gleason 7 , 3 + 4 . T1C ,psa 9.6 and apparently contained...so what does it really mean?

We can only aspire for "cure"
Beacon
Nobody can say those words of “cured”. But we can aspire for it as like the many guys that really have been many years without recurrence.
If the cancer can be “cut out” or “burned” totally then a cure is certain, but there is no guaranty from any treatment to assure such happening. It all depends if the cancer is totally contained which is impossible of knowing at the present. All is based on statistics.

A T1c has many treatment options. Your family member should be aware of the side effects of each one in detail (many are really nasty and permanent). Advice from good oncologists is the best way.

Gleason 7 classify his cancer in the mid aggressivity class, but the chronology of the PSA (velocity, doubling time, etc.) is very important for a final judgement. His diagnosis of PSA<10, Gleason <7 and T1 is within the “scale” for AS. This is the modality with the lesser side effects, nowadays chosen by the famous surgeon Dr. P. Walsh, if his cancer is of the “indolent” type. The PSA can explain better about his status.
To verify such possibility he should get a second opinion on the biopsy and pathologist report from a reliable laboratory (JH or Bostwick).

I hope this helps.

The best to you and your family.
VGama

Many Unknowns
Beacon,

Your family member has much to consider as he begins his battle with prostate cancer. When we are first diagnosed we often tend to look at this disease in terms of black and white...is the cancer contained or not contained, is it aggressive or indolent, will we see a recurrence or not, and which course of treatment is best to follow to address the cancer? What treatment will "cure" the cancer?

Unfortunately, there are few black and whites but many, many shades of gray. A Gleason score of 3+4=7 is typically less worrisome than a Gleason 4+3, but they both add up to a score of 7. A Gleason score is a subjective evaluation by the pathologist reading the biopsy slide as to the degree of differentiation of the among the cancer cells in the positive core on a scale of 1 to 10, the higher the number the more poorly differentiated (worse) the grade. The first number represents the most prevelant number of cells and the second indicates the second most prevelant number of cells. A staging of T1c only means that the cancer was discovered through a rising PSA score and that the digital rectal examination failed to show any lumps, bumps, or hardness that might indicate a cancer nodule.

Much depends on the skill and experience of the pathologist in reading the biopsy slide which is why it is often recommended that patients seek a second opinion on the reading. The biopsy resuslts are also dependent upon the number of cores taken. For example, if it was a six core biopsy there is much less chance of detecting cancer throughout the prostate than say a 12 or 18 core sample. A 3+4 sample in one part of the prostate does not rule out a more aggressive degree of cancer in another part of the prostate. It might mean that they found the most aggressive cancer or then again, it might mean they simply missed it when the biopsy was taken. A typical biopsy only samples about 1% of the total prostate volume. This is why second opinions are so important with biopsy samples.

As Vasco suggested, other factors come into play as well. The PSA velocity, or how quickly the PSA score is rising, is another method of determining the aggressiveness of the cancer. It is not a straight line but rather a logarithmic relationship. The higher the velocity, the faster the cancer is growing. Other parameters that give doctors insight include PSA doubling time (how long it takes the PSA score to double) and PSA density (the ration of PSA to prostate volume). There are nomograms available on the web that enable you to calculate these scores if you have a good history of PSA scores and know your prostate volume which should have been measured during the ultrasound.

It is impossible to predict with certainty which treatment will be most efficient in addressing the cancer and again, there is no black and white answer here. Each potential treatment carries the possibility of adverse side effects that will affect the patient for the rest of his life. Some treatments have potentially more severe side effects than others. This makes a treatment decision a highly personal choice and should be a function of the desired quality of life following treatment. Your family member should carefully consider the side effects of each treatment course and weigh them against the desired quality of life. This typically takes a lot of research and consultations with multiple experts in different specialties such as open surgery, robotic surgery, and the several types of radiation available for treatment, as well as the possibility of using hormone treatments to lower testosterone levels that will slow the cancer growth. There are other treatments that involve cryosurgery (freezing of the prostate), high frequency ultrasound, and so forth. Depending on the pathology and side desired quality of life, there are not black and white (or right or wrong) answers about which is best.

Other factors that affect treatment are things like health, size of the prostate, age, and other conditions. For example, a 65-year old man with a history of heart conditions may not be a good candidate for the major surgery required to remove the prostate. Very enlarged prostates are harder to remove surgically, or radiate effectively without increasing potential damage to other tissue and organs outside the prostate. Men with a history of sexual dysfunction or urinary issues will most likely see these conditions grow more severe following some types of treatment. In virtually all cases, some decrease in sexual capability is likely regardless of treatment which is why a realistic assessment of quality of life after treatment is so important.

