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Posted 3/6/2012 8:26 PM (GMT 0)
Diagnosed on 2/21. Bx was on 2/6, with 3 of 13 cores graded 3+3, and PIN found in a 4th.

Here's the kicker: My wife (who's an oncology nurse manager) decided to have one of the pathologists she works with take a look at the Bx slides. He graded the Gleason at 3+4, and he sat down with some of his colleagues who deal primarily (only?) with prostates. They all agreed on the 3+4. So, now after two weeks considering my options/outlook based on a Gleason 6, I get the Gleason 7 news.

I've been leaning toward the robot (my uro has a lot of experience there), so the new news doesn't really change that path--in fact, it solidifies it in my mind. But now I'm worried about whether everything's been contained.

Meeting with the uro this Thursday to discuss where/how to go from here...
Posted 3/6/2012 8:52 PM (GMT 0)
ShoreGuy,

Welcome to the Healingwell site.  You made the first crucial step and that is getting informed.  This site is a great place for that.  You will find a wealth of information and support here.

I was faced with worse numbers than you and it was fairly obvious that surgery was going to happen for me.  Each case is different.  I am sure a number of guys more closely related to your stats will chime in and you will be able to debate the options.

Keep us posted how you are doing.

Jerry L.

Posted 3/6/2012 9:46 PM (GMT 0)
ShoreGuy,

Hubby is just behind you in his walk. He had his surgery 2/2/2012. He was a 4+3 gleason 7, and his post op path showed organ confined. There is no one size fits all, however. It's was VERY stressful at times, but what helped me most was trying to stay in the moment and not let my/our minds wonder too far out there with the "what if" questions. So hard to do, but when you find yourself going "there", just remind your self focus back to the present moment. If you are a numbers guy and want to see what the future MAY hold, there is a scale that you can use to type in your numbers, and it will give you the percentages you are looking for. The guys here should be able to help you with that. I/we didn't use it. Also, because hubby had such an elevated PSA, his docs had him do both a CT and bone scan. Maybe you should include your PSA in your signature.

Take care,
Posted 3/6/2012 10:02 PM (GMT 0)
ShoreGuy,

"walkbyfaith" is incredible and offers both great experience and also an extremely valuable wife's perspective. She has helped me alot already as a newbie and I only joined HW last week.

Take one step at a time, sounds like you have a great URO, learn, research, decision, commit, visualize a successful outcome and most of all stay positive PCa iat your staging is not life threatening only life changing in many great ways!

You will find your new family here unbelievabel with support.

All the best to you and your family with a great outcome in your journey.

TJ

Posted 3/6/2012 10:40 PM (GMT 0)
SG

Your experience is not uncommon. If you do some web searches, you will find that both the Germans and Johns Hopkins have done studies finding about 1/3 of biopsies result in underestimates of the Gleason scores, That's why anyone considering Active Surveillance needs to get a second opinion on their slides.

You can get the CT and bone scans, but they are highly unlikely to be informative. Since you're getting surgery, the doc can tell you immediately post-surgery if there appeared to be positive margins, meaning cancer beyond the removed gland tissue.
The three and six month PSA tests will provide further data.

Until then, focus on what you can do, e.g., get into better shape now, and enjoy life. Don't waste time on hypotheticals of what could go wrong.
Posted 3/6/2012 10:54 PM (GMT 0)
I agree with all that has been said. I had gleason 7 as well as numerous others on this forum that have had organ contained cancer. I do not regret the robotic surgery and I am still healing. Good luck to you and hope to see you on the other side - as they say here.
Posted 3/7/2012 1:21 AM (GMT 0)
Hey shoreguy, welcome to the forum, I'm new here also and wish I'd found this place sooner. I'm 44 and was diagnosed in Sept. '11 with a Gleason 4+4, clean DRE, and my psa had gone from a 3.5 in 2008 to a 6.5 in 2011. I went the robot route and have No regrets! I was extremely comfortable with my urologist who also did the surgery. I did alot of research like we all do and met with the radiologist and felt the most comfortable having my prostate removed.... I liked the idea of it GONE! and also liked the idea of it being looked at again after being removed. My Gleason was lowered to a 4+3 and there were no positive margins. You need to be comfortable with your choice and your doctor. I wish you the best in making your decision,
I know I was less stressed after I made my mind up and I took the first available appointment I could get. I had the cath. out in 1 week and back to work the third week(took it slows for awhile) no regrets here and I'm sure you'll do just fine whichever treatment you chose. Jeff
Posted 3/7/2012 2:32 PM (GMT 0)
Shorebuy: I had RP on Jan 3, 2012 based upon a needle biopsy that came back G6 3x3. One week later, my final path report came back a G7 3x4 so we probably have a very similar PC diagnosis. According to the post surgery path, the PC should be contained within the gland as you can see from my signature. My first PSA will be known on April 11th. I'll post the results when I get them.

