My Recent Pathology Report
Comments
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PCa Staging?JMS58 said:Update! My PSA is .1ng after RP
I had a new PSA blood draw (1 week after the .1 reading)
This new draw was at Mass Gen Hosp. and will go to 2 decimal places. I don't have the results yet.
It has bee 8 weeks since RP with 50% nerve sparing on both bundles.
I will be meeting with a radio oncologist soon to discuss radiation and or Hormonr Dep Treatment.
From what I read this .1 is not a good sign and it has me really worried.My Gleason was 6 prior to RP and after surgery my pathology graded as T3c in which I had two positive margins and positive PNI, but no seminal vessel cancer.
Since gleason was a 6 prior to RP no Lymph were tested.It surprised me to go from a Gleason 6 to T3c. Now a .1 after RP.
This must indicate I have very agressive PCa.JMS58:
Unfortunately, I agree that you probably have an aggressive cancer.
In your original post, you said you were staged at T3a, which means that the pathologist believed that your cancer had already spread outside of the prostate capsule at that time. There is no stage T3c. So, not sure what stage you are now but it really doesn't matter -- the only question is, Where has the cancer spread?
You also said in the original post that your cancer was rated at Gleason 7 (3+4) after surgery. Your were rated Gleason 6 from the biospy but that was superceded by the post-surgical pathology report.
It's probably not good that your post-surgerical PSA was 0.1 (it should be around 0.01 post surgery) and further treatment (radiation and/or hormone therapy) would probably be in order. However, your PSA level does not address the question of whether the cancer has already spread to other areas of your body. So, some additional testing to determine the spread (if any) would also be advisable.
Good luck!
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Thank you, do you know what other testing should be done?Swingshiftworker said:PCa Staging?
JMS58:
Unfortunately, I agree that you probably have an aggressive cancer.
In your original post, you said you were staged at T3a, which means that the pathologist believed that your cancer had already spread outside of the prostate capsule at that time. There is no stage T3c. So, not sure what stage you are now but it really doesn't matter -- the only question is, Where has the cancer spread?
You also said in the original post that your cancer was rated at Gleason 7 (3+4) after surgery. Your were rated Gleason 6 from the biospy but that was superceded by the post-surgical pathology report.
It's probably not good that your post-surgerical PSA was 0.1 (it should be around 0.01 post surgery) and further treatment (radiation and/or hormone therapy) would probably be in order. However, your PSA level does not address the question of whether the cancer has already spread to other areas of your body. So, some additional testing to determine the spread (if any) would also be advisable.
Good luck!
Thankyou Swingshiftworker,
do you know what other tests should be done?
I am thinking bone scan,what kind and where in the body?
enhanced MRI ? Does/should this include full body scan or just pelvic area ?
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Discuss with your doctor, butJMS58 said:Thank you, do you know what other testing should be done?
Thankyou Swingshiftworker,
do you know what other tests should be done?
I am thinking bone scan,what kind and where in the body?
enhanced MRI ? Does/should this include full body scan or just pelvic area ?
To my limited (!) knowledge, the tests that you mentioned won't show anything because your PSA level is so low.
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Cancer ScansJMS58 said:Thank you, do you know what other testing should be done?
Thankyou Swingshiftworker,
do you know what other tests should be done?
I am thinking bone scan,what kind and where in the body?
enhanced MRI ? Does/should this include full body scan or just pelvic area ?
There are a variety of methods that could be used to scan for cancer in other areas of the body. The most common methods are MRI, CT, PET and Nuclear Bone scans. The problem is that most doctors (and insurance companies) do not want to use these expensive procedures unless there is a good reason to do so; ie., some evidence of cancer in a specific area.
In your situation, I would first ask for an MRI/MRSI scan using a Tesla magnet inserted into the rectum to scan the area where the prostate was located as well as the adjoining areas of the bladder and rectum. These are the areas where cancer is most likely to be found if the cancer escaped from the prostate. The MRSI is a method of spectrographic imaging that can detect the presense of cancer by measuring the level of choline found w/in the scanned area; choline is a marker for cancer.
At a minimum this scan can be useful for determining where post-surgical radiation treatment should be directed and may also indicate the source of additional cancer sites in proximity to the prior location of the prostate.
