gleason score of 9

Mikes2990 said:

Dear Rake-
I'm 54 and in the last year I have been in very much your situation. Gleason 5+4, 13/13 samples positive in biopsy, bone scan clean. I started hormone therapy immediately. I had a davinci radical prostatectomy, the margins were dirty and one of my lymph nodes had metastasized. T3N1 I went to an oncologist, Dr Moskowitz in Naples Florida, who gave me 6 doses of chemo, on the very probable assumption that micrometastases had already occured and this was my best chance to cure rather than palliate. After the chemo, which is very tough stuff, every bit as nasty as people say, I has 40 doses of radiation. I have exhausted every known treatment. They cannot be done a second time.

Right now, cancer is undetectable, if it stays that way I might live to be 100, if it recurs, I've got about a year. The best I can suggest to you my friend, is that you hit back at this awful disease as hard as you can as soon as you can. You have everything to gain and lose, so be maximally aggressive.

I know how much the disease AND the treatment mess with your mind. Everybody breaks down once in a while but you have to stay strong for yourself and those who love you. Get right with God. Stay tough and fight back, learn to appreciate how much you have been given and remind yourself how much there is in your life that is worth fighting for. I know what a gut check this is. Good luck and God bless.

Mike

BTW, I have gotten some solace from this, maybe you will too:
http://www.youtube.com/watch?v=nLD09Qa3kMk&feature=results_main&playnext=1&list=PL361CE5C9167977FC

Treatment recommendations
I was diagnosed with Cancer Jan 2012- Gleason Score of 9 (5+4) in 4 of the 6 sections of the Prostate.PSA in Nov was 7.26.Of these 3/3 of the Right Lobe have 50-80% cancerous tissues and right base has less than 5% cancerous tissues. No lymphovascular invasion seen. CT and Bone Scan-no metastasis but on DRE doctors feel cancer has gone outside the capsule.
Has anyone tried HIFU with similar scores. Doctors recommending 2 different plans.
First robotic surgery and then adjuvant treatment
Second- hormonal or chemo then MRI and finalize treatment. if prostate outside capsule then no surgery.
Any suggestions please.

VascodaGama said:

Get Second Opinions before committing
Hi Pravin

Welcome to the board.
I wonder what your age is and what made you to get to a biopsy. Have you any symptom or was it an unexpected high PSA?

Gs 9 are aggressive types of cancer but your negative bone scan and CT may indicate that the cancer is still localized. The negative aspect of your diagnosis is the positive DRE. Most probably the cancer has already penetrated the capsule to which condition surgery would not provide a cure.

Your doctor is advising two typical forms of treatment correctly. However, the combi of surgery plus adjuvant is ambiguous. What does he have in mind as adjuvant treatment? Is it radiation?
If the answer is Yes then his approach is “debulking” which may be unnecessary, because the radiation will radiate the whole prostate while caring for surrounding areas too. This would relief you from the risks of surgery and the side effects. In fact treatments for cancer are not perfect and many decisions are made on guessing.

The second option with Hormonal or Chemo is viable but it is palliative not curable. This is recommended for patients with systemic cancer, which by the info you share it seems not be the case. The MRI to confirm the “outside” diagnosis is not that reliable in low PSA levels (lower than 10). Typical image studies (MRI, CT) cannot ascertain small tumours (less than 1.5 mm) so that using the test to judge for extra capsular extensions may not be practical. The newer MRI with higher resolution or PET scan with the newer contrast agents (C11) are better but still lots of guessing will be required to define on extra capsular extension.

HT plus RT is recommended for cases similar to yours where positive DRE exist. The “debulking” principle is also suggested by some doctors when the patient is young. However, the practice will involve doubled risks from double radical treatments (RP + RT) that may impair the quality of life.

I would recommend you to prepare a list of questions and to get second opinions from other specialists.

The best to you.

VGama

Gleason Score 9
Hi VGama

Thanks.I am 57 and currently single and no children. I did not have any symptons and the only reason for the Biopsy was the unexpected high PSA.
I have consulted with 4 Urologist/Oncology surgeons, 1 Medical Oncologist, and 2 Urologist/Oncologist. Of these the 4 Surgeons+ the Medical Oncologist recommend surgery. The other 2 who are with my HMO recommend initial Hormonal or Chemo then MRI after 8 weeks and decide the plan of treatment.
One surgeon who is the highest rated feels that there is a 80% probability of his being able to remove all the cancer and has ordered the MRI to be done immediately-this week before the robotic surgery.Adj treatment would probably be RT
The Biopsy report gives a maxm.length of 0.6 mm for the tumour.

