how does gleason 10 aggressiveness compare with other cancers/

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logoslidat
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Date Joined Sep 2009
Total Posts : 6079
   Posted 5/18/2011 2:35 PM (GMT -6)   
Trying to get a comparison of how most aggressive PCA compares with other types, pancreatic lung, breast ,et al. In other words is an aggressive PCA cancer still relatively slow compared to the " normal cancers " , loaded word, but u know what i mean.
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

Sleepless09
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Date Joined Jul 2009
Total Posts : 1267
   Posted 5/18/2011 2:59 PM (GMT -6)   
Hi Logo,

First, not sure I'm going to make Maui this summer --- the heat is rolling over the prairies and I'm anxious to get to the cottage. But, I'll not visit without warning you!

Second, interesting question.

I had a brother-in-law die of pancreatic cancer, and a few weeks ago a dear friend died of ovarian cancer. Two "bad" cancers. The problem with them is that when they present the cancer is already well established and the unlucky person is likely in their last days already. I don't think the issue is Gleason 10 compared to these sorts of cancers. The issue is when is a Gleason 10 diagnosed, compared to whatever other cancer you want to compare to. Granted, some cancers spread faster than others and do terminal damage quicker. And, granted, PCa may be one of the statistically less awful ones, but I don't think it's possible to compare one cancer to another --- except they are all awful.

Others may well have a different, and better, understanding.

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
  

Squirm
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Date Joined Sep 2008
Total Posts : 744
   Posted 5/18/2011 3:07 PM (GMT -6)   
Ovarian, pancreatic, esophagus, lung and various others are usually found late and such could have already metastasized and even caused symptoms. This referred to as staging.

Prostate cancer, thanks to the PSA testing can be found relatively early. The hope is newer diagnostic testing can detect prostate cancer earlier while it is still confined to the prostate. Gleason 10 indicates a aggressive tumor, meaning it grows rapidly and is undifferentiated and has a higher chance that it has escaped the capsule. This is referred to as grading. All cancers have a grade scale (as far as I know).

But the staging and grading are not mutually exclusive in my opinion. Catalona stated that delaying treatment could risk prostate cancer cells to mutate and therefore become more aggressive.

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 5/18/2011 3:09 PM (GMT -6)   
Few cancers compare to pancreatic and liver cancers. When they are advanced there is little that can be done.

This is not the case with Gleason 10 prostate cancer. However that stated, G10 prostate cancer is very serious and it can progress rapidly. I have seen cases respond to therapy come by here (Smilingoldcoot is doing well on the cancer front but has had some challenges elsewhere - he is at 3 years post HT, seeds, and proton therapy)

Breast cancer and prostate cancer have closer similarities that G10 may be the same. However I know many men that have grade 5 cells survive for well over ten years.

Tony
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 5/18/2011 3:35 PM (GMT -6)   
Not to change the subject, but I think a better question is how does Gleason 10 compare to other Gleasons. I see so many charts lumping together Gleason 8,9, and 10. Does this mean there is no difference as far as prognosis, or they didn't have enough numbers to separate out the cases? And what is the prognosis between a 10 and a 7?

However, to address your question, just as one data point I had a friend with esophageal cancer who looked fine when diagnosed but passed away 6 months later. I still say we could have a lot worse cancers, even with a perfect 10.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 and 19 month detectable .05.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 5/18/2011 3:59 PM (GMT -6)   
Logo- you wouldn't believe the spectrum in PCa's the worst case I know of is with 'small cell PCa' the guys wife posted on a forum he was just diagnosed (probably late with bone pains and such), well he died in between week 2 and 3 thereafter even under some docs care (not sure of his protocols). Her second post on the forum was informing us of his death....saddest case I ever heard of. Small cell has a very risky prognosis, some drugs or chemos don't even respond to it.

Others that are crazy to some degree in PCa variants: squamous cell, signet ring and another one I can't think of right now. Most people have acinar adenocarcinoma which is the better news, I suppose. The variants are rarer.