Beyond that, I doubt that your doctor (or insurance company) could be willing to authorize additional scans, unless you are feeling some pain or irregularity in other areas of the body, except perhaps a bone scan, where prostate cancer also tends to gravitate. However, it doesn't hurt to ask for the moon and see what they are willing to do for you.
Good luck!
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Thank you, great info for when i see the radiation oncologist neSwingshiftworker said:Cancer Scans
There are a variety of methods that could be used to scan for cancer in other areas of the body. The most common methods are MRI, CT, PET and Nuclear Bone scans. The problem is that most doctors (and insurance companies) do not want to use these expensive procedures unless there is a good reason to do so; ie., some evidence of cancer in a specific area.
In your situation, I would first ask for an MRI/MRSI scan using a Tesla magnet inserted into the rectum to scan the area where the prostate was located as well as the adjoining areas of the bladder and rectum. These are the areas where cancer is most likely to be found if the cancer escaped from the prostate. The MRSI is a method of spectrographic imaging that can detect the presense of cancer by measuring the level of choline found w/in the scanned area; choline is a marker for cancer.
At a minimum this scan can be useful for determining where post-surgical radiation treatment should be directed and may also indicate the source of additional cancer sites in proximity to the prior location of the prostate.
Beyond that, I doubt that your doctor (or insurance company) could be willing to authorize additional scans, unless you are feeling some pain or irregularity in other areas of the body, except perhaps a bone scan, where prostate cancer also tends to gravitate. However, it doesn't hurt to ask for the moon and see what they are willing to do for you.
Good luck!
Thank you for that information.
I will research these scanning technologies you mentioned.
I did not know the cancer choline connection.
I am homozygous for PEMT gene which is involved in choline metabolism.
I will definitely research this more though.0 -
GPS apparatus for PCa
Unfortunately there is still no perfect GPS machine to locate cancerous prostatic cells (PCa). The image study suggested by Swing above may provide a clue on abnormalities in shape and size of a tissue but to judge it as being a PCa is difficult.
At the present, the best exam to locate those cells (with numerous cases of positive results) seems to be the C11 PET/CT scan. The contrast agent is Carbon 11 choline or Carbon 11 acetate that are “absorbed” by those cells, providing its location. There is also a newer exam in trials since 2013 that has shown potentially better results than the C11 PET/CT in detecting PCa which is known as the 68Ga-PSMA PET/MRI. However, from trials we know that these exams provide false negatives in cases of low PSA serum (<1.50 ng/ml). For you with such low level of PSA in the 0.1 these exams may be futile and may not provide aparent targets for radiation. The radiologist will probably follow his own experience in other treated patients or follow the recommendations from the NCCN guide lines which protocol include the radiation of the prostate bed with or without lymph nodes.
You may read details on those exams from the links in my thread at:
http://csn.cancer.org/node/290854#comment-1504743The PSA is a marker of cancer progression post treatment. PCa produces it but aggressive type of cells typically produces little serum. These could be the ones classified as Gleason grade 4 in your score of 7. I read that typically a tumour of 1cm in size produces 2.0 ng/ml PSA. A MRI machine 3-tesla may detect deformities with sizes of 7mm. A CT requires at least one centimetre to provide a positive scan.
15 years ago (at the age of 50) I also experienced recurrence after a failed RP. I was in need of a salvage treatment but wanted to get the “targets” to throw the arrows. During the waiting period all tests come negative apart of an increasing PSA. Doctors diagnosed me with micrometastases which refer to cancer forming several tiny tumours in spread colonies. This condition is still harder to be detected by traditional image study machines. My Gleason rate was 3 (score 6) representing low aggressivity in progression which may be behind my 15 years in survivorship.
The PSA has been the marker to trigger treatments. In 2006 with a PSA of 3.8 ng/ml I did salvage radiation even with no targets founds (false negatives from annual MRI and Bone scans). In 2010 with a PSA of 1.0 ng/ml I started hormonal therapy. Cancer has never shown its “face”. It never bother me. But the side effects from treatments have impaired my quality living to certain extent.Best of lucks in your continuous care.
VG
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WonderfulVascodaGama said:GPS apparatus for PCa
Unfortunately there is still no perfect GPS machine to locate cancerous prostatic cells (PCa). The image study suggested by Swing above may provide a clue on abnormalities in shape and size of a tissue but to judge it as being a PCa is difficult.
