CSN Login
Members Online: 11

PSA5.2 , gleason 7 , 3 + 4 . T1C ,

STC
Posts: 21
Joined: Jun 2011

A friend diagnosis PC , PSA5.2 , T1C ,55yrs old.

First biopsy test 10 cores was normal.

second biopsy test(2 cores are positive out of 10 cores):
one core needle biopsy gleason 3+4=7 tumor occupies appx 5% of the biopsy, no capsular penetration
the other core , for a minute focus of adenocarcioma composed of a few glands only,the focus occupies less than 1% of the biopsy.

I don't know if it's serious or not?
Can he be cured after surgery? or what's the best choice of treatment?

Thank you for your comments.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC

The info you posted about your friend is not sufficient to decide on a treatment. Gleason 7 (3+4) is of an intermediate risk in aggressivity but the volume of cancer is small judging from the biopsy results.
The chronology of PSAs, particularly the doubling time and the volume of the prostate gland, etc, are usually used to decide on the treatment. If the cancer is considered contained, both surgery and radiation have similar rates for success in cure. In case of metastasis, surgery is not recommended and radiation with adjuvant hormonal therapy is usually indicated. In cases similar to the status of your friend survival rates are high over the 20 year mark.

You should advice your friend about the side effects from treatment. Some are nasty and permanent, and some are of the type that one cannot live with it or without it. The choice also can influence the type of treatment. Just google “Treatment Side effects for Prostate Cancer”, to read details.

Wishing you both the best.
VGama

STC
Posts: 21
Joined: Jun 2011

Hi VascodaGama,

Thanks to your reply.

I got more detail pathology report as following,
Diagnosis PC , PSA5.3 , T1C ,55yrs old.

First biopsy test 10 cores was normal.
(only tiny focus of atypical glands suspicious for but not diagnostic of adenocarcinoma).

Second biopsy test(2 cores are positive out of 10 cores):

1. 1st core needle biopsy gleason 3+4=7 tumor occupies appx 5% of the biopsy, no capsular penetration, the core biopsy fragment measuring 1.5cm in length.

2. 2nd core , for a minute focus of adenocarcioma composed of a few glands only,the focus occupies less than 1% of the biopsy.the core biopsy fragment measuring 2cm in length.

His doctor told to him:
his prostate volume was 35ml,
DRE benign,
ALT and Alkaline Phosphatase was normal,
Whole body born scan Radiological consultation stated: NO focal lucent or selerotic bony lesions are demonstrated,
X-Ray check was normal.

He is likely to have a Davinci surgery 4 monthes after his 2nd biopsy, If the date of surgery arrangement is too late or not? BTW, He take Vitamim D3 2000IU and AHCC If it's helpful?

Can he be cured after surgery? or what's the best choice of treatment?

Thank you for your comments.

Best regards

STC

STC
Posts: 21
Joined: Jun 2011

Thanks Gama,
BTW, My friend also be diagnosis acute and chronic prostatitis with atypical change within the glands,
but he didn't take any medicine, He feel some cramping pain occasionally,his doctor didn't agree to give any prescription, I am worried if it will become more serious before his surgery,how can I help him?

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC
The info from the pathologist’s report is very positive for an indolent type of cancer. In my opinion all types of treatment would be successful in your friend’s case, and four months waiting is just fine. However, the agreement on the scheduled treatment should be flexible enough to allow for cancelation or changes of dates in case your friend decides for another treatment.
Do not rush.

Your friend may as well choose Watchful Waiting (AS) with the control of PSA (tests every two months for a period of six months) and check for PSA velocity and doubling time. If found that the cancer is aggressive he could then start the treatment which would add only two months on the schedule.

Meanwhile your friend could investigate about treatment choices, side effects, and places (facilities) where to get the treatment (surgeons for Davinci should have performed over 300 operations). He could also get second opinions from independent specialists in each type of treatment and consult about the "cramping pain", before committing.
I would advice you to read books on Pca to understand better its facts. I recommend A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh; which may help you understanding options and the treatments of surgery and radiation.

Hope my insight is of help.

VGama

hopeful and opt...
Posts: 1313
Joined: Apr 2009

is a moderately aggressive cancer, eventhough the amount of cancer found is very small....if your friend is relatively young, and has no other major physical problems, I think that Active Surveillance is not appropriate..what is the age of your friend?

