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Gleason 6 Progression - Study shows 12% to 24% likelihood

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Posted 11/12/2013 2:26 AM (GMT 0)
After a reread JohnT. In all the mri's and scientific research. Has it ever been proven that all the neural rewires, pretty shades of reds,blues and yellows on the MR EYED brain is a cause or an effect of such marvelous truths. Did the activity of the persons mind create the patterns or did the patterns create the activity??
Posted 11/12/2013 3:20 AM (GMT 0)
I think it's simple indeed.

230,000 will be diagnosed this year. 28,000 will die likely at some time. That leaves 200,000 that 75% will feel their lives were saved by screening which is statistically impossible. But it's a moot point. Some will be saved.

It's what happens to the rest that gets lost in the scuffle. Some will die from the therapies. Others will have their lives changed physically. And yet others will be satisfied and happy with they things are.

It's a very large pool of various results and beliefs.

That said. This post is about men that were diagnosed with Gleason 6 and later determined to have a higher Gleason sum. I looked in the ASCO membership directory to see if I could find Dr. Inoue but not found. I wrote Mike Scott to see if he can reach Inoue. My question is "how many of the 627 died of prostate cancer?"

I know one two doctors at UW. I'll ask them if they can get me in touch with Inoue. My bet is he/she is a biostatistician and not an oncologist.

Tony
Posted 11/12/2013 3:25 AM (GMT 0)
Longo and Davidg,
You misunderstood my point. In the short term evidence, one way or another has no effect in changing deep set beliefs. There is no right or wrong, gay marriage and the Iraq war are just two examples of many that people's beliefs changed over time, not immediately when conflicting evidence was presented. 20% of all individuals will never change their minds regardless of any evidence presented.
46% of Americans believe in ghosts, over 50% in paranormal activity, and 7% in reptilian aliens disguised as humans, when all scientific evidence proves no evidence at all. Beliefs are emotional, not rational, as much as we think otherwise.
To answer your question Logo, the neural networks are created by one's experiences, and the patterns created influence activity.
You just have to look at the Supreme Court, 9 of the most intelligent individuals in America are most always split according to ideological lines, even though they see the exact same evidence in a very narrow area, the law. Rational individuals seeing the same evidence should come to the same conclusion, but they rarely do. Their decisions are based on their beliefs and not the evidence presented.
Posted 11/12/2013 3:30 AM (GMT 0)
Sad that this thread has already taken the normal and expected course, with the same tired answers that are always given on this subject. it's like no one ever learns anything. seems totally pointless to keep re-hashing the same stuff over and over, to what purpose?

The real topic was about the progression of G6 diagnoses, not battling PSA testing, ODOT, etc.

Perhaps it can get back on topic, for the good of the thread.

While rare, G6's can and do progress. May not be the norm, but it happens. Plus, as discussed endlessly before, look how many times a G6 has "turned" into a G7 or G8 after post-surgery data is in.

Not trying to promote a pro-surgery bias, as I do not have one, but knowing for sure what you are dealing with, is still a good point of having surgery as a primary treatment.

David in SC
Posted 11/12/2013 3:31 AM (GMT 0)
And yes....let's keep social subjects out of HW PC, not the place, not appropriate, can go no where but downhill to hell in a bucket.

David
Posted 11/12/2013 3:33 AM (GMT 0)
Agreed DavidP.

This is a good thread on it's merits of progression for G6 men. It should stick to that. AS is an important option that we need to better understand. It would be best to look at the post from Mike Scott at the Infolink link posted by Jerry and try to stick to that discussion. The better we can safely apply AS the more we'll improve quality of life in a lot of men.

Tony
Posted 11/12/2013 3:34 AM (GMT 0)
Tony,

This is something you and I both agree on, the proper use of AS, and hoping it will become the "norm" where appropriate, I still feel in my heart of heart, that it could be a driving force in reducing true OT.

David
Posted 11/12/2013 3:42 AM (GMT 0)
davidP,
Active Surveillance is the only option that isn't therapy after a diagnose. There's pretty much no other method to avoid over treatment.

