CSN Login
Members Online: 4

gleason 7 , 3 + 4 . T1C ,psa 9.6 and apparently contained...so what does it really mean?

beacon
Posts: 82
Joined: Apr 2009

gleason 7 , 3 + 4 . T1C , and apparently contained...so what does it really mean?

hi

a family member has just been diagnosed with prostate cancer, gleason 7 , 3+4 ,psa 9.6 and T1C.
the mass was too small to palpate, but a biopsy was taken because of rising psa over a period of time.

he has had a ct scan and was told the cancer is contained, and is reading the books given by his doctor,along with as much other info as possible to inform himself before the next step is taken.
we have also read alot of stuff, but i still have some questions, if any one would mind answering them!

- if the cancer is contained, and the prostate is surgically removed, does that mean thats it? you are cured?, or does it just mean that you appear to be cured, but the wait begins to see if microscopic cells may have escaped and waiting to spread elsewhere, but are just not evident at that point? can you ever be permanently cured of a gleason 7 cancer?

-is getting the prostate removed the best chance of a cure?
-can anyone tell me - if the prostate is removed, what is the statistical chance of longterm survival, and no recurrance. i asked my family member and they believed it was pretty uch a 100% cure if the cancer is contained and removed, but i am not so sure from what i have read..its all confusing...
is there anything else that he should know about/ do/ read???

obviously they are getting all sorts of advice at the moment, you would all imagine what thats like, and they want to make the best choice that they can, obviously...

i have read lots of posts here, but it is all a bit bamboozling at the moment. so i was hoping that someone else on the journey could help shed some light...
many thanks....

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

Beacon
Nobody can say those words of “cured”. But we can aspire for it as like the many guys that really have been many years without recurrence.
If the cancer can be “cut out” or “burned” totally then a cure is certain, but there is no guaranty from any treatment to assure such happening. It all depends if the cancer is totally contained which is impossible of knowing at the present. All is based on statistics.

A T1c has many treatment options. Your family member should be aware of the side effects of each one in detail (many are really nasty and permanent). Advice from good oncologists is the best way.

Gleason 7 classify his cancer in the mid aggressivity class, but the chronology of the PSA (velocity, doubling time, etc.) is very important for a final judgement. His diagnosis of PSA<10, Gleason <7 and T1 is within the “scale” for AS. This is the modality with the lesser side effects, nowadays chosen by the famous surgeon Dr. P. Walsh, if his cancer is of the “indolent” type. The PSA can explain better about his status.
To verify such possibility he should get a second opinion on the biopsy and pathologist report from a reliable laboratory (JH or Bostwick).

I hope this helps.

The best to you and your family.
VGama

beacon
Posts: 82
Joined: Apr 2009

thanks for your reply!

as far as i know, he has been having psa tests for ages...
it rose a little over time, and for some reason the doctor said he wanted to keep an eye on it.
i believe his psa had always been around 4 and for some reason,he's not sure, but maybe it had raised a little from the last time, so the doctor said he wanted him back in before the usual year to check it, and thats when they discovered the psa had jumped to what it is now...( i thought it was 9.6 but my husband thinks it is 9.1)that sounds rather active doesn't it?

could you please clarify in simpler terms what you were saying in this paragraph below...sorry, i am very familiar with other types of cancer etc, but don't know much about prostate cancer:

"Gleason 7 classify his cancer in the mid aggressivity class, but the chronology of the PSA (velocity, doubling time, etc.) is very important for a final judgement. His diagnosis of PSA<10, Gleason <7 and T1 is within the “scale” for AS. This is the modality with the lesser side effects, nowadays chosen by the famous surgeon Dr. P. Walsh, if his cancer is of the “indolent” type. The PSA can explain better about his status.
To verify such possibility he should get a second opinion on the biopsy and pathologist report from a reliable laboratory (JH or Bostwick)."

-what do you mean by "AS" ? would you mean active surveillance??? the specialist told him that had he not discovered the cancer ,he would surely know about its prescence within 8 years, which leads me to assume that if he did nothing, his life would be cut short by it..
he is a young 65 yrs ...

- he lives in australia....just mentioning because i guess the labs you suggested were american? how does he go about getting a 2nd opinion from another lab? how do you find out the best place to do that?

thanks for your time!

