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Husband dx with prostate ca today. Gleason score is 8. Extremely frightened.

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Posted 8/7/2007 1:57 AM (GMT 0)
Hello Everyone,

My husband finally had the prostate biopsy done on July 16 and he received the results today, August 6. His PSA was 8 in May. His Gleason score is 8 (3+4+5). He is now scheduled to have an abd ct scan and total bone scan next Monday and a follow-up appt with the urologist on Aug 20 to decide on a treatment plan. My husband is only 55. The urologist recommends the robotic surgery but there is a two month wait. I am extremely worried and sick to my stomach over all this. I'm so afraid I'm going to lose him and I don't know enough about the disease yet to reassure myself and my husband.

Is it a normal course of action to do further tests to rule out the possibility of metastases? Right away I assumed it is because the doctor thinks the cancer has spread.

Also, does anyone know what is meant by "Perineural invasion"? (I just did a search and it states, " Perineural invasion (PNI) is the major mechanism of prostate cancer spread outside the prostate." Oh, my gosh, I am feeling very sick right now...


This was the results of his biopsy: Five of the eight samples came back positive.

A. Infiltrating, poorly differentiated adenocarcinoma, Glesason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue. No perineural or capsular invasion is identified.

B. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 50-55% of the submitted tissue. Perineural invasion identified. Capsular invasion is not seen.

C. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 70% of the submitted tissue. No perineural or capsular invasion is identified.

D. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 60% of the submitted tissue. No perineural or capsular invasion is identified.

E. Infiltrating, poorly differentiated adenocarcinoam, Gleason Score 8 (3+4+5). The tumor involves approx 20% of the submitted tissue. No perineural or capsular invasion is identified.
Posted 8/7/2007 2:08 AM (GMT 0)
Welcome back....Maria Teresa, I'm sorry you never posted again....  after these 2 threads... listed below... I hope the reply postings helped you in the weeks that followed.... 06-24-07    Help, my husband is avoiding following up on the abnormal PSA and DRE 06-26-07   That about the enema you have to give yourself before the biopsy?     If you stay with us.... you'll pull from the strength that we share and it will help you to let go of the fear...  Knowledge is Power .... and there is a lot of Knowledge here....   Continue to post on "this" thread....  We are here for you and it will help you to stay calmer...   Keeping you close as you move forward in "Your Journey"... In Friendship ~ Lee & Buddy        
Posted 8/7/2007 2:12 AM (GMT 0)
** Excerpts taken from “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer” by: Patrick C. Walsh, M.D. and Janet Farrar Worthington.    Copyright 2001   This book gave us so much knowledge… and Knowledge is Power .     Page 145 ** What about Perineural Invasion? As cancers grow, they compress normal tissue, looking for “elbow room”—spaces with less resistance, where they can spread.   Nerves are usually surrounded by some empty space; for cancer, this is the real estate equivalent of a nice suburban lot with a big backyard—plenty of elbow room.   Thus, it’s not uncommon to find prostate cancer in the spaces around the nerves; this is called ‘perineural invasion.”   Because the nerves are most common close to the surface of the prostate, the findings of perineural invasion on a biopsy suggests that the cancer is close to the edge of the prostate, and may well have penetrated the capsule.   However—this is important to keep in mind— cancer that has penetrated the capsule can still be cured .   Which makes this a paradoxical finding—because, although men with perineural invaion are more likely to have capsular penetration than men without it, perineural invasion has no long-term impact on whether or not a man can be cured .   For this reason, some noted pathologists have suggested that it should not even be commented on when found in a biopsy, because it’s not worth worrying about .
Posted 8/7/2007 2:48 AM (GMT 0)

Marie Teresa

Follow up scans and ct's are very common.  I had them.  They are used to identify the possibilites of obvious spread. Often they find nothing which can be assuring.

I am not as well read as others on this forum, but I am not familiar with the the three number gleason scores.  My Gleason was an 8 (4+4=8) and so far I'm doing ok. We wish you only the best.  You will get good advice and support for you and your husband from the very caring people here. 

Posted 8/7/2007 2:53 AM (GMT 0)
sorry that you find yourself here, but happy that you are. You will find the largest collection of experiences and knowledge here that you can find possibly everywhere.

Your decision on treatment is in fact your decision. No one else can or should make it for you. First and foremost do you trust your doctor? That is probably the most important thing. Getting a second or third opinion is always a good idea. Secondly ask your doctor how many surgery he/she has done. Good doctors have done usually over 250 surgeries. Don't get a beginner

In regard to your numbers. A quick look at my signature will tell you that I was in almost the identical place that you are, even down to the age.
Of course one person's experience is never the same as anyone else's experiences so there is no guarantee that your outcome. However, I am fine. Medical care is incredible. And there are several "lines of defense" if a person were to need them.

From all I have read the least thing you need to worry about is perineural invasion. All of the recent articles I have read say that it is not a good indicator that the cancer has left the prostate capsule. I too had perineural invasion and my prostate cancer was contained.