Tony
Posted 11/12/2013 3:46 AM (GMT 0)
Tony, I fully agree.

Also, if that "new testing tool" could ever be developed and utilized, it could make directing men to use AS even more safely with less risk. And I know most here disagree with me, but will say again, I could see the time ahead, where if AS is appropriate and safe, then it might have to be the available "treatment" choice that health insurance companies agree to sanction. And save the invasive treatments such as surgery and/or RT for those that really need it. I don't see this as a civil liberties issue, as some will claim, or you "can't tell me how to be treated" item, but more of what is best for the patient.

Who would really want to undertake an invasive treatment when it could be safely proven that it isn't even needed? This is how my sense of logic sees all of this. Plus, when I look back at my own medical history, of undergoing a lot of very invasive treatments for various things, including 4 bouts of cancer, from the time I was 28 years of age.

David
Posted 11/12/2013 3:55 AM (GMT 0)
Well I heard back from an oncologist friend at the University of Washington. He will put me in contact with the biostatistician who did this paper.

Evan,s point though is that there were probably no deaths in this study, and that there would need to be another ten years in it to determine a mortality rate. He points out that we probably won't see that data from this paper.

Tony
Posted 11/12/2013 5:02 AM (GMT 0)
John,

During those four years that it took for this forum to come to accept AS as an acceptable option the favorable evidence continued to mount and new testing methodologies have started to emerge that hold the promise of further reducing the risks associated with AS.

Your notions about beliefs and how hard they are to change is interesting but, I think, not that useful for furthering your argument. Or at least, including such notions in your argument is counterproductive. I, for instance, acknowledge that I am not altogether rational at times, but never-the-less I am unlikely to be made more receptive to difficult ideas by having my thought processes dismissed as a mere symptom of my pathology. I do know that things change -- at least in medicine -- and I am open to the idea that AS is getting better and safer and that that it may be time to put aside some of my nervousness about it -- not because I was wrong before but because the world has changed.

I'll still have some reservations about it until I think it has a more compelling story for guys like me. It's getting there but a man with my cancer entering a typical AS program might well be in trouble by the time he was kicked out for treatment. That guy would be a statistical anomaly (as am I) but I find it difficult to completely get past it.
Posted 11/12/2013 6:00 AM (GMT 0)
JohnT you can say what you want definitively about what causes and what is effected. At its highest level, you really don't know unless you believe in a limit to knowledge. I say each discovery gives birth to another path to an expanded discovery ad inifinitum, or ad neauseum, based on perspective. I have to agree, based on the narrow paths of discussion allowed, the tangent should be curved, as we have not evolved to the point of total civil discussion in any and all subjects,... but politics, issues of the body, and religion, issues of the spirit, are specifically verboten, so I defer to the invisible host, whose house, not home,{ thats the forums domain,} we are invited into…..
Posted 11/12/2013 2:13 PM (GMT 0)

TC-LasVegas said...
davidP,
Active Surveillance is the only option that isn't therapy after a diagnose. There's pretty much no other method to avoid over treatment.

Tony

Sure there is, by having different definitions of it.


David - took all of one post to go back on the AS, ODOT theme some prefer.
Posted 11/12/2013 2:18 PM (GMT 0)
Logo - on your very last post above - very well said, even I got it completely on the first pass. Perhaps I am getting use to your unique language. Good point in your words.

David in SC
Posted 11/12/2013 2:25 PM (GMT 0)
Without accurate post surgery pathology work done, there's no way of knowing with certainty if there is any Gleason bounce. I have seen many here discount that as an advantage to having surgery as a primary treatment. They argue that if you need a secondary treatment, then perhaps you shouldn't have had surgery as a primary treatment. I think that is flawed.

If a pretreatment biopsy was better designed, there would be less chance of seeing Gleason bounce, and better primary treatment choices could be made, and perhaps in some cases, surgery and all its ill side effects could be safely avoided. The whole point of a conventional biopsy, is that at best, its gives an estimate of what is going on, but doesn't always show the volume of the cancer, all of its location, or as the case in point, the highest level of Gleason in the samples.

