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Posted 4/4/2012 2:44 PM (GMT 0)
Hi all. I just found out yesterday that I do have PC. It really hasn't sunk in yet. I am 55 and have never been sick or in the hospital so I am really freaking out about all this. I am going in for a bone scan and chest x-ray next week. My urologist said he will discuss treatments after those results. But for right now can anyone help me de-code this path report? Here are the findings:

Left...Gleason score 7 (3+4) 3 of 4 cores. 35% of total biopsy length. Fragmented.

Right..Gleason score 7 (4+3) 2 of 5 cores. 23% of total biopsy length. 10mm.

Of course my main question is on a scale of 1-10 with 10 being the worst, where does this rank?

By the way my PSA history is:

March 2011 - 4.3

Oct. 2011 - 6.5 (put on an antibiotic for a month)

Dec. 2011 - 9.6 (a different antibiotic for a month)

Jan. 2012 - 6.6 (still another antibiotic)

Mar. 2012 - 7.4 (Biopsy ordered)

I have been on this forum for just a few months and I find it very informative and the people on it are wonderful. Thank you for all your help.

Bill

 

Posted 4/4/2012 2:52 PM (GMT 0)
Hey Bill... Welcome to the site...

Not intending to be funny... But on a scale of 1 to 10, your Gleason 7 puts you at Seven which is a better place to be then 9...

With your numbers you should be able to do any of the treatments.

Stay tuned as I'm sure others will chime in soon.
Posted 4/4/2012 2:56 PM (GMT 0)
Bill

I'll let others smarter than me decode the numbers for you.

My suggestions;

1. Do NOT goggle anything until you have some idea what is what. Come here and ask questions first. There is so much stuff out on the internet that is either wrong or out of date.

3. Be calm - Right yeah I know. Scary stuff. There is a lot of information you need to get first beforeyou decide on any treatment plan. Other than gathering the information (scans, x-rays, oncologist, urologist) there is nothing you have to do right away. Once you have all the information than you can start deciding on treatment plan. Note - start - do not rush into anything until YOU are comfortable with it.

4. If you are not comfortable with your Doc – get another one. In addition to your urologist you also want a oncologist.

4. The medical community has a full arsenal of drugs and other treatments - with more coming down the pipe line.

5. When you go to the Doc’s .
Bring someone with you - preferably someone who can remain calm. Someone suggested audio taping the doctors conversation, that can be very helpful if the Doc agrees.
Write out all his questions before you go to the Doctors appt - than hand a copy of the written questions to the Doc and go over them one by one. Keep a record of your doctor visits and treatments and bring with you every time.

When my Doc tells me something and I'm not sure I understand (which is frequently) - I'll say "Ok I'm going to tell you what I think you told me."

My Medical team laughs at that. But they do listen and correct me if my understanding is wrong.

I was with my Doc yesterday and he said I was not due for my next Eligard until May ( I get Eligard every 3 months) – I showed him my ‘notes’ – which he has seen before – Oh yeah April you are right.

8. Prostate Cancer: The Really Useful List made by HW people for HW people.
www.healingwell.com/community/default.aspx?f=35&m=1717641

Hugs!
Bud
Posted 4/4/2012 3:16 PM (GMT 0)
From one Bill to another:  welcome to HW, but I sure wish neither of us had to be here :)

Many of us have a firsthand idea of what you're going through right now:  healthy and feeling great one minute, and out of the uro's office with a cancer diagnosis the next.  Talk about a game changer!

You DO have that one "4" in your biopsy results.  Biopsy results can be upgraded or downgraded when second opinions are sought, and some might suggest you consider having that done with your specimens.

The important thing is that the cancer has been found, you're being treated for it, and there are very effective treatments, both surgically and radiologically to deal with your disease.  Right now, you need to read and learn about prostate cancer and decide which treatment course is most suitable for you. 

Please keep posting as you have questions.  Very often, there are multiple "right" answers, but it's always good to have options.  Keep your spirits up.  There are a lot of "veterans" here to help you through this.

