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Biopsy Results... Gleason scores, %'s, etc...

Paul M
Posts: 17
Joined: Nov 2012

Age 52:

PSA 25 Nov-2011 (was not notified of prior year results)
PSA 30 Nov 03, 2012

DRE Nov 08, 2012 Results seem normal; discomfort when pressed hard..

Biopsy Nov 16, 2012 Results below:
RPZ Benign 4 cores
RCZ 3+4=7 1/2 cores, present in 18%
LCZ 3+4=7 2/2 cores, present in 92%, HGPIN
LPZ 3+4=7 4/4 cores, present in 100%, perineural invasion by adenocarcinoma is present, HGPIN

CAT & Bone Scan scheduled for 12/07/12

hopeful and opt...
Posts: 2336
Joined: Apr 2009

to the previous thread that you started so all information is together

Paul M
Posts: 17
Joined: Nov 2012

01/02/13 MRI of pelvis w/wo contrast on 3 Tesla system / Results (disk)
 3rd Opinion:  University of Penn Medical Center of Urology;  Dr. Malkowicz / Dr. David Lee
01/04/13 Office Appt:  Dr Stanley Bruce Malkowicz (understand non-robotic prostrate surgery option)
01/07/13 MRI of pelvis w/inj Combined with Endo Coil
01/14/13 CT Abdomen and Pelvis with IV Contrast (U. of Penn)
01/09/13 Follow up appointment with Dr. Angelo Baccala Jr. MD, Lehigh Valley Urology Specialty Care;  next available robotic surgery in March of 2013, so had procedure done at U. of Penn on 1/30/13
01/17/13 Appointment w/Dr David Lee, University of Penn Urology;
01/30/13 Robotic Prostectimy Surgery at University of Penn; Dr. David Lee (Surgeon)
             Gleason Score Post Surgery:  4+3=7
02/05/13 Office Appt w/Dr. David Lee, Kelly Monahan (removed Cathedar)

05/01/13 P.S.A. Test…    <0.1   (3 months post prostectimy)  U-P.S.A. test ordered; standard was done
05/10/13 3-month post surgery follow-up w/Dr. David Lee;  prescribed Cialis
07/08/13 Ultra P.S.A. Test…    0.07        (6 months post prostectimy)
10/18/13 Ultra P.S.A. Test…    0.12        (9 months post prostectimy)
11/14/13 Ultra P.S.A. Test…    0.16        (10 months post prostectimy)
11/14/13 U. of Penn: (8:10 MRI w/Coil, 12:30 Radiology injection, 2:30 Bone Scan)
11/22/13 Dr. David Lee Review Results / Recommends Radiation at St. Lukes Cancer Center, Lehigh Valley, PA
12/03/13 Meet w/Deb Nimisha, MD,  Radiation Oncology, St. Lukes Cancer Center
12/18/13 Start Radiation Treatment  12/18/2013 - 2/14/14  (39 treatments; weekdays)
02/14/14 Last Radiation Treatment
05/14/14 Ultra P.S.A. Test…     0.07        (3 months post radiation)
08/14/14 Ultra P.S.A. Test…     0.10        (6 months post radiation)
08/22/14 P.S.A. Test Results reviewed by Kelly Monahan MPAS, PA-C (U. of Penn); retest in another 3 months.
08/22/14 Faxed P.S.A. Test Results & correspondence to Dr. Deb MD,  Radiation Oncology, St. Lukes Cancer Center
09/09/14 Office appt w/Dr. Deb MD,  Radiation Oncology, St. Lukes Cancer Center; retest in another 3 months.
11/14/14 Ultra P.S.A. Test…     0.14        (9 months post radiation)

11/25/14 Office Visit w//Deb Nimisha, MD,  Radiation Oncology, St. Lukes Cancer Center; Orders CAT Scan & Bone Scan and recommends Urologist; Urologist may consider starting hormone therapy.

12/01/14 CAT Scan; Discovery CT750 HD at St. Lukes Anderson Campus
12/04/14 Bone Scan; St. Lukes Anderson Campus
12/09/14 Office Visit - Andrea Majczan PA-C, Dr. Angelo Baccala; Results from scans not yet available; another Ultra PSA Test ordered:

12/10/14 Received Results from CAT & Bone Scan; no indication of cancer.

