Active Surveillance update

VascodaGama said:

Trust the results

Ira

I do not think that you need a 3rd opinion if the second comes from a reliable laboratory.

Surely the results indicate an increase in the Gleason which you should accept. It also provides a different aspect in volume/size but that would not influence the purposes of the results.
In any case, such does not mean that you should discontinue AS.

Having a DNA maping of your type of cancer cells is good if you can afford it. It will provide you with more info about the aggressivity of your cancer.

I would try to get as much info as I could with other markers even if you are already diagnosed with PCa.

Best regards.

VG

Ira,

You know so much more about AS and “markers” than I, so I will not try to answer your questions concerning those matters.  

From my understanding of the information that you put forward, you no longer have an indolent PCa (i.e. G7 with significant volume).  If the PCa is not indolent, why is the doctor recommending further AS?  I am sure there is a good answer to this question and that I just don’t see it; however, I would recommend another opinion.

Well the fish burgers are about to go on the grill, have a good 4th of July.

Best wishes and good luck! 

hopeful and optimistic said:

Some info and thoughts

Beau.......I hope that you enjoy the fish burgers.......I just had a great veggie burger.

This was just published in uro today. This study from Johns Hopkins expands the criteria to identify men eleigible for Active Surveillance

http://www.urotoday.com/Prostate-Cancer/expanded-criteria-to-identify-men-eligible-for-active-surveillance-of-low-risk-prostate-cancer-at-johns-hopkins-a-preliminary-analysis-abstract.html

Additionally , I came across an article, "Clues Found To Prostate Cancer Upgrading" in the April 2013 US Too Prostate Cancer Education and Support Hot Sheet that states that at Sunnybrook Health Science Center "Eligibility for AS required a biopsy Gleason score(GS)equal or less than 6 and a PSA level equal or less than 10ng/ml. For men older than 70, the criteria cosnsisted of a GS equal or less than 3+4 and a PSA level equal or less than 15ng/ml. Men had a repeat PSA every 3 months for 2 years and then every 6 months thereafter. Scheduled follow -up biopsies biopsies occurred after 1 year and then every 3 years until age 80."

Site: www.ustoo.org

 

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Not saying that I am not concerned with this increase to 3+=7....I am. I want as best a decision as possible to be made.

My knowledge is limited about which  markers will add to showing how aggressive my cancer is. Aside from PSA, about two years ago I had a PCA3 that was negative.I am interested in any thoughts about markers .

The original pathology was done at UCLA. My second opinion was from J. Epstein at Johns Hopkins. Both institutions with excellent reputations....since analyzing gleason scores are subjective, my guess is that the score is on the border of 3+3=6 and 3+4=7. It would be nice if each of these gleason scores were quantified, however I don't think that this is done. Vasco you are probably right, and I may as well accept the information that was provided.

 Any thoughts about my above question,

"In the MRI that was done, Lesion 3 (Central Mid gland) shows the longest diameter to be 1.5 cm. , I wonder if when considering a tumor ;  is size significant in making a treatment decision, and are the cores (M1 and M2) that were found to be positive reflective of the entire tumor?"

Thanks again

IRA

Dr. Strum (one of the authors of The Primer) uses other markers to access aggressivity. The higher or existence of any of the markers in sampling, the aggressive the cancer is. He opinions that Gleason score >9 PCa would secrete these biomarkers in higher values:
PAP (prostatic acid phosphatase)
CEA (Carcinoembryonic Antigen)
NSE (Neuron Specific Enolase)
CGA (Chromogranin A)
There is some explanation in the second edition of the Primer. My opinion is that these and any other marker or image study requires a base line to use for comparing, so that proper judgement is done. In your case at least these markers may provide a clue on the aggressivity at the first stage and a comparison from the second tests.

My GP doctor used PAP to test me annually for PCa, since I become 45 yo. The tests all were negative during the 5 year period but in 2000, when I was 50 yo, the first PSA taken (22.4 ng/ml) lead me to a biopsy and to the diagnosis of cancer. I regard this fact (low PAP and high PSA) for the type of cancer cells found in my gland (patterns of 2 and 3).
If the G pattern were higher, therefore more aggressive, the PAP would express itself higher.

A particular in your case is the bouncing PSA. Your latest comes at PSA=3.8 ng/ml lower than the ones done last year (in calendar reverse; 4.3/4.1/3.9/4.2/…….). Probably we could relate the volume of cancer to the jump in PSA. Theoretically you had in the beginning a medium PSA of 2.5 with 5% of core involvement in two out of twelve cores and now you have a medium of PSA 4.0 with 10% of core involvement in a three positive out of fifteen cores taken. This would be conclusive to a progressive case but not in regards to aggressivity.

Other “markers” for judgement is the PSA velocity, PSA density and PSADT. The thresholds for aggressivity established by many researchers are; PSAv =< 0.40 to <0.75 ng/mL/y {the o.40 is for young guys, the 0.75 is in PSA=4 to 10 group ( I think your case)}; PSAd =< 0.18 ng/mL/cm3 in positive cases and PSA level divided by prostate volume {measured as an ellipsoid with maximum length × width × height × 0.52}; PSADT =>3 year, respectively.

DNA profiling is new but very developed. Many genes have been identified to the aggressiveness and positiveness of prostate cancer. Though there are already several laboratories providing the test cheaply, only a few number of physicians can reliably interpret the results. If you decide that route for getting an “answer” you have to research for the best and try obtaining approval from your insurance.

My lay opinion regarding the shape or size of a tumour in treatment decision is that a fewer number of localized colonies may provide better outcomes. I believe that PCa may be caused by more than one defected gene and that the duplication of cells in the same line will create one tumour (cells glued together), meaning that other groups will form other tumours with other defected genes. Both are prostate cancers but they increase in size in two separate tumours which could be made of different Gleason patterns. This may justify the method used in genetics to access and distinguish between indolent and aggressive types.

1.5 cm in diameter is a large tumour. It can be seen in the MRI and I wonder about its location. You refer to “central mid” that could mean central zone of the gland. This is not the peripheral zone where most of cases occur. Cancers in the central zone are “deep” and in conventional biopsies are hard to find. M1 and M2 were targeted because they were seen. If smaller probably the 3T MRI would not detect them. The overall context is still the importance of the negative biopsies done in 2010 and 2011 and again the other 12 needles negative to cancer, this time, which leads to think that you are not confronting a micro metastatic type. It seems that you got a contained PCa case that could have equal results from any radical therapy. The side effects would make the difference.

I believe that you can still continue AS with the periodical testing. You know that I am not a doctor, so that you should investigate and get the opinions from recognized AS specialists.

There are other factors that you should care for apart of the veggie-burgers. Testosterone test and bone density is proper I young fellas of 70+.

I hope my opinion helps you in this delicate moment of your vigilance.

Best wishes.

VGama