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Uptick in gleason score

denistd's picture
denistd
Posts: 596
Joined: Apr 2009

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?

 

Old Salt
Posts: 720
Joined: Aug 2014

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 opt...
Posts: 2224
Joined: Apr 2009

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
Posts: 115
Joined: Apr 2017

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's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

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's picture
denistd
Posts: 596
Joined: Apr 2009

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.

Old Salt
Posts: 720
Joined: Aug 2014

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's picture
denistd
Posts: 596
Joined: Apr 2009

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.

SubDenis's picture
SubDenis
Posts: 130
Joined: Jul 2017

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's picture
denistd
Posts: 596
Joined: Apr 2009

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

contento
Posts: 76
Joined: Jul 2017

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.

JJO
Posts: 10
Joined: Sep 2017

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 Salt
Posts: 720
Joined: Aug 2014

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.

contento
Posts: 76
Joined: Jul 2017

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
Posts: 174
Joined: Jun 2016

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
Posts: 76
Joined: Jul 2017

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.

denistd's picture
denistd
Posts: 596
Joined: Apr 2009

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's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

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

denistd's picture
denistd
Posts: 596
Joined: Apr 2009

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.

 

Clevelandguy
Posts: 441
Joined: Jun 2015

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

hopeful and opt...
Posts: 2224
Joined: Apr 2009

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

 

1005tanner
Posts: 29
Joined: Dec 2017

Wise decision my brother . I have been to Vanderbilt for second opinion myself with a Gleeson 3+3 = 6 t2a  .How much has it spread in 4 years?

VascodaGama's picture
VascodaGama
Posts: 2988
Joined: Nov 2010

 

Yes I would love to receive that recording. At the 60's I also played bass for fun with a group of school friends. We had fewer arrangements of our own and most of the time played music of others (probably something of you). You are 6 years older than me (68). I sent you my email address via CSN.

Regarding the PSA histology of 2017, I am also curious for the decreasing to almost an half in one year (from 6.7 to 3.8). Typically a sharp increase relates to inflammation (UTI) or BPH. A PSA graph of Cancer is represented more as a continuous upward curve. This decrease could be a reflex of your past larynx cancer chemo treatment done in 2009. It also could be the effects of any medication you taking for your heart or CKD complications or a change in your diet. Surely the Cisplatin Hi dose chemo intervenes in the PCa affairs too. This chemo is used in the treatment of breast cancer which genes also relate to PCa. Many times we see PCa treatments to follow the standards of breast cancer care.

In any case a review of your past health history regarding the persistent inflammation cases makes me to think that past occurrences (such as BPH, etc) could have been behind past high PSA levels and that such a case have just normalized (???).
In your thread of 2016 (https://csn.cancer.org/node/305503), you point out about a PSA of 5.8 from 2006 that did maintain the same level in 2013, when you were diagnosed for PCa. The higher level of PSA=6.7 ng/ml started in August 2016. Please reread our exchanged posts. However, what impresses me the most in your PCa history are the results of the biopsies that were confirmed at Johns Hopkins. The summary of your shared information is below. Please validate me if not correct:

2013; Gleason 6. two cores positive for small amount of cancer

2016; Positive cores have gone from 2 up to 5. All 5 cores were still shown as Gleason 6 with one showing perineural invasion

2017; one core showed up as Gleason 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.
 But, these cores were rechecked at JH and the results lowered the number of positive cores from 4 to one and the Gleason rate 4 to rate 3 involving 10% of the core. (from your above post)

 

Accordingly, I see it as a decrease in cancer involvement. Could it be the work of the past chemo therapy? Who knows it.

I wonder what your doctor can say on my above guessing.

I want to celebrate the news. Let's have a Portuguese red Esporao.

Best wishes,

VGama

 

Robd777
Posts: 3
Joined: Dec 2017

Does anyone know anything about getting a multiparametric mri images and fusion biopsy instead of getting the transrectal ultrasound biopsy? I would like to get the mri but have read that it is only a better diagnostic tool if it is performed by an experienced radiology team. Does anyone know of the best place with a 3t magnet in Florida and close to Tampa Bay?

Clevelandguy
Posts: 441
Joined: Jun 2015

Hi Rob,

 

How about the Cleveland Clinic, I thought they had a place in Florida. They have a really good reputation here in Northeast Ohio.

 

Dave 3+4

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