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

Vascodagama is insightful with his comments and advice. The doubling time is how long it takes for the PSA to double in it's reading hence go from 4 to 8 and then to 16. That time it takes is the key to knowing the agressiveness of the cancer. Additionally, the way the gleason is reported is important...since it's a 3 + 4 then that means the bulk of cancer identified in the biopsy is a 3 as it's listed first which is not overly agressive as 4 is more aggressive and a 5 is very agressive. Your 65 year old friend has much to consider and Vascodagama's comment on the side affects is a critical consideration that needs to be sorted out personally. There are many options with Cyberknife, Rad, Proton beam, Surgery etc. It is always good to get a second opinion from a lab....your current doc should not hesitate to send the samples to another lab of your choice...if he/she does then you should look for another doctor. Bostwick is one of it not the authority on reading biopsy samples in prostate as that is all they read and concentrate on.

I would like to caution however...a biopsey is not end all and 100% foolproof accurate..as was the case in mine. I had 8 samples taken (small prostate only 23 grams or maybe 17 can't remember) they found cancer in only the right lobe...where a papable tumor was detected in a DRE. After removal the post op report determined the cancer was in both sides and only 1mm from breaking out of the capsle and becoming a completely different beast with fewer treatment options and much harder win the fight against.

My advice is to seek other opinions...read as much as you can about ALL treatment options...weigh all the pro's and con's of each and then make a personally informed decision as to the treatment path based on what your life's needs and desires are.

Here is my path and I don't regret one minute on choosing it.

Da Vinci Surgery on 12/29/09 Here are my stats and path taken:

52 years old at time of Surgery
PSA 9/09 7.25
PSA 10/09 6.125
Diagnosis confirmed Oct 27, 2009
8 Needle Biopsy = 5 clear , 3 postive
<20%, 10%, 10%
Gleason Score (3+3) 6 in all positive cores

11/09 Second Opinion on Biopsy slides from Dr. Koch
(4+3) = 7 5%
(3+4) = 7 10%
(3+4) = 7 10%

Endorectol MRI with Coil - Indicated the Palpal tumor was Organ confined

Da Vinci performed 12/29/09 - Dr. Hollensbee & Scott
Sling installed at time of Da Vinci – not sure what name of it is but not the 800 that is causing all the problems. Attached to Coopers Ligament.

Post Surgery Pathology:
Prostate size 5 x 4 x 3.5 cm Weight: 27 g
Gleason: Changed to (3+4) = 7
Primary Pattern 3, 80%
Secondary Pattern 4, 18%
Tertiary Pattern 5, 2%
Tumor Quantitation:
Greatest Dimension, Largest tumor focus: 19 mm
Additional Dimension 18 x 15 mm
Location, largest tumor focus: Right posterior quadrant
Multifocality: Yes
Greatest dimension second largest focus 10 mm
Location: second largest focus: Left Posterior quadrant
Extraprostatic extension: Yes
If yes, focal or non-focal: Nonfocal
If yes: location(s) right and left antero-lateral
Seminal vesicle invasion: No
Cancer at surgical margin: No
If no, closest distance with location: less than 1 mm, right posterior quadrant
Apex involvement: No
Bladder involvement: NO
Lymph-vascular invasion: No
Perineural invasion: Yes
Lymph nodes: 9 from right pelvic 0/9 positive
Stage: pT3a, pNo, pMX
All nerves sparred - found two additional pudendal arteries

FIRST PSA TEST 2-11-10 <0.1 NON-DETECTABLE

Virtually Pad free 2-20-10

SECOND PSA TEST 5-26-10 <0.1 NON-DETECTABLE

THIRD PSA TEST Must have missed posting this....it was NON-DETECTABLE

FOURTH PSA TEST 1-20-11 <0.1 NON_DECTECTABLE

Notes on Recovery: Was at my desk working (from home office – sales) 6 days following my surgery. No pain to speak of (very lucky as many have some pain) I think because I took the Tramadol they gave religiously and found it to be the best drug in the world. BM’s where the trickiest part and most uncomfortable in the early stages but improved with time – follow the diet they give you!...I strayed off and the next BM helped to get me back on track – I like food very hot and spicy - don’t recommend that for at least a month following surgery. Cream soups, mushroom, celery, and chicken worked great the first week following surgery. Mashed Potatoes…Ah the first time following surgery it was heaven!...the first really solid food I ate…..you will learn to appreciate food all over again as you add back your favorites following surgery when the time is right. Take all the help from everyone around you…it might be a while you get that opportunity again to be waited on hand and foot. Liquids are a concern but some affect people differently it seems reading through the discussion board…I found anything carbonated would cause much leaking…alcohol was not good either…but I justified doing it thinking It’s my training method to work on my bladder control!...lol I love homebrewed beers too much! And am an admitted hop head.