PCa is not just one variety, to many variables, DNA ploidy, variants, missed biopsy areas that can harbor a different Gleason score, too. Wild n crazy to say the least.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/18/2011 5:49 PM (GMT -6)   
zufus, was just going to invoke your might name, when i saw your post. look at our own group here at hw, we have several gleason 9 guys and gleason 8 guys that are doing remarkably well for themselves, despite having poor pathology on paper.

with gleason 7's, you never know what you are going to get, i notice we have a lot of gleason 7 guys with recurrance,

i was downgraded at pathology to a 3+4 instead of a 4+3 ( i am still not convinced it is correct), and yet my cancer has been blowing right through treatments in no time.

made me think of you, zufus, and the many vairants of PC that you often mention. i will be bringing this up to my new medical oncologist in a week.

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

John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 5/18/2011 6:24 PM (GMT -6)   
It depends on how fast the cancer is growing. Lung and pancreatic double in a matter of weeks as most prostate cancers double in years. The very agressive types double in months. It takes 44 doubling for any cancer to go from cell stage to complete invasion of the organs. So the speed in which it is doubling is a good indicator of how long you have.
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/18/2011 6:30 PM (GMT -6)   
John, have heard you cite the 44 doublings before in your posts, interesting, but what is your source?
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

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/18/2011 7:48 PM (GMT -6)   
It's math (from a post I made last September):

"If you say that cancer begins with a single cell that doubles every year, it would take 40 years for the cancer to get over a kilogram (100, 000, 000, 000 cells). Who knows if that's true. It could be that PCa arises from multiple cells, or that as it grows, more malignant clones of cells arise and the doubling time increases. "

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3994
   Posted 5/18/2011 7:51 PM (GMT -6)   
>>with gleason 7's, you never know what you are going to get, i notice we have a lot of gleason 7 guys with recurrance,<<
 
i've noticed that too.  i've always figured that many were gleason 6 before surgery or they didn't receive adjuvant treatment.
 
ed
 

 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 5/18/2011 8:11 PM (GMT -6)   
Postoperative, your 44 doublings is roughly validated in this paper (for breast cancer) that mentions 30 doublings for conventional detection and an additional 10 for fatality.
http://www.biomath.ucla.edu/vsavage/guiot.pdf

Of course, the doubling rate depends on cancer type, and isn't uniform over time, but around 40 doublings seem to be the critical mass.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 and 19 month detectable .05.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 5/18/2011 8:18 PM (GMT -6)   
sounds like a rule of thumb rather than a fact
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

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/18/2011 8:25 PM (GMT -6)   
I just worked it out by looking up the weight of a cell, and guessing out that a kilogram of tumor cells, showing up in lumps in the wrong places in your body would kill you. The rest is arithmetic--2 to the 40th power x the weight of a cell = 1 kg, so 40 doublings is lethal. Glad to know that that there is an actual study that comes up with about the same answer, and that I wasn't just making a wild guess. The main point is that it means that for most of the "life" of a cancer, it is too small to cause symptoms. It's only a few doublings from symptoms to death, unless something is done to either slow the doubling time or kill off a large fraction of the cancer cells.

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 5/18/2011 8:37 PM (GMT -6)   
Here's another article on doublings
http://www.gyncancer.com/what-is.html
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 and 19 month detectable .05.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/18/2011 8:48 PM (GMT -6)   
David,
I heard it from Dr Scholz. If anyone would know a trained mdeical oncologist should. In prostate cancer doubling time usually remains constant as it is genetic to the cell type.
JT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 5/18/2011 9:04 PM (GMT -6)   
Thanks gentlemen all. I ask and use a 10 cause it is most aggressive and was concerned for packfan11, no 10 there,just trying to get a handle on " aggressiveness " generally, plus it has always been in the back of my mind. They say PCA is The " slow cancer but how slow is slow, lidat. Not sure of the grading part with other cancers, just dont know. John T indicated even a aggressive PCA cancer appears to be slower than others,but this is i the adencancer, big spelling thing, hope you get it tho. The varients and ploidy, which I have zero handle on, for sure changes everything, I think. I thank you all individually in a collective way, I know, I stay lazy.

Sleepless, Yeh let me know when you ever come, green bottles, maybe paddleboarding, you can do it , Im a good teacher, learning curve is low, cept for the surfing part, but you no need do that, if no like. As we say here, If can, can, if no can, no can! Aloha all! Logo
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

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 487
   Posted 5/18/2011 9:11 PM (GMT -6)   
FWIW, my uro pointed out to me that a 4+3=7 is 3 times more aggressive than a 3+4=7. As a g9, that did not make me feel better.