Statistics show that about a third of the men who have surgery see a recurrence of prostate cancer within five years. If radiation is chosesn and depending on the type of treatment used, varying percentages of men see a recurrence here as well. Much of this depends upon the stage of the cancer at the time of treatment, the age of the man, overall health, body mass, and so forth.

Many experts feel that despite what a MRI or CT scan might reveal, microscopic amounts of cancer are fully capable of spreading throughout the lymph system or blood stream despite an initial determination that the “cancer is contained within the prostate.” Depending on the choice of treatment, the very act of treatment may encourage the growth of cancer beyond the prostate, particularly if the cancer is growing at or very near the edges of the prostate capsule.

I wish there were black and white answers to your questions but that just isn’t the way this cancer works. Your family member needs lots of support at this point as he gathers information and determines which course of action to take. I hope that you encourage him to seek multiple opinions about his choices and that he doggedly pursue a precise understanding of the potential side effect s from what each specialist will recommend. A frustrating factor in all of this is that many experts will give you widely varying answers to what is the best course to follow. At the end of the day, this is a decision only your family member can decide.

Best of luck to your family.

K

Cures
You are lucky if your cancer has not spread and with radiation or surgery you should be pretty certain to be able to prevent a bad outcome. My cancer had already spread and all I could do was the radiation. It did kill all the cancer in my prostate and I was Gleason 9. This was confirmed by a second biopsy several years later. I have survived over 7 years with psa 24 and gleason 9. I am now in hospice care but am still working and able to play golf. I do not let it stop me. I take the 50 or 60 pills a day to maintain and just push through the pain.

There is no sure cure out there and taking one treatment over another has no real benefit as far as survival goes. So you choose the treatment you prefer taking into account the side effects. I will say that the radiation had no bad side effects on me and like I said it did kill all the cancer it was intended to kill. No treatment will cure after it spreads and taking treatment after it spreads is a waste of time and money in my opinion. I have had no more treatment and have outlived 95% of the men who took further treatment.

Kongo said:

Many Unknowns
Beacon,

Your family member has much to consider as he begins his battle with prostate cancer. When we are first diagnosed we often tend to look at this disease in terms of black and white...is the cancer contained or not contained, is it aggressive or indolent, will we see a recurrence or not, and which course of treatment is best to follow to address the cancer? What treatment will "cure" the cancer?

Unfortunately, there are few black and whites but many, many shades of gray. A Gleason score of 3+4=7 is typically less worrisome than a Gleason 4+3, but they both add up to a score of 7. A Gleason score is a subjective evaluation by the pathologist reading the biopsy slide as to the degree of differentiation of the among the cancer cells in the positive core on a scale of 1 to 10, the higher the number the more poorly differentiated (worse) the grade. The first number represents the most prevelant number of cells and the second indicates the second most prevelant number of cells. A staging of T1c only means that the cancer was discovered through a rising PSA score and that the digital rectal examination failed to show any lumps, bumps, or hardness that might indicate a cancer nodule.

Much depends on the skill and experience of the pathologist in reading the biopsy slide which is why it is often recommended that patients seek a second opinion on the reading. The biopsy resuslts are also dependent upon the number of cores taken. For example, if it was a six core biopsy there is much less chance of detecting cancer throughout the prostate than say a 12 or 18 core sample. A 3+4 sample in one part of the prostate does not rule out a more aggressive degree of cancer in another part of the prostate. It might mean that they found the most aggressive cancer or then again, it might mean they simply missed it when the biopsy was taken. A typical biopsy only samples about 1% of the total prostate volume. This is why second opinions are so important with biopsy samples.

As Vasco suggested, other factors come into play as well. The PSA velocity, or how quickly the PSA score is rising, is another method of determining the aggressiveness of the cancer. It is not a straight line but rather a logarithmic relationship. The higher the velocity, the faster the cancer is growing. Other parameters that give doctors insight include PSA doubling time (how long it takes the PSA score to double) and PSA density (the ration of PSA to prostate volume). There are nomograms available on the web that enable you to calculate these scores if you have a good history of PSA scores and know your prostate volume which should have been measured during the ultrasound.