ED path:
Early on started on Viagra 100mg pills cut into 4ths so 25mg per day dose then a full 100mg on every 7th day.
Also bought pump and used sporadically to get blood flow to member. Within about three weeks or 5 weeks from surgery (cannot remember but probably posted on CSN somewhere) had usable erections.

Currently only need ¼ pill to get usable . Day 150 am starting to get semi hard without any drug.

Randy in Indy

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Beacon,

Your family member has much to consider as he begins his battle with prostate cancer. When we are first diagnosed we often tend to look at this disease in terms of black and white...is the cancer contained or not contained, is it aggressive or indolent, will we see a recurrence or not, and which course of treatment is best to follow to address the cancer? What treatment will "cure" the cancer?

Unfortunately, there are few black and whites but many, many shades of gray. A Gleason score of 3+4=7 is typically less worrisome than a Gleason 4+3, but they both add up to a score of 7. A Gleason score is a subjective evaluation by the pathologist reading the biopsy slide as to the degree of differentiation of the among the cancer cells in the positive core on a scale of 1 to 10, the higher the number the more poorly differentiated (worse) the grade. The first number represents the most prevelant number of cells and the second indicates the second most prevelant number of cells. A staging of T1c only means that the cancer was discovered through a rising PSA score and that the digital rectal examination failed to show any lumps, bumps, or hardness that might indicate a cancer nodule.

Much depends on the skill and experience of the pathologist in reading the biopsy slide which is why it is often recommended that patients seek a second opinion on the reading. The biopsy resuslts are also dependent upon the number of cores taken. For example, if it was a six core biopsy there is much less chance of detecting cancer throughout the prostate than say a 12 or 18 core sample. A 3+4 sample in one part of the prostate does not rule out a more aggressive degree of cancer in another part of the prostate. It might mean that they found the most aggressive cancer or then again, it might mean they simply missed it when the biopsy was taken. A typical biopsy only samples about 1% of the total prostate volume. This is why second opinions are so important with biopsy samples.

As Vasco suggested, other factors come into play as well. The PSA velocity, or how quickly the PSA score is rising, is another method of determining the aggressiveness of the cancer. It is not a straight line but rather a logarithmic relationship. The higher the velocity, the faster the cancer is growing. Other parameters that give doctors insight include PSA doubling time (how long it takes the PSA score to double) and PSA density (the ration of PSA to prostate volume). There are nomograms available on the web that enable you to calculate these scores if you have a good history of PSA scores and know your prostate volume which should have been measured during the ultrasound.

It is impossible to predict with certainty which treatment will be most efficient in addressing the cancer and again, there is no black and white answer here. Each potential treatment carries the possibility of adverse side effects that will affect the patient for the rest of his life. Some treatments have potentially more severe side effects than others. This makes a treatment decision a highly personal choice and should be a function of the desired quality of life following treatment. Your family member should carefully consider the side effects of each treatment course and weigh them against the desired quality of life. This typically takes a lot of research and consultations with multiple experts in different specialties such as open surgery, robotic surgery, and the several types of radiation available for treatment, as well as the possibility of using hormone treatments to lower testosterone levels that will slow the cancer growth. There are other treatments that involve cryosurgery (freezing of the prostate), high frequency ultrasound, and so forth. Depending on the pathology and side desired quality of life, there are not black and white (or right or wrong) answers about which is best.

Other factors that affect treatment are things like health, size of the prostate, age, and other conditions. For example, a 65-year old man with a history of heart conditions may not be a good candidate for the major surgery required to remove the prostate. Very enlarged prostates are harder to remove surgically, or radiate effectively without increasing potential damage to other tissue and organs outside the prostate. Men with a history of sexual dysfunction or urinary issues will most likely see these conditions grow more severe following some types of treatment. In virtually all cases, some decrease in sexual capability is likely regardless of treatment which is why a realistic assessment of quality of life after treatment is so important.

Statistics show that about a third of the men who have surgery see a recurrence of prostate cancer within five years. If radiation is chosesn and depending on the type of treatment used, varying percentages of men see a recurrence here as well. Much of this depends upon the stage of the cancer at the time of treatment, the age of the man, overall health, body mass, and so forth.

Many experts feel that despite what a MRI or CT scan might reveal, microscopic amounts of cancer are fully capable of spreading throughout the lymph system or blood stream despite an initial determination that the “cancer is contained within the prostate.” Depending on the choice of treatment, the very act of treatment may encourage the growth of cancer beyond the prostate, particularly if the cancer is growing at or very near the edges of the prostate capsule.

