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Gleason 3 + 4

robert.sayre1
Posts: 4
Joined: Aug 2012

Background-was applying for life insurance last fall and found my PSA had rose from 2.4 to 3.4 in a few months. Insurance co. asked for Dr. to confirm. Did so, PSA was 4.2 after a few months. Did biopsy, 3 spots of Gleason 6 and one with Gleason 3 + 4.

Was set to do seeds, but had to get second opinion as my uruologist could not practice at hospitals that do seeds only.

Had to go to another uruologist. His opinion is that 3 + 4 may require seeds and then moderate level of external radiation. They are looking at slides again, so I'll get another set of gleason scores.

My diagnosis was T1c, gleason 6 and 1 7, 3 + 4.

I am not sure now, how to assess my risk.

laserlight's picture
laserlight
Posts: 165
Joined: May 2012

Robert, it might be good idea to research all of the treatment options available. Stage T1c is treatable. From your posting you indicate that you are working with 2 urologist's. It might be good idea to settle on one good urologist and have the doctor explain all of the options and find out what treatments he is able to provide. The risk is not getting this cancer treated. If left untreated it will most likely spread and cause many problems. Sorry to hear about this. I applied for life insurance and answered the questions, my rates jumped when I answered yes to cancer. Cancer sucks hang in there.

Kurt

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

Hi, Robert and welcome to the forum. It's difficult to assess risk with just the information you've provided. Age, Gleason grade, PSA velocity, and other health issues all come into play.

In terms cancer assessment, I believe most doctors will develop a treatment recommendation based on the worst Gleason grade which, in your case, is a 3+4=7. Gleason scores in the 7 range are considered "intermediate" risk but a 3+4 is less risky than a 4+3.

Your PSA seems to be going up rapidly but there are many things that could cause that independent of your cancer such as sexual activity leading to orgasm within 48 hours of a blood draw, certain types of exercise that pushes against the prostate (like bike riding), doing the DRE before drawing blood, and so forth. BPH can also cause an elevated PSA so it would be useful to know your prostate volume. Larger than normal prostates are typically accompanied by higher PSA scores. PSA also increases as we age and unless you are fairly young (like in your early 40s) your original PSA that started this whole process doesn't seem so high. An undiagnosed UTI is also another common cause of elevated PSA scores.

I think it is a smart thing to be consulting with more than one urologist. Seeds, or a combination of seeds and external beam radiation are certainly two common methods to treat your Gleason 7 cancer. There are other methods too involving different types of external radiation that do not involve seeds (such as IMRT, SBRT), proton therapy, and surgery. I recommend you consult with doctors in all of these specialties before deciding what course of action may be best for your individual situation.

Best of luck to you.

K

robert.sayre1
Posts: 4
Joined: Aug 2012

I had to change urologists as the hospitals he had priviledges in were either not covered by my insurance or did not offers seed therapy of any kind, only external beam radiation. So, in essence I had to start over. The first urologist assessed my risk as low, seeds only as fine, with no other test necessary.He sees 3-4 in my situation as low risk. New urologist sees my risk as intermediate. Am now getting bone and CT scan and re-reading of my slides from my biopsy.

He indicated that seeds might be 2/3 of radiation and 1/3 external beam, over shorter period of time.

First PSA was Nov. 2011 from annual exam, 2.4. Next was for new insurance app., Feb. 3.2, then April, 4.1, so it is going up.

Bone and CT scan and meeting with radiation specialist are scheduled for 8/24 with followup with urologist on 8/30.

Both hospitals and urologists have 20+ years experience.

I guess I'll know more on 8/30.

robert.sayre1
Posts: 4
Joined: Aug 2012

I had to change urologists as the hospitals he had priviledges in were either not covered by my insurance or did not offers seed therapy of any kind, only external beam radiation. So, in essence I had to start over. The first urologist assessed my risk as low, seeds only as fine, with no other test necessary.He sees 3-4 in my situation as low risk. New urologist sees my risk as intermediate. Am now getting bone and CT scan and re-reading of my slides from my biopsy.

He indicated that seeds might be 2/3 of radiation and 1/3 external beam, over shorter period of time.

First PSA was Nov. 2011 from annual exam, 2.4. Next was for new insurance app., Feb. 3.2, then April, 4.1, so it is going up.

Bone and CT scan and meeting with radiation specialist are scheduled for 8/24 with followup with urologist on 8/30.

Both hospitals and urologists have 20+ years experience.

I guess I'll know more on 8/30.

hopeful and opt...
Posts: 1363
Joined: Apr 2009

I am sorry for your condition; inorder to help you assess your risk, you need to provide more information so we can look at it with you..

YOur age; general health and life expectency; total number of cores taken in the biopsy, for each core that was positive the percent involvement....are your slides being sent to an independent world class pathologist( by the way, this was a good decision to get a second opinion on the slides so that you are not under or over treated).

Have you had any other diagnostic tests, ie an MRI with a T3, to determine if there is extracapsular extension.

What is the size of your prostate, what did the digital rectal exam show.

Are you reading any books about this, going to any local support groups.

How did you determine your second urologist, how do you know he is qualified?

hunter49
Posts: 204
Joined: Oct 2011

there are other things to consider. How old are you , what is your overall health and how active are you. These may affect your choice of tratment but you need to get another opinion on your biopsy they are very subjective

robert.sayre1
Posts: 4
Joined: Aug 2012

I just turned 60, and am in very good health, normal cholesterol. height 5-9, weight 170, 117-80 blood pressure.

hunter49
Posts: 204
Joined: Oct 2011

Robert the odds are this beast is contanined in your gland. However, you have a 1 in 3 shot that your cancer can be upgraded if you have surgery and they can examine the entire specimen. That means you may be a a 4+3. That happened to me. You are young and in good health and surgery definately has it's potential side affects. I do not know where you live but Hopkins has a multi diagnostic clinic where you have your slides examined by the top pathologist in the field and meet with their top doctors where they all meet and recomend the best course of treatment after reviewing your case. I did it and highjly recomend it. They are not cut-happy either. Good luck.

taarph
Posts: 18
Joined: Aug 2012

i too am diagnosed like you i am receiving rapis arc external radiation with lupron inj for six months. the rapid arc is great very fast and accurate it uses half of radiation as other do but the aiming is much better i had 2 visicoils inserted into prostrate"much like bioposy" so far i have haf 12 rad treatments and one needle no ill effects from rad yet but the lupron is kikcing my butt fatigue light headed feet and legs swelling a lot flu like
synthoms testies deff downsizing and so is penis a little. i am a little concerned about having a secons shot maybe doc can help with side effects will ask on thursday

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

Lupron is a form of chemotherapy that affects your whole body. It's not unusual that your are feeling the effects of this drug and the symptoms that you describe are fairly common. It's important to complete the regimen prescribed by you doctor but you need to understand the side effects. Make sure you have your medical team explain all the symptoms you can expect and understand the affect this drug can have on your heart and other key bodily functions. Good luck to you and welcome to the forum.

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