It is impossible to predict with certainty which treatment will be most efficient in addressing the cancer and again, there is no black and white answer here. Each potential treatment carries the possibility of adverse side effects that will affect the patient for the rest of his life. Some treatments have potentially more severe side effects than others. This makes a treatment decision a highly personal choice and should be a function of the desired quality of life following treatment. Your family member should carefully consider the side effects of each treatment course and weigh them against the desired quality of life. This typically takes a lot of research and consultations with multiple experts in different specialties such as open surgery, robotic surgery, and the several types of radiation available for treatment, as well as the possibility of using hormone treatments to lower testosterone levels that will slow the cancer growth. There are other treatments that involve cryosurgery (freezing of the prostate), high frequency ultrasound, and so forth. Depending on the pathology and side desired quality of life, there are not black and white (or right or wrong) answers about which is best.

Other factors that affect treatment are things like health, size of the prostate, age, and other conditions. For example, a 65-year old man with a history of heart conditions may not be a good candidate for the major surgery required to remove the prostate. Very enlarged prostates are harder to remove surgically, or radiate effectively without increasing potential damage to other tissue and organs outside the prostate. Men with a history of sexual dysfunction or urinary issues will most likely see these conditions grow more severe following some types of treatment. In virtually all cases, some decrease in sexual capability is likely regardless of treatment which is why a realistic assessment of quality of life after treatment is so important.

Statistics show that about a third of the men who have surgery see a recurrence of prostate cancer within five years. If radiation is chosesn and depending on the type of treatment used, varying percentages of men see a recurrence here as well. Much of this depends upon the stage of the cancer at the time of treatment, the age of the man, overall health, body mass, and so forth.

Many experts feel that despite what a MRI or CT scan might reveal, microscopic amounts of cancer are fully capable of spreading throughout the lymph system or blood stream despite an initial determination that the “cancer is contained within the prostate.” Depending on the choice of treatment, the very act of treatment may encourage the growth of cancer beyond the prostate, particularly if the cancer is growing at or very near the edges of the prostate capsule.

I wish there were black and white answers to your questions but that just isn’t the way this cancer works. Your family member needs lots of support at this point as he gathers information and determines which course of action to take. I hope that you encourage him to seek multiple opinions about his choices and that he doggedly pursue a precise understanding of the potential side effect s from what each specialist will recommend. A frustrating factor in all of this is that many experts will give you widely varying answers to what is the best course to follow. At the end of the day, this is a decision only your family member can decide.

Best of luck to your family.

K

Kongo
AS always you completely cover the entire gambit with thoughtful and realistic insights!

Hope all is well with work and family!

Pca Information
When I was diagnossed with prostate cancer my Urologist recommended the book by the famous Dr. Walsh called "The Guide to Surviving Prostate Cancer" it is an easy to read book that discusses prostate cancer, most of the treatments available (including side effects), and long term survivability.

Kongo said:

Many Unknowns
Beacon,

Your family member has much to consider as he begins his battle with prostate cancer. When we are first diagnosed we often tend to look at this disease in terms of black and white...is the cancer contained or not contained, is it aggressive or indolent, will we see a recurrence or not, and which course of treatment is best to follow to address the cancer? What treatment will "cure" the cancer?

Unfortunately, there are few black and whites but many, many shades of gray. A Gleason score of 3+4=7 is typically less worrisome than a Gleason 4+3, but they both add up to a score of 7. A Gleason score is a subjective evaluation by the pathologist reading the biopsy slide as to the degree of differentiation of the among the cancer cells in the positive core on a scale of 1 to 10, the higher the number the more poorly differentiated (worse) the grade. The first number represents the most prevelant number of cells and the second indicates the second most prevelant number of cells. A staging of T1c only means that the cancer was discovered through a rising PSA score and that the digital rectal examination failed to show any lumps, bumps, or hardness that might indicate a cancer nodule.

Much depends on the skill and experience of the pathologist in reading the biopsy slide which is why it is often recommended that patients seek a second opinion on the reading. The biopsy resuslts are also dependent upon the number of cores taken. For example, if it was a six core biopsy there is much less chance of detecting cancer throughout the prostate than say a 12 or 18 core sample. A 3+4 sample in one part of the prostate does not rule out a more aggressive degree of cancer in another part of the prostate. It might mean that they found the most aggressive cancer or then again, it might mean they simply missed it when the biopsy was taken. A typical biopsy only samples about 1% of the total prostate volume. This is why second opinions are so important with biopsy samples.

As Vasco suggested, other factors come into play as well. The PSA velocity, or how quickly the PSA score is rising, is another method of determining the aggressiveness of the cancer. It is not a straight line but rather a logarithmic relationship. The higher the velocity, the faster the cancer is growing. Other parameters that give doctors insight include PSA doubling time (how long it takes the PSA score to double) and PSA density (the ration of PSA to prostate volume). There are nomograms available on the web that enable you to calculate these scores if you have a good history of PSA scores and know your prostate volume which should have been measured during the ultrasound.

