Low Gleason, not aggressive, mets to bone?

13

Comments

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,736 Member
    Tdoyle said:

    Test

    PSA was checked last probably 3 weeks ago and it was 2.12  and that is around 2 months into this 4 month Lupron shot, here are other blood test results.

    WBC 6.64 K/uL 3.60 - 9.50 K/uL
    RBC 4.62 M/uL 4.50 - 5.70 M/uL
    Hemoglobin 13.2 g/dL 13.0 - 17.0 g/dL
    Hematocrit 41.1 % 40.0 - 50.0 %
    MCV 89.0 fL 80.0 - 100.0 fL
    MCH 28.6 pg 26.0 - 33.0 pg
    MCHC 32.1 g/dL 32.0 - 36.0 g/dL
    RDW 12.2 % 12.0 - 15.0 %
    Platelet 195 K/µL 150 - 450 K/µL
    MPV 10.9 fL 9.0 - 13.0 fL
    ANC 3.6 K/uL 1.4 - 6.0 K/uL
    Nucleated RBC 0.0 #/100 WBC #/100 WBC
    Neutrophils, Auto 54.5 % 35.0 - 65.0 %
    Lymphs, Auto 34.6 % 23.0 - 50.0 %
    Monocytes, Auto 5.9 % 4.6 - 12.0 %
    Eosinophils, Auto 3.6 % 0.5 - 6.5 %
    Basophils, Auto 1.1 % 0.1 - 1.1 %
    Immature Grans, Auto 0.3 % 0.0 - 0.5 %
    Neutrophils, Absolute 3.62 K/uL 1.40 - 6.00 K/uL
    Lymphocytes, Absolute 2.30 K/uL 1.20 - 3.40 K/uL
    Monocytes, Absolute 0.39 K/uL 0.20 - 1.00 K/uL
    Eosinophils, Absolute 0.24 K/uL 0.00 - 0.50 K/uL
    Basophils, Absolute 0.07 K/uL 0.00 - 0.07 K/uL
    Immature Grans, Absolute 0.02 K/uL K/uL

     

    Great

    Your blood panels are perfect, T, as Vasco commented.

    You might want to ask your urologist if an LDH blood test is warrented (NOT 'LDL').

    LDH is a specialty cancer test, usually given for blood cancers, but valid for others.  It detects cell death from cancer or trauma.  A urologist who is not a medical oncologist might not immediately think of administering it,

    max

  • VascodaGama
    VascodaGama Member Posts: 3,512 Member
    3T MRI at UAMS

    Doyle,

    You should contact the nuclear department of the University of Arkansas for Medical Sciences in Little Rock. They have 3t MRI machines doing researches but if not available they can help you to find a place. Please read these links;

    http://cancer.uams.edu/glossary/cdr0000658758/  

     

     

  • Tdoyle
    Tdoyle Member Posts: 36
    edited December 2017 #44

    3T MRI at UAMS

    Doyle,

    You should contact the nuclear department of the University of Arkansas for Medical Sciences in Little Rock. They have 3t MRI machines doing researches but if not available they can help you to find a place. Please read these links;

    http://cancer.uams.edu/glossary/cdr0000658758/  

     

     

    I called, Thanks

    VGama, 

     Thanks I called and they said i am scheduled for that machine but to tell them when I go in, to make sure at that time.

    Thanks for the link.

     

  • Tdoyle
    Tdoyle Member Posts: 36
    edited January 2018 #45
    MD Anderson

    I'm not sure if I should start a new thread or not. I was wanting some input from anyone that has used MD Anderson in their PC fight...I am thinking of going to them for a 3rd opinion...Thanks in advance

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    .

    MD Amderson is a world class institution, great choice; can't do better than number 1 for cancer.

    US New and World Report ranks hospital by speciality. Here you go.

    https://www.usnews.com/info/blogs/press-room/articles/2017-08-08/us-news-announces-2017-18-best-hospitals

    Here is the listing for urology

    https://health.usnews.com/best-hospitals/rankings/urology

    MD Anderson is a great choice; you may also a find another great hospital in this listing nearer to Little Rock, AK

     

     

     

  • contento
    contento Member Posts: 75
    edited January 2018 #47
    MD Anderson

    Troy, I had my salvage radiation treatment at MD Anderson and I would definately recommend  them. I also  went to them for a second opinion and I ended up getting treated there.