Thanks again
Prav

wikanders said:

I just joined this network. I don't know where to begin in this blog....so I just selected this posting to interject with a question.

My husband was diagnosed with PC in 2008. (5+4 Gleason) Had DiVinci Surgery and follow on radiation. Since then he was put on Lupralite Depo - 2x year and Kasodex. In 2010 the doctor skipped one injection but the PSA started up again. They took him off Kasodex and returned to the 2X year of Lupralite. His last injection was in Nov 2011.

He had a PSA test about a month ago and it was over 5. We are on the Atkins diet as he was gaining a great deal of weight. One month later, his follow-up PSA was 17.

Question: Can red meat affect the PC negatively?

Prostate Cancer and Red Meat
Wikanders,

Sorry that you and your husband are dealing with this serious diagnosis.

Many believe that red meat has a direct correlation to prostate cancer (breast cancer too). Dairy is another animal product that may affect his cancer.

In the United States our beef comes from cattle fattened on corn in giant feedlots. The natural diet for cattle is grass but about forty years ago ranchers discovered that they could increase the yield of beef per cow and speed its time to slaughter by feeding them corn instead of letting them loose on the range to mature naturally. Growth hormones were also discovered that accelerated the growth of cattle. These corn fed cattle with their growth hormones and massive amounts of antibiotics (because of the conditions in the feedlot) carry over directly into the meat we eat in America. These products increase the ICFs (Insulin Growth Hormones) in our food and have been shown in many studies to accelerate cancer growth.

Dairy products, in my opinion, are even more dangerous because they produce even higher amounts of ICFs and are completely unnecessary in the human diet. Cows milk is great for baby cows but humans do not need milk (or dairy products) after they have been weaned from breast milk.

There is a lot of material out there on this subject and I encourage you to do your own research and draw your own conclusions.

Many of us with prostate cancer have chosen to reduce or eliminate our intake of dairy and red meat.

Best of luck to you.

K

sueanne1 said:

gleason score of 9
Hi Norwood. My husband had a PSA count of over 4000 when he went into surgery five years ago. It went over 4000 again last year. His latest count is 749. He has prostate bone cancer and is doing very well. He is 74 years old, and we expect him to be around for the next five to ten years. Bob has gone through the hormone treatment at the beginning, along with radiation. When he came off of the hormone treatment he went through the chemo therapy for almost two years, then another round of radiation. the only thing that has caused him any grief was the Zometa he was advised to take. This has caused him nothing but trouble with his mouth. Two years ago he had an abscessed tooth and was treated for that and had the tooth extracted. The gum will never heal and the dentist is just waiting for the bone to rot out enough so he can get the bone out. Bob cannot go through a bone transplant using his own bone since he has bone cancer. Just keep yourself busy and keep your mind active, and you can live a long, healthy life. Do not give in to the cancer. Good luck, and God bless.

KUDOS
Hi Sueanne and Husband: Your story and your husband are an inspiration to the strength of the human spirit and physiology! Thanks! I am Tony, you can read my story on Anthony S. Winterer YANA on google, it should be updated by tomorrow or Tuesday at the latest. At any rate, I am 63, married 42 years, Gleason 9 Human Being, receiving a robotic prostatectomy on May 21, 2010. This was followed by 4 months of Adjuvant Therapy, Radiation(IMRT) and Lupron with Casodex. My psa has recently climbed to .32, I was staged at 3b, and I hope to have a long life with my dear wife and sons and family. Thanks again for your inspiration, God Bless you both and your family.....Tony p.s I am scheduled for all the bone scans again, ct scan, and dexa scan on May 3, it has been 2 years! Please Pray for all of us!