Bill

 

Posted 4/4/2012 3:33 PM (GMT 0)
Blue Velvet: Don't panic and FIRST thing, plug your numbers into this NOMOGRAM (calculator) from Memorial Sloan Kettering:

http://nomograms.mskcc.org/Prostate/PreTreatment.aspx

You have all of the numbers that you need and you can base your probabilty on both radiation or surgery as a treatment and see just how good you do! DO THIS NOW AND YOU WILL SURELY BE RELIEVED and it will TAKE THE "EDGE" OFF your recent shock. Next, remember that we (PCa folks) all basically exist in a GLEASON range of 6 to 10. So, it is not to fair to base your condition on a 1 to 10 scale! I don't think I ever saw anyone on this forum with a Gleason 5! I was diagnosed with a Gleason 7 and it was downgraded to a 6 after surgery pathology. If you get stuck with the nomogram, just ask us for help. It is not that bad! Just do the NOMOGRAM now..I put this off for 2 weeks after the surgeon telling me to do this....I worried way too much as a result!

Bill K. from NJ
Posted 4/4/2012 4:05 PM (GMT 0)
As the others say - sorry you have to be hear, but you have already found out how extremely helpful your brothers are here.

On the technical side to help you with your question of decoding your Gleason score - check this link first - http://gleasonscore.net/ 

Your left G7 (3+4), 3 of 4 cores tested positive with cancer cells and 35% of the total core volume has cancer, 65% normal cancer free, G7(3+4) means at least 50% or more of the cancer cells are gleason 3 and the balance are gleason 4

Your right G7(4+3), 2 of 5 cores tested positive with cancer cells and 23% of the total core volume has cancer, 77% is normal cancer free. G7(4+4) means at least 50% or more of the cancer cells are gleason 4 (more cell differentiation) and the balance are gleason 3.

So what does this mean, lower gleason scores are better and lower first numbers are better than higher first numbers. I've been told most PR's don't report lower than a Gleason 6 (3+3), that's based on my URO, other members will correct me if that is not the case though. So typically we don't see Gleason scores of G1 to G5. See my signature I started at Gleason 6(3+3), I just had a < 5% cancer from my first Bx and then a jump from G6 to G7(3+4) with 10% on my second Bx.

IMHO, I think most of us experience the hit by a truck emotional cocktail of denial, why me, anger, fear, sadness and worry about all of the what if's of our journey. You need to understand these are normal and you need to process these and acquire as much knowledge on PCa as you are comfortable with to help you control and manage your journey one step at a time.

Stay with us here, for as much help and support as you need. All the best success with your journey.

TJ

Posted 4/4/2012 4:44 PM (GMT 0)
Welcome aboard, but sorry you need to be here.

With the number of positive cores you have, you have a pretty solid case of Gleason 7 PC. Gleason 7's can be problematic, in that some will act less agressive, more like a Gleason 6, while others (myself included) will have the cancer act very agressive.

You should have all primary treatment choices available to you. So take your time, don't get pushed into anything immediately. You have time to get educated, and to learn your options. All treatments will have their risks and potential for side effects ranging from mild to serious.

Please keep us posted, and good luck to you.


David in SC
Posted 4/4/2012 4:51 PM (GMT 0)
Hi Bluevelvet,

When determining treatment recommendations for PC your clinical results (psa and gleason) are usually put into three catagories, low risk, intermediate risk and high risk. You can go to the Prostate Cancer Research Institute's website and see how the risk catagories are determined (Know your color) as they are put into color codes along with recommended treatment options for each color code. You are in the intermediate risk catagory, which means that your PC has a very good probability of progressing and should be treated. You also have a high volume of pc which includes both lobes. Futher scans such as a color doppler ultrasound or an MRIS can give you more information on tumor size and location which is important in choosing a treatment option. If the scans show a tumor location in the APEX, near the margins of the prostate, in the seminal vessicles or nerves then surgery may not be the best option for you as these areas have a very high reoccurrance rate and a much higher probability of permanent side effects. A PCA3 test can give you more information about the aggressiveness of your cancer and a PAP test can give you an indication of systemic spread. The above tests will give you much more information than the bone and CT scans that your doctor recommended which will most likely show clear with any psa less than 40. With additional information you can make a treatment decision that will increase your probability of a favorable outcome. The usual cure rate for intermediate risk PC is about 70%; there have been some recent studies that indicate that brachytherapy with a short 6 month course of hormone therapy can raise this to above 90%.
JohnT
Posted 4/4/2012 10:16 PM (GMT 0)
Bill,