At the present, the best exam to locate those cells (with numerous cases of positive results) seems to be the C11 PET/CT scan. The contrast agent is Carbon 11 choline or Carbon 11 acetate that are “absorbed” by those cells, providing its location. There is also a newer exam in trials since 2013 that has shown potentially better results than the C11 PET/CT in detecting PCa which is known as the 68Ga-PSMA PET/MRI. However, from trials we know that these exams provide false negatives in cases of low PSA serum (<1.50 ng/ml). For you with such low level of PSA in the 0.1 these exams may be futile and may not provide aparent targets for radiation. The radiologist will probably follow his own experience in other treated patients or follow the recommendations from the NCCN guide lines which protocol include the radiation of the prostate bed with or without lymph nodes.
You may read details on those exams from the links in my thread at:
http://csn.cancer.org/node/290854#comment-1504743The PSA is a marker of cancer progression post treatment. PCa produces it but aggressive type of cells typically produces little serum. These could be the ones classified as Gleason grade 4 in your score of 7. I read that typically a tumour of 1cm in size produces 2.0 ng/ml PSA. A MRI machine 3-tesla may detect deformities with sizes of 7mm. A CT requires at least one centimetre to provide a positive scan.
15 years ago (at the age of 50) I also experienced recurrence after a failed RP. I was in need of a salvage treatment but wanted to get the “targets” to throw the arrows. During the waiting period all tests come negative apart of an increasing PSA. Doctors diagnosed me with micrometastases which refer to cancer forming several tiny tumours in spread colonies. This condition is still harder to be detected by traditional image study machines. My Gleason rate was 3 (score 6) representing low aggressivity in progression which may be behind my 15 years in survivorship.
The PSA has been the marker to trigger treatments. In 2006 with a PSA of 3.8 ng/ml I did salvage radiation even with no targets founds (false negatives from annual MRI and Bone scans). In 2010 with a PSA of 1.0 ng/ml I started hormonal therapy. Cancer has never shown its “face”. It never bother me. But the side effects from treatments have impaired my quality living to certain extent.Best of lucks in your continuous care.
VG
Vasco,
So clear, such marvelous detail, as always. Should be handed out to oncology interns !
I just get a sense from all of this that you have got the disease beat, or at least permanently at bay, and will be around here writing at 90 years of age. All ahead flank !
max
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Great information and history of your PCaVascodaGama said:GPS apparatus for PCa
Unfortunately there is still no perfect GPS machine to locate cancerous prostatic cells (PCa). The image study suggested by Swing above may provide a clue on abnormalities in shape and size of a tissue but to judge it as being a PCa is difficult.
At the present, the best exam to locate those cells (with numerous cases of positive results) seems to be the C11 PET/CT scan. The contrast agent is Carbon 11 choline or Carbon 11 acetate that are “absorbed” by those cells, providing its location. There is also a newer exam in trials since 2013 that has shown potentially better results than the C11 PET/CT in detecting PCa which is known as the 68Ga-PSMA PET/MRI. However, from trials we know that these exams provide false negatives in cases of low PSA serum (<1.50 ng/ml). For you with such low level of PSA in the 0.1 these exams may be futile and may not provide aparent targets for radiation. The radiologist will probably follow his own experience in other treated patients or follow the recommendations from the NCCN guide lines which protocol include the radiation of the prostate bed with or without lymph nodes.
You may read details on those exams from the links in my thread at:
http://csn.cancer.org/node/290854#comment-1504743The PSA is a marker of cancer progression post treatment. PCa produces it but aggressive type of cells typically produces little serum. These could be the ones classified as Gleason grade 4 in your score of 7. I read that typically a tumour of 1cm in size produces 2.0 ng/ml PSA. A MRI machine 3-tesla may detect deformities with sizes of 7mm. A CT requires at least one centimetre to provide a positive scan.
15 years ago (at the age of 50) I also experienced recurrence after a failed RP. I was in need of a salvage treatment but wanted to get the “targets” to throw the arrows. During the waiting period all tests come negative apart of an increasing PSA. Doctors diagnosed me with micrometastases which refer to cancer forming several tiny tumours in spread colonies. This condition is still harder to be detected by traditional image study machines. My Gleason rate was 3 (score 6) representing low aggressivity in progression which may be behind my 15 years in survivorship.
