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Dr. says high grade high volume cancer

Posts: 5
Joined: Nov 2012

Biopsy on 3/18/13 showed. 6 of 12 cores positive. 3 @ G7, 3 @ G6.  One core has tertiary G5.  involves  75%, with perineural invasion. Others 44%, 66%.

All adenocarcinoma. Scheduled for endorectal MRI on 5/31. I have unexplained pain for 9 months in right scapula. No bone scan scheduled.

I also have kidney cancer. chRCC both kidneys. 15 tumors removed from left kidney on 1/8/13. only 1 chromophobe type. anyone know what any of this means. thanks Keith

Posts: 351
Joined: Jan 2011

Sorry, but I have no idea what it all means.  I can sy that my Oncologist told me that prostate cancer can go two ways.  It either goes to organs or bones.  What kind of tests have you had?  

PI Giles's my next question would be if your doc says it is so agressive why are you having to wait a month for an MRI? It seems like a CT scan, including barium for organs is called for also a PET scan.  Is this MRI going head to toe?  Make sure it is.

I wish you well.

If you are a vietNam vet it clearly states that prostate cancer metastis occurs  at the beginning.  

Good luck,


Kongo's picture
Posts: 1167
Joined: Mar 2010

Dear Keith,

Welcome to the prostate cancer forum but I wish you didn't have to be here, especially with all the other issues you're dealing with at the moment.

Your biopsy should have been explained to you in great detail by your urologist.  In the United States urologists are required to brief you on the meaning of your biopsy results and possible courses of treatment for a positive cancer diagnosis.

Essentially, from the 12-cores in your biopsy 50% showed positive signs of adenocarcinoma which simply means glandular cancer.  Adenocarcinoma is the most common type of prostate cancer but there are as many as 25 different variants.  Some are more aggressive than others.

The "G" scores stand for Gleason Score, which is the protocol pathologists use to subjectively evaluate the cancer cells from your core sample as they are studied under a microscope.  The Gleason score is the sum of two numbers.  The first number is the grade on a scale of 1 to 5 of the most prevelant type of cancer cell present.  The second number is the second most prevelant type of cell.  The rating goes from the least dangerous to the most dangerous and is a relative measure of how differentiated the cells have become.  For practical purposes, the lowest rating normally given is a Gleason 3, the others being too close to normal prostate cells to clearly identify as cancer and are very rarely seen.  Thus a Gleason 6 is a 3+3 score.  A Gleason 7 can be a 3+4 or a 4+3.  The 4+3 is more worrisome than the 3+4.  Make sense?  

When first detected, prostate cancer cells look and act very much like normal prostate gland cells except that then tend to throw off more PSA than normal cells.  As the cancer becomes more advanced, the cells look less and less like prostate cancer cells.

Since your biopsy showed both Gleason 6 and Gleason 7 cores, they tend to classify it as the most advanced cancer, so you have a Gleason 7 prostate cancer which is considered an intermediate threat.  Gleason 6 cancers are considered low threat and are often indolent.  Gleason scores of 8 or higher (up to 10), are considered aggressive.

Sometimes a tertiary Gleason score is assigned.  This is when a smaller but significant number of cells are present which pose a troublesome diagnosis.  In your case the Gleason 5 tertiary indication means that in some parts of one of the cores has an area where the cells do not resemble prostate cells at all and is considered to be very aggressive (i.e. prone to move to other parts of the body).

Perineural invasion means that some of the cancer cells were found in the very outer edge of the prostate gland where spider webs of nerve bundles exist.  These nerve bundles are what enable a man to achieve and maintain an erection.  It is not uncommon to see perineural invasion in a biopsy as prostate cancer cells seem to like congregating near the nerve bundles.  There are differing opinions as to whether PNI is significant or not but many doctors feel that evidence of perineural invasion equates to an increased probability that prostate cancer cells have left the prostate and may be elsewhere in the body.  Even if the prostate cancer escapes the prostate, it is still considered prostate cancer.

The pain in your shoulder could be caused by a number of things and frankly I doubt it has anything at all to do with your prostate cancer.

A MRI may or may not detect prostate cancer elsewhere in your body.  Prostate cancer likes to go to the bones and other organs like the liver, lung, and kidneys but it typically takes years of metastasis before these remote tumor colonies can be detected by normal MRI procedures.  Initial metastasis is microscopic.

Keep in mind that the Gleason Score is a subjective evaluation by the pathologist.  I recommend that you seek second opinions on your biopsy slides from an institution that specializes in reading prostate cancer biopsies.  Your doctor can tell you how to do this.  It's a rather simple procedure but it isn't free and involves shipping your slides to another institution.  I would not consider any treatment course until the slides have been read by a pathologist who is an expert in prostate cancer.

I hope this helps.  I would encourage you to go back to your urologist and have him explain your results in detail.

All the best,



NOTE FOR SAMSUNGTECH:  Technically, bones are organs.  They are rigid organs that produce red and white blood cells and store minerals.

Posts: 351
Joined: Jan 2011


PI was quoting my Oncologist. He told me that if cancer goes to the bones it usually stays in bones.  Same thing for organs.  He also told me that if it does go to organs, like mine, it tends to go to the brain.


Rakendra's picture
Posts: 111
Joined: Apr 2013

Kongo, I just wanted to say that I have spent many hours on the net studying, and your explanation is by far the most concise and most informative one that I have read.  Thank you.

 Kieth, I am a newbie here, and you have probably done all of the following things.  Find all the information you can, especially reading all the posts here that apply to your case.  Study the net.  Always get second opinions.  Never assume anything.  It seems that while all PSa cancer cases have similarities, it also seems that each case is unique unto to itself, and future speculation about survival rates or regression rates seem to be just guesses and not specific to any one case.  There is always hope, and there is always need to take a positive atitude to make the most of every moment.  Take as much control of this as you can. A change of diet may be essential.  Learn to counter this disease in every way possible. I regret that you have suffered this kind of attack.  There are methods of mind control that can help you to not become depressed and think constantly about this, which is easy to do.  Concentrating on the best things that can happen to you will help your healing process.  Concentrating on the negatives will do the oposite.  I use meditation and controlled breathing to help keep my mind clear and possibly free from distress.  There is always hope,and there is always the oportunity to make the most of every moment if you chose.  love, Rakendra

Kongo's picture
Posts: 1167
Joined: Mar 2010

Thank you, Rakendra, for the nice words.  Your experiences with this disease offer great insight to those who suffer from the effects of prostate cancer.  Your age and physical condition are an inspiration to all of us.


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