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Post op Gleason Question

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Posted 6/22/2007 8:56 PM (GMT -8)
Hi Everyone, Hope everyone is doing well. Things are going better for me, I am almost completely in control of urinary control and feeling much better. I have a question about Gleason scores that maybe I'm just missing something here:

If biopsy gleason was 8 and post-op Gleason is 9 does this mean the cancer was more aggressive then originally thought? If the prostate is now gone and all cancer is gone with it, what difference does the Gleason 9 make now? The radiation doc wants to give me radiation due to Gleason 9 and positive margins but I don't understand why he would be concerened with the Gleason after surgery? My 2 post-op PSA's have been 0.02 which makes me think all the cancer is gone. Why would a Gleason score make a difference after surgery? I assume they upgraded it to a 9 when they looked at the prostate under a microscope but with the prostate now gone why would they be concerned about the gleason score?

Sorry for the rambling, but I am seeing a oncologist this week who also reccomends radiation due to positive margins and Gleason 9 and I would just like to better understand what they are basing the need for radiation on.

Again Thanks for all of your help and support.

Rick (aka anniea) 

Posted 6/23/2007 6:07 AM (GMT -8)
Rick (anniea)

Well Kiddo, so far so good. Your follow up PSA is looking good but that isn't all there is to it. Your Doc's are hoping that by hitting the cancer from all sides, it will be a cure for you. History says, with Gleasons 8-10, they have a very high incidence of recurrence. Now...there is an exception to every rule and you could be one of those....I hope and pray you are. We all have our Sunday hats on and praying for that.

The other reality is a positive margine/s. A posotive margine combined with a Gleason 9 is leading your Doc's to believe that by treating so aggressively they may be able to kill off any stray cells that could have been left behind. Since most low PSA cancers tend to remain in the prostate bed, the plan is to hit the cells where they live, assuming they are there. Radiation is sometimes combined with a year or so of hormone therapy but you make no mention of it in your post. Anything that is caught early is a bonus...the chance of cure climbs higher.

We wish you the very best,

Vickie / Paul
Posted 6/23/2007 9:07 AM (GMT -8)

I also had positive margins, but a lower Gleason. and am facing further treatments as well.  There have been two major studies showing that adjuvant radiation therapy after surgery when there are positive margins will lower the percentage of reoccurance.  Just Google "radiation therapy following prostate cancer surgery" and you can get to a bunch of information about this.  (Perhaps others in this forum have some exact internet addresses.)

While I've been thinking about starting adjuvant therapy since my doctor discussed it in March, now that my PSA is .08, that basically sealed the deal.  While I'm not fearful about the radiation, the hormones they advise to go along with it cause me some concern.  Some don't have hormones along with the radiation, while others show by studies that it helps.  That's what's so frustrating about prostate cancer - there are so many ways to handle it, with no one way that is best.  Just research, read the many good postings on this site, and listen to your doctors.  Then YOU get to make the decision

Posted 6/24/2007 5:19 AM (GMT -8)
Hi, Anniea/Rick. Ditto to Swim and Hawk above. We're on the cusp and I'm only throwing this out as an opinion. We were upgraded from a 6 to a 7 post-path. Had that been an 8, we likely would have pursued further treatment. Also, two PSAs later (post-surgery), we're still at less than 0.01. Had that been any higher, again, we would have pursued further treatment. Our chance of recurrence lies between 20% and 50%. We're taking the gamble of no further treatment at this time, but feel like we're living on the edge sometimes.

Just some things to think about.
Posted 6/24/2007 11:16 AM (GMT -8)
Anniea

The above answers to your question are excellent. Please get second and third opinions until you are comfortable and knowledgeable about your cancer.
I was in a similar situation. After surgery my
Gleason is 9. Biopsy was 10. I also have seminal vesicle involvement. With high gleason and margins you must know that this is an aggressive cancer that may respond better to multi-modal treatment similar to adjuvant EBRT I had.

ALL the Best,

Vet1
Posted 6/24/2007 9:00 PM (GMT -8)
Hi everyone!!
Thank you for your responses. It gives me more to think about.
I have been reading Dr. Sheldon Marks book "Prostate and cancer" I just read that positive margins aong the back wall of the prostate (posterior) are of more concern. Well I pulled out my pathlogy report and guess what? My positive margins are the (posterior) ones. Does anyone know why it would make a difference as to where the positive margins are? I really feel that I should wait for a rise in PSA before going for radiation but I don't know what I should do. The urologist says wait and the oncologist and radiation dr. say start radiation before the PSA rises for better treatment.
Posted 6/25/2007 7:14 AM (GMT -8)
Hi Anniea,
I've been mired with the same decisions but I did not hesitate. My post-op Gleason is 4+3. I had positive margins as well. The location of the positive margins was not a factor in my decisions as it twas clear that I have a high risk of recurrance. I am on HT and just started my third week of IMRT. I am doing Whole Pelvic Radiation Treatment (WPRT) on the advice of my clinical and radiation oncologists. There is a new study that suggests successful results are highly improved with this approach. See the link below.

http://med.stanford.edu/profiles/frdActionServlet?choiceId=showPublication&pubid=237079&fid=4348

You are a high risk patient for two reasons, your cancer has mestisized locally and the gleason is high grade cancer. I did not hesitate on ratiation with my Gleason 7, pos margins, pre op PSA 19.8, and stage pT3b. I am also considering chemo after the affects of the radiation wear off. (I was told I am a model radiation patient because after treatment I walk and stay active as opposed to being a "couch potato"). I also weighed the affects of HT against the risk of recurrance and went with that treatment as well. So far, so good. Time for another walk...

Tony
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