The PSA has been the marker to trigger treatments. In 2006 with a PSA of 3.8 ng/ml I did salvage radiation even with no targets founds (false negatives from annual MRI and Bone scans). In 2010 with a PSA of 1.0 ng/ml I started hormonal therapy. Cancer has never shown its “face”. It never bother me. But the side effects from treatments have impaired my quality living to certain extent.Best of lucks in your continuous care.
VG
I can't thank you enough VascodaGama,
My wife and I met with the my Radiation Oncologist yesterday and he recommended exactly as you detailed it.
He was thorough and reviewed my pathology report and had already plugged in my numbers on the Sloan Kittering website which showed my 6 year cancer free as 75%.
He also said that since I had positive inked margins and extraprostatic extension and my PSA is 0.11 after RP he was very confident the cancer is only in the prostate bed, and any scans will probably not detect any tumors even the C11 acetate.
My Radiation Oncologist also does not recommend ADT at this time because of quality of life and possible masking of PSA after radiation and the ADT treatment. He scheduled an appointment with the Oncologist to discuss ADT.
He recommends 35 treatments and said to come in with a full bladder, and as far as side effects he said I will start feeling tired the last two weeks and may incur incontinence and more frequent bowel movements, but that will be temporary.
He also said to get my incontinent issues resolved (which are 90% healed) or plateaued before we start the radiation within 30 days as it will never get better after treatment.
he asked about my sex life and what my progress with that is. I told him I have quite a few Homozygous mutations in the NOS3 (eNOS) genes which control blood vessel relaxation and constriction, and my sex life had been non existent before and after RP so I did not expect any changes. My wife and I still love each other and have excepted this.
I am not going to push for a C11 acetate scan at this time even though I have recent extreme neck degeneration and pain.
My Rad Onc stated it probably won't pick up tumors at 0.11 PSA, and he said if I had a tumor in my neck my PSA would be much higher.
The neck pain started at the exact time of my contraction of Lyme disease so I believe the Lyme spirochetes ate away my collagen and damaged my neck area.
I went on 6 weeks of antibiotics and feel the spirochetes are long gone. Talk about extreme head/neck/eye pain from Lymes. I could not even go outside for three months without dark sunglasses with welding goggles and a jacket completely covering my head.
I also feel the Lymes weakened my immune system more and allowed my Gleason score 6 PCa to escalate into prostae escape.0 -
Avoid antioxidants while in treatmentJMS58 said:Great information and history of your PCa
I can't thank you enough VascodaGama,
My wife and I met with the my Radiation Oncologist yesterday and he recommended exactly as you detailed it.
He was thorough and reviewed my pathology report and had already plugged in my numbers on the Sloan Kittering website which showed my 6 year cancer free as 75%.
He also said that since I had positive inked margins and extraprostatic extension and my PSA is 0.11 after RP he was very confident the cancer is only in the prostate bed, and any scans will probably not detect any tumors even the C11 acetate.
My Radiation Oncologist also does not recommend ADT at this time because of quality of life and possible masking of PSA after radiation and the ADT treatment. He scheduled an appointment with the Oncologist to discuss ADT.
He recommends 35 treatments and said to come in with a full bladder, and as far as side effects he said I will start feeling tired the last two weeks and may incur incontinence and more frequent bowel movements, but that will be temporary.
He also said to get my incontinent issues resolved (which are 90% healed) or plateaued before we start the radiation within 30 days as it will never get better after treatment.
he asked about my sex life and what my progress with that is. I told him I have quite a few Homozygous mutations in the NOS3 (eNOS) genes which control blood vessel relaxation and constriction, and my sex life had been non existent before and after RP so I did not expect any changes. My wife and I still love each other and have excepted this.
I am not going to push for a C11 acetate scan at this time even though I have recent extreme neck degeneration and pain.
My Rad Onc stated it probably won't pick up tumors at 0.11 PSA, and he said if I had a tumor in my neck my PSA would be much higher.
The neck pain started at the exact time of my contraction of Lyme disease so I believe the Lyme spirochetes ate away my collagen and damaged my neck area.