Good Luck
Rod
Posted 3/7/2012 2:36 PM (GMT 0)
Thanks for the welcomes and the best wishes.

I'll report back after my visit with the uro tomorrow...
Posted 3/7/2012 2:41 PM (GMT 0)
ShoreGuy. Good luck with your quest for info. You have found a wonderful site with lots of great guys willing to help. Do keep us posted.

Cajun Jeff
Posted 3/7/2012 3:13 PM (GMT 0)
Welcome to our fraternity Shoreguy, I bet you didn't want to join this fraternity, but this is a dang good place to be.

This month is my one year anniversary that my PSA had gone from 3.5 to 5.25 in 2 months and I needed to have a biopsy. It came back as G7 3+4 and i had the same thoughts and worries you are going through now. Unfortunately I didn't find this forum until after my surgery.

I had my RALP in June and my post pathology came back as G7 with my prostate 60% tumor involved but with clean margins and 100% organ contained. So far my PSA have been undetectable.  The biggest difference between a G6 and G6 is the 7 is more aggressive and you have less time to consider treatment options and for most AS is not an option. My URO  told me that based upon my pathology and rapid PSA rise his best guess was that my cancer would not have been organ contained in less than 2 years, so I made my right decision with RALP and doing it right away.

Good luck in your journey.

Posted 3/7/2012 5:52 PM (GMT 0)
Dear ShoreGuy:

Welcome to HW.  Sorry you have to be here but I think you will find lots of info and support from posters on this site.  I have the following thoughts re your situation:

1.  Reading protate pathology is more art than science.  I would suggest that you have your slide sent to one of the acknowledged experts in the field like Epstein or Bostwick so you have a better idea about what you are dealing with.

2.  You should get yourself educated on our disease.  That means reading more than posts on the internet.  Three good books are "Surviving Prostate Cancer" by Dr. Patrick Walsh, "A Primer on Prostate Cancer" by Dr. Strum and "Invasion of the Prostate Snatchers" by Dr. Scholz and Mr. Blum.  Those three books will give you a broad persepective of prostate cancer.

3.  Explore other treatment options.  Take the time to consult with a radiation oncologist to see what he/she thinks.  Depending on the case, radiation options may offer equal cure rates with significantly less chance of onerous side effects.

4.  Whomever you choose for your treatment, make sure they are highly experienced.  That means at least several hundred.  Studies clearly show that experience matters and there is a wide variety of results based on the doctor you choose.

Good luck and please keep us posted,

Tudpock (Jim)

Posted 3/7/2012 6:03 PM (GMT 0)
Hi, Shoreguy

I had similar experience, my biopsy slides were first read as a mix of 3+3 and 3+4 with an overall grade of 3+3 but then when I sent to see the surgeon he had his lab review them independently so the overall grade was raised to 3+4. This is not uncommon; there is some subjectivity involved. There are also different incentives; insurers and HMO's have incentive to fudge the numbers downward so as to reduce the number of people seeking expensive treatment; physicians keeping statistics on their results have an incentive to fudge the numbers upwards so their gleason-adjusted recurrence rates look better.

With three positive cores and PNI I wouldn't be consider AS, personally. I had davinci and was very pleased with result both in terms of cancer control thus far (2 years) and side effects too. But it is a very personal decision.

Can't really tell if everything's contained until the surgery is done but consider doppler ultrasound to provide some insight into that. If your PSA is high they will want scans to check for mets but with only 3 cores and low intermediate gleason it's unlikley. You can use the nomograms at SKMCC to predict the likelihood of extra capsular extension based on your stats to date.
Posted 3/7/2012 9:57 PM (GMT 0)
Proscapt, sorry I just can't let your post pass without comment.  What evidence do you have that anyone is fudging pathology reports for some sort of "incentive".  Unless you have some sort of study to refer to, may I sincerely suggest that you preference such comments with "in my opinion but without proof" or something like that.  Otherwise we risk new patients getting an erroneous impression.  Of course, if you do have evidence then I apologize for raising the issue but would appreciate seeing it since that would be a service to all new patients.

Tudpock (Jim)

Posted 3/8/2012 12:26 AM (GMT 0)
Unlikely any fudging occrurs as pathologists are an independent from urologists and have nothing to gain or lose as they get paid by the slide. The Gleason grading system was devised so as 90% of pathologists reviewing a slide would come up with the same answer, so there is already a 10% error rate built in on any given slide. Best is to have a 2nd opinion on all slides from Epstien or Bostwick and always get a 2nd opinion from an independent doctor (not referred by your doctor) on all major treatment issues.

JT

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