Is it true, the higher the Gleason score the easier it is to destroy?

No, of course it's not true. Higher Gleason scores have a higher probability of recurrence after treatment. They are less differentiated, more immortal, recruit more growth factors, are increasingly mobile, are able to exist outside of the prostatic environment, more radio-resistant, etc. Silly nurse.

- Allen

I cannot believe that you were told that. Wait, let me take that back, we've been told some pretty stupid wrong stuff from nurses also, so I'm kinda not surprised. Looks like yours is confined and not spread so THAT is good news. But to say G9 is easier to treat than G7 is absolutely stupid. Danny did chemo before surgery and so far, so good a year later!!!

My oncologist has said from the start, that many Gleason 8/9's are far more manageable to control then some of the Gleason 7 cases. Said the higher ones tend to respond better and are more predictable to treatment, whereas there are Gleason 7 cases (mine, and a couple of other guys here Gleason 7 cases that I know of) that have a mind of their own, tend to not respond to normal treatment, and act more aggressive than some of the higher Gleason cases. And he only deals with advanced PC and advanced BC cases in his practice. So I don't think it was something "stupid" being told.

Purgatory said...
My oncologist has said from the start, that many Gleason 8/9's are far more manageable to control then some of the Gleason 7 cases. Said the higher ones tend to respond better and are more predictable to treatment, whereas there are Gleason 7 cases (mine, and a couple of other guys here Gleason 7 cases that I know of) that have a mind of their own, tend to not respond to normal treatment, and act more aggressive than some of the higher Gleason cases. And he only deals with advanced PC and advanced BC cases in his practice. So I don't think it was something "stupid" being told.

The oncologist treating our age 39 Daughter-in-law's stage 4 Mesothelioma said- before we knew exactly what it was- that though she had a very rapidly growing Ca of some sort, that paradoxically sometimes these very types were the most responsive to treatment. So there may be something, sort of, to what that nurse said. That may be for reasons not related to PC and Gleasons and normal ways of treating PCs. However, what the oncologist told our DIA was certainly not true for her, as their chemotherapy simply bounced of of her rapidly spreading Meso and she has now been taken off the Chemo which was doing nothing more than almost killing the patient. The only response she had to chemo was to rapidly get worse. So now we wait with no treatment.

Post Edited (BillyBob@388) : 10/9/2014 8:13:48 AM (GMT-6)

There is likely another factor at work here, namely, the fact that the individual knowledge of all matters PCa of quite a number of the posters here, and certainly the cumulative knowledge of such matters that we possess as a forum group, is formidable compared to that of even many lower-level medical staff.

We have experienced this beast, have been reading about it (sometimes for years), and we have come to know so very much about it. Because we had to.

In fact I'm convinced that the individual knowledge of some of us here (TallAllen comes to mind) may be on a par with that of licensed medical doctors.

So I guess it's both a blessing and a curse. Whenever we are at a medical appointment and we hear something said, whether by a nurse or tech assistant, perhaps, or in some cases even by a doctor (such as a non-specialist GP) about PCa that we know is wrong, it is grating on the nerves to be sure.

But the having of this knowledge also makes it so much easier to understand the doctor's explanations and recommendations. We even become knowledgable participants in our own treatments because we know what it's all about.

So in the end I believe most of us would rather have this detailed knowledge than not, and just tolerate what may be ignorance on the part of some, even medical staff.

Ive had a few Nurses and PA's that have said things contradicting my Drs. But I dont listen to them. In my opinion many of them like to think they know more than they do when they should stick to their skill level and pay grade.

Moonlitnight said...
Casper, I have met many nurses who knew considerably more than those they worked for and one with three degrees in nursing - the old VP of nursing at the hospital where I worked. Often, doctors need to be contradicted as they can also spout a lot of nonsense. It has very little to do with "pay grade." How's this from the doctor who Dx'd my husband. "Think yourself lucky it has been found at this stage (4 with mets) as now you can go on ADT and not have to get your prostate removed." Or the doctor who saw his PSA jump from 1.6 to 4.0 in five months and did nothing as "Four is OK." By the way, it was that one's nurse, an associate of mine, who asked me if I was aware that this was NOT OK. We then went to see another doctor who made the "think yourself lucky" comment.