12/10/14 Dr. David Lee / Kelly Monahan MPAS, PA-C (U. of Penn); their Urology office does not do hormone treatment. We send patients to our medical oncology team at HUP or Presbyterian or patients see a local doctor for this.

12/11/14 PSA:  TBD

12/18/14:  TBD - Meeting w/Dr. Angelo Baccala to discuss course of treatment



Is hormone treatment the best course of treatment for PSA Rising after Prostectamy and Radiation ?

Results from scans show no signs of cancer..




Max Former Hodg...
Posts: 3701
Joined: May 2012


I am relatively new here (and therefore far from the best informed), but I did quite a lot of research in planning my first-line treatment, which will be RP. I also read extensively on RT, and had a consult with a Radiation Oncologist.  MY priority has always been (1) cure the cancer. Side-effects I don't much care about.  Dead, side-effects are pretty irrelevant.

To my knowledge (and I was also told this by the RO), Hormonal Therapy is the standard and most effective treatment after RP and RT have failed.  I understand it to ordinarily be very effective for long-term maintenance of the disease.  It may be the only real option for long term benefit at this point. By 'long-term' I mean many, many years -- often over a decade.

You have obviously been to quite a number of great doctors (I count at least five) at great treatment centers. Trust them; no one here is an MD, but of course the feedback here is valuable and supportive.



Paul M
Posts: 17
Joined: Nov 2012


Thanks!  I appreciate your feedback.

I met with Dr.Baccala today, and after reviewing the CAT & Bone scan results; suggested rechecking the PSA in 3 months; and if the PSA stays at a low level; not increasing sharply every 3 months, we can hold off on Hormone thearapy as long as it stays under 1.0

And it could be another 5 years or more for my PSA to increase to 1.0

Below is a summary of PSA Post Radiation:

05/14/14 Ultra P.S.A. Test…     0.07        (3 months post radiation)
08/14/14 Ultra P.S.A. Test…     0.10        (6 months post radiation)
11/14/14 Ultra P.S.A. Test…     0.14        (9 months post radiation)
12/11/14 Ultra P.S.A. Test…     0.14        (10 months post radiation)

So, in the meantime, can diet help decrease PSA Level post RP & RT ?





Posts: 195
Joined: Aug 2006

For men with small amounts of slow growing prostate cancer (you) diet can indeed have an effect on psa change. An ultra low fat diet is best for this. Vegetarian and closely monitored, though this is difficult for those without significant experience in this type of diet. Eating out will take fortitude and patience, for example. Over the counter options include vitamin D, curcumin, and others may also assist. There is great difference of opinion on these. You are fortunate to have such a fine result from your treatments.

Paul M
Posts: 17
Joined: Nov 2012

Thanks for the feedback;  i do take vitamin D supplement along with baby aspirin for the last 2 years. 

Does other medication impact PSA ?

For many years taking daily Adderall, Depakote, Celexa; and post RP added Cialis (3 days per week).


Posts: 1013
Joined: Mar 2010

Statins that are taken to reduce cholesterol levels have been associated w/a decline in PSA levels:


And there is a recent study which suggests that the use of statins also reduces susceptibility to PCA:



However, FWIW, I've been taking a statin drug to control my cholesterol for over 20 years, which apparently had no effect on my susceptibility to PCa or in lowering my PSA levels. 

I have also taken a 2000-4000IU daily of a VitD3 supplement for many years because of consistently low VitD measurement, which apparently also didn't do anything to prevent my PCa.  However, the major benefit of VitD is apparently in strengthening the immune system and, apart from my PCa, I have been very heathly (few colds/flus or other ailments) otherwise.



VascodaGama's picture
Posts: 3407
Joined: Nov 2010

Hi Paul,

I could not find any of your previous threads to have a closer “picture” of your story. In any case, it seems evident, from the constant increases of PSA, that the radiation did not catch the bandit fully. The theory of “three constant increases” after nadir is used by doctors to classify a SRT patient in biochemical failure. This is your status so that you will need continuing treatments.

Hormonal manipulations are recommended but this is a palliative way that only controls the progress of the disease. Chemotherapy seems to be the only option to SRT patients looking for cure but up to date I have never read or encounter a case about someone been cured with such a treatment.

