gleason 9 phone call...

I too had surgery, knowing it was a 50-50 deal.. But I figured 50% chance for a "cure' was better than nothing..Well my PSA was "persistant", never went below 0.9 after surgery..Not a good sign....

For us Gleason 8+ guys, the treatment path is pretty much standard..Radiation as soon as you are ready for it (regardless of what your PSA does) combined with hormone therapy...You want to be as continent as possible BEFORE they start the radiation..

I did some research, found an aggressive Radiation Oncologist who had access to the latest Linac , a Varian Novalis RapidArc which can deliver a high dose safely..He put me on Eligard (a six month shot) and hit me with 72 Gy in 80 fractions, the same treatment plan that he would use for men getting radiation as their primary treatment...My PSA dropped to undetectable and my "T" level dropped to 6. It's a time will tell deal now...

You might gain some knowledge from reading this blog..Read the last 3 entries..

http://myprostatedoc.blogspot.com/
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

Putt
Regular Member


Date Joined Aug 2010
Total Posts : 154
   Posted 5/10/2011 12:06 PM (GMT -6)   
 
 
 
 
Here is an excellent site taylored to provide about anything you wish to know.                                       

http://www.yananow.org/

 

This address will take you to the experiences pages.

http://www.yananow.org/exp_data.php?desc=All

 

This is my PC story. 

http://www.yananow.org/Mentors/GP.htm

               
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3bc NO MO, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.42, 12/10 0.47. 4/11 0.60. Will start ADT3 after PSA reaches 1.2.

Oncas
Regular Member


Date Joined Jan 2009
Total Posts : 390
   Posted 5/10/2011 1:30 PM (GMT -6)   
Devastated,
 
Welcome to the board. I was bumped up to a Gleason 9(5+4) after surgery. Seminal vesicle invasion,positive margins and two positive nodes. Post surgery PSA was .6.  A prostascint scan couldn't find anything outside the bed so I opted for SRT nine months later.  Didn't drop the PSA and it's continuing to climb nine months later. I'm now at 2.3 but since my doubling time is over 12 months I have chosen not to begin hormone therapy yet. This may or may not be a wise decision but I am currently trying a number of supplements to slow the progression and buy some valuable time as I watch the progress of clinical trials.  Collect the best advice that you can and make your choices. Never consider for a moment that your situation is hopeless because it truly is not. Continue soliciting advice and moral support from the brothers on this board because this is a great gang of guys and they are weathered and wise. Best of luck.
 
Jim

Age 61
Northeastern Penna.
11/08/08 annual checkup (3 yrs late) PSA 8.04 from previously 2.7 in 11/05
1/23/09 biopsy 12 cores positive, 10 cores Gleason 7, 2 cores Gleason 8 70% tumor
2/06/09 cat +bone scans clean ..
3/26/09 RRP surgery Post op path .. upgraded to Gleason 9 (5+4), seminal vesicles involved, several positive margins, 2 of 9 lymph nodes positive.

80% involved
4/4/09 Dr. advising wait for significant rise in PSA and start hormonal treatment.

1st post op at 4 weeks PSA .6 urologist concerned

will retest in one month

8/15/09 bone and pelvic scans redone .. clean PSA .65

onc/radiologist recommending starting radiation treatments and 6 month shot of Lupron .. decided against this gameplan

9/11/09 consulting with med/onc today .. not impressed
My urologist now suggesting prostascint scan

Prostascint test done at U of Penna indicates cancer still confined to prostate bed.

PSA at .7
Gonna need a bigger boat .. found a good rad oncologist

10/21/09 Rad onc suggesting clinical trial of samarium 153 followed by IMRT

2/1/10 Samarium trial completed PSA 1.0

2/1/10 began IMRT 39 treatments 70 Gy

3/25/10 finished IMRT

4/28/10 PSA .93

7/23/10 PSA 1.2

duke68
Regular Member


Date Joined Mar 2007
Total Posts : 243
   Posted 5/10/2011 1:45 PM (GMT -6)   
Hi
 
You have received some excellent advice from the members here.
 
