Has anyone else had a high volume gleason 6? Positive margins with G6?
My prostate was (4.5cm length) x (3.6cm width) x (3.5cm thick), so total (56.7 cubic cm). I had 30% involvement, mostly in right side, focally in left. So I very likely had a big chunk of cancer just like your husband did. Mine was (3 + 4 = 7) but the gleason 4 part was very small. So probably very similar to your husband's prostate.
My one margin was 3mm at right lateral. My Epstein 2nd opinion scored margin at (3 + 3 = 6).
I went 5 years totally undetectable on uPSA. Then it showed as mid .020s in Feb 2017. Have been tracking my uPSA about
monthly, and recently it's been about
mid .030s, at about
2.5 years later. So something to watch, but not sure where mine will go in future. My theory is my gleason 6 margin bit of tissue is just sitting there, doing not much, and I hope I can just outlive it without further bother.
Your husband may have a similar outcome. You definitely need to get Epstein to score the positive margin. If that margin is all that remains of the bladder neck invasion, and it (the margin) is truly gleason 6, you may not need to do anything for a while, maybe forever. Even if it does grow and produce uPSA, that does not mean it will metastasize outside the (former) prostate area. It could (very likely) stay local. But you won't know for some time. You would be well advised to watch uPSA about
quarterly for the long haul, and be prepared to hit it with SRT if it does start getting out of control and uPSA really does spike up and up. If it does spike, or if at age 45 he just feels adjuvant SRT now is the way to go, your docs will likely agree on it.
Not sure about
your comment about
gleason 6 not supposed to invade outside prostate. Locally advanced and metastatic are not the same. Your husband may have had locally advanced PCa, but not metastatic. See this from the cited paper:
"Locally advanced prostate cancer has extended clinically beyond the prostatic capsule, with invasion of the pericapsular tissue, bladder neck, or seminal vesicles, but without lymph node involvement or distant metastases. It is referred to as T3–T4 N0 M0 prostatic cancer."https://www.sciencedirect.com/science/article/pii/s2214388215000259
And here is another publication that give you info about
Yes, get the Epstein ruling. Make sure Epstein provides the gleason at the one margin. And, of course, make sure this is the standard PCa cancer, and not the rare type that puts out low PSA even when growing wildly. It does seem odd about
his 1.9 PSA and minimal biopsy cores, then having such a large amount of PCa on path. But maybe just because he is young, and biopsies can miss a lot. So that's probably not an issue.
I think the first uPSA at <.01 is really, really good news, and hope the best for you both.
Jan '08-'11 PSAs 2.2 2.5 2.7 2.6, DREs-
Jan '12: PSA 3.6, DRE+
Jan '12: MRI inconclusive
Feb '12: PCaDx pT2a, 4/12+ (3 @ 3+3, 1 @ 4+3); 3% tot cores; bone scan-
Apr '12: RALP; 3+4=7; pT2c pN0 pMx; 30%; 3mm r lat margin of 3+3=6 so pT2+; EPE-; PNI+; 8 LN-; SV-
TRT 03/'14- uPSAs: <.015 til 02/17; mostly .020-.030 then .048 on 12/1/18; off TRT since 12/2018 and uPSA settling in mid .030s