First, the good news. With your PSA, it is highly unlikely that the bone scan or lung x-ray will find anything.
You need them as baselines and so the gas man will do general anesthesia for any treatment, but true bad news is unlikely.

Second, the mid-grade news. You can get a second opinion on the biopsy, but with 5 cores with Gleason 3+4 or 4+3, it's unlikely that the reading of all five cores was wrong, and any reading of 7 puts you in a different game than the 6's.

Third, the not so good news. Most of the guys here have a Gleason 6. You have a 7, which is not 1/6th worse that a 6, but means you have a truly serious disease. Some guys with 6's can do nothing for 10 years with no likely downside. You cannot.

That being said, you are not an 8 or 9 (never heard of an actual 10) which means that much more likely than not, your treatment will work.

So, actually answering your question, and not being flippant, you are about a 7 on a 1-10 scale.
Could be worse, but you are not paranoid, you have real enemies.
Posted 4/4/2012 11:44 PM (GMT 0)
Bill,
Glad you found this site.
Great people who are educated and genuinely care about your journey. I have found them invaluable.
Ask any and all questions that come to mind.
Hang in there.
Posted 4/4/2012 11:45 PM (GMT 0)
Sorry forgot to include signature.
Posted 4/5/2012 2:07 AM (GMT 0)
Bill, glad you found is..... I didn't stumble up on this site till right before my surgery. Like others have said, take your time and ask lots of questions and once you decide on which treatment path you will take you will feel alot better. I was a G-8 and it really stressed me out untill I plugged all my info. in ( psa, Gleason, clinical stage ) that I finally relaxed a little. I did lots of research and talking to others with pc but with the G-8 I felt I should not wait around too long. I was diagnosed in September '11 and surgery December 1,2011. My G-score was reduced to a 4+3 after surgery. Stay positive Bill and good luck to you with whatever treatment you decide to go with. Jeff
Posted 4/5/2012 3:37 PM (GMT 0)
Bill: sorry you needed to join but this is a good site for general advice from guys that "have been there, done that." I am a 3x4 G7. I recommend you find some books to read that are written by doctors. The good thing about books written by Urologists, Oncologists and Radiation Oncologists is you are getting professional advice. The bad thing is the information is sometimes very dated. IMHO the radical prostatectomy(SP?) has changed the least over the last ten years. With that said, since 2005 they can do it today with the Davinci robot but the only real difference in my opinion between an open prostatectomy and a RALP s a shorter recovery time. There have been some studies posted on this site that show the open method has a small advantage on the incontinence issue over the robot, and the robot has a slight advantage in regards to ED. The difference being only a 1 or 2 percent difference. My uro told me that since the Davinci was introduced, the issue of positive margins went from 2% in 2004 up to 6% today with the only significant difference being the introduction of the davinci. That is a three fold increase in reported positive margins which means a higher probability of the patients needing salvage radiation therapy. However, that still means that 94% of the RALP patients had zero positive margins. I suggest that if you should decide to go with a prostatectomy, go with the procedure your uro likes the best.

The next two treatment tiers, tier 1 being surgery, are radiation and HT/Chemo treatments. These two treatments have seen the greatest improvements in the last ten years. To name a few RT, they have proton beam, calypso, seeds and others options you can look up. The last tier is HT and Chemo and this last tier has seen the greatest improvements in the last couple of years. The reason I am bringing all of this up is so you will understand that books will more likely be out of date concerning RT and HT/Chemo.