I went on 6 weeks of antibiotics and feel the spirochetes are long gone. Talk about extreme head/neck/eye pain from Lymes. I could not even go outside for three months without dark sunglasses with welding goggles and a jacket completely covering my head.
I also feel the Lymes weakened my immune system more and allowed my Gleason score 6 PCa to escalate into prostae escape.JMS
I absolutely agree with your decision. You should get your incontinent issues resolved before starting RT, even if the fact causes you to postpone the schedule of the SRT. Your PSA is not alarming high to require a quick fit.
In the sex department, RT will not affect much your present condition. In any case, tinny nerve bundles may be distressed and to avoid any atrophy I would recommend you to be active using Viagra type of meds and massages several times a week. These are recommended in all PCa treatments.
Diet is also important and you should avoid antioxidants during RT and for a period after that. Antioxidants may revive cancer that has been knocked down by the radiation. You can find a good copy about nutrition in here;
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf
Once you get your doctors protocol (number of Gy and field of radiation in regards to the lymph nodes), I suggest you to get a second opinion at a separate facility. Different doctors may diagnose you diferentely and recommend different protocols.
Best wishes,
VG
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Thanks VG, What diet should one take during radiationVascodaGama said:Avoid antioxidants while in treatment
JMS
I absolutely agree with your decision. You should get your incontinent issues resolved before starting RT, even if the fact causes you to postpone the schedule of the SRT. Your PSA is not alarming high to require a quick fit.
In the sex department, RT will not affect much your present condition. In any case, tinny nerve bundles may be distressed and to avoid any atrophy I would recommend you to be active using Viagra type of meds and massages several times a week. These are recommended in all PCa treatments.
Diet is also important and you should avoid antioxidants during RT and for a period after that. Antioxidants may revive cancer that has been knocked down by the radiation. You can find a good copy about nutrition in here;
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf
Once you get your doctors protocol (number of Gy and field of radiation in regards to the lymph nodes), I suggest you to get a second opinion at a separate facility. Different doctors may diagnose you diferentely and recommend different protocols.
Best wishes,
VG
Than Nutrition and Prostate Cancer PDF is a good comprehensive article.
Your statement about avoid anti-oxidants during RT and a little after is a heavy thought....my instinct was to load up on anti-oxidants to prevent damage from the radiation, but I guess I want the radiation to damage me (cancer and other surrounding tissues) or else why would i do it.
The article is all about nutrition and how it helps against prostate cancer, and how anti-oxidants fight PCa, but what diet should one take during radiation if you want it to kill your cancer?0 -
Thanks Max, I will be starting RT as soon as my incontinants isSecondary Treatments
JMS,
Your pathology report (Item #1) indicates that the disease escaped the gland, and in addition there was PNI (Perineural invasion; cancer growing along the nerves inside the gland), and several positive margins (cancer touching the edges of the gland).
At a minimum I would expect the doctor to begin precautionary/possibly curative radiation therapy. I would expect him to insist on this regardless of the PSA results. If he does not propose this, I would ask him why he is not.
max
I will be starting RT as soon as my incontinants is 100% or plateu'd as it is 90% healed right now.
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TreatmentJMS58 said:Thanks VG, What diet should one take during radiation
Than Nutrition and Prostate Cancer PDF is a good comprehensive article.
Your statement about avoid anti-oxidants during RT and a little after is a heavy thought....my instinct was to load up on anti-oxidants to prevent damage from the radiation, but I guess I want the radiation to damage me (cancer and other surrounding tissues) or else why would i do it.
The article is all about nutrition and how it helps against prostate cancer, and how anti-oxidants fight PCa, but what diet should one take during radiation if you want it to kill your cancer?If I were you, JMS, I would also do the radiation, and do it now. The oncologist is right: whatever spread you have is likely in the bed area, and not going to show up on even the best currently-available scans. He is proceeding partially from guesswork, but very well-educated guesswork. At times, that is the best we can get. I also agree with his thoughts regarding not doing Hormonal therapy now. Statistically, his approach seems quite sound to me as a layman.
Regarding antioxidants expert opinions vary. My hematologist during lymphoma treatments recommended drinking green tea, but some good studies do indeed recommend against. Regardless, eat healthy, since it can only help.