Perfect 10
I was diagnosed with a perfect 10 Friday, 5/13/11. Had robotic prostatectomy 6/8/11. My doc (Ahlering) said mine was the most interesting (difficult) of the 1072 he'd done at the time. Prostate stuck to rectum, metastisized to lymph glands & bones. And worse, if possible. Started Lupron 6/15/11, still on it. Had 5 rounds of taxotere. PSA was as high as 27, but taxotere knocked it out. It's currently undetectable. Sadly, it will be back. Hopefully in 20 or so years, but I expect less. I'm fighting it with lots of exercise, healthy eating, and FU attitude toward the Bas***d cancer. I'll be 67 next month.

JoeKidd said:

Attack Ca or Paliative care?
My dad is 71yrs old.
He is somewhat obese and about 200 pounds and 5foot 9inches.
He is borderline diabetic and has high Blood pressure.

He does not have any major symptoms of prostate cancer other than a mild restriction in urination. No other pains.

He had a PSA of 160.
A bone scan was done which turned up negative.
His Gleason score was given as 6.
The Ca has spread to the lymph nodes and seminal vesicles.

Based on this, an orchiectomy was done 4 weeks ago.
His PSA reduced to 15, which was considered high considering the orhiectomy.

A more precise bone scan was done that identified metastasis in the right pedicle of D12 vertebra. His Gleason score was now mentioned as 8,9.

Are there any further tests that need to be done?
Should we wait for more time?
What are the treatment options?

Can you direct me to some reading material and also suggest a suitable approach?

Thanks!

Next Steps
Joe,

Welcome to the forum and I'm sorry that your father's condition finds you here. Hopefully you will gain some information that can help your father in the years ahead.

I would not be surprised to see future PSA scores continue to diminish below the present level. While the testes produce most of the testosterone in males some is also produced by the adrenal glands. You way wish to inquire about your father's testosterone levels from his latest blood test or ask for a T-level test the next time he goes in for a PSA reading.

I would get copies of your father's medical paperwork so that you can precisely know what his condition is and have it available should you seek second opinions in the future. The initial Gleason score you cited at 6 seems very unusual given that the prostate cancer spread to the seminal vesicles and lymph nodes. The later Gleason of 8/9 seems more on the mark but it would be useful to know what the rest of his pathology was before treatment.

As you probably know, an orchiectomy is a form of hormone treatment that is used to eliminate testosterone from the body which most prostate cancer needs to grow. After the procedure the cancer will probably stop growing or shrink for some period of time but as the cancer becomes progressively advanced, prostate cancer cells find other sources to fuel themselves and even begin to produce small amounts of testosterone on their own. When this occurs, the cancer will begin to spread again. There are other drugs available that may be effective in slowing this stage of cancer such as abiraterone (Zytiga) but there are many potential side effects that can occur. It is important that your father have regular PSA checks as an increase in the readings will be an indicator to his medical team that his cancer is becoming castrate resistant and trigger the use of drugs such as Zytiga.

Prostate cancer loves the bones, particularly in the spine, where your father's doctors evidently found mets. As the mets grow they may become very painful and radiation to these is often used a palliative treatment to alleviate the pain but it is not considered a cure.

Your father's borderline diabetes, excess weight, and high blood pressure also pose a serious threat to your father's long term health and fortunately these are fairly easy to address with diet and exercise. You might also investigate a diet that eliminates dairy and red meat which are often correlated to having chemicals and enzymes that fuel prostate cancer growth. In the United States our dairy and beef cattle are filled with artificial growth hormones and contain excess Insulin Growth Factors (IGFs) that can fuel the spread of cancer. Adopting a heart healthy diet that eliminates or significantly reduces protein from animal sources will not only help your father get to a healthy weight but it can very well help the body's natural immune system in fighting the prostate cancer.

Other things to be alert for after orchiectomy are hot flashes, depression, osteoporosis, and eventually brittle bones. Make sure he takes the supplements he needs and exercises regularly to preserve muscle mass.

Best wishes to you and your father as you battle this disease.

K

gleason 9
I am 73, have a gleason of 9, psa 1.4, clear bone scan and an mri showing that there is cancer in the vesicles and out of the margins. Just got on harmone therapy and trying to decide to have surgery or radiation. The senior experience doctors pick radiation and the younger aggressive doctor recommends Da Vince robotic surgery. Advice very much appreciated.