After 36 years in anesthesia for OB and surgery and another 8 or so before that in various forms of hospital work- 1st I was an OJT lab tech and then an Air Force medic and then an ER RN- I can tell you there is a lot of truth in what you just posted. However, it can go both ways, nurses and non-physicians can also think they know more than they actually do. But the trouble with the physician can often be ego- even more than with the others. Because- in many cases- they just can not be wrong, if they are challenged it is as though God- or at least Nero- has been challenged.

In my experience as a CRNA(Nurse Anesthetist) I often times worked either employed by or at least supervised by(due to hospital policy, not law) MD Anesthesiologists(MDA). Many other times I worked alone, the only MD involved being the surgeon. During that time I knew some excellent MDAs AND CRNAs, and I knew some in each group who were less excellent. But here is the thing: The nurses who worked in OB and surgery obviously knew who was really good in both groups, and since they knew all of us personally, they could and would always make special requests for who they wanted to do their or their loved one's anesthesia, MD or CRNA. And I am here to testify that more often than not, they would ask whoever they thought was the best CRNA. This is mainly because after each group finishes their training and is legally allowed to administer anesthesia, then they go to work and start honing their skills over many years. For the most part, the MDAs that supervise CRNAs become supervisors and no longer actually do the anesthesia, they hang out more in the pre-op area and the lounge, and respond to calls for help. While the CRNA is, in many cases, the one actually putting the ET tubes and spinals and epidurals in day after day, year after year. Thousands of times. Heck, a CRNA may put in 20-30,000 ET tubes in a career! You do much fewer blocks, but I personally put in between 5 and 10 thousand epidurals. You kind of get the hang of it after the 1st few thousand.

I worked in more than one situation where ONLY the CRNAs did the labor epidurals. This was mainly because the MDs did not want to be bothered with all of that night work and various other things they thought was unpleasant about labor and delivery, they just wanted to stay in surgery. This resulted in a situation where, over many years, individual CRNAs each would have done many thousands of epidurals while the MDAs had not done any since residency many years ago. This not only resulted in OB and OR nurses requesting certain CRNAs to give their or their daughters or friends epidurals, but even more important was making sure certain MDs DID NOT do their epidurals. It was supposed to go this way: we would be in surgery until there was a call for a labor epidural. Then the supervising MD would get us out of the OR and take over while we went and did the epidural, then we would come back and get them out again. But when the normal MDAs went on vacation, or at night, he was relieved by other MDAs. One or two of these guys did not realize they were no good at epidurals and for some reason wanted to do them. They were brilliant at some things related to anesthesia, but couldn't do a working epidural to save their lives. But they would come over, refuse to get us out of surgery, leave surgery where they were supposed to be and go get bogged down trying to do the epidurals which would never work. This resulted in miserable patients and nurses and obstetricians. And tons of *****ing, but for the most part no one would ever do anything to stop them, because they were after all the big shot anesthesiologists. No one was going to tell them that they could not do an epidural. But I can guarantee you one thing: every OB nurse and every Obstetrician just cringed when they heard one certain MDA was going to be on, they all wanted any one of the NURSE anesthetists to be doing the epidurals.

But, bottom line on all of that rant is that it can go both ways, and there are sometimes some specialized nurses with years of experience who- in some specific cases- know more than certain MDs. And especially newer MDs or MDs who basically stop clinical practice to hire nurses to do most of their work for them while they supervise. But as a normal patient, Y'all have no way to know- usually- who these nurses are or who the Docs are, and it is normally the doc who is responsible, except in the unique case of a CRNA working without an MDA. So you have to go with the MD. Just like I have to depend on my MD when I leave my field and enter the realm of PCa.

Someday I am going to have to write a book about all of the s*it I have seen since I started working in a hospital in 1968! ( Maybe I already have wrote a book here at HW, whether anyone wants to read it all or not!

142 said...
Was that nurse covered in horsecrap and leaning on a shovel?

Get my drift?

I do not.(Is that question for me?) Which nurse do you refer to?

Post Edited (BillyBob@388) : 10/15/2014 1:55:51 PM (GMT-6)

PSA3DOT7,

It is troubling that this nurse would speak so inaccurately and out of turn. I think you should report this to the doctor. Not only did he/she give you the incorrect impression, it is simply not his/her turn to comment on this. He/she should be reprimanded so as to not cause such confusion and potential harm in the future, and the doctor will not know to take such action unless you and/or others speak up.