    I don't know anything about their AS program or even if they have one.  They were very through in their evaluation so I hope you have the means or have good  insurance. They did tests that we had to fight with the insurance company to cover that they said was not typical for my situation but ultimately proved invaluble in detecting where my cancer was located. I believe they are very aggressive in their approach. Some want that some don't depending on how they view their specific situation. They did collaborate with each other meaning my case was presented to a team of specialists including other radiation and chemo oncologists on their staff. I did have 7 weeks of radiation along with HT so since I was out of town I had to rent a temp apt which there are many. That was 2 1/2 years ago and I'm still doing fine.

    PS - I was stage 3 , gleason 8

    good luck -- contento

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    Aureon molecular test

    "Could you tell me about this test? And it gives a percentage on how aggresive the cancer could spread?  I think my findings are similiar to what you have experienced.

    Thanks

    Troy"

    Troy, you are doing your research by reading my "about me" page.

    The Aureon test was a molecular test based on a multi-instituion finding of men who have had radical prostatectomy, that was presented in conjunction with other available information about my situation; Gleason, PSA, etc which added some to the basic information that was available. That company, although the test was a good one, has since gone bankrupt. 

    Currently there are genomic tests that are available, that provide finding of molecular information based on amount of markers found that contribute to prostate cancer. There are few out there now; decipher, Prolaris and Genomic Health oncotype DX. There are some differences among these tests. This field is growing and there will be other more refined molecular test that will come on the market.

    Troy, In the future if you have any questions about prostate cancer, please post in the public forum. I feel that the csn email is designed for personal messages only..........Best of luck

  • Tdoyle
    Tdoyle Member Posts: 36
    Myriad Prolaris Biopsy Test Results

    Block(s) Analyzed: BL17-0105-0007987 B1 Consistent With Average AUA1 Low Risk This patient's clinical stage is different than that defined by this category, and clinical management should be adjusted accordingly. PROLARIS SCORE 2.9 US Distribution Percentile: 27% (For AUA Low Risk) Interpretation: 27% of patients in the AUA Low Risk* category have a lower Prolaris Score Mortality Risk __________________ __________________ Metastasis Risk __________________ __________________ Mortality Risk: 1.4% 10-Year Prostate Cancer-Specific (with conservative management) Disease Specific Mortality This patient's 10 year risk of prostate cancer-specific mortality is 1.4% (95% CI:0.7-2.6%) with conservative management. Mortality risks could be altered by various therapeutic interventions.*** In a clinical study estimating 10-year prostate cancer-specific mortality risks for men undergoing conservative management, there were no observed prostate cancer deaths in patients with a predefined clinical risk score (CCP combined with CAPRA) corresponding to a 3.2% (95% CI 2.0, 5.2%) prostate cancer-specific mortality risk. ** Metastasis Risk: <1.0% 10-Year (with definitive treatment) Metastasis This patient's risk of metastasis within 10 years of diagnosis is <1.0% (95% CI:0.1-0.7%) after definitive treatment. Individual Mortality Risk Stratification  1.4% ****

  • Tdoyle
    Tdoyle Member Posts: 36
    edited February 2018 #50
    MRI Results

    Impression

    A 5 mm lesion in the right central gland near the base with imaging
    findings suggestive of PI-RADS category 3 lesion. No disruption of
    prostate capsule. No concerning pelvic lymphadenopathy.


    PI-RADS 1: Very low (clinically significant cancer is highly unlikely
    to be present)
    PI-RADS 2: Low (clinically significant cancer is unlikely to be present)
    PI-RADS 3: Intermediate (the presence of clinically significant cancer
    is equivocal)
    PI-RADS 4: High (clinically significant cancer is likely to be present)
    PI-RADS 5: Very high (clinically significant cancer is highly likely to
    be present)


    I have read this case with MRI fellow Dr. Gitanjali Bajaj.



