Gleason upgrading post RP

hewhositsoncushions
hewhositsoncushions Member Posts: 411 Member
in Prostate Cancer #1

Hi all

So been reading more about RP as it looks like I am erring towards that (but still not sure) and found some stuff out about diagnostics.

As with any diagnostic process there is a margin for error and it seems that there is a 40% chance that a Gleason score of 4 + 3 will be upgraded post RP. I also understand that even if this happens is is still better to be a post RP 8 than a pre RP 8.

I assume that there are chances for no change and downgrading too.

This plus the fact that there are rumblings of more aggressive PCa being associated with low T (<3 ngml) and smaller prostate size.

Does anyone know if this is now accepted fact or just scientific papers playing with numbers?

My T was 3.4 ngml (12 nmol) and the consultant said my prostate was "normal" size.

Given that I went from borderline PSA to iffy first biopsy to intermediate second biopsy to gawd knows what after my MRI tomorrow, you can see my thought processes like neon above my head.

I'm starting to think that the best approach is to stop thinking about this and focus on each step as it comes and act as needed because figuring the odds with The Lady is a road that leads to madness. I lost the plot today for the first time and need to pull myself up and this thinking is not helping.

C

Comments

  • Old Salt
    Old Salt Member Posts: 1,505 Member
    edited May 2017 #2
    Yes, stop thinking about this

    You are addressing the wrong issue(s). Focus on the big decision:

    Radiation (many approaches) or

    Surgery

    Good luck!

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,817 Member
    #3
    Analysis

    hewho,

    I've had Stage II PCa and surgical removal, and I've never had my T-level tested in my life.  We read here occasionally about purported linkages to t-levels and/or Low-PSA with aggressive disease, but in most cases T-Level is irrelvant to a man's diagnosis or chosen course of action (hence, my Large Urological Oncology Center never found it worth testing). T-testing is required when HT comes in to play, but you currently show no liklihood of that occuring in your case. Aggressivity is nearly always linked to Gleason, PSA level, and vector.  Not 100%, but most of the time.

    It is true that the Gleason can be changed post-op in the pathology report.  And higher, lower, and the same levels are possible. But most remain the same, a few are found to be slightly higher Gleason.  A lower Gleason is almost never reported.  My own Gleason remained the same as it was estimated at pre-op, but my Stage was increased from I to II by the pathologist.   One advantage of surgery is that when the gland is cut out and analyzed in a lab, the man knows exactly what he was dealing with.  This includes the results from the seminal vesicles and nodes.   No current scans can compare with this level of certitude.  And no post-radiation watching PSA levels oscillate for months or a year or more are necessary to document cure.

    Prostate size also is very nearly irrelevant also in assessing PCa aggressivity.   Men with low-level PCa, or even no cancer at all, routinely suffer from BPH and huge prostates.  What is indicative of disease rating are Gleason, PSA, and PSA vector.  Palpable tumors on DRE are also significant.

    There has probably at some point in time been a study linking PCa aggressivity and toenail thinckness. Forget about it !  A friend earned a PhD in Medical Statistics years ago.  But you don't need one to choose a good treatment option for a minor case of PCa.

    max

  • hewhositsoncushions
    hewhositsoncushions Member Posts: 411 Member
    edited May 2017 #4
    Cheers guys

    Cheers guys

    I needed a good "Gibbs slap" because I took my eye off the ball.

    Trying to understand all this led me dumpster diving in PubMed and other places probably a bit too hard.

    I need to realise that these are *studies* not necessarily accepted mainstream.

    So new mindset - "Hard Facts, Next Steps, Eye on the Prize".

    MRI shortly so more facts soon.

    C

  • RobLee
    RobLee Member Posts: 269 Member
    #5
    Max Former Hodgkins Stage 3 said:

    Analysis

    hewho,

    I've had Stage II PCa and surgical removal, and I've never had my T-level tested in my life.  We read here occasionally about purported linkages to t-levels and/or Low-PSA with aggressive disease, but in most cases T-Level is irrelvant to a man's diagnosis or chosen course of action (hence, my Large Urological Oncology Center never found it worth testing). T-testing is required when HT comes in to play, but you currently show no liklihood of that occuring in your case. Aggressivity is nearly always linked to Gleason, PSA level, and vector.  Not 100%, but most of the time.

    It is true that the Gleason can be changed post-op in the pathology report.  And higher, lower, and the same levels are possible. But most remain the same, a few are found to be slightly higher Gleason.  A lower Gleason is almost never reported.  My own Gleason remained the same as it was estimated at pre-op, but my Stage was increased from I to II by the pathologist.   One advantage of surgery is that when the gland is cut out and analyzed in a lab, the man knows exactly what he was dealing with.  This includes the results from the seminal vesicles and nodes.   No current scans can compare with this level of certitude.  And no post-radiation watching PSA levels oscillate for months or a year or more are necessary to document cure.

    Prostate size also is very nearly irrelevant also in assessing PCa aggressivity.   Men with low-level PCa, or even no cancer at all, routinely suffer from BPH and huge prostates.  What is indicative of disease rating are Gleason, PSA, and PSA vector.  Palpable tumors on DRE are also significant.

    There has probably at some point in time been a study linking PCa aggressivity and toenail thinckness. Forget about it !  A friend earned a PhD in Medical Statistics years ago.  But you don't need one to choose a good treatment option for a minor case of PCa.

    max

    T-testing is required when HT comes in to play

    FWIW my T-level has NEVER been tested, not at any time including when my right testicle was removed in 2012. Also I am now four months into ADT and T-level has never even been mentioned, though I have had numerous blood tests in addition to PSA's every five weeks since RALP. BTW my stage was downgraded from the biopsy's clinical T2c to pathological T3b due to seminal vesivcle invasion. Also two additional cores were downgraded from G7 to match the known G8 of two others from the biopsy (total of four, 2x40% and 2x100%, all 4+4).

    Of course, I am not a young man. Anything that my T-level might influence probably became irrelavent over a decade ago.  I know some of the younger guys obsess over their T-levels as well as ED, but TBH, I'll consider myself fortunate to finally say goodbye to cancer, once the SRT has concluded somewhere around the end of this year.  For now my second greatest concern is my upcoming AUS surgery a week from tomorrow.

     

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