Hello, new here...have some questions

Hi Squirm...very good questions. I don't know of any study that would suggest that there is a connection concerning gleason scores between fathers and sons. I know that you would be at higher risk to get it, but I don't know if it means that you could get an agressive stage if you do as a result. Others may provide a better take on that. Only thing I know is that lycopene is known to help reduce as well as selinium the potential of getting PCa. To what extent, I think the jury is still out. There are many other dietary supplements that also are suppose to work. Bottom line, diet would be important regardless of PCa. As far as age group...yeah it was always the 6th decade, but that has changed due to the PSA testing. Many many more men at a younger age are getting tested and as a result many more biopsies are being performed and thus the age is dropping.

As far as selecting treatment options....WOW are you really putting the cart before the horse here. Besides by the time you get the diagnosis...and that is not necessarily gonna happen anyway...alot of new treatments will be available. So don't base anything now until you need to. For the latest developments just continue searching the web...just today there was an article about blood calcium having a link to agressive forms of PCa in early detection.

Oh and by the way...welcome to Healing Well

 

I'm not really sure what you are meaning when you say aggressive.  Cell morphology is what comes to mind when you say aggressive.  The Gleason scores are determined by the lowest and highest degree of differentiation from normal cells.  If you look at a biopsy slide and the greater number of aberant cells are scored at a 3, but you also have cells that are morphed to a 4 but not as many, you Gleason score will be 3 +4 or 7.  If the majority of cells are 4 but there are fewer that are 3 your score will be 4+3 or 7.  These two scores are both 7s, but they are different 7s.  So, in my case I have a 3+4 and a 4 + 4 or a 7 and 8.  Still you take into consideration how many cores were taken at biopsy and how many contained cancer cells.  10 positive cells out of 12 with Gleason scores of 7 or 8 is different than 2 of 12 cores being positive even if the Gleason is a 7 and an 8 total scores.  Now, what about the percentage of cancer cells found in each positive core? A core containing 80% cancer cells is different, as you can imagine, that one with 14%.  Lastly, the PSA level should be an indicator of a good or poor prognosis.

Someone please correct me if I'm wrong here, but a Gleason 3 in time will likely be a 4 or 5 as it continues to differentiate if it isn't treated.   When someone says aggressive I wonder if some mean advanced or a cancer that has advanced to where it has broken free of the prostate and has metastiasized.

You are a young man, and while you are wise to have annual DRE and PSAs, the only thing you really can or need do is think about  your over-all health.  Get exercise, eat well, and toss some dehydrated tomotatoes in the mix if you like.  Really, I'm not discounting your concerns, but as we baby boomers enter middle and old age, you can bet that research on prostate cancers is going to pick up dramatically and by the time you are diagnosed -IF- you are diagnosed, the treatment considered the gold standard may be one shot or a pill. 

Be well and forgive me in errors in the information I gave you - I'm confident, and hopefull, that someone will/would correct any errors.

Wouldn't it be just terrible to be preoccupied with cancer, diagnosis, prognosis, and then walk outside and get hit by a bus?  Many things are even more dangerous than cancer.

Be well,

----------------------

Diagnosis 7/08 PSA 6.8 , DRE negative

Biopsy 7/08 2 or 12 cores positive with 14% tissue involvement Gleason 3+4 (7) and 4+4 (8)

Bone scan negative - MRI evaluation of my prostate and area was negative

8/26/08 had my first Zoladex shot (8 days ago) - I can't tell any difference so far.

No hot flashes and no ED.  As I understand it, I'll be on Zoladex for 2 months and then begin IMRT.

My surgical urologist suggested surgery. my Radiology urologist said that either would work just as well.

I chose IMRT because the side effect profile seemed worse - from what I've read - than radiation.

Squirm said...

1) Since my dad had aggressive form of PCa  (G9) does that mean if I get it, I will get a high gleason score too?

Not necessarily... I can't claim to be an expert, but in my case I had a lower Gleason score than my Dad. I started screening fairly young due to family history... my Dad caught his in time but it runs pretty strong in the family. Some good advice above... stay on top of it with screening and you should catch it in time to have good treatment options, which might be different by that time.

Squirm,

How are you doing? You don't talk about yourself much.

How about an update?

Yes, eating healthy and exercise is very good.

I'm doing fine, I don't write about myself because there isn't much to write about.
I told myself that I would keep abreast of PCa after seeing my dad be a victim to this terrible disease. He had a very aggressive version of it. I wish I knew then, what I know now, he didn't have anyone to talk to about it. Funny how we're all different, I can't even get my brother to go in for a PSA after almost begging him.

My hope is there is a cure for this darn disease very soon.

Squirm,

Grab your brother by his sideburns and make him go get his PSA tested and do it every year. Denial and avoidance just can make his cancer worse. I am a huge advocate for early PSA tests beginning at 40 and every year thereafter to track if your father had it and died because of it.

After my biopsies, my Uro Oncologist told me to go back and tell my internist he blew it (which I did respectively). The reason why he blew it, was the rule of thumb for waiting until a man's PSA hits 4 or higher is when they should send a man for biopsies.

That is true for men that do not have a familial history of prostate cancer. For those of us with family genetics of it, they track what they call Rate of Volicity (ROV). Please look it up on Google for a better and thorough discussion. The rule of thumb that my oncologist was focused on is when my annual rate of change increased by 20% or more. It doesn't take much of a numeric change when your PSA is low to equate to a percent increase that should someone for biopsies.

When I went back to my internist, he got really defensive and smug and said that we was going to check his electronic software for guidelines that the clinic pays $300,000 a year for. I could tell when he had the Oh Crap moment when he read the guidelines that were not congruent with his practice. I could tell he went to the top of the guideline and reread it and then looked at me and said "I just made a change in my practice".

Needless to say, he should have sent me up for biopsies three to four years earlier. I found out I was a G9 and chances were the cancer had jumped ship outside of the capsule. Surgery confirmed that it was in tissues outside of the prostate and in one lymph node. It could have saved me from horrible hormone deprivation and eight weeks of daily intensive radiation, a lot of time recovering from the radiation and the impacts of hormone deprivation.

So for yourself, please watch your annual ROV, and tell your brother to go get his PSA drawn. It is a simple little blood test and that he needs to watch and track his ROV as well.

I made my older three brothers go get biopsied even though their PSA was under 1 for two of them and 1.5 for the third brother. Two of them were dx with G6 and one with G7. So if it is an unpleasant conversation to have with him, just know, my three brothers are grateful that I was relentless on them until they got biopsied. Hopefully you and your brother will be spared this horrific cancer.

gunfighter,

The frustration has completely abated since what was done was done with good intentions and since I am not perfect and make mistakes, I just wanted him to learn so he never made the same mistake and inform his other partners so they don't make the mistake.

I have learned through different trials in life, that the only person that gets hurt is the person holding a grudge and won't forgive and move on. I know that doesn't apply to all situations, but he is a very good man and does great things for me over the years.

At that appointment when I told him of his error, he was very defensive until I told him I wasn't going to sue him and all I wanted was for him to learn from me. In hind sight, being undetectable after four years with G9 makes it even easier to put behind me.

It has paid dividends for me for when I call to make an appointment with him on infections, etc. I get immediately in, usually the very same day of the call. I would not want to be an internist, a person expected to know everything about everything. Obviously, that task is insurmountable.

Best wishes to you and your PCa jourey.