Posted 12/7/2014 1:37 PM (GMT -6)
I've read the Harvard study, and my surgeon from JH also seemed to agree that gleason score doesn't change over time. Gleason scores are somewhat subjective, but a given pathologist presumably has his/her standard which doesn't change. Given that biopsies are only samples, I suspect that changes on subsequent biopsies are due to pure chance due to the location of the samples. I also suspect that higher risk pCa (gl 8-10), grows faster and therefore is easier to find on biopsy.
Just my humble opinion!
DOB January 1944 (age 70)
1981: prostatitis corrected with meds.
2000-2013 BPH treated with finasteride & tamsulosin; also hypogonadism treated with androgel.
PSA history: Nominal / Est. Adjustment for finasteride effect
11/2011 2.2 / 4.4
8/2012 2.7 / 5.4
2/2013 5.5/ 11.0
4/2013 6.1/ 12.2
5/2013 6.6/ 13.2 (testosterone level ~700)
11/2013 0.1/ na
1/2014 0.2/ na
4/2014 0.3/ na (testosterone level~ 350)
9/2014 undetectable na (testosterone level= 3)
12/2014 undetectable na (testosterone level <3)
6/2013 Trans rectal Bx. Dx: PCa Gleason 4+4=8 (Bostwick), 2nd opinion 4+5= 9(Johns Hopkins), 2/6 cores on right positive, 10% & 40%, DRE neg. (Stage PT1c)
7/2013 Bone scan and 1.5T pelvic MRI, negative for PCa
9/7/13 open RRP, Johns Hopkins, Ted Schaeffer MD PhD. No complications.
9/9/13 Pathology: 33G, Gleason 9, both nerves spared, SVI+, EPE+ and 4mm + margin at base (Gl7), 10 lymph nodes dissected, all negative for PCa (Stage upgraded to PT3bN0M0)
5/14/14 First Three month Lupron shot (22.5 mg.)
5/20/14 3T pelvic MRI to locate spot of BCR; negative for PCa
6/4-7/31/14 SRT: 38 sessions of IMRT/IGRT, total 68.2 Gy to prostate bed and area of + margin.
7/11/14 Started taking Megestrol Acetate for hot flashes and Flomax for urinary frequency as needed.
9/5/14 Second 3 month Lupron shot
12/5/14 Lupron discontinued; Started daily Cialis
Side Effects of treatments:
RRP: Incontinence: one pad per day for 13 weeks post op, none thereafter.
ED: some pre op due to meds., total ED post op. Tried Viagra and VED to no avail.
ADT: Weight gain, hot flashes, fatigue, joint and bone pain, constipation, diarrhea, urinary frequency, loss of libido, shrinkage of penis and scrotum.
SRT: None until about a week before the end, then diarrhea, anal pain, blood from internal hemorrhoids, fatigue. (Lasted for about one month after SRT was completed).