Also historically I wonder what your friends PSA's have been .........what is the trend.

STC
Posts: 21
Joined: Jun 2011

Thanks to all of your reply,

His age is 55years old. Because his 2nd biopsy was in May, his PSA will test on early Jul.

Could I check how many operations the surgeons for Davinci have performed ?

Thanks again.

STC

STC
Posts: 21
Joined: Jun 2011

My friend checked his PSA, it's was a surprise,
his PSA down to 3.1,
PSA density=0.089.(Prostate volume was 35ml)

I don't know what he should do? RP or AS?

Another question.... because the PSA test result was from different lab , if it will cause such big difference?

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC

Surprising news but positive. I wonder what have your friend’s doctor commented in regards to the drop.
The difference of 40% down from 5.3 to 3.1 is big and it should be analyzed carefully. One possibility could be due to any supplement your friend start taking since your last post as you indicated (AHCC, etc). Some of those pills are known to include estrogen like compounds which act similarly to hormonal drugs, lowering the PSA fast.
There is also the possibility that the past PSA of May (5.3) have been “artificially” increased due to facts other than cancer. Sex the night before drawing blood or a hard stool or any manipulation in the prostate may cause an increase of the value of PSA.
You could ask your friend if he recalls the events he done at that time. Different values between different assays (different laboratories) exist but for small tolerances of 0.05. Rarely but sometimes guys report about laboratory "mistakes" with blood samples from different people.

His prostate size is normal (35ml) and the density (0.089) falls in the group of the less than 0.1 threshold to identify indolent type of cancer in normal sizes. Smaller volume prostates have less epithelial cells (cells that line the prostate gland) therefore producing less PSA. If the latest PSA was “masked” by the effect of a supplement, the density would be higher inducing a different diagnosis.

I see only one “baddy” in the diagnosis which is the Gleason grade 4. However, this grade is in very small quantity found as the secondary value in the score of 7, and in just one core out of 10 needles.

My opinion as a layman is that your friend DOES NOT NEED TO RUSH. The latest information (negative doubling=negative activity) is not of an aggressive cancer in need of the “soonest” intervention.
As commented in my above post. I would recommend you to get acquainted with the various types of treatments, their risks and side effects (nasty for 55 years olds), and that you get second opinions from different specialists. He could check again in three months where the PSA stands, and then decide for a treatment or AS.

Wishing you peace of mind.

VGama

hopeful and opt...
Posts: 1313
Joined: Apr 2009

Since your friend is 55, he is too young to do Active Surveillance long term. He needs to decide on a treatment. I believe that it is appropriate for him to take some time to seek the
"best" treatment for him, but not Active Surveillance.

I am not against Active Surveillance. I have been doing such for the the last 2 1/2 years. Even at my age of 68 I would seek treatment if my numbers were 3+4.

STC
Posts: 21
Joined: Jun 2011

He took AHCC only 500mg 1CAP daily.
I think the negative doubling may caused by getting cure of his prostitis,(he took medicine for 2 months)

I don't know if the prostitis will affect his Gleason grade or not?

hopeful and opt...
Posts: 1313
Joined: Apr 2009

measures the aggressive of the cancer that is found in the biopsy. The prostitis does not affect the gleason grade.

It is very important for your friend to get a second opinion of results found in the slides from an independent pathologist who specializes in this so that he is not under or over treated. There are only a dozen or specialist in the country. Boswick being one of them.

robert1
Posts: 82
Joined: Apr 2011

Your friend has quite a few options. AS is difficult choice for those touched by the disease. A biopsy with more total cores (12-14) could yield the same results or turn up something not yet seen. Although this is typically a slow progressing disease, without treatment it will progress.

When looking at surgery, one of the top brass at a major cancer fighting organization told me not to consider a surgeon for open or robotic procedures that has less than 1000 under their belt. While the progress from procedure 250 to 2000 is less profound than that from 1-250, he felt it was very important for the trifecta (cure, continence and potency). The more expereinced surgeons will gladly tell you how many they have done and they should all be able to produce some staistical results. Look at these results very closely and question them.