So a difficult decision has to be made on partial or even flawed information, never a good situation.

David
Posted 11/12/2013 2:32 PM (GMT 0)

John T said...
Longo and Davidg,
You misunderstood my point. In the short term evidence, one way or another has no effect in changing deep set beliefs. There is no right or wrong, gay marriage and the Iraq war are just two examples of many that people's beliefs changed over time, not immediately when conflicting evidence was presented. 20% of all individuals will never change their minds regardless of any evidence presented.
46% of Americans believe in ghosts, over 50% in paranormal activity, and 7% in reptilian aliens disguised as humans, when all scientific evidence proves no evidence at all. Beliefs are emotional, not rational, as much as we think otherwise.
To answer your question Logo, the neural networks are created by one's experiences, and the patterns created influence activity.
You just have to look at the Supreme Court, 9 of the most intelligent individuals in America are most always split according to ideological lines, even though they see the exact same evidence in a very narrow area, the law. Rational individuals seeing the same evidence should come to the same conclusion, but they rarely do. Their decisions are based on their beliefs and not the evidence presented.

John, often evidence isn't even presented.

Not sure the SC is a good example as that is so obviously a body driven by politics and ideology.

What drives human beings is adaptive behavior. So they may chose to have certain beliefs, like say the belief in super natural beings, because it is functional and thus adaptive.

To you and me a cow is a steak, to a billion other people it is a divine being. There is no evidence that proves it to be divine. Yet if you explore economic circumstances you can see why it becomes necessary for the 1 billion people to consider it divine rather than steak. There is surely an element of learned behavior and ideology, but behind it all, there is functionalism and adaptation.
Posted 11/12/2013 5:11 PM (GMT 0)
PeterDisAbelard,

I had to refresh my memory and do a double take at your signature.  1 out of 14 samples generally thought to be G6; fast forward to G9 after surgery?  Your type of case would be a great testing ground for any new screening / AS monitoring system.  Certainly, the biospy didn't show the G9 portion...and thus the dilemna, and the need for a better test.

I think that is where I'm learning something.  Over the years, I mistakenly have grouped all the G6 guys into a "no worry" category as it relates to their cancer.  I remember a thread on HW where a G6 guy was anxious about his upcoming PSA test.  Coming from my vantage point I somewhat dismissed his worrying, but that was not right.  And, I remember Logo (I think) calling me out on it, and rightfully so.

I've seen strange and odd things with this disease.  So, I am curious how a G6 can turn into (or get reclassified) as something higher.  For me, some of my initial biopsy was G6 with a bunch of G9.  

Jerry

Posted 11/12/2013 5:29 PM (GMT 0)
I tend to go along with a previous, recent study that said a Gleason grade tends to STAY at that same grade throughout its life.

Most likely, when a lower Gleason graded prostate is upgraded in post-op pathology, it simply means that the biopsies failed to detect the higher grade tumor while finding the lower grade one.

In any event, it sure will be nice whenever we reach the medical point where we KNOW for certain about these confusing issues.

Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 11/12/2013 5:54 PM (GMT 0)
I firmly believe the point made by others here, about a G6 not likely (possible, but not likely) to upgrade - but rather a patient with an initial DX of G6 and then a subsequent upgrade to G7, G8 is most likely due to the higher G-patterns present all along but missed during BX.

The best support of this that I have found came from a publication in the Journal of Urology, led by Johathan Epstein:

"More men than ever are being diagnosed with prostate cancer when it is very early — with minimal, low-grade cancer. Some of these men choose to have the cancer removed; at Hopkins, about a fourth of men who undergo radical prostatectomy have this kind of “insignificant” disease. But some of these men, with their doctor’s guidance, decide on a course of “expectant management” — active surveillance, with PSA and needle biopsies, until there is evidence that the cancer has progressed.