Like you, I had a variety of health problems before ever getting PCa (severe trauma, late-stage lymophoma), so I am pulling for you dude,
max
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Get informed on Fibre productsTreatment
If I were you, JMS, I would also do the radiation, and do it now. The oncologist is right: whatever spread you have is likely in the bed area, and not going to show up on even the best currently-available scans. He is proceeding partially from guesswork, but very well-educated guesswork. At times, that is the best we can get. I also agree with his thoughts regarding not doing Hormonal therapy now. Statistically, his approach seems quite sound to me as a layman.
Regarding antioxidants expert opinions vary. My hematologist during lymphoma treatments recommended drinking green tea, but some good studies do indeed recommend against. Regardless, eat healthy, since it can only help.
Like you, I had a variety of health problems before ever getting PCa (severe trauma, late-stage lymophoma), so I am pulling for you dude,
max
As commented by Max above you have or had other issues that should be considered in all your choices. Radiation causes bowel issues therefore foods with fibre are best. My typical breakfast since a case of haemorrhoids in 1980 is 100% bran with yogurt. That has put my bowel in continuous check cleaning it when needed. Fibre may counter the effects of the scars from radiation but it does not interfere in its action against cancer.
You can read my experiences with SRT in this link;
http://csn.cancer.org/node/293453#comment-1496929Best,
VG
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As for the anti-oxidants....VascodaGama said:Get informed on Fibre products
As commented by Max above you have or had other issues that should be considered in all your choices. Radiation causes bowel issues therefore foods with fibre are best. My typical breakfast since a case of haemorrhoids in 1980 is 100% bran with yogurt. That has put my bowel in continuous check cleaning it when needed. Fibre may counter the effects of the scars from radiation but it does not interfere in its action against cancer.
You can read my experiences with SRT in this link;
http://csn.cancer.org/node/293453#comment-1496929Best,
VG
...RT increases the oxidants in the irradiated cells. The mitochondria (small inner cellular organelles) deal with oxidants to protect and preserve the cell. The higher the Gleason score of the cancer cell, the fewer mitochondria it has to do that job. Yes, the mitochondria use antioxidants to nuetralize those oxidants, but the cancer cells have so few they simply cannot keep up with the damage and thus die. This especially so if they have been already stressed by lack of testosterone and/or removal of the primary tumor along with its blood supply. That is the theory, at least.
Yeah, diet is always an important factor...like exercise, lowering stress and getting plenty of sleep. However, trying to eliminate anti - oxidants from your diet seems an effort in futility to me....a quick fix that may well give more of a feeling/illusion of control than an actuality of control.
Heh - I have had serious hemorrhoids since I was a Longshoreman 45 years ago. Super - healthy balanced diet since then, bleeding got pretty bad after ART for a while.....
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Antioxidants and nutrition during radiationstoniphi said:As for the anti-oxidants....
...RT increases the oxidants in the irradiated cells. The mitochondria (small inner cellular organelles) deal with oxidants to protect and preserve the cell. The higher the Gleason score of the cancer cell, the fewer mitochondria it has to do that job. Yes, the mitochondria use antioxidants to nuetralize those oxidants, but the cancer cells have so few they simply cannot keep up with the damage and thus die. This especially so if they have been already stressed by lack of testosterone and/or removal of the primary tumor along with its blood supply. That is the theory, at least.
Yeah, diet is always an important factor...like exercise, lowering stress and getting plenty of sleep. However, trying to eliminate anti - oxidants from your diet seems an effort in futility to me....a quick fix that may well give more of a feeling/illusion of control than an actuality of control.
Heh - I have had serious hemorrhoids since I was a Longshoreman 45 years ago. Super - healthy balanced diet since then, bleeding got pretty bad after ART for a while.....
Thanks all, and thank you stophini for that theory on cancer cells not having the amount of mitichondria to deal with the amount of oxidants received by radiation treatment.
I will be consulting with my naturopathic doctor to go over what herbs/mushrooms to take before/during/after radiation treatment.
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Update on Treatment
Hi All,
I started my EBRT this week.
I will have 35 treatments at 70gray.
I plugged in my statistics for 6 year survival and it shows 75% chance on not have a recurence.This radiation treatment/side effects seems easy compared to freinds and family who have had lung and neck cancers.
I will let you all now how I fell halfway through and if I start haviing side effects.
Thanks All,
john
0
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