As for Radio Therapy, he has over a half dozen options. External radiation (IGRT), Brachytherapy (seed implanation), Proton Beam Therapy (PBT), High Dose Rate Brachytherapy (seeds temporarily), CyberKnife (CK) and the combination of external raditaion and seeds. All have produced excellent results.

There is also freezing (Cryosurgery) and High Intensity Focused Untrasound (HIFU). These treatment options also have been effective and certainly have their place.

Your friend has time to study or have someone help him study. The information is there, so urge him to take total charge of this decision use his time wisely.

Please send our sincere best wishes,

robert1

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC

The medication for proctitis would not affect the Gleason grade. His treatment for proctitis is highly indicative as the cause of the decrease in PSA. Inflammation or infections are known to cause high variations in PSA serum.
This is a relief and I would take this value of PSA=3.1 as “real”. That also validates a density of 0.089 indicating a higher probability for an indolent type of cancer. For peace of mind you can check again on PSA in three months.

I still insist that your friend do not need to RUSH. Monograms indicate survival rates over the 20 year mark in identical cases. He should get acquainted with the various types of treatment, their RISKS AND SIDE EFFECTS, and procure for a doctor and facilities that he would be satisfied with.

Your friend’s Gleason score of 7 is at the “border” for yes/no AS option but the volume of cancer is relatively small. NCCN guidelines recommend AS to similar cases. Nevertheless, biopsies can miss cancerous "pockets" in the gland.
Surgery as suggested by his doctor can be successful at the proper “hands” too. A good book to check about the difference between surgery and radiotherapy is; a “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (second edition June 2007), himself a surgeon therefore biased through surgery. You can listen to an interview done with him here;
http://www.charlierose.com/view/interview/9016

Getting second opinions is proper and a “must do” thing. Surgeons will always recommend surgery and so do radiologists recommend radiotherapy. The final decision must be done by your friend (he will sign the agreement for such treatment), so that he should be confident on his choice.
You can investigate on the treatment team’s experience, by contacting the hospital/clinic and getting their CVs, and checking on the number of successes and failures. You can also talk with some of their patients.
If they reject to give you the information that means that they are not confident of their own job on prostate cancer cases.

A word on AHCC; this is a good anti-oxidant supplement for cancer patients as it protects/helps the immunologic system. However, some brands include other compounds in the mixture which are not recommended in the care of prostate cancer. Here is a comprehensive study done to the stuff;
http://www.ncbi.nlm.nih.gov/pubmed/20522448?dopt=Citation

Hope for the best.

VGama

hopeful and opt...
Posts: 1313
Joined: Apr 2009

INTERMEDIATE
. T2b-t2c or gleason score 7 or, psa 10-20 ng/ml

for less than 10 years patient survival ---Active Surveillance

ajfishin_fool
Posts: 7
Joined: Apr 2009

Hello, Please read: "My Journey for the newly diagnosed & Success!" This gives a good look at doctors giving my husband the advice of "Watchful Waiting" or "Active Surveillance". At first he had only ONE positive core out of 12. However, after they removed his prostate... his cancer was throughout his prostate. I am not confident in the core biopsies as a measure as to whether it is contained or throughout. His was also upgraded from a 6 to a 7 after the full biopsy of the organ. Good luck with your decision.

God's Blessings.

STC
Posts: 21
Joined: Jun 2011

Thanks to you all.

My friend did PSA test again on yesterday,
again the result was 3.1.
However he decide to have a RP on the next week.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC

I am glad to know that you have reached to a conclusion. RP will provide peace of mind and most probable a total cure to your friend.
I hope the surgery is eventless and that he recovers the soonest. I will appreciate your sharing with us details on the procedure.

Good luck to him and soothingness to you.
VG

hopeful and opt...
Posts: 1313
Joined: Apr 2009

is a valid treatment option.

I hope that the surgeon is experienced?

What are the qualifications of the surgeon?

STC
Posts: 21
Joined: Jun 2011

My friend did RP successfully on yesterday,
no capsular penetration, and he is lucky to have well done nerve sparing,excellent pain control,no blood transmission required,

Swingshiftworker
Posts: 634
Joined: Mar 2010

I think the surgery was unnecessary given his age and the original diagnosis, but I hope your friend recovers quickly w/o any significant negative side effects.

hopeful and opt...
Posts: 1313
Joined: Apr 2009

I wish him a speedy recovery with long life and good health.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

Success will follow. Surely he will need time for recovery, Please let us know on the continuous results.

