Beyond PSA and Gleason: Predicting Your Cancer's Course

Gleason 4+4=8 from Bostwick Labs and 4+5=9 from John Hopkins.   Per my understanding, the ProstaVysion is not intended for you. Today, the “gray area” of focus for most researchers in this area is trying to differentiate which intermediate (3+4) risk cases will benefit from treatment and which will not.     ProstaVysion is one of the new tools to solidify the Active Surveillance/deferred curative treatment choice. I gotta wonder if you are even in the reference range for the test.   Gleason 4+4=8 from Bostwick Labs and 4+5=9 from John Hopkins speaks volumes. I would email Dr Bostwick specifically, since he created ProstaVysion…ask him how his ProstaVysion results mesh with his 4+4 biopsy readings. Did insurance pick up the $1,100 cost?  

I would go with the Gleason scoring for your decision making process since it more closely represents the current state of your disease while the ProstaVysion score is more of a prediction. But I would be interested in what Dr. Bostwick has to say if he responds.

Bob,

The concept of the best hormone therapy is something of an oxymoron -- a contradiction in terms -- nor is there any clear winner in the worst category either. It just all sort of evenly sucks. The good news here is that your doctors are probably hoping for a durable remission (they don't like to use the 'cure' word with G9 guys) and you HT will be a temporary treatment you will be given as part of a combined treatment with curative intent. The HT will be temporary and not (hopefully) a permanent part of your life.

We do have some guys here who are enthusiasts, believe it or not, but they are mostly into the oddball things that can help guys with long-term established metastases beat the odds.

Depending on your medical oncologist you will be put on one to three kinds of drugs. I am on all three. I get Casodex (bicalutamide) -- a small white pill that blocks the effect of testosterone and upsets an empty stomach; Trelstar (a GnRH agonist) a shot every three months that suppresses the production of testosterone in your testes and makes them shrink to the size of gumdrops; and Avodart (Dutasteride) a 5aRi drug that prevents the conversion of testosterone to dihydrotestosterone (DHT) and makes bald men grow patchy useless hair. This combination is called ADT3. I've been on it for a year and am scheduled for another year. Then it will take a third year to wear off completely.

Your oncologist may prefer a different mix of drugs or a different duration. There is some pretty good science that suggests that HT helps other prostate cancer treatments work better for high-risk cases, but the science about which HT drug combination is best or how long it should be given is wobbly at best and oncologists are all over the map. Whatever your oncologist says won't be much better or worse than the other options (although if he talks about more than two years duration you might try for a plea bargain.)

Where you can help yourself is by being ready for it. Join a gym if you aren't already a member. Decide how often you are going to go and try to become obsessive about it. You want to work with weights/resistance that is as much as you can comfortably manage. HT makes men tend to lose muscle and bone density and put on fat. The muscle and bone thing can be markedly improved by vigorous load-bearing exercise. Cardio is good too, as always, but while you are on HT cardio isn't enough.) I find that restricting my carbohydrates helps me control my weight, even on HT, but weight control is tough. The average weight gain for men on HT is something like 20 lbs at one year and it keeps on piling up.

Peter
Thanks for the info. I am a gym member so that won't be an issue. I also play a lot of golf so I need to keep my strength up. My Doc said only short stint of HT is indicated to aid IMRT since he does not recommend brachotherapy for me but scans may tell different story about how much HT i will need. Did you have scans and MRI? How did you find out you had more PC: based on post surgery biopsy?

I've been on avodart then generic (finasteride) for many years but I was also on androgel which I've stopped since bad biopsy. Ironically it may have contributed to PC , but according to my Doc only marginally since there's no proof that testosterone replacement due to low T causes PC. What a quandary!

I note you had surgery then Rad then HT; do you regret having surgery? I have chosen to avoid surgery for that very reason.

Bob

So I'm T1c N0 M0 after scans. Given GL 9 is there any reason why adt is necessary before IGRT? i can't find where it's recommended for any stage 1 cancer even with high GL. I don't like what I read about adt even for short period.
Bob

Bob,

Somehow I didn't see your questions until today.

You said...
Did you have scans and MRI? How did you find out you had more PC: based on post surgery biopsy?

I had four biopsies before surgery and only one of them was positive (the third one). That one showed a tiny amount of cancer in one of the cores -- less than five percent -- and it was scored Gleason 6(3+3) originally and upgraded slightly to 7(3+4) on a second opinion. The fourth biopsy was negative and my PSA never got above 10. I didn't have an MRI or any scans. I was believed to be too low risk to justify them. I found out I was a Gleason 9(4+5) from my post-op pathology report.

You also said...
I note you had surgery then Rad then HT; do you regret having surgery? I have chosen to avoid surgery for that very reason.

Oh I dunno. Kind of a difficult question. Do I think the way things worked out kinda sucks? I guess so. Were there other treatments that would have given me the same disease control with fewer side effects. Yes, I think so. Maybe HDR brachy plus IMRT plus ADT. Still would have been a lot to recover from but might have done better. But here's the interesting question: Given what I knew then, did I make a mistake? I don't think so. The combination treatment I just outlined would have represented wild overtreatment of the low gleason, low volume cancer that was all I knew I had. If I had the cancer we thought I had then the surgery would probably have been all I needed and I would have been done. The fact that my treatment rolled seamlessly from a low-risk treatment (surgery only) to a high-risk multi-mode treatment (surgery + IMRT + ADT) is a feature not a bug.

Hello. My husband just had this test on his biopsy. He is a clinical 3+3=6. 2 core biopsies 2% and 5%. The test results say he is positive for hemiozygous PTEN deletion. (as opposed to homogenous). Was wondering if anyone had any results similar to this? Our doctor still feels optomistic - and it solidified our decision to do surgery which is scheduled for this Thursday, instead of active surveillance.

Just curious about others...