Can you die from Gleason 6 PC

Living,

You had to bring Mamma into the discussion, didn't you?  Well, mamma also said that life (and PC) is like a box of chocolates...you never know what ya going get...

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But yeah, G-6, contained as identified at surgery...close as you'll get to a cure I think...but there are exceptions to all PC rules...as we all know...

 

This is an excellent thread.

I was treated at Hopkins and my Dr was more concerned about the palpable nodule than anything initially, as well. He immediately scheduled a biopsy for the next week. It came back G6. I don't know if Epstein did it, but all of my work was done at Hopkins. The surgical pathology remained G6, OC. My Dr also said that, "Well, you will die, but probably not from PCa."

The complicating factors for G6 have to be a quickly rising PSA, nodule(s), and not being OC in the post-surgical pathology. Otherwise, it seems to be the grade of PCa the experts feel strongly can actually be cured. My Dr said categorically that, "...you should NOT wait a year to decide what you are going to do."

So, as Casey suggests, some G6's are not "low risk" and should not opt for AS. Either way, tho, true G6's, are far more predictable than the other grades, imo, from what I've read. I think that is proven by ChrisR's stats about true G6's.

Regarding predictability, I recall an article I read where G7, specifically 4 + 3, was seen in some studies as even more unpredictable than a true G8, 4 + 4...

SpecialLady,

1st, I am sorry to hear about your fathers metastic cancer.  All of my studies and stats. were based on post-op pathologies.  So, it is possible that if your father had is prostate taken out he could have a higher Gleason score in there.  But, maybe not.  I am not saying that G6 does not spread, but your father is the first case I have read about that was G6 on dx. and had metastasis.  Not that I have seen every case in the world, but this is very rare especially with PSA under 10.  I think you are right to have a second opinion on his slides.  Where did you send them?  I would send them to either J.H. or Bostwick.  If you send to J.H. you can request that Epstein read them. 

Anyway, on the other hand yea, he might have had it for a long time and it is progressing slowly.  How was he diagnosed?  Was this his 1st PSA ever?

Frackme,

Nobody is claiming that G6 is never fatal. It just seems to be rarely fatal. I don't know about prostate cancer morphing to higher grade cells over time. I have never seen any studies on that. I would imagine if it were something that happened nobody would push AS, since there is a risk of the cancer, over time, turning more aggressive. Why would you risk it.

Does anyone have any studies that talk about Gleason grades starting out at a certian level and then increasing over time?

SpecialLady, Have you been able to confirm that the two spots are prostate cancer? It is possible unless they did a biospy that they could be something else. I have read the only way to confirm it is by biopsy.

Increased prostate cell proliferation and loss of cell differentiation of prostate cells is a natural part of the aging process .   Pathologist Donald Gleason classified the extent of cell differentiation seen under a microscope nearly 50 years ago which is still used today. [Interesting historical commentary:   here in the 21 st century , our method of identifying cell differentiation remains the same as when German pathologist Rudolf Virchow defined most cancers in the mid-19 th century — using a lighted microscope …I agree with SpecialLady’s belief that this will change soon to molecular profiling/biomarkers which will improve the individualization of treatment modes.] The Fred Hutchinson Cancer Research Center (Seattle), which is one of the leading research organizations focused on the biology of PC, is conducting research to better understand if/and when inactive or slow-growing prostate tumors lose cell differentiation and become increasingly aggressive...some do, and others do not.   At the Hutchinson website:   " There's an emerging consensus that we dramatically over treat prostate cancer in general ," said Nelson. "The overall prevalence of the disease in the population far exceeds the number of men whose disease progresses to cause serious problems. Yet, there are clearly many prostate cancers that behave aggressively and patients benefit from treatment. It is a challenging problem." In the study, men diagnosed with early-stage prostate cancer will not be treated right away but will be closely followed in an active surveillance program involving regular collection of blood and urine samples as well as prostate biopsies. ... The samples will be tested for candidate biomarkers — proteins in the blood — that can signal when indolent disease has progressed to more aggressive illness . Such biomarkers could help physicians better determine when to initiate treatment versus watchful waiting.   Post Edited (Casey59) : 4/19/2012 9:16:55 AM (GMT-6)

ChrisR, no, it is not 100% sure that the 2 spots are cancer, but the radiologists told us 90%, especially the one on the pubic bone - because of its proximity to prostate. There is a spot on the head of left femur, and they told us that one is 50-50, could be cancer, could be something else. Biopsy was not considered, since dad has already started hormonal therapy, and they told us that the biopsies in those cases can lead to false negatives.

SpecialLady,

I am not a doctor and I am not saying I konw what the spots are and I don't want to get your hopes up, but......