I wish there were black and white answers to your questions but that just isn’t the way this cancer works. Your family member needs lots of support at this point as he gathers information and determines which course of action to take. I hope that you encourage him to seek multiple opinions about his choices and that he doggedly pursue a precise understanding of the potential side effect s from what each specialist will recommend. A frustrating factor in all of this is that many experts will give you widely varying answers to what is the best course to follow. At the end of the day, this is a decision only your family member can decide.

Best of luck to your family.

K

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

AS always you completely cover the entire gambit with thoughtful and realistic insights!

Hope all is well with work and family!

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Hi, Randy. All is well on all fronts. Hope the same is well with you and yours.

Best,

K

davidp46
Posts: 11
Joined: Mar 2011

I'm not sure of the rules for these forums. I just joined today, and I'm very glad to have found this site. I picked up some stuff today from the last 65 days: Prostate MRI imaging, CT imaging, Bone scan imaging, Biopsy report, Bone scan report, and CT scan report. While I've spent much time reading internet material about PCa, most of these technical reports are beyond me.

My immediate concern is how to decipher the biopsy report. While I've had three prior biopsies, they found no cancer so I never asked for a copy of those reports. The latest biopsy was done after getting a Prostate MRI in which the radiologist identified 2 "areas of concern" in the imaging. Happily (for me) he assisted the urologist doing the biopsy by confirming the location of the biopsy gun to concur with the MRI. 31 cores plus 20+fragments went to the pathologist, taken from 8 locations all on the right side of the prostate: Right Mid 1 through Right Mid 4, and Right Apex 1 through Right Apex. I presume that the middle "third" and the apex "third of the right side of the prostate was subdivided into 4 zones/areas and that is was these location reference pertain to. Is this the case???

The first area/zone report is as follows:

A: Right Mid 1: Prostatic adenocarcinoma, Gleason score 8 (4+4), 6mm focus, involving 1 of 3 biopsy cores, and representing 10% of the biopsy cores.

Similar reports using the same format follow for all 8 zones.

The specific items that confuse me are "6 mm focus", "... 1 of 3 biopsy cores",
and "... 10% of the biopsy scores".

Any help decoding the specific meaning of this report format is appreciated.

Sorry if this forum is not the correct venue for this question. If there is a better location for test report questions, please advise.

Thanks for any assist.

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

David
Your view is correct in interpreting the “zones”. “6 mm focus” refer to the length in the core that a Gleason pattern of 4 was identified.
I would suggest you to start your own thread in regards to your question. You probably will receive more opinions from survivors in this forum.
Wishing you the best.
VGama

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

Your post is clear and concise. I wonder when you will write a book on your case and experiences. I would buy one.

VG

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

You are lucky if your cancer has not spread and with radiation or surgery you should be pretty certain to be able to prevent a bad outcome. My cancer had already spread and all I could do was the radiation. It did kill all the cancer in my prostate and I was Gleason 9. This was confirmed by a second biopsy several years later. I have survived over 7 years with psa 24 and gleason 9. I am now in hospice care but am still working and able to play golf. I do not let it stop me. I take the 50 or 60 pills a day to maintain and just push through the pain.

There is no sure cure out there and taking one treatment over another has no real benefit as far as survival goes. So you choose the treatment you prefer taking into account the side effects. I will say that the radiation had no bad side effects on me and like I said it did kill all the cancer it was intended to kill. No treatment will cure after it spreads and taking treatment after it spreads is a waste of time and money in my opinion. I have had no more treatment and have outlived 95% of the men who took further treatment.

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

You are lucky if your cancer has not spread and with radiation or surgery you should be pretty certain to be able to prevent a bad outcome. My cancer had already spread and all I could do was the radiation. It did kill all the cancer in my prostate and I was Gleason 9. This was confirmed by a second biopsy several years later. I have survived over 7 years with psa 24 and gleason 9. I am now in hospice care but am still working and able to play golf. I do not let it stop me. I take the 50 or 60 pills a day to maintain and just push through the pain.

There is no sure cure out there and taking one treatment over another has no real benefit as far as survival goes. So you choose the treatment you prefer taking into account the side effects. I will say that the radiation had no bad side effects on me and like I said it did kill all the cancer it was intended to kill. No treatment will cure after it spreads and taking treatment after it spreads is a waste of time and money in my opinion. I have had no more treatment and have outlived 95% of the men who took further treatment.

rstopps's picture
rstopps
Posts: 10
Joined: Dec 2010

When I was diagnossed with prostate cancer my Urologist recommended the book by the famous Dr. Walsh called "The Guide to Surviving Prostate Cancer" it is an easy to read book that discusses prostate cancer, most of the treatments available (including side effects), and long term survivability.