    Electronically Signed by: Tarun Pandey, M.D. on 02/16/2018 at 16:23:06

    Narrative

    EXAM DESCRIPTION:
    MRI PELVIS W WO CONTRAST

    HISTORY
    prostate cancer
    Most recent PSA date and result: 5.9
    Biopsy date and results: 2 cores positive for cancer
    Gleason Score: 3+ 3
    Prior Treatment or Active Surveillance: Active surveillance

    COMPARISON
    None available

    TECHNIQUE
    Multiparametric MRI of the prostate was performed utilizing multiplanar
    T2W sequences, diffusion-weighted imaging, and dynamic
    contrast-enhanced sequences without an endorectal coil on a 3T magnet.

    FINDINGS
    PROSTATE: The prostate gland is normal in size. No disruption of the
    prostate capsule is noted.

    Index lesion (highest PI-RADS assessment category)
    Location: Right central gland near the base, best seen on image 14/30
    of series 4
    Size: 5 mm
    T2WI characteristics: Indistinct on T2 weighted images.
    DWI characteristics: Minimally hyperintense on diffusion weighted
    images and moderately hypointense on ADC maps.
    Contrast Enhancement: No early enhancement
    Overall PI-RADS score: 3

    Additional Lesions:

    Other Prostate Findings: Mild diffuse hyperintensity of the peripheral
    zone. No T1 hyperintensity is noted to suggest hemorrhage.

    SEMINAL VESICLES: Unremarkable.

    LYMPH NODES: No pelvic adenopathy.

    BLADDER: Unremarkable.

    PELVIS: No free fluid.

    RECTUM: Unremarkable.

    BONES AND SOFT TISSUES: Unremarkable.

  • Old Salt
    Old Salt Member Posts: 934 Member
    Now what?

    It looks to me that the results from your most recent MRI confirm the earlier one. The big decsion is how to treat the Gleason 6 cancers in your prostate; many options!

     

    PS: Note that the MRI report has an error; an earlier biopsy reported 7 Gleason 6 cores out of 24 taken.

  • Tdoyle
    Tdoyle Member Posts: 36
    Old Salt said:

    Now what?

    It looks to me that the results from your most recent MRI confirm the earlier one. The big decsion is how to treat the Gleason 6 cancers in your prostate; many options!

     

    PS: Note that the MRI report has an error; an earlier biopsy reported 7 Gleason 6 cores out of 24 taken.

    error

     Old Salt, I did notice that, not sure why they missed that, I have an appiontment tomorrow with the doctor to go over the results...And yes now to decide the best path to take

  • VascodaGama
    VascodaGama Member Posts: 3,512 Member
    The 7 out of 24 may have been from the same region

    I think that the 7 positive cores out of 24 may have been from the same region indicated in the initial biopsy of 1 positive core out of 12. The MRI report on "two cores" is questionable but irrelevant in its conclusions. It locates two possible lesions/areas with intermediate probably of clinically significant cancer (PI-RADS 3); one is 5 mm at right central gland near the base and the second at the peripheral zone. This correlates with previous findings in your description in above post "The 7 cores all on the right mid (central) and right side (peripheral) of the prostate ... ".

    It all indicates to be a contained case. The final decision is now in your hands. This is a difficult moment because one got cancer and the first though is to eliminate it. However, the risks from a treatment are great and will affect the present quality of life. In your shoes I would give consideration to AS due to the low aggressivity of the cancer and the other good results/findings from the image studies. In my lay opinion you do not need to rush. You have time to decide and even can postpone any intervention, while monitoring the situation.

    Best wishes,

    VGama

     

  • Tdoyle
    Tdoyle Member Posts: 36
    edited February 2018 #54
    AS

    Had the follow up with the oncologist about the MRI results. As of now I have chossen AS as my plan, The doctors agreed this is a way to go and he wants to do psa test in 6 months to see if it is holding steady and said if it jumps around that he would like to do a MRI guided biopsy of the lesion. He confused me a little when he said that the PI-RADS 3 meant that there was a 50/50 chance of the gleason 6 coild possible be a 7 or more... and the APRN said that the lesion was in the middle and not on the edge of the prostate...