When can we raise the glass?

Regards
VG

STC
Posts: 21
Joined: Jun 2011

His surgical pathology report shown that the tumor occupies approximately 35% of gland.Gleason 3+4=7,PSA3.1,the prostate meas.5x5x4cm

The inked bladder neck/radial resection margins and seminal vesicles are all negative for adenocarcinoma,

There is no extraprostatic extension.
Extensive high grade PIN is present

Right/Left lymph node,excision: Benign nodal tissue,negative for metastatic malignancy.

He is lucky to have the RP,because the tumor is present at the inked apical resection margin for a distance of approximately 1mm., Thanks God!

STC
Posts: 21
Joined: Jun 2011

Thanks to every friends in this forum,
I like to report his first PSA test after surgery was 0.00x,something less 0.01,which is undetectable.

He is still ED and incontinent,but under good recovery,he need 1 pad daily for drips.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC
These are wonderful news. I am very glad for you and your friend. The Zeros will continue to come.
Let’s all celebrate and wish for a complete recovery.
VG

hunter49
Posts: 201
Joined: Oct 2011

great news. I was dripping until last week a few drops aday and it just stopped on Friday

STC
Posts: 21
Joined: Jun 2011

Thanks VG & Hunter!
I am so happy for the great news from Hunter,I believe you will get recovery very fast.

STC
Posts: 21
Joined: Jun 2011

I like to update his PSA test half year after surgery was <0.01,which is undetectable.

He is still ED(4 o'clock wise) but continent. His doctor believe he could get good recovery within 1-2year,because his nerve sparing was successful in both side.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC

Thanks for the good news. Zeros in PSA are numbers to celebrate.
Hopefully in your next post we will read about his return to a more normalcy way of life. Tell him to be active in the ED problem to avoid atrophy and to shorten the time to recovery. Pump regimens may help in improving things. Never give up.

Congratulations.
VG

STC
Posts: 21
Joined: Jun 2011

PSA test 9 monthes after surgery was <0.01,which is undetectable.
ED improving,, continent.

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

Super report. I hope everything continues like this. You couldn't ask for a better update.

K

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC
I am so glad for you and your friend. The information you share is extraordinary. Continent and improvements in the sex-department, I believe.

Let's celebrate with a good red of Esporao.

VG

STC
Posts: 21
Joined: Jun 2011

Thanks VG & Kongo.
PSA test 1 year after surgery was <0.01,which is undetectable.
ED improving,, continent.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

I don’t care, let’s celebrate.
Another Zero and happy moments to share.
Tell him to consider counselling on the ED, now at the 1 year mark since RP. Improvements can be expected but we never return fully to the same levels as before surgery. In time we learn how to manage things.

Congratulations on the Zeros.
VG

STC
Posts: 21
Joined: Jun 2011

Thanks VG

I like to update his PSA test
PSA test 15 month after surgery was <0.003(different lab),which is undetectable

PSA test 18 month  after surgery was <0.01,which is undetectable.
ED keep improving,, continent.