PSA3D0T7,
Happy Anniversary! I also have one for you. I will start with a question: are there not some folks here, folks advised either by reading studies or in person from some very high Guru doctors, that a G9 with a PSA >10 might be better treated with RT/ADT right off the bat, rather than surgery? Considering the high risk that a G9 is likely to have already spread outside of the prostate capsule? Now I'm sure there is a varied opinion on this among some very learned people, MDs and non-MDs here at HW, but wouldn't a lot of folks agree that RT/ADT would be a better 1st line approach because it has a better chance of killing those bad cells out in the positive margins and SV etc? And possibly even with lower SEs to boot? Any here ever heard that advice from at least a few big name MDs, even if others might debate the issue?

Well here is how it went down for me: my local uro surgeon referred me out of state, even though this is a big medical center here, for a 2nd opinion on treatment from a very well known authority at an even bigger high volume Prostate Cancer treatment center. Before this doc came in, the NP talked with me 1st, going over my PSA and Bx results. I told the NP that we were mainly there seeking advice on whether we should go RT or surgery. The NP quickly said "You know a lot of times the G9s just start with RT" listing all of the reasons I wrote above. Then the doc comes in, does an exam, and tells me based on the very small tumor felt on DRE, that surgery is a no brainer, because he feels it is probably contained. And if contained he can offer me a cure. But with RT, we will never know if that G9 is contained or outside the prostate and maybe in the lymph nodes until the PSA starts rising years later maybe after mets. And if I go to JH or wherever they will tell me the same thing.

OK, so go forward. I have my surgery. I am NOT contained. I had a positive margin and +SV, not good, though at least the lymph nodes are clear. I have no cure but I have had plenty of the SEs and the wait is on for the future PSA deal. ( not whining just telling the facts) Now I'm not going to say I for sure got bad advice, because he was making his best case based on what he felt on DRE and 30+ years of experience, and it might well have been contained as was his best guess. And if it had been contained I'd be a much happier camper.

But it wasn't. And if I had gone RT/ADT(just enough ADT to shrink my prostate for the seeds+EBR), that margin and SV would have been radiated. And seems to me better odds that all PC in the immediate area would have been killed than the odds I have now. Plus probably lower SEs.

Therefore, who gave me the better advice, the MD Guru or the Urology Nurse Practitioner? Well, too many variables and being fair to all maybe impossible to say. But can anyone really claim that the NP's advice was not just as good as the Docs, even though they did not agree on the best approach for me?
Bill

Moonlitnight said...
Often, doctors need to be contradicted as they can also spout a lot of nonsense. It has very little to do with "pay grade".

+1 for this, brothers and sisters. My husband watched an oncology CRNP correct a medical oncologist at a highly respected cancer institution. This actually made me feel better (oddly enough!). It's well known from airplane safety studies that when other cockpit crew feel comfortable pointing out possible pilot error, safety improves significantly.

Note the "also" though in Moon's comment, as spouting nonsense is something we all do occasionally.

And Billybob is also absolutely right - the people doing the actual work over many years and thousands of cases deserve our respect and attention, whether they are nurses (which they usually are) or doctors. And, I can't help adding, whether they are men or women. Just saying.

Part of that respect is NOT threatening people with disciplinary action when they were probably just trying to cheer the OP up - by saying something that might even be true in certain cases, even if it's not true generally. For goodness sakes.

This is a great discussion, but PSA3.7, can you get hold of that nurse and ask what they meant?? I'd love to know.

Carolyn

In some cancers, the more aggressive kind may be more "curable" than the more slow growing type. For instance, there are several different types of b-cell lymphoma. The more aggressive kind such as Diffuse Large B Cell Lymphoma (dlbcl) or Burkett's Lymphoma are harder to treat but are curable if the treatment works. Indolent lymphomas such as Follicular Lymphoma grade 1 or 2 are more slow growing ( so much so that one of the treatment options is watchful waiting) but tend to be chronic: relapses are common and, for the most part, treatable. Like with PCa, people are known to live with the disease for more than twenty years. It is possible that the nurse thought that PCa works the same way.