Good Luck and keep us posted.
Posted 4/5/2012 7:14 PM (GMT 0)
Take a breath, take you're time deciding what to do and educate yourself as much ans possible. Find the best doctors you can and talk to surgeons and radiation doctors. You can read what I went through by clicking on the link in my signature. Good luck to you.
Posted 4/9/2012 5:56 PM (GMT 0)
ZO6Dude...thank you for the nonogram link however it asks me for some info I can't supply. It will not let me caculate until I put a clinical staging on the tumor. But I don't have a staging on a tumor on my path report. To my knowledge no tumor has been found unless thats where my positive cores came from. Any thoughts on this?

Bill

Posted 4/9/2012 6:25 PM (GMT 0)
To all who replied to me.....all I can say is thank you-thank you, and WOW! What a terrific group of new friends.  I feel better and much more educated after the responses. I am thankful to have you all by my side thru this and to be by your side. Time now to "get busy livin." ( "Shawshank Redemption" quote.) 

PSA history:

March 2011 - 4.3

Oct. 2011 - 6.5 (put on an antibiotic for a month)

Dec. 2011 - 9.6 (a different antibiotic for a month)

Jan. 2012 - 6.6 (still another antibiotic)

Mar. 2012 - 7.4 (Biopsy ordered)

PR: Left...Gleason score 7 (3+4) 3 of 4 cores. 35% of total biopsy length. Fragmented.

      Right..Gleason score 7 (4+3) 2 of 5 cores. 23% of total biopsy length. 10mm.

Bone scan and chest X-Ray scheduled for Apr 11, 2012

Posted 4/9/2012 6:33 PM (GMT 0)
Bluevelvet..........

We are all inspired by your renewed "get busy livin" - that is the best spirit and great news to hear. Wishing you a great outcome with you April 11 tests and your curative treatment. Stay with us here at the forum with your journey. All the best!!

TJ
Posted 4/9/2012 6:41 PM (GMT 0)
Desert rat,

I don't know where you heard the 94% negative margin rate, but it is way too optimistic. The published positive margin rates for major institutions range from 21% to 30%. This is across all gleason grades, but is also from the best institutions with the most experienced surgeons. The general positive rate is closer to 30% for the population in general. There have been many studies comparing open with robotic and all show no difference in the positive margin rates or side effects. The biggest difference between the two procedures is in the amount of blood loss and the recovery time.

JT

Posted 4/9/2012 10:10 PM (GMT 0)
John T: Here is a quote from my post:

"My uro told me that since the Davinci was introduced, the issue of positive margins went from 2% in 2004 up to 6% today with the only significant difference being the introduction of the davinci. That is a three fold increase in reported positive margins which means a higher probability of the patients needing salvage radiation therapy. However, that still means that 94% of the RALP patients had zero positive margins. I suggest that if you should decide to go with a prostatectomy, go with the procedure your uro likes the best."

The first two words tell the story. It comes from my urologist. I don't have a study to back it up or a link. With that said, I'm not making it up either. I do agree with the recovery time. With the open procedure, the foley stays in another week compared to the davinci prostatectomy. For me, the foley hurt like hell and I'm was a happy camper when it was removed. If you have some links supporting the difference between open vs davinci RP, I would be very happy to see them.
Posted 4/10/2012 12:29 AM (GMT 0)
Desert Rat,
Didn't mean to question you personally, but it did come out that way. Just trying to get the correct data out there so new patients are not given either an overly optimistic or overly negative of what to expect.
You can go to the New Prostate Cancer Infolink and do a search of open Vs RALP and several articles will pop up.
JT
Posted 4/10/2012 1:53 AM (GMT 0)
The surgeon who did my surgery has a positive margin rate of under 9%. This is peer reviewed and published. He has done over 4000 procedures. I was in the hospital for less than 24 hours, had my catheter out in a week and didn't have significant blood loss. My surgery lasted just over an hour.

It is possible to find doctors with much better stats than the average. You need to do your homework.
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