hopeful and opt...
Posts: 1313
Joined: Apr 2009

great to hear of successes

OTIS4242
Posts: 5
Joined: Apr 2013

I'M GLAD YOUR FRIEND IS DOING SO WELL. AT AGE 54 I WAS DIAGNOSED WITH PC. 5.4 PSA WHICH DOUBLED FROM 2.7 LESS THAN 4 MONTHS BEFORE. BIOPSY RESULTS - APPROX. 5 %. GLEASON 4 & 3 = 7. MY BIGGEST CONCERN WAS ED. I DISCUSSED WITH MY DRS AND WAS REFERRED TO A UROLOGIST WHO WAS PROACTIVE IN TREATING PC PATIENTS TO PREVENT ED. PRIOR TO EXTERNAL BEAM RADIATION TREATMENTS - 41 TOTAL - HE HAD ME START TAKING CIALIS - APPROX 10 - 15 MG PER WEEK. HE SAID BY KEEPING THE NERVES STIMULATED THAT IT WOULD MINIMIZE NERVE DAMAGE AND ED. DURING THE TREATMENT PERIOD, WE CONTINUED TO BE SEXUALLY ACTIVE - THE RADIATION MADE IT PAINFUL TO EJACULATE ( WEIRD - INCREDIBLE PLEASURE FOLLOWED IMMEDIATELY BY A VERY STRONG BURNING SENSATION THROUGH OUT ENTIRE URINARY TRACT ). WE KEPT THE 'PUMP PRIMED' . ULTIMATELY THE BURNING DURING SEX WENT AWAY. 5.5 YEARS LATER, STILL NO ED - I STILL USE CIALIS 5 - 10 MG A WEEK JUST CUZ I LIKE FEELING 13 AGAIN- A MIRACLE DRUG  ( THEY AREN'T LYING ABOUT THE POSSIBILTY OF A 4 HOUR ERECTION ). CIALIS CERTAINLY MADE THE ENTIRE PC MUCH, MUCH BETTER. HAS YOUR FRIEND TRIED CIALIS ?

 

TO ALL - I'M VERY MUCH ENJOYING BEING PART OF THE CSN - JUST JOINED. GREAT TO BE ABLE TO SHARE. AS MEN, IT'S INTERESTING HOW WE APPROACH PC - A PROBLEM TO BE ADDRESSED AND SOLVED RATIONALLY, NOT EMOTIONALLY - PC IS DIFFERENT - NO SUSAN G KOMEN 3 DAY WALK KISSES AND SUPPORT

 

LIKE WE ALL DID, I CONSULTED A NUMBER OF DRS AND CHECKED OUT ALL THE TREATMENT OPTIONS. I FINALLY CHOOSE MY DR NOT SO MUCH ON THE BASIS OF HIS CONSIDERABLE EXPERTISE IN CANCER ( HE WAS CHIEF OF ONC. AT A MAJOR HOSPITAL ), BUT RATHER BECAUSE DURING THE PROSTATE EXAM HE TOLD ME A JOKE. I THOUGHT, HAY, THIS IS A GUY YOU CAN DEAL WITH. WE DON'T KNOW THE ULTIMATE OUTCOME, BUT HIS ATTITUDE CERTAINLY MADE THE PROCESS A LOT MORE BEARABLE. EVERY MORNING THE 'CHIEF' WAS MAKING HIS ROUNDS WHEN I WOULD SHOW UP FOR MY RADIATION. WE WOULD JOKE AND THAT SOMEHOW MADE IT A LOT BETTER. SOMETIMES IT'S THE LITTLE THINGS............

 

STC
Posts: 21
Joined: Jun 2011

Thanks VG,Hopeful & Otis4242

I like to update my friend's PSA test result
PSA test 15 month after surgery was <0.003(different lab),which is undetectable

PSA test 18 month  after surgery was <0.01,which is undetectable.

PSA test 21 month  after surgery was <0.01,which is undetectable.

ED keep improving,, continent. he took cialis but changed to viagra now.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

STC

Congratulations on the continuous Zeros results.

I hope your friend gets better in the ED issue. May I suggest him to stop taking the pill during a period to allow the body to recuperate naturally? He may return to V at any time or may try other means of success more natural. Certain diets got the “spices”.

I celebrate the good news from this little corner of the Europe.

VG

STC
Posts: 21
Joined: Jun 2011

Thanks VG,

I like to update my friend's PSA test result
PSA test 15 month after surgery was <0.003(different lab),which is undetectable

PSA test 18 month  after surgery was <0.01,which is undetectable.

PSA test 21 month  after surgery was <0.01,which is undetectable.

PSA test 24 month  after surgery was <0.01,which is undetectable.

ED keep improving,, continent. he took cialis but changed to viagra now.

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

Thanks for the continuous reports and congratulations for the results.

Can you tell us of any change in life style or diet or supplements he is taking?
What is his performance without the V pill?

Best wishes

VG Kiss

STC
Posts: 21
Joined: Jun 2011
 

Thanks VG,

I like to update my friend's PSA test result
PSA test 30  month after surgery was <0.010,which is undetectable

VascodaGama's picture
VascodaGama
Posts: 1550
Joined: Nov 2010

Congratulations again.

I like to read reports on Zeros.

Best.

VG  Smile

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