No one can give you a guarantee, but you have not been given a death sentence. We are called to life. And you are not alone.
Post often, ask questions, and study. Talk to your doctor--get a second opinion and make a decision that is right for you

Good luck

David
Posted 8/7/2007 3:27 AM (GMT 0)

Mariateresa:

Sorry to hear that you have been given a bigger bump in the road than some, but there are so many treatment options now available for Pca.  The scans are very normal - it's important to know all you can about your hubby's condition - every test result is a tool you can use to determine the treatment best for HIM!

Having gone thru 3 possibly life threatening episodes with Dutch, I can relate to your fear, but having someone to talk to is so important.  Hope you will let us be that someone when you have questions, doubts or just want to talk.  Keeping you both in our thoughts.

DutchESS

Posted 8/7/2007 4:47 AM (GMT 0)
Mariateresa:
Yes, I know the fear, I had a Gleason 7 with perineural invasion, but I'm in remission now after surgery and radiation and supplements. In the 6 years since, I have spent countless hours researching this disease, and it can be beat. The scans will almost certainly show nothing because his PSA is below 10. They do this as a precaution.

I know the angst you are experiencing, and back when I was diagnosed, there were few internet forums like this. I had lost my wife to cancer and I was as depressed as a person can be, with no one to help me with extensive knowledge, except for the doctors. I need an outside person, a survivor so I was really desperate. If I can be of help, let me know, or you can email me.

David
Posted 8/7/2007 5:01 AM (GMT 0)
Hi Mariateresa,

Take a deep breath and kick back for a while. Your husband's biopsy shows cancer but nothing really frightening. Gleason 8 is an indication that further testing should be done to be sure that his cancer has not spread. But remember, nothing is for certain unless a post-op patholoy is taken.

There are many options open to him. Research, ask questions, talk to us. We are here for you. Start a journal where you can write down your thoughts, feelings and questions. Take it with you to the doctors and write down the answers you get. Doctor appointments are tension filled times and we tend to forget questions and mis-interpret answers. (Especially old folks like me.) Go with him to the appointments and afterward review the answers with each other. MaryLu and I have heard completely different things on several occasions.

Cancer changes lives. But it can be a change for the better if you and he can be open and honest with each other about your feelings. I hadn't cried for 50 years but letting my emotions out brought us closer together. I had to let MaryLu be the strong one - and she came through like a champ. We have lost nothing as the result of PCa and we have gained so much - from each other and from our friends here on the forum.

Please stay with us and let's get well together...

Jim
Posted 8/7/2007 3:06 PM (GMT 0)
I thank all of you with all of my heart! I wish there was something more I could do to express my appreciation to all of you. I hope that someday I'll be able to help others like you're helping me!

Love,

Maria Teresa
Posted 8/7/2007 11:49 PM (GMT 0)

Hi Maria, at first, it is a shock to the system to be told that you have prostate cancer, before we went for the diagnosis, I discussed all the options with my wife, and came to the conclusion that if I indeed had Pca, I would request an RP as soon as the surgeon could do it, which was the case, and I am now 8 days out from surgery. I chose Radical Prostatectomy, because after research, and consultation with a family member of the Medical profession, it was agreed that the "hands on" approach was better than the robotic, reason being, that open surgery provides a better view of the operating field, as it turned out, we acted just in time, as you can read down below.

Not everyone can do it, but my approach to situations, is to make plans beforehand for positive and negative situations, then you can act confidently following your list of decisions to make, whether plus or minus. (but then most ppl think that engineers are slightly off beam)

I wish you and your husband the very best, on your journey, remember modern medicine is going ahead in leaps and bounds daily, research, and pick a surgeon who you are confident in, and who is skilled in this surgery,....and stay on this forum...it's great!!

Regards Mal.

Posted 8/9/2007 12:34 PM (GMT 0)

Hello Mariateresa,

 

The Cat scans and the bone scan is normal procedure :-) and is to check for spreadage.

My husband's urologist had him get a CAT scan of the stomach and pelvis with contrast and a bone scan. 

 

Also, my husband's radiologist told him he could handle up to a 10 psa. So, if you go with radiation

that's good to know.  Please try not to worry.Although a cancer diagnosis is certainly stressful, many men have had prostate cancer and have overcome it.

 

May God Hold You and Your Husband In His Arms of Love and Comfort You During This Time and May He Give You Both The Wisdom To Choose The Treatment That is Best For Your Husband.

 

Wiggyann

 

Husband's psa 6.6 at biopsy, had been 7.3 at one time.  Gleason score 7, eight cores out of 12 positive for Adenocarcinoma, seven cores had a gleason score of 3+3=6 and one had a gleason score of 3+4=7.  Stage T1c  Treatment 25 IMRT

(radiation treatments) and a 90 seed Palidium

implant.  psa 1.7 at three months after treatment. Praise The Lord :-)

 

Posted 8/9/2007 1:54 PM (GMT 0)
Hi, MariaTeresa. I know you already feel the power of the forum folks. I just want to add that although we chose to go it alone during the process (just a brother and a friend knew about it), we could not have done without everyone here. Don't hesitate to state or ask anything that's on your mind.

These days of discovery are certainly shockers, but you still have some good numbers to work with and the chance for a very good outcome. Even when you can't take time to post, know that we're all thinking of you and walking that very scary path right by your side.
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