define aggressive pc

I have made it to my third <.04 PSA test which reduced the stress until the 12 month one comes around.  Sure would like to find the stress "off" switch before each test.  I have been watching (do a lot of watching and not much posting) some of the posts about different levels of PSA and gleason scores.  I fall into the group of both high PSA and gleason scores (PSA 20 + and gleason 8).  I have read that the gleason 8,9, and 10 are all about the same aggressive level.  I think of that term everytime I have a PSA test.  Before it was determined that I had cancer, a doctor told me that if it was cancer it was very likely to have already spread due to the high PSA level. 

If this is true, and gleason 8 being an "aggressive" cancer, I have wondered how long it would take to show its face again with a increasing PSA level.  How does this "aggressive" compare to the aggressive of other cancers?  Or even to the aggressiveness of the gleason 6 and 7 cancers.  Sorry for the long ramble, just get to thinking about the numbers, odds and such things.  I am happy about my psa so far but am having trouble getting that aggressive thing out of my mind.

Bob

 

Hello Bob..I'm another Gleason 9 ..Like Goodlife says, every case is different..Yes, we are all 'high-risk" compared to the G-6 and G7 guys..But they have their nightmares too..I have resigned myself to just playing it one day at a time..It's pretty much out of my hands now..

Yeah, G-8 and PSA20 are bad numbers but the pathology report looks very good and the PSA.04 looks even better...That first year at .04 means a lot..So maybe you got lucky...But the real moment of truth is that 3 year mark. Usually, if it did get out, it will show up by then. After that, the odds are WAY in your favor...

Did your doctors recommend any further treatment right away, or are they content just to monitor your PSA? Sometimes with high-risk patients they like to add radiation but with your clean margins, I guess you have escaped that..

Anyway, I guess you know, the longer you stay in the zero club the better. With any luck you are done...You are going to be FINE!!

Post Edited (Fairwind) : 11/20/2010 10:43:10 PM (GMT-7)

Excellent post and thanks for writing. It seems as though we are seeing several of the higher gleasons starting to post and ask questions and that is a good thing. I too am a gleason 9 however unlike many (call me strange) I do not worry to much about the cancer anymore. I live life to the absolute fullest every single day. Between work, running, swimming, biking, reading, family, and church there just isn't much time to think about the cancer. I say this only to say that staying busy for me is great therapy and increases my sense of purpose. I decided early on that cancer was not going to have any control over me. It may come back someday and probably will and when and if it does I hope I can keep doing what I am doing.
Our gleasons are aggressive on yes but hey so are we so lets get up, get out, and win this battle.

peace to all
Dale

I'm a gleason 8 and only got 1 year before BCR. If and when it PCa returns you just move on to the next stage of treatment. I intend to go the intermittant HT route that Dale is on and I am looking forward to enjoying my family and life in general for many years. Although, unlike Dale I am looking forward to retirement and doing some traveling. Best of luck and my years of those undetectable PSA's. BB

Bob,  I'm also a G8 and made it 2 1/2 yrs. before I had a little rise.   Ironically, after 2 yrs. of <0.1, I wasn't very concerned before my last test.  I feel pretty much like BB Fan - take it one step at a time and do what you have to when the time comes.  I also believe age may make a difference.  I'm 74 now and my outlook and  priorities may be  different than the younger men such as Alf, Dale or Galileo.

Carlos

I'm a Gleason 8 and PSA was under 4 at diagnosis. My PSA has always come in <.04 for the past 2.5 years. I have been told by members here is the < means that is as low as the machine is calabrated. I have not had my PSA tested by a machine that goes less than .04. I tried at my general practictioners office and the PSA came back < .04 as well.

Wow Carlos... I had forgotten about making that post.

Since my psa has jumped of late, and I was looking for glimmers of hope, thanks for reminding that all is not lost.

Bob.

I wish to thank everyone for taking the time to reply to my questions.  Just knowing that there are others that can relate and understand is a very big help.  There have been quite a few sleepless nights in the last year when I would log on to this forum and find answers to some of my questions.

Sounds like there are more folks in the gleason 8-9 club than I had thought which just makes for a bigger, better support group!

Carlos, thanks for the link to the other cancer information.  This helps put things in a different prespective as many with other types of cancer have far more to worry about than we do.  I have a little knowledge of this as my father lasted 2 months after being told he had pancreatic cancer and my sister is a 4 year surviver of breast cancer.

As I read somewhere on this forum: "The day that we are born we also start to die".  As this is true for all of us, what we do with the precious time in between is what really counts.

Bob

Goodlife,

I have double checked the site where I got the 82% information.  When I was first told that I had a very small amout ot gleason 6 upon biopsy, I went into major panic mode and checked everything I could find on the subject.  Once I determined that gleason 6 was the "friendly" cancer I settled down a bit.  After surgery the 6 changed to 8 and the panic really hit big time.  I checked everything that mentioned anything to do with high PSA or gleason 8.  One of those sites was prostatecalculator.org.  This site has what is called a PSA recurrance calculator.  I just entered my information and it said that I now have a 6% chance that the PSA would not increase.  ???  I had never heard of a PSA recurrance calculator and it gave much different figures than others I have looked at.

I have also been playing with the Sloan Kettering calculator and like the odds there much better.  It shows a 79% chance of the cancer not coming back within 10 years.

Having looked at a bunch of these things I finally decided that everyone is different and just to try to take it one test at a time.   

Bob

 

There are three important aspects to aggressive cancer, 1) PSA, 2) Velocity and 3) Gleason score. But remember there are exceptions to every thing we discuss here.

The PSA is usually an indicator of the tumor volume. Numbers below 4 or 5 suggest that the volume is fairly low and that is is mostly confined in the prostate. And a tumor contained in one lobe of the capsule is better than one that is in both lobes. A number higher than 10 or 20 or suggests that the tumor may be out of the prostate. Numbers over 50 or 100 indicate that the tumor is probably definitely out of the prostate.

Velocity relates to how fast the PSA is increasing. A PSA that doubles every year is a very aggressive cancer. Velocity is one of the most important numbers we look at following curative treatment. If velocity doubles in three or six months it is even more dangerous.

Gleason score relates to how differentiated the tumor cells are from normal prostate cells. A G5 or G6 tumor is barely differentiated from normal cells, whereas a G9 or G10 is highly differentiated. The importance of this is that a highly differentiated cell can divide and reproduce much easier outside of the prostate than one that is more like normal cells. This is why with G8, G9 and G10 PCa there is always a risk of micro mets in the body that won't show up even with the most sophisticated kind of testing.

All of these factors are important in determining what type of curative treatment one chooses. My urologist recommended a RP, but after studying the literature of nomograms and prostate calculators I determined that a RP was a very poor choice for me as there was such a high probability that the tumor was already out of the capsule. If that is the case a RP is a waste of time and of your life energy because the probability is that it will not get all of the PCa and you will then have to have salvage radiation and/or HT.

The problem with all of this is that the correlation between Gleason score and the ability of the tumor to survive outside of the prostate is not absolute. For some reason many G6 and G7 cancers find a hospitable environment outside of the capsule while a very few G8, G9 and G10s remain in the prostate. But you really never know with any PCa because there is always the danger of micro mets which can result in a return of the cancer, even many years out from treatment.

Another very important consideration for life expectancy in the event the PCa has escaped the prostate capsule and become systemic is how it reacts to androgen deprivation therapy (Hormone Therapy) over the long term. Most PCa is quite responsive to ADT at first, but after about three straight years on it about 50% of men will become refractory. Some men, on the other hand, have PCa which responds to ADT far longer, up to 10-15 years and perhaps even longer.

Sancarlos