  • Tdoyle
    Tdoyle Member Posts: 36
    ????

    Other Prostate Findings: Mild diffuse hyperintensity of the peripheral
    zone. No T1 hyperintensity is noted to suggest hemorrhage.

     

    What does this part mean?  Does this have anything to do with perineural invasion?  

    Thanks

     

  • tcrissup
    tcrissup Member Posts: 1
    Tdoyle said:

    AS

    Had the follow up with the oncologist about the MRI results. As of now I have chossen AS as my plan, The doctors agreed this is a way to go and he wants to do psa test in 6 months to see if it is holding steady and said if it jumps around that he would like to do a MRI guided biopsy of the lesion. He confused me a little when he said that the PI-RADS 3 meant that there was a 50/50 chance of the gleason 6 coild possible be a 7 or more... and the APRN said that the lesion was in the middle and not on the edge of the prostate...

    Pro Cure

    I am 66 year old with gleason score 7-8  cancer contain in prostrate,  Psa was 1.33.  I went to ProCure okc.  Great People, Great job with little side effects.  You might want to check them out.

  • VascodaGama
    VascodaGama Member Posts: 3,512 Member
    Your confusion

     

    Congratulations for reaching to a decision. AS seems to be the best choice for the moment. Regarding your confusion with the doctor’s comment that “ … the Gleason 6 could possibly be a 7 or more …”, I think that he meant to say that the PI-RADS indexation doesn’t qualify the Gleason rates. Analysis of the biopsy cores under the microscope provides the Gleason of the cancerous cells. In your case they were classified as rate 3. PI-RADS 3 refers to an intermediate probably of having cancer that would be recommended for further investigation, which in your case has been done.

     

    "Mild diffuse hyperintensity" refers to rate of detection captured in the MRI. T2W is taken as lesion and T1W refers usually to calculi or scars (such as hemorrhage from previous biopsy). Perineural invasion (PNI) refers to cancer in the nerves, which in this case surrounds the prostate. The MRI did not detect extraprostatic extensions so that one could assume a negative PNI.

    You doing well in investigating all details.

    Good luck in your journey.

    VG

  • Tdoyle
    Tdoyle Member Posts: 36
    PSA 4 months later

    Had a PSA test done a couple weeks ago. First one since choosing AS 4 months ago. It was 3.08 , but I was wondering if the 4 month Lupron shot I had taken back in October of last year is fully out of my system or does it linger on until now???  Tend to get a little nervous as months go by on AS.

  • Old Salt
    Old Salt Member Posts: 934 Member
    Yes, being nervous is normal, unfortunately

    Your last shot was in October; it should have lasted 4 months, until Feb. After that, it should have washed out slowly. How slowly depends on the individual, but as an average, one might assume that it is largely gone from your system by now (early July), 4+ months later. 

    One can do a testosterone (T) test. If the T should has returned to, what is for you, normal, then you can be sure that the Lupron is gone.

    However, non of this is particularly relevant. What is relevant is your next PSA result. And, yes, we all get nervous about those numbers.

  • MG0351
    MG0351 Member Posts: 1
    edited July 2018 #60
    New to the Big "C" club

    July 23rd I got the news about my PC, I thought I was prepared, But when I got out to the parking lot I lost it....

    I'm 65 and my Dr, did a lab. and he found out I had a PSA 5.2, So off to the Urologist I go, I had the Biopsy....Gleason score 9...4/5

    Aug 3rd I will have a CT, Waiting on Ins. to get Bone scan....

        So I guess the next big hurdle is to see if it has spread....

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    MG0351

    Best to start a new thread, so as not to cannibalize this one.

    Click discussion board above, then on the next page click "add new forum topic" upper left corner under discussion board.

    MG, your case is a serious one and requires the attention that it deserves on on one thread.

    Please, let us know how many cores were taken, and how many were positive, and the gleason scores of each core.

    Best