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Joined: Jun 2017

I recently underwent radical prostatectomy-pre-op. the Gleason score was 3+4, post op analaysis showed 4+5-surgeon suggests chemo and hormone treatment now a possibility. Urine & blood tests show levels within acceptable ranges, but at the low wne of the scale. Does anyone have an idea of what I can expect in regards to life expectancy?

Posts: 162
Joined: Apr 2017

Hi and welcome. I am sorry to hear of your post-op pathology, which indcates that you will be in for a hard fight, but one for which the odds are steadily improving.

Last week, I attended a local prostate cancer support group meeting with presenttaions from a surgeon, a radiation guy, and a chemo guy, all who specialize in prostate cancer. While I am a low-risk case, I stayed and saw the radiation and chemo doctors present how they deal with advanced cases. There were many technologies and medicines available, with a long pipeline of others entering testing. Over 70 clinical trials for prostate cancer going on right now. The basic protocol is that when one chemical fails, they already have another one to take over. And, the future may belong to immune and genomic treatments, which are receiving a lot of press and investment.

What I took away from that meeting was that the existing mortality predictions may not/probably won't apply to new cases now entering the treatment cycle. You may want to start asking about clinical trials, and worry less about old data on life expectancy. Good luck.



Posts: 29
Joined: Jun 2017

Hello Ellerman,

I agree with AS, there are many things open to you. I do have a question. How could the pathologist of your biopsy slide be so far off on the Gleason score? I have not heard of the scores being so far off. Please clarify.


Best to you,



Posts: 223
Joined: Jun 2016

Biopsy needle did not hit right spot. According to the statistics, post surgery Gleason score is upgraded 30% compared to biopsy findings. Biopsy samples very small area of the prostat. After surgery whole gland is examiNed and in about 1/3 finding is different from biopsy. Post surgical pathology report is done on complete gland and most complete one.


VascodaGama's picture
Posts: 3406
Joined: Nov 2010


There is no such "... life expectancy" when talking on PCa. One could say that a guy in a very advanced status is at high risk to die of the cancer instead of dying with the cancer. In such respect the "advanced" status should have a meaningful grade for considering probable death.

The worse upgrade Gleason classification (Gs7 to Gs9) is not linked with death but with a more aggressive form of cancerous cells. Death of PCa is linked with the spread of the cancer (far metastases). This is when the bandit invade other organs and interfere with their natural function, leading to a cataclysm of events in our body systems crippling the vital signs.
PCa treatments therefore, look to eliminate such a possibility of cancer progression and spread, and for such success conclusion one needs to locate the hidden bandit to strike it the proper blow. This was the intent at your initial surgery, however, for some reason or due to other data in his hands (other than the Gleason upgrade) your doctor has judged the surgery already as treatment failure, and is now suggesting you a salvage therapy.

The procedure may be repeated, but before any decision you need firstly to try locating the bandit. If that is still localized probably radiotherapy can resolve the problem and provide cure. Chemo and hormone treatment are palliative (no cure expected) but manage some control in cancer progression, providing many years of survivorship. One must learn to live with the side effects.

You have not shared details of your case (age, PSA histology, Image study results, testosterone level, lipids and other blood markers, other existing illnesses, bone health, etc) so that it is impossible for us to provide better opinions. Gleason rate 5 cells are poorly differentiated, acting abnormally and cannot produce PSA serum as much those acting more like normal cells (lower Gleason rates). In your case, lower levels of PSA can be significant of cancer progression. Wherever in a Gleason 6 patient, it could mean remission.

I suggest you to research on salvage therapies for recurrence cases after surgery, if such has been found and declared by your doctor. Surely any decision should be made with proper diagnosis in hand. This means a due image exam (preferably choline based PET scan or PSMA radiopharmaceutical).

Best wishes,


Posts: 2
Joined: Jun 2017

Many thanks for you kindness in replying.


Posts: 83
Joined: Apr 2017

Hey Ellerman. I'm here acting as an advocate for a neighbor with advanced metastatic PCa. Of course, as a cancer patient one of the first things you want to know is 'how long do I have'. We all know that doctors are often inaccurate in their estimates, but we want to have something to go on. It's a basic and understandable question in my opinion.

In my very limited knowledge it does seem difficult for Dr.'s to give a good guess because everyone responds differently to the variety of treatment options for PCa. My neighbor's diagnosis is dire but he is responding well to treatment and may have longer than originally guesstimated.

All that to say that I understand your desire to know more about your prognosis but as wonderful and helpful as this board has been to me personally, it doesn't seem to be a question that is welcomed here. I also agree with ASAdvocate that treatments are changing and getting better all the time which also makes a determination difficult.

I wish you the very best.

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