“A concern for these men is whether their cancer will become worse in grade over time,” says Jonathan I. Epstein, M.D., the Rose-Lee and Keith Reinhard Professor of Urologic Pathology. This movement from a nice, harmless, low-grade cancer toward a higher-grade cancer that needs to be treated is called “dedifferentiation.” Differentiated cells have well-defined, or differentiated, walls, and grow slowly. The worst cancer cells are poorly differentiated, and seem to melt with other cells into blobs.

What can these men expect? Until recently, no one knew. In a recent study, led by Epstein and published in the Journal of Urology, pathologists monitored grade changes over time in 241 men with cancer considered “good” enough to follow expectantly — too small to be felt, with an initial Gleason score of 6 or lower. For the majority of men, the cancer did not progress right away. “Our results suggest that if dedifferentiation does occur, the risk is low in the short-term,” Epstein says.


But sometimes it did progress, and this seemed to happen fairly quickly. Epstein suspects that these men probably had more advanced cancer cells in the prostate all along — but they had so few of them, they weren’t detected by needle biopsy. about 19 percent (45 men) showed a significant change in grade to a Gleason score of 7 or higher (41 men), and 4 men showed a Gleason score of 8. “about half of the men who moved to a higher grade did so within 24 months of diagnosis,” says Epstein.

Other men showed an increase in Gleason grade after three years, and “this may represent true dedifferentiation,” says Epstein. Many of the men in this study had multiple biopsies over three years of follow-up, and showed no change. “This suggests extremely low volumes of tumor in these patients, and very slow-growing tumors,” says Epstein. “These results should be reassuring to patients suspected of harboring small-volume, low-grade cancer,
and they further support the concept of active surveillance as a reasonable alternative
to immediate surgery or radiation.”

I concur. . . .

Posted 11/12/2013 5:57 PM (GMT 0)
another thread devolves into semantical mumbo jumbo. 

ed

 

Posted 11/12/2013 6:11 PM (GMT 0)
But it makes a good soup,as the GFPH cruise originating in N'awlins, will soon discover, N'est-ce pa?
Posted 11/12/2013 6:20 PM (GMT 0)
That's Gumbo, not mumbo jumbo, dumbo.
Posted 11/12/2013 6:29 PM (GMT 0)
usmessageboard is a good forum for non PC posts...
Posted 11/12/2013 6:42 PM (GMT 0)
I don't know about "mumbo jumbo," but we sure are a bunch of guys willing to argue over beliefs that are, in the last analysis, still somewhat theoretical and speculative.

I don't see any absolute consensus among the subject matter experts, so I think for the present I'll just try to keep an open mind and certainly understand why a man, especially a young man, would choose to err on the side of caution. 

Does such a man risk acting illogically?  Well, so be it.  Most of live only some portion of our lives "logically."

Posted 11/12/2013 7:11 PM (GMT 0)
I don't even think it's illogical.

Say a 40 year old man is told he has a G6 with 1 or 2 cores out 12 at 5%. He is told he will qualify for AS and do well with any treatment.

At this stage, the man will make a lot of considerations. He may think that the tumor could be upstaged after treatment, he can think that given his age and his desire to live cancer free another 30-40 years he would rather treat it now given the possibilities of future treatment, he may consider that at a young age and the status of being fit, his chances of overcoming potential SEs greatly outweigh the chances of overcoming potential side effects should he wait to treat the tumor years later. This last way of looking at it is as logical as someone saying "I'll enjoy 10+ more years sand potential SEs and then deal with whatever cards I'm thrown later on.

These are extremely logical choices. In fact, many, if not most, practitioners and oncologists will tell you to consider these. I know the actual experts I consulted with did.

The point is that these are logical individualized choices that many men, including many here, have made. Having a resident non-practitioner "expert"tell you (repeatedly) that they are not logical is insulting and counter productive.

We've had many guys here in their 60s and 70s who have made the same arguments I listed above. Their decisions were perfectly logical to them.

Just as one can, very often, make a very logical argument for AS in the same men.

It all comes down to the individual and what he thinks is best for him. Since these men are not acting as outlaws, but rather listening to what experts are telling them, it's silly to accuse any of them of making illogical choices.

Post Edited (davidg) : 11/12/2013 12:20:18 PM (GMT-7)

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