Uptick in gleason score

denistd
denistd Member Posts: 597

Have had prostate cancer for a long time now, do not know how long but at lest 4 years, have been on AS since then,got the results of my latest biopsy today and one core showed up as gleson 7. 3 plus 4. Three other cores showing gleason 6. 13 cores taken with 4 showing cancer. The 7 shows 30% of the core as cancerous. Will see the doc again  on January 2, 2018 as I am having the samples tested at Johns Hopkins. If the same results come fro JH my doc thinks DaVinci surgery to be the best bet, what do you think?

 

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Comments

  • Old Salt
    Old Salt Member Posts: 952 Member
    Other options

    Many of us would recommend to look at ALL options available, including radiation therapies. But I have (too) little information to go beyond that. Among other issues, the site of the 3+4 tumor within the prostate is relevant. 

    Having the samples examined again by the JH specialists is a good move.

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    denistd

    In the summer of 2016 my fusion biopsy also revealed a Gleason of 3+4=7, 30% of the core.....5% was a Gleason 4. With a fusion biopsy, which is 3 dimemsional, there is ability to go back to that spot in a future fusion biopsy which I did in August of 2017.....the biopsy did not find any Gleason 4. I am continuing with Active Surveillance.

    Here is the thread that was posted here in August 2017

    https://csn.cancer.org/node/311533

    Here is an interview with Dr. KIlotz, the expert's expert on Active Surveillance from Canada. He talks about the limits of Active Surveillance. Toward the end of the interview there is dicussion about Gleason 3+4=7 and the amount of involvement that is acceptable. You and I are still within the range for active surveilance, but coming close to the limit that is acceptable.

    Listen to this interview for up to date information from this expert, especially the last several minutss.

     

    ...July 2017 Interview with Dr. Klotz https://www.urotoday.com/video-lectures/advanced-prostate-cancer/video/mediaitem/778-embedded-media2017-06-02-13-54-01.html?utm_source=newsletter_4652&utm_medium=email&utm_campaign=uroalerts-prostate-cancer-weekly    .........................................................................

    If , after investigation, it is decided that Active Surveillance is no longer acceptable, consider SBRT (a from of radiation) for treatment. The cure rate is comparable to surgery while the potential side effects are significantly less

     

  • ASAdvocate
    ASAdvocate Member Posts: 182 Member
    All the above comments are useful

    Personally, I would not leave AS due to one core of G (3+4), but we all have different thresholds.

    Certainly, I would explore more treatment options. Urologists are surgeons, and that's what they will try to steer you towards. Also, they are often not well informed on other treatments.

    You should research SBRT radiation, as that is getting great articles about high cure rates and few side effects.

     

  • VascodaGama
    VascodaGama Member Posts: 3,525 Member
    Consider second opinions and relevant data

    Denistd,

    I do not recall your initial clinical stage and wonder if the present findings are that much worse than the previous. What is there that made you to think in a treatment? What are the latest results of the PET scans?

    My opinion pairs the above comments. The best choice to care about PCa is AS if the patient's condition/status permits that. This is what you have been doing so that you know the feel in living with the unwanted guess. I think that you can rely on JH laboratories for the review of the samples. Their results will provide your doctor with arguments on the treatment, in any case you should also consult specialists in the field of radiotherapies. Your CKD affair will have no role in the final decision, but some other issues, such as any ulcerative colitis and bone health, should be investigated before you engage in any thing.

    Best wishes,

    VG

  • denistd
    denistd Member Posts: 597
    gleason 7

    OK, here is the pathology report.

    13 needles. Needle 1. R base lat, benign prostatic tissue. Needle 2. R mid lat. benign prostatic tissue. needle 3. R apex lat, benign prostatic tissue.

    needle 4, R base medial. benign prostatic tissue. needle 5, R mid medial, benign prostatic tissue. needle 7. L base lat. -prostatic adenocarcinoma, gleason score 3 + 4= 7 (grade group 2)-carcinoma in 1 of 2 cores, linear extent 4mm (30% of core)-perineural involvement present.-Pattern 4 accounts for 10% of carcinoma. Needle 8 L mid lat, benign prostatic tissue. needle 9, L apex lat, benign prostatic tissue. all the rest showed as benign prostatic tissue.

  • SubDenis
    SubDenis Member Posts: 130
    Denistd, FIsrt are you a one

    Denistd, FIsrt are you a one N Denis?  I have not met many.   I was G6 initially but upon the second opinion pathology, I have one core with 3+4 <5%   I did decipher test which showed an intermediate risk of metastasis.   I am going to get treated, probably RP.  I wish you Well Denis

  • denistd
    denistd Member Posts: 597
    one n

    yep just one n, Im living in the uSA but originally from the UK

  • contento
    contento Member Posts: 75
    Think hard about this

    denistd, I would seriously think hard about getting treatment. I had only 1 of 8 cores with cancer at a grade 7 ( 3+4 ) but my psa was also high ( around 7 ng/ml ). I opted for surgery  and my post op pathology was a lot worse. Gleason 8 (4+4) and all the trimmings , Lvi, positive margin, extension  .....

    So evaluate all your options givin your specific diagnosis. 
    For me , in hindsight, I would have chosed radiation since i did have a reoccurrence.

  • Old Salt
    Old Salt Member Posts: 952 Member
    denistd said:

    gleason 7

    OK, here is the pathology report.