I am also a failed SRT patient. In 2010 I started HT (ADT) on an intermittent modality which so far has allowed me to have a grip on the advancement of the bandit. You can read my story in the bellow links, but you cannot compare our cases because we started with different diagnosis. I was a Gleason 5 (2+3) and you are a Gs7 with primary pattern of 4, which turns your case more aggressive.
In saying that I do not mean that your chances are lower than mine in aspiring for a better outcome. Just that, doctors typically prefers to attack the cancer more aggressively in higher risk cases, particularly in younger patients. Some guys do HT after a failed chemo and some do both in combination, but none “escape” from continued treatment. Complete blockade (ADT3) is also preferred by oncologists in more aggressive cases than mono blockade which was my case.
The problem with the chemo is that it affects both; benign and malignant cells, so that its “power” to treat must be controlled turning its efficacy difficult. The side effects are also nasty.

The American Urological Association says this about chemotherapy;

“….In contrast to surgery and radiation therapy that remove, destroy or damage cancer cells in a specific area, chemotherapy works throughout the body via the bloodstream. Chemotherapy can destroy cancer cells that have metastasized, or spread from the prostate gland to other parts of the body, including bones, lymph nodes or organs like the liver or lungs. Chemotherapy refers to drug treatment that is used to destroy cancer cells. The drugs circulate throughout the body in the bloodstream and can kill any rapidly growing cells, including both cancerous and non-cancerous ones. Chemotherapy drugs are carefully controlled in both dosage and frequency so that cancer cells are destroyed while the risk to healthy cells is minimized. Often, it is not the primary therapy for prostate cancer patients, but may be used when prostate cancer has spread outside of the prostate gland. There are many different types of chemotherapy drugs and combinations used in all kinds of cancers. The specific characteristics of these drug regimens determine the side effect profiles that can range from a mere nuisance to life threatening complications.”


I would suggest you to read about the side effects of both therapies to look for counter measures. Changing diets, life styles and physical fitness are important aspects in your journey with the bandit.

My experiences with HT;





Best wishes,


hopeful and opt...
Posts: 2336
Joined: Apr 2009
Paul M
Posts: 17
Joined: Nov 2012


Thanks for the feedback and info! 

I will review your experiences w/HT. 

I need to learn as much as I can for an upcoming appointment next Monday, Jan 5, 2015 at Penn Medicine / Medical Onocology. 




VascodaGama's picture
Posts: 3407
Joined: Nov 2010


A quick note on your last post; is for you not to rush. I noticed, after reading the thread indicated by Hopeful above, that you did the series of treatments in no time. You did chose well regarding the team of doctors (all famous “performers”) and they may have advised for the quick sequential; however, at this moment your PSA is still low so that you have time to consult specialists, (medical oncologists will be the best choice in your status) and educate about future treatments.

The negative CT750 HD is no surprise because of the low level in PSA. This new CT scan provides better image resolution but the levels of detection points to a higher PSA level, close to the 3 ng/ml, as the minimum to avail a positive result. The bone scan is probably the best test but it also provides false negatives. C11 PET/CT seems to be better for detecting metastases but, again, there are limitations if the tumour is small in size (lower PSA levels). In other words, if one manages to locate the cancer position then one still got a chance to radiate it with precision spot therapy, and get cured. This is what it is known as Oligometastatic cancer. Here is a link for you to read details if interested;


Surely you can allow the PSA to “grow” to a certain level (threshold level to trigger the next treatment) without prejudice to a good outcome. You can inquire in your next meeting with the doctor about the above. Typically oncologist use the PSA at 1 or 5 ng/ml (depending on previous histology) or the PSADT (doubling) average within one year, being 9 months the bodder line between non-aggressive and agressive.

I would recommend you to prepare a List of Questions in particular regarding the type of drugs, any combination and their impact in future needs (in other illnesses). You can also discuss about supplements and diet.
You can use this link to adapt ideas when preparing your list;

There is a good book teaching well about hormonal treatments. It is old but still the best;
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers.

UCSF got a publication on Nutrition & Prostate Cancer, highly recommend;

Remember to request for additional testing (Dexa scan, testosterone test and DNA profile) before starting any therapy.

Best wishes and luck in your continuing journey



Paul M
Posts: 17
Joined: Nov 2012


Thank you for all your feedback, references and advice !!!




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