Please keep in mind as hard as it may be. There are many treatments for you.
I'm 4 1/2 yrs out with undetectable psa.
 
I'm updating the clinical trial i'm on friday.
 
Your next step is to knock it down with the radiation and at least ADT2.
 This is just my opinion you are the boss,and you make the decisions. :)
 
Best wishes
 
Gerry    
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

Post Edited (duke68) : 5/10/2011 12:54:06 PM (GMT-6)


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 5/10/2011 3:50 PM (GMT -6)   
I was Gleason 9 at biopsy, and downgraded to 8 after surgery. Because I was organ confined, and no lymph node involvement, I did not, and probably won't have radiation.

Currently my PSA is static at 0.4 but if it continues to rise, I expect HT will be in my future...
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but then rose to 0.4, doubling time 7 months
Following diet change, PSA static at 0.4...

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 5/10/2011 3:55 PM (GMT -6)   
I was 4+3 with a small amount of 5 at pathology, which I understand is supposed to "act" as an 8 or 9. My PSA just crept up to .05 after 18 months so we'll see what it does from here.

My neighbor was a 9 at surgery about 4 years ago and has been undetectable. In fact, at 75, his urologist told him not to bother with any more PSA tests.

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 5/10/2011 4:19 PM (GMT -6)   
Hang in there buddy I know it is a difficult blow to get this news. As you have already seen there are many a guy that got that same G score. I also know that there are many more that have not replied yet to you. Best of luck with your treatment. keep you head on straight and do your homework. Your in a wonderful place where you will get great advice and many suggestions. Now is the time to get educated about the PCa stuff. Do keep us informed. Don't hesitate to all all the questions. We have been there.

Cajun jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 5/10/2011 4:31 PM (GMT -6)   
I am a G8, Good pathology, but even so I had a BCR after 1 year and then SRT with HT. Chapter 12 of Walsh's book paints a pretty bleak senario for G8-10 with evidence of advanced or locally advanced desease. Check out Dr Myers book, Hormone Therapy and Diet. It gives a much more positive view about the effectiveness of HT.
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 RP March 2009
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes - tumor volume 9%, nerves spared, no negitive side effects.
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT .01, < .01

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 5/10/2011 4:32 PM (GMT -6)   
There is life after G 9. I have deferred SRT until significant rise in PSA. So far, so good.

In your case,with the Sv, and the lymph node, I would think that adjuvant radiation in 4 months will probably be advisable.

In my own case, I have not been shy about consulting multiple doctors to arrive at my decisions. One doctor, one opinion is a little risky in this game in my opinion.

Good luck, and keep us in the loop. Many of us guys have active emails in our sigs, if you want to take these discussions a little deeper.
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

Northfoot
Regular Member


Date Joined Mar 2011
Total Posts : 81
   Posted 5/10/2011 5:39 PM (GMT -6)   
I am Gleason 4+5. Had RP 1/08 and found out I had a positive margin and ECE, but no seminal vesicles or nodes involved. Undetectable for 2.5 years, then had an increase over 6 months to 0.08. As this was an increase for each of three tests, I chose to get SRT at that stage. First PSA only 13 days after completion (I know, too soon) but it had already decrease to 0.05. I am hoping that by my next test in June that my psa will go below detection. I won't lie. It is scary sometimes, but hopeful at others. Don't let yourself get too depressed, as you can't think clearly that way. Also, don't give up. Whether you choose adjuvant therapy or salvage therapy (if needed), you have to believe that you have many years ahead of you. Even at this stage for me, I am considering getting a midlife crisis used sports car (nothing expensive). Do your research, and best of luck to you.
Bill

howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 5/10/2011 6:01 PM (GMT -6)   
Devestated,
 
Don't be.
 
As you can see by my ststs i had a really bad pathology. I did do a clinical trial at COH which I think has helped me at least has prolonged the time be fore I have to if necessary go to HT. I am over 2 years out since DX and feel great. I do all the normal things golf, eliptical for exercise. I ahve not missed a dfay of work except for the week for RP.
 
FIGHT ON>
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.
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