Gleason 8-Reoccuring Pca

contento

Hi guys, Ive been following the forum for a few months now but I didn't post my story as most of you have done. so here it goes. Any comments would be appreciated.

 Though my cancer was diagnosed in January 2013 , my journey began in January 2010 when I got a call from my older brother who told me he had prostate cancer and that it runs in both sides of our family and that I should get checked out. I immediately had a biopsy which was negative but it did show HGPIN in the Left Lateral Mid. My PSA was 2.7 Ng/ml and I was 56 yrs old. I continued to monitor my psa and DRE over the next few years ( Aug 2011 -3.2 Ng/ml ; Nov 2011 - 3.4 Ng/ml ; March 2012 - 4.1 Ng/ml ( biopsy ). June 2012 biopsy revealed Left Mid prostatic tissue with atypical small acinar proliferation suspicious for adenocarcinoma. Urologist recommended another biopsy in 6 months which I did. In the meantime my psa rose to 6.6 by Aug 2012 ( annual physical ) DRE still normal. January 2013 biopsy revealed the cancer in one of the 8 samples located in the left transition zone and was a Gleason 7 ( 3+4 ). Some of the other samples was rated HGPIN.
Opted for robotic RP in Feb 2013. Post surgical pathology was a lot worse. Prostatic adenocarcinoma Gleason 8 (4+4). Focal extraprostatic extension identified ; tumor involves the left apical margin of resection ( 1 positive margin ); lymphovascular invasion identified ; removed 1 lymph node from right pelvic with no tumor present ( 0/1 ); bilateral seminal vesicles negative for tumor. Tumor involves approx. 12 % of the prostate and involves the right anterior, right posterior and left posterior quadrants.
PSA June 2013 - <.1 Ng/ml ; March 2014 =.1 Ng/ml ; retest May 2014 = .1 Ng/ml; July 2014 - < .1 Ng/ml ; Jan 2015- .2 Ng/ml , retest confirms
the .2 Ng/ml reading.
Went to radiation oncologist , had all scans ,bone, pelvic, chest, bladder, colonoscopy - all negative. Testosterone was 444. However one scan of the prostate bed did reveal a 4 mm suspicious spot. Tried to biopsy but was negative. Doc still believed it was real and I was given a 3 month Lupron shot with casodex. A post lupron scan showed no visible tumor and my PSA was < .1 Ng/ml. Had 35 radiation treatments to the pelvic and prostate areas, along with an additional 3 month Lupron shot with casodex . Finished radiation in June 2015 ( now 62 yrs old ). Fast forward to today , 2 years post radiation and 4+ years post surgery, and my PSA remains @ <.1 Ng/ml and testosterone @ 441. Hoping for the best . I'm on 6 month PSA schedule.

VascodaGama

Congratulations for the remission

Contendo,

In our exchanged mails you commented to experience a similar situation to Josephg's but that may regard just the pathology stage of pT3a N0, post surgery, followed by recurrence and salvage treatment with a combination therapy of RT plus HT. Josephg is now experiencing systemic disease for his confirmed recurrence after RT which situation is not your case. I do understand your worry in expecting the worse because of the pathological findings after surgery. Your cancer seem to be more aggressive with a Gleason score 8 (4+4), one positive margin and lymphovascular invasion. The PSA doubling time after surgery was also worse at PSADT= 6 months while Josephg's was slower with lesser progression.

To compare the cases is erroneous and even if they were similar one could not assure an equal outcome. The only way to eliminate PCa is by identifying its location and destroying the flesh where it lays. However, by doing so one may die of the treatment, not the cancer. In any case, your last results two years post SRT+HT are great, in remission levels with a due and clean PSA of <0.1 ng/ml (out of chemical castration with T=441 ng/dL).

I hope that after 4 years you have fully recuperated from the treatments side effects or that you have managed to find the way in dealing with the results, most comfortable to you. This is quality living that we all aspire but may need to adapt.

Best wishes for continued remission.

VGama

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Vasco, thank you for your input , as usual it's always appreciated.

I guess when I read Josephg's psa results I only looked at the final number of .05 and thought that was very low . I didn't consider the rate of increase.

I hoping Josehpg keeps us posted.