How fast does prostate cancer progress?

First of all, as a newcomer to this forum, many thanks to all who have provided helpful suggestions. I have learned a lot from your experiences. I wonder if others would benefit from knowing how often they need to be tested to ensure they detect PC as early as possible.

At age 59, I was diagnosed with prostate cancer five weeks ago. Pathology report from biopsy showed adenocarcinoma in 6 of 12 cores:
-- one core was G3+4=7 (75% of specimen)
-- five cores were G3+3=6 (ranging from 5% to 80% of specimen)
Cancer is multifocal (on left and right side of gland).
My urologist says I'm stage T1c, intermediate risk. But he also stunned me by saying that according to Sloan Kettering's calculator, I have a 60% chance of extracapsular extension (the probability that the cancer extends through the capsule of the prostate into the surrounding tissue).https://www.mskcc.org/nomograms/prostate/pre-op

This news floored me because I thought I had done everything possible to detect cancer as early as possible. My dad had PC ten years ago, so I knew I was in a high risk category. I was determined to be extra vigilant, and got annual PSA tests, and even more frequently starting this year. To me, it was stunning how quickly the cancer spread despite frequent tests. I always thought PC grew slowly.

4/24/2015: PSA was 3.98. My uro did not order a biopsy at this point.
9/4/2015, PSA had increased to 4.28.
9/29/2015: Uro told me he recommended a biopsy. The biopsy took another month to schedule, since he does them only on Thursdays.
10/29/2015: Biopsy (which hurt like hell).
11/13/2015: Uro gave me the pathology report.

RALP is scheduled to take place on 23 December, six days from now.

For other guys, especially high-risk guys, how often should they be tested? I received frequent tests, and still didn't detect this blankety-blank disease until I was intermediate risk, with a significant risk of extracapsular extension.

Hello NovaMan,

There is a lot that we don't know about PC. Growth rate is one of those things. There are at least a couple of 'types' or behaviours' of PC. The slow growing one you have described results in something like 80% or men in their 80s have PC and 90% of men in their 90s. Most all of these men die with PC, not because of it. The much more rapid growth 'type' or 'behaviour' can grow much more rapidly. IN my parental family my Dad's Dad had fast PC and passed at age 62, my Dad has fast PC that was diagnosed as inoperative at age 55 and even though he fought very hard and had the best treatment at UCSF and Stanford, he passed at 64. All of Dad's uncles all passed at about the same age. My brother (1.5 years younger than my 56 years) was diagnosed and had an open prostatectomy (because he was not close to a robot and because his older doctor operated that way) when he was 44 years old. Because of all of this history, I have kept close tabs on my PSA total and free and had a DRE at least once a year. I was diagnosed a little more than a year ago. My GP barely felt a little lump, my Urologist barely felt a little lump, my PSA was up to 1.6/1.0 on re-test. I went in for the biopst T1c bilateral G3+3 in 4 in 14 cores. SK calculation of no Extra Capsular. I had a RALP exactly 1 year ago today. One positive margin, but extra tissue taken. PSA <0.1 for 3 quarters in a row. I wore diapers until the catheter was out and was then on thick pad for a couple weeks , then to thin pad for another 2 weeks. I get a rare occasional stress leak of a few drops. On daily viagra 10mg since then and ED is improving still, back to about 85% with expectations to get to 90-95% over the next year or so.

A couple things...

You are not in the high risk category. You should go to the sticky thread for "Newly diagnosed with PC..." where you will find info about risk categorizations (Step 1 prior to deciding on treatment) and lots of other PC educational material).

Second, PC is mostly sporadic, not hereditary. Mostly, men with brothers or fathers with PC tend to undergo more aggressive screening which quite naturally uncovers some PC since it is natural aging. The more aggressively you screen for it, the more likely you are to find it.

Don't be stunned that you have PC...60% of 60 year olds have it.

Novaman,

I plugged your numbers into the MSK nomogram and, as your uro said, it shows you having a 60% probablility of extracapsular extension. Your Gleason 7 puts you in the intermediate risk category. But now that we've got past the scary part, the less scary part of the nomogram's result is that you should have an 82 percent probability of being progression-free 10 years after prostatectomy and a 99% chance of not dying of prostate cancer 15 years after radical prostatectomy.

Unfortunately PSA does not indicate you have PCa until long after it
has been in place. My doc told me he figured my Gleason 9 was ten years old when I had biopsy. The old threshold of 4.0 is totally archaic but that seems to be the standard for lab tests.
Bob

Welcome to HW, sorry you need to be here.

Don't beat yourself up. There is no way you would have found it sooner and you've got it in time. PC is a slow growing beast.

You're surgery should getting all. Including any extensions.