It is impossible to predict with certainty which treatment will be most efficient in addressing the cancer and again, there is no black and white answer here. Each potential treatment carries the possibility of adverse side effects that will affect the patient for the rest of his life. Some treatments have potentially more severe side effects than others. This makes a treatment decision a highly personal choice and should be a function of the desired quality of life following treatment. Your family member should carefully consider the side effects of each treatment course and weigh them against the desired quality of life. This typically takes a lot of research and consultations with multiple experts in different specialties such as open surgery, robotic surgery, and the several types of radiation available for treatment, as well as the possibility of using hormone treatments to lower testosterone levels that will slow the cancer growth. There are other treatments that involve cryosurgery (freezing of the prostate), high frequency ultrasound, and so forth. Depending on the pathology and side desired quality of life, there are not black and white (or right or wrong) answers about which is best.

Other factors that affect treatment are things like health, size of the prostate, age, and other conditions. For example, a 65-year old man with a history of heart conditions may not be a good candidate for the major surgery required to remove the prostate. Very enlarged prostates are harder to remove surgically, or radiate effectively without increasing potential damage to other tissue and organs outside the prostate. Men with a history of sexual dysfunction or urinary issues will most likely see these conditions grow more severe following some types of treatment. In virtually all cases, some decrease in sexual capability is likely regardless of treatment which is why a realistic assessment of quality of life after treatment is so important.

Statistics show that about a third of the men who have surgery see a recurrence of prostate cancer within five years. If radiation is chosesn and depending on the type of treatment used, varying percentages of men see a recurrence here as well. Much of this depends upon the stage of the cancer at the time of treatment, the age of the man, overall health, body mass, and so forth.

Many experts feel that despite what a MRI or CT scan might reveal, microscopic amounts of cancer are fully capable of spreading throughout the lymph system or blood stream despite an initial determination that the “cancer is contained within the prostate.” Depending on the choice of treatment, the very act of treatment may encourage the growth of cancer beyond the prostate, particularly if the cancer is growing at or very near the edges of the prostate capsule.

I wish there were black and white answers to your questions but that just isn’t the way this cancer works. Your family member needs lots of support at this point as he gathers information and determines which course of action to take. I hope that you encourage him to seek multiple opinions about his choices and that he doggedly pursue a precise understanding of the potential side effect s from what each specialist will recommend. A frustrating factor in all of this is that many experts will give you widely varying answers to what is the best course to follow. At the end of the day, this is a decision only your family member can decide.

Best of luck to your family.

K

A Note to KONGO
Your post is clear and concise. I wonder when you will write a book on your case and experiences. I would buy one.

VG

beacon said:

thank you all for taking the
thank you all for taking the time to reply with all this information!

it is invaluable for those that are just starting on the path,and i will encourage my family member to come and read this thread, and also to consider discussing his ideas for treatment options with those that have actually experienced them.

i think he has around 7 weeks to decide before they will remove his prostate, which is what the doctor has recommended so far...
its not much time to decide and gather information...but he is reading as much info as he can, including to begin, dr walshs' book.

Beacon Here is Additional Reading on Pca
I have compiled this list from all those on here over my time that indicated value in the material.

Recommend-Guide to Surviving Prostate Cancer-Second Edition
Dr Patrick Walsh
Recommend-The First Year Prostate Cancer-An Essential Guide for the Newly Diagnosed
Chris Lukas
Recommend-Saving Your Sex Life-A guide for Men with Prostate Cancer
Dr. John Mulhall
Prostate Cancer Meet The Proton Beam-Apatient's Experience
Fuller Jones
Recommend-You Can Beat Protate Cancer and you do nto need surgery to do it
Robert J. Marckini
Recommend-Surviving Protate Cancer without Surgery-The New Gold Standard that save your life and life style
Dr Michael J. Dattoli
Conquer Prostate Cancer
Rabbi Ed Weinsberg
Recommend-Eat to Beat Prostate Cancer Cookbook
Ricketts
Page with Free Guides to Prostate Cancer and Exercise and Nutrition
http://www.pcf.org/site/c.leJRIROrEpH/b.5814067/k.C966/Guides.htm


Comprehensive Book list on Prostate Cancer - http://www.wellnessbooks.com/bookstore/

http://www.havasupaitribe.com/waterfalls.html


Studies:

http://www.nytimes.com/2010/02/14/health/14robot.html

http://nyp.org/news/hospital/robotic-prostate-surgery-study.html

http://news.yahoo.com/s/nm/20100512/hl_nm/us_prostate_cancer

http://www.urmc.rochester.edu/news/story/index.cfm?id=2868


Randy in Indy