Figuring Out All the Information from a Prostate Cancer Diagnosis

hopeful and optimistic said:

Hi
I am sorry that your diagnosis has brought you to this site,however where we are able to support you ,and share information from our lay research and experiences with you about the beast.

The PSA which is an inicator is affected not only by prostate cancer, but other factors such as prostate size. Since your prostate is large there had been more PSA secreted, and your PSA numbers were high. There is a ratio that measures psa density= psa divided size of prostate. The lower the number the better.

That said the biopsy is the key information. The gleason score measures the aggresiveness of the cancer. The range is 2-5. One has to look at the highest grade to determine treatment. In your case that is 3+4=7, which means that in that core the most prevelent is a 3, and the secondary score is a 4. A 3+4=7 is better than a 4+3=7, however a 3+4=7 is still a mid level aggressive cancer.

Involvement indicates how much cancer there is in each core, so as understand there is a 4 percent involvement in the core, that is 4% of the 3+4=7 core is cancerous, ( a small involvement), the other cores that are 3+4 have an even smaller involvement.

A cancer that is mid aggressiveness like your needs to be treated, unless you are aged, and your life expectency is limited. The vast majority of us will die from something else, such as heart disease than from prostate cancer.

Acording to the information provided there is no extracapsular extension found in this test( a good thing, probably because there is low involvement).

Non palable indicates that the the Digital Rectal Exam did not show any abnormalties.


Now all that said, I strongly recommend that

1- you get a second opinion on the pathology of your biopsy by a world class pathologist that specilizes in prostate cancer since determining gleason grade is very subjective. You do not want to be under or over treated.

2-what is your age? Life expectence is important in determining treatment.

3-If you do receive active treatment, prostate surgery will solve your BPH problem as well address your prostate cancer, however there is risk of side effects from the surgery.

Kongo said:

Slow Down
Tom,
Unlike some of the suggestions from others, I tend to think your doctor handled your situation correctly and prudently.

Your rather high PSA score coupled with the enlarged prostate and symptoms of BPH are common. The prostate sits in a very confined space within the pelvic structure. As the prostate expands with BPH it has nowhere to go and presses up against the surround skeleton structure. This begins to squeeze the gland which pushes more PSA into your bloodstream--thus the higher PSA. The expanding prostate also tends to squeeze against the urethra (which passes from the bladder to the penis by going through the middle of the prostate) which causes frequent urination, faltering or weak stream, start/stopping, and so forth.

Your doctor correctly tested for prostate cancer through biopsies that would have targeted the most likely places to find it. He didn't find anything but kept at it over time until eventually he found some.

I suppose he could have done a saturation biopsy which may have increased the likelihood of finding something but that's not a sure thing either. A biopsy only samples about 1% of the volume inside the prostate so it's easy to miss something, particularly when your other symptoms and PSA could be explained by the BPH.

Many urologists suspect that BPH is a precursor for prostate cancer. But on the other hand the indolent cancer cells found near the center of the prostate and often associated with BPH are nothing to really worry about.

What your pathology shows is a overall 3+4=7 Gleason score which is a 3+3 on the left side and a 3+4 on the right. From what you've written it seems that there is a low level of involvement in each of the cores, which is a good thing. There is also no perineural involvement. That means that they didn't find any cancer near the nerve bundles that surround the prostate which is often considered a precursor for the cancer to leave the prostate gland.

Overall you are somewhere between low and medium risk with many excellent treatment options that should enable you to control this disease now and have no impact on your long term mortality. Treatment choices can affect your quality of life so do your research on potential side effects associated with each treatment choice.

It's always a good idea to get second opinions, particularly on the biopsy samples, but I think your urologist correctly handled your case.

Good luck to you.

K

Kongo said:

Good points
Mike,

You make some good points and I understand your perspective. My opinion, however, is that given the limited information Tom has made available to us that the doctor acted within accepted norms for the profession. Hindsight is always 20/20 but frankly I respect this doctor for not rushing to an over treatment that could have had an adverse impact on Toms quality of life. M I think urologists have to walk a fine line between being complacent, overly aggressive, and they have to do all of this within the professional and insurance parameters they have to work in.

Coulda, woulda, shoulda doesn't make sense to me in this case from the information that has been presented. Of course he could have done more and maybe he suggested options that we don't know about but this is an imperfect and imprecise process and I think the doctor acted appropriately. At the end of the day Tom still ens up with a relatively low grade prostate cancer and I don't see any way his treatment options have bee compromised.


I hear you about being proactive but I believe proactive too often leads to overly aggressive and inappropriate treatment. That was one of the fundamental reasons the USPTF task force came up with their controversial decision about doing away with the PSA test for men without symptoms.

In any event we are all entitled to our individual opinions and mine is that I think we should use caution when criticizing decisions without having the full picture or the medical background to second guess a professional. I have certainly criticized doctor recommendations in the past but I hope they have only been in situations the seem to obviously deviate from the normal standard of practice. I didn't feel Tom's description met that level.

Best

ralph.townsend1 said:

First is sorry for your condition, and secondly get a new Doctor or a second opinion!!!!

Maybe even a CT scan to see the area of the prostate before you remove it and change your life. Go to a real specialist on prostate cancer and take your biopsy report to allow them to review your condition. Don't just remove your prostate, when you might not need to!

But don't waste time, because you could lose time!!!