K
Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg, Ves neg
tumor contained, still 4+5=9
pni ext.
9/3, 2010 PSA - 0.04
9/3/2010, I'm 99% continent
10/14/10, PSA still 0.04, and lupron #1, now 99.9% continent
Total ED, 3 caverject failed
10/20/10 OD'd .5cc trimix, after 3hrs, neo synephrine shot
tried .15 & .17 cc neg, next .2

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/19/2011 12:26 AM (GMT -6)   
The article that reachout found, www.gyncancer.com/what-is.html says that 30 doublings gives you the smallest tumor you can detect (0.25 inches in diameter, the size of a pea), and that 40 doublings gives you a lethal tumor. That gives you 10 doubling times to treat the cancer. It's hard to believe that you could detect a prostate cancer that small with a biopsy, so it may be more like 8 doublings.

The growth rate of most prostate cancer is dependent on hormones, so ADT must increase the doubling time. But HT reduces the PSA, so the cells must also actually die and go away, but HT fails if some cancer cells are not hormone dependent and keep on growing.

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 5/19/2011 12:43 AM (GMT -6)   
The best treatment for cancer is early detection and aggressive treatment.  Both of my cancers are stage 2 and both are in remission as the result.  PSA tests and chest xrays (for COPD) did the detecting and surgery/chemo did the treatment.
 
Jim
Age 76. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06. Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
50 mg Viagra + .05 cc Trimix = Excellent Results
PSAs from 1/3/07 - 8/02/2010 zero.
Next PSA - July/2011
Lung cancer dxed 6/08. Surgery followed by chemo. In remission since.

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6079
   Posted 5/19/2011 12:59 AM (GMT -6)   
Growth rate is dependent on gleason grade,and testosterone, Adt/ hT reduces T, I believe, hence reduces cancer cell except hormone resistance ones at some point, they are the ones that will cause problems.
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

reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 5/19/2011 7:14 AM (GMT -6)   
PostOp, although that article confirms the idea of roughly 40 doublings to lethal cancer, I'd be careful about applying specific details to PC. The article says "The smallest cancer that can be detected by examination, x-ray or scan is a little less than one fourth inch in diameter," but I believe is referring to tumors found in OB-GYN examinations of women. With PSA, most early tumors are found through PSA and are presumably (though not necessarily) smaller. Also, I don't know if there's an equivalent to Gleason scoring for OB-GYN tumors, but with PSA many of the early tumors are lower grade and slower growing.

So even though the 40 doublings probably applies because it's just math, I don't think we can conclude that PC is identified after 30 doublings, it could be much earlier, and HT, etc, can slow the doubling rate so those last 10 could last a long time. Slow them down to 1 or 2 years and that's 10 or 20 years lifetime.
Age: 66
PSA: 7 tests over 2 years bounced around from 2.6 to 5.6
Biopsy 8 of 12 positive, Gleason 3+4, T2a
DaVinci August 2009, pathology Gleason 4+3, neg margins, T2c
Continent right away, ED
Viagra, Cialis did't work, Trimix works well
Post-surgery PSA:
3, month: undetectable <.1; 6 month: undetectable <.014 (ultrasensitive); 9, 12, 15 month: undetectable <.1; 18 and 19 month detectable .05.

Postop
Regular Member


Date Joined Feb 2010
Total Posts : 385
   Posted 5/19/2011 3:02 PM (GMT -6)   
Reachout,

I agree with a lot of what you've said, except that PSA alone is not enough to diagnosis prostate cancer, as many of us who've undergone multiple biopsies can attest to. I think that a cancer would have to be at least as big as a pea, if not bigger, to have a reasonable chance to get hit with a biopsy needle.

I agree that having 8 to 10 doubling times can be reassuring to most of us that have very long doubling times for our postoperative PSA readings. There is a lot of prostate cancer were the doubling is 3, 5 or more years, so a lot us can be comforted by multiplying 3 or 5 by 8 or 10. However, thinking about this can be nerve-wracking for those of us with short doubling times. Knowing that treatments like HT can change these statistics, and kill off tumor cells and maybe lengthen the doubling time is the main reassurance for those brothers.
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