    13 needles. Needle 1. R base lat, benign prostatic tissue. Needle 2. R mid lat. benign prostatic tissue. needle 3. R apex lat, benign prostatic tissue.

    needle 4, R base medial. benign prostatic tissue. needle 5, R mid medial, benign prostatic tissue. needle 7. L base lat. -prostatic adenocarcinoma, gleason score 3 + 4= 7 (grade group 2)-carcinoma in 1 of 2 cores, linear extent 4mm (30% of core)-perineural involvement present.-Pattern 4 accounts for 10% of carcinoma. Needle 8 L mid lat, benign prostatic tissue. needle 9, L apex lat, benign prostatic tissue. all the rest showed as benign prostatic tissue.

    Inconsistent

    According to your first post you had three Gleason 6 cores and one Gleason 7 (in other words, 4 positives out of 13), but in your second post only a Gleason 3+4 is mentioned???

  • denistd
    denistd Member Posts: 597
    Old Salt said:

    Inconsistent

    According to your first post you had three Gleason 6 cores and one Gleason 7 (in other words, 4 positives out of 13), but in your second post only a Gleason 3+4 is mentioned???

    Cores

    Yea, the doctor told me in the exam room that three showed up as gleason six, when I checked out they gave me the path report and it says there is only one core showing cancer, will check tomorrow, Thanksgiving today so tomorrow.

  • JJO
    JJO Member Posts: 22 Member
    contento said:

    Think hard about this

    denistd, I would seriously think hard about getting treatment. I had only 1 of 8 cores with cancer at a grade 7 ( 3+4 ) but my psa was also high ( around 7 ng/ml ). I opted for surgery  and my post op pathology was a lot worse. Gleason 8 (4+4) and all the trimmings , Lvi, positive margin, extension  .....

    So evaluate all your options givin your specific diagnosis. 
    For me , in hindsight, I would have chosed radiation since i did have a reoccurrence.

    contento:  Why would you like

    contento:  Why would you like to have chosen radiation?  I've had doctors tell me that if you choose surgery, and there is a reoccurrance, you can do radiation, but not the reverse.  This has been touted as a slight benefit to surgery.  

  • contento
    contento Member Posts: 75
    JJO good question

    I only would have chosen radiation in hindsight. You are correct in that in most cases if you have radiation as a primary treatment then surgery  is most likely off the table if you have a reoccurrence. But for my case I did have a reoccurance that was located in the prostate bed that surgery  did not address probably because it was too small to see at the time of the operation. If I chose radiation first it should have radiated the area where the cancer was later found. Im I 100 % sure about this ? - No.. but I think that's how it would have went down. Like killing two birds with one stone..

    Hope this clarifies my reasoning somewhat..contento

     

  • MK1965
    MK1965 Member Posts: 231 Member
    edited November 2017 #14
    Salvage RP

    Salvage RP is also possible and more and more surgeons are performing it. That was thought to be somew true same 20 years ago.

    If I couod change my course, RP would be last. 

    MK

  • contento
    contento Member Posts: 75
    Didn't know that

    MK, didn't know anything about salvage RP. I would have thought that a reoccurrence  after primary radiation would not reoccur in the prostate that was radiated but in the surrounding tissue . Interesting what your saying. Hey Im learning something new everyday.

  • Old Salt
    Old Salt Member Posts: 952 Member
    JJO said:

    contento:  Why would you like

    contento:  Why would you like to have chosen radiation?  I've had doctors tell me that if you choose surgery, and there is a reoccurrance, you can do radiation, but not the reverse.  This has been touted as a slight benefit to surgery.  

    Old wives tale to confuse new patients

    Yes, some urologists/surgeons do say that. But it's nonsense. We have gone over this many times on this forum. Radiation, in many, but not all cases, is preferable because surrounding tissues can be treated as well. And if radiation fails, there are other arrows in the quiver of knowledgeable radiation and medical oncologists.

  • denistd
    denistd Member Posts: 597
    gleason score

    Just received the second opinion pathology report from Johns Hopkins. It differs from the pathology report from Hershey Med Center in that the one core (7) they have as gleason 3 + 3 involving 10% of core, any thoughts, Hershey had it as a 7. ther were 13 cores taken all of the oyher ones show benign prostatic tissue.

  • VascodaGama
    VascodaGama Member Posts: 3,525 Member
    Lower is better and JH is a trustful Lab

    Great to know about the degrading. Can you provide the histology of the PSA?

    For the moment enjoy life and the guitar.

    Best wishes

    VG

  • Clevelandguy
    Clevelandguy Member Posts: 782 Member
    6 or 7?

    Hi,

    Need to decide if it's a Gleason 6 or 7, it does make a difference.  Also as Old Salt said where is the tumor located?  Burried inside the Prostate or close to the edge.  Based on the Gleason & location it might help on doing something now or waiting a little longer.

    Dave 3+4

  • denistd
    denistd Member Posts: 597

    Lower is better and JH is a trustful Lab

    Great to know about the degrading. Can you provide the histology of the PSA?

    For the moment enjoy life and the guitar.

    Best wishes

    VG

    VG

    The psa score has been retreating over the past few months, was 6.7 earlier this year, then down to 4.9 then down again to 3.8, don't know what that means. Denis, Still rocking Vasco, will have to send you some of my old recordings from the UK in the 60's and one very rare recording done in Lisbon Portugal. message me your e-mail address.

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    WONDERFUL News

    You can take John's Hopkins review of the pathology to the bank.....John's Hopkins pathology depart are the experts...there is a difference among skills and facilities among pathologists.

    Time to really really celebrate....continue with Active Surveillance.....

    You can play, "Happy times are here again"

    Best