Steve199 said:

Same Gleason 9 Is it still in the prostrate
norwood I chose HIFU as a first treatment. It's not done in the USA except with the FDA trials. Procedure was in Canada by a very experienced Dr. on 10-22-09. My 6 month PSA is .001. The first thing I think you need to do is do everything you can to see if its still in the prostrate then decide on the treatment. I went to Sarasota, Fla and had a MRI Telsa-3 done. It's like looking at your prostrate in High Definition. It's my understanding only five are in the USA and mostly at research Institutions. The Dr. in Sarasota is also a HIFU Doctor however; I chose another Doctor to do the HIFU procedure. I'm blessed that I chose the path I took and I'm greatly in appreciation to both Doctors for the knowledge I learned from both. After you have done all you can do in determining it's still in the prostrate then choose the best and most experienced Doctor with what ever method you choose in your treatment.

hifu
who was the doctor in canada? kevin

Rangertug said:

What treatment
What treatment did you go with ? How are you traveling now?

I had Gleason 9 (4+5) for 50% of the 12 samples and 4+4 for 40% of samples with 1 negative. I was told surgery was a waste of time and have just had HT , my PSA was 254 in July 2010 in July 2012 was 5.1. My cancer had metastized to my bones and lymph nodes, PSA was see sawing up and down, so I joined the Prevail MDV 3100 clinical trial, so far with fantastic results.

Ranger, wishing you the very
Ranger, wishing you the very best.

-Trew

cptkenny said:

Prostate Cancer Gleason 10
Hi Larry,

I was in the jungle for seven months and at times, for lack of h2o, we had to drink out of bomb craters in areas that were sprayed with agent orange. YES, there is help for several different types of cancers that are "presumptive" with agent orange. I have been on the agent orange registry with the VA for 25 years (before that, there was no VA to speak of). Last summer, my PSA went to a 7 and three months later to a 9. I almost walked away from the bioposy but was talked into it. I studied hard and got a perfect 10! I opted for the operation, but the oncologist said hormone therapy and radiation were the best bet. They did TWO bone scans and TWO soft tissue scans and were surprised that there seemed to be no spread. I got the hormone shot in September and radiation started in January. They went with "high beam" for 25 treatments and theyn with the "regular focused" beam for the next 20. Not bad for the first half, but the last month, it was a race to the bathroom at any time of day.
Two days age, June 13th, I met with the oncologist and the PSA is way down, but he suggests hormone therapy for the next two years and then, even longer till the effect of the treatment wears off in time. As he said, "Some people are curious to see if the cancer is gone and quit the hormone therapy, but if it is not, then we have to look at other more drastic treatments". I am not curious!
My suggestion to you is visit with your local VA and if you were in Vietnam and have a covered cancer, you may qualify for 100% disability while you are being treated.
Side effects. I have to hit the "john" six to eight times a night and I take a daily pill to get my "crap" together as much as possible. I lift weights, but me arms and chest still got flabby. I get tired more easily. I can discribe EIGHT different colors of blue...ha, ha. Just kidding on the blue. Not fun, but beats the alternative. By the way, I* was with the Air Cav, 1968-69. III Corp.

Agent Orange
cptkenny,
Good luck on your journey. I too was in Viet Nam 68-69. I have tremendous respect for those of you that were out in the jungle. I was stationed at the Air Force Base where they stored all of the Agent Orange for the Country and worked on the flightline fueling the C123’s that sprayed it. I was diagnosed with a Gleason 9 stage T3b in December of 2009 and had the Davinci Surgery followed up with 45 Radiation treatments. Last month I was given my last three month hormone shot which will bring me to a total of 36 months on hormones. I also have been taking Biclutimide every day for the past year at the direction of my VA urologist. My PSA has remained >0.1. I will have another PSA test next month as well as a test for testosterone levels, which I assume is to determine a base line as they will continue to test PSA every 3 months to look for an increase.
My side effects have been typical, hot flashes, breast tenderness, incontinence, tiredness, weight gain, depression, loss of libido and general lack of energy.
I am curious if anyone else that has been on hormone treatment for three years has had a recurrence and how long it took for PSA to begin rising. My initial PSA was only 2.2. I am looking forward to regaining a somewhat normal existence after the effects of the last hormone shot go away in 3 months.