Everything I have read in the past says that metastatic PCa with G6 and PSA under 10 is so rare that a bone scan is not even recommended unless the patient has unexplained pain or other symptoms. I wonder why before your doctor started him on HT and then told you surgery was not an option that he did not confirm definitively that the spots were prostate cancer. Especially with the very low chance that they would be based on his biopsy stats. It will be interesting to see if the spots shrink after HT or not.

Again, I am not saying I know what is going on and that the spots are not metastatic PCa, but with his stats, I personally would have wanted proof before I started treatement. If his Gleason score was higher I would be less insistant about it.

Casey, thanks for the link, all the best to your wife...

ChrisR, that is a good question, I am not quite happy with how those first decisions were made. The urologist sent dad to scintigraphy, I suppose because through DRE he could feel that the tumor was extensive, he wrote that "we can probably speak of locally advanced disease". First bone scan was done March last year, then, since it was inconclusive (showed 1 spot on pubic bone) decided to wait another 6 months to repeat it, and after the second one showed the same spot, dad was sent to do MRI of pelvis. So it took almost a year to "conclude" dad had mets. His is a strange case, indeed.

A few months ago we talked about the possibility of being born with a GS 8 cancer and the fact that prostate cancer dedifferentiation with time explained the evolution of Gleason Grades from well differntiated to poorly differentiated. Will a GS6 kill?

It depends on several factors such as: no other focus of cancer are present(missed at the biopsy), the age and health of the man, the man's life style and the man's attention about his disease. That is, the attantion placed in following potential progression.

Many men with prostate cancer die of other diseases, but that should not be an excuse to ignore prostate cancer. In the era before the PSA test became available and in countries in which PSA is not used as often as in the US, prostate cancer was typically diagnosed at advanced stages. This is an indication of a progressive disease. A disease that if arrested at an early stage, can be survived. The reduction in prostate cancer mortality during the PSA era in the US is a sign that PSA saves lives in spite of the USPSTF recommendations.

See the thread mentioned above here:

tinyurl.com/d89hpjv

RalphV

Hi Desertrat1,

You weren't really a candidate for AS because even though you had 3+3, you weren't in the "low risk" category due to the amount of cancer found.  There are multiple criteria for "low-risk," and it is most appropriate when one meets all, not just some, of the criteria.  This was what was meant in my earlier post which read:

Common misconception is that Gleason 3+3 alone means "low-risk." It does not.

While about half of all prostate biopsies result in Gleason 3+3, only about half or 3/4 of those meet the criteria for "low-risk." Men with low risk PC are encouraged by the NCCN to consider active surveillance after a second, confirmatory biopsy, but they should meet ALL the "low-risk" criteria, not just some of the criteria.

OK, here's your answer. I just got off the phone with Dr Scholz for my yearly consult and asked him that question.
He said that in most all cases a G6 remains a G6 and rarely progresses to a G7. What usually occurs is that a higher grade grows independently as another tumor starting off with the higher grade. So a G6 tumor can grow larger as time progresses, but it won't turn into a higher grade.
That's what I thought as the PSA doubling time is in the DNA of the cancer and rarely changes. If a tumor progressed to a higher grade then the doubling time would also change as different grades of tumors generate psa at consistant, but differing amounts.
JohnT

DanO,
Dr Scholz is one of the most highly regarded prostate oncologists in the US and has 30 years treating and researching prostate cancer and only prostate cancer. If anyone understands how tumors form and grow he is the person. If he says that G6s remain G6s and don't progress I would take that to the bank, especially when there is no evidence to support another viewpoint.
Many patients on this board have had small G8 tumors discovered early. It is very doubtful that they started as G6. It is not unusual for a G6 patient to go 20 or more years without treatment and it is rare for a patient to die of a G6 cancer. If cancers progressed as you suggest these patients would have died years earlier. It may be illogical to you, but the DNA of the cancer you have is the DNA that stays with that cancer and determines how it will act. It is not at all unreasonable to expect that if one has a predisposition to prostate cancer that other tumors will not form somewhere along the line and it is well known that PC is a multifocal disease and that if you have one tumor there are mostl likely more. A patient can have a G6 tumor in one place and a G8 in another, in fact this is very common. Tumors that start independently can also grow into one another appearing as one tumor, but are actually multiple tumors.
JT

I would think that if different grades of PCa morphed into subsequent higher grades someone-somewhere would have seen this in a test tube or a lab rat.  To my knowledge nobody has ever published a paper about this happening.  Not that I have seen everything published about PCa ever printed.   I just have never run accross anyone ever discussing it.  I would tend to think this would be a very important issue for people considering AS.  I think that in a biopsy situation where one grade is dx. and then a higher grade is found post-op that it was only missed by the biopsy and it did not "morph". 

I tend to agree with John T, if this were a regular occurence you would not see people on 20 year AS programs with G6 doing so well.  Unfortunately, I need 30-40 years...But, I'll take the 20 for have cancer....

The bottom line is that there is no evidence for this happening anywhere.

We are off topic.....