VascodaGama's picture
VascodaGama
Posts: 1508
Joined: Nov 2010

Beacon,

You are welcome. I am sorry for the short summary in my answer to your first post.
Survivors above have given you their opinions to help you in understanding the ups&downs of this disease. Their examples are unique to their case and conditions vary among patients. No one case is equal to another. You can take us as examples that could be similar to your friend’s case.

AS means active surveillance also known as Watchful Waiting. In these sites you can read what it entails. The NCCN which guides prostate cancer practices around the world (standards for treatment) have AS included in their recommendations too;
http://www.medscape.com/viewarticle/715129
http://www.usrf.org/news/WW_for_CaP/wwmain.html

Your family member has been WW before he committed to biopsy (follow progress of PSA). In AS he could go through palliative treatments like hormonal therapy or immunological therapy just to control cancers’ progress, which is recommended in case of patients with other health problems, or just because one wouldn’t like to confront the side effects from therapies.

PSA 9.4 or 9.1 could be from a slow active cancer too. It is not the number but the doubling in short periods (smaller than 6 months) that indicates high “activity”. The intervals of the tests (dates) are therefore also important to know to calculate the risk. His doctors’ comment of “8 years” was not with the meaning of “death”. I believe he was referring to symptoms your family member would probably notice when cancer metastasis to the bone (usually at hip) and becomes painful.
Please do not be anxious. I am a survivor of ten years, confronted two major treatments and now I am on my continuous protocol in the fight against the bandit. Your friend will do well too and survive the problem. He needs to educate himself about the disease and he should look for some doctor he trust to receive advice. Surgeons will imply surgery as well as radiologists will imply radiation therapy. The best comes from a doctor away from bias.

There is an Australian site named “You Are Not Alone” (YANA) dedicated to survivors of prostate cancer with hundreds of case history which you could recommend to your friend to read. Cases are listed by age (65) and diagnosis (Gs 7, PSA=9, etc). Here it is ; http://www.yananow.org/homepage_links.html

You may inquire at your local hospital for a reliable pathologists Laboratory in Australia. His doctor could send the biopsy samples or your friend can send it by courier.
Diet and physical exercises (fitness) are important factors in the recovery from treatments.

Hope you find what you are looking for. Keep questioning and guys here will pass you their opinions.

Take care
VGama

beacon
Posts: 82
Joined: Apr 2009

thank you all for taking the time to reply with all this information!

it is invaluable for those that are just starting on the path,and i will encourage my family member to come and read this thread, and also to consider discussing his ideas for treatment options with those that have actually experienced them.

i think he has around 7 weeks to decide before they will remove his prostate, which is what the doctor has recommended so far...
its not much time to decide and gather information...but he is reading as much info as he can, including to begin, dr walshs' book.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I have compiled this list from all those on here over my time that indicated value in the material.

Recommend-Guide to Surviving Prostate Cancer-Second Edition
Dr Patrick Walsh
Recommend-The First Year Prostate Cancer-An Essential Guide for the Newly Diagnosed
Chris Lukas
Recommend-Saving Your Sex Life-A guide for Men with Prostate Cancer
Dr. John Mulhall
Prostate Cancer Meet The Proton Beam-Apatient's Experience
Fuller Jones
Recommend-You Can Beat Protate Cancer and you do nto need surgery to do it
Robert J. Marckini
Recommend-Surviving Protate Cancer without Surgery-The New Gold Standard that save your life and life style
Dr Michael J. Dattoli
Conquer Prostate Cancer
Rabbi Ed Weinsberg
Recommend-Eat to Beat Prostate Cancer Cookbook
Ricketts
Page with Free Guides to Prostate Cancer and Exercise and Nutrition
http://www.pcf.org/site/c.leJRIROrEpH/b.5814067/k.C966/Guides.htm

Comprehensive Book list on Prostate Cancer - http://www.wellnessbooks.com/bookstore/

http://www.havasupaitribe.com/waterfalls.html

Studies:

http://www.nytimes.com/2010/02/14/health/14robot.html

http://nyp.org/news/hospital/robotic-prostate-surgery-study.html

http://news.yahoo.com/s/nm/20100512/hl_nm/us_prostate_cancer

http://www.urmc.rochester.edu/news/story/index.cfm?id=2868

Randy in Indy

Subscribe with RSS
About Cancer Society

The content on this site is for informational purposes only. It is not a substitute for professional medical advice. Do not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.

Copyright 2000-2014 © Cancer Survivors Network