Hang in there and keep us updated on your progress,
Andrew

halbert said...
JackH, please cite your peer-reviewed studies that show that PC is not hereditary, which would suggest the common statement of risk factor of "first line male relatives" is false. Most studies I've seen suggest the opposite.

halbert, you can look it up yourself (there are numerous sources), but in a thread you participated in just last month, Pratoman provided two links to two of the most authoritative sources on the topic: MSKCC (recognized as the world’s leading prostate cancer care center), and the NIH National Cancer Institute. The very first sentence of the MSKCC link reads: “about 5 to 10 percent of all prostate cancers diagnosed are hereditary, meaning that an increased risk for the disease runs in the family.” Re-read the thread for yourself, and the links Pratoman provided here: https://www.healingwell.com/community/default.aspx?f=35&m=3528051

While you are looking things up to educate yourself in this topic halbert, google Dr Kathleen Cooney. She is a physician-scientist recognized internationally for her seminal research in understanding sporadic and hereditary forms of prostate cancers. You may also search for her work in PubMed if you are looking for peer-reviewed literature on this topic. Most of her work is going to be over your head, but she published an article (LINK) in the AUA News (AUA News is the official newsmagazine of the American Urological Association, written for urologists by urologists) a couple years ago which clarified the complete landscape that about 75% of PC cases are sporadic, 15-20% are familial, and 5-10% are hereditary.

Prostate cancer does seem to “run in some families;” this is well known. The epidemiological reasons why are interesting, since we know that most prostate cancers are sporadic.

I already mentioned one of those key factors – if your brother or father were diagnosed with PC, you have a higher probability of increased diagnostic activity; the more rigorously one is screened, the more apt one is to be diagnosed. Even when diagnosed with favorable-risk PC, the men in this category also seem to be amongst the ones who “rush” most quickly to a decision for immediate treatment. Even when their case characteristics indicate that they will garner absolutely no benefit in longevity from pursuing immediate aggressive treatment, an emotion-driven decision often outpaces their ability to gather information to make a thorough data-driven decision.

Another interesting factor is fact that the environmental/lifestyle choices of the parents will generally “rub off” on the children such that their risks for a sporadic cancer are similar. If your family ate a lot of processed meat, or dairy proteins (like red meat) instead of fish or plant proteins, or other foods which are high risk for PC, then you and your brother (and your dad) probably ate roughly the same diet (and probably carried those dietary habits into adulthood). Keep in mind that PC incidence varies 60-fold around the globe, which appears to be primarily driven by variations in environmental influences (strongly driven by diet and lifestyle).

Bottom line, and a point that we can help educate newcomers on is that prostate cancer is a ubiquitous disease which increases with age. 50% of 50-year olds have it, 60% of 60-year olds have it, 70% of 70-year olds, etc. Many men here at this site are a product of our times—the “PSA-era”—where increased screening, increased rates of prostate biopsy, and increased sampling of the prostate during biopsy have created new levels of cancer “victims” with smaller-and-smaller amounts of PC found. Pre-PSA-era, the indolent prostate cancers were largely ignored as harmless (and they were); today, those same cancers are often aggressively cut, burned or poisoned…typically for no real benefit of longevity to the patient.


---------------
added later as an edit:

halbert, I realize you are still a PC newbie and learning lots about the disease, so your questions are fair. Here's another article you should read on this topic in Medscape, titled "Prostate Cancer in the Family: Risks Are Inflated" (link: http://www.medscape.com/viewarticle/727662#vp_1) A Medscape subscription is required, but it is free and if you want to give others meaningful inputs I recommend it to be an informative site to enrich your own PC education, but second to the "New" PC Infolink site and PubMed.

Post Edited (JackH) : 12/18/2015 2:06:46 PM (GMT-7)

jpenn44, please re-read what I posted previously; specifically the part which follows "Prostate cancer does seem to “run in some families;” this is well known..."


Regarding your question on the data behind the PC autopsy study, where have you actually looked?

Never mind.

I posted this over a year ago: https://www.healingwell.com/community/default.aspx?f=35&m=3176208&p=5

halbert said...
To tell a newcomer that they are NOT at higher risk because they had a father or uncle with PC--as you did, Jack--is a profound disservice and a serious error.

Higher risk of being diagnosed. The meaningful part is WHY.

Maybe this IS over your head...which part of my sentence did you not understand?

"Prostate cancer does seem to “run in some families;” this is well known..."

"And please, please, cut out the condescension."

good luck with that haha!

ed

Sorry if my imprecise language caused any confusion. I understand that I'm in the intermediate risk category, as defined by the D'Amico Classification system (Intermediate risk: Have a PSA between 10 and 20, a Gleason score of 7, or are in clinical stage T2b).

When I said I considered myself high risk before diagnosis, I meant to say that I believed I was at higher risk than the normal population to be diagnosed. According to the American Cancer Society, "Having a father or brother with prostate cancer doubles a man’s risk of developing the disease." reference: http://www.cancer.org/acs/groups/content/@highplains/documents/document/05junepdf.pdf

Just fr the record, my purpose in posting that link was to demonstrate that there IS a familial/hereditary link. And to be complete, here is the other link and quote that I posted in that thread....



""And fm MSKCC...

"
Family history is the strongest risk factor for prostate cancer. A man with one close relative with prostate cancer – for example, a father or a brother – is twice as likely to develop prostate cancer as a man with no family history of the disease.

If two close male relatives are affected, a man’s lifetime risk of developing prostate cancer is increased five-fold."

/www.mskcc.org/cancer-care/risk-assessment-screening/hereditary-genetics/genetic-counseling/inherited-risk-prostate

Nobody, nor any amount of semantics will convince me otherwise. Ever. Every Dr I've spoken to has recommended that my son begin PSA testing at age 40. And I've made sure he is aware of that.

Lucky for me.