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I'm really puzzled.

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Posted 3/8/2010 4:07 PM (GMT 0)
Today I spend a couple of hours on this site, checking many, many signature, to see what your post surgery Gleason numbers were.

Am I the ONLY one with a path. report that says:

"GLEASON cannot be detected because of the hormone treatment" I had Casodex and Lupron 60 days before surgery.

Why can they NOT detect it and tell me the numbers?

Pre-op was 4+4=8. Post op. ?????

Could this be a 'sloppy' path. report?

Would I be out of line to ask to have another one done ? How long do they keep these anyway?

The reason why I'm SO concerned is that based on my path. report,  I recently had another Lupron shot (90 day) and I'm to start radiation soon. What if the other info is not accurate or not with complete information?

Also, I wont have the post-op. PSA for another 3 weeks.

My surgery doc. is amongst the best in Canada but everyone on this board seems to have a Gleason score but me. (almost feel lonely) LOL!

Jerry.

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Posted 3/8/2010 4:25 PM (GMT 0)
I can only offer a tiny bit of info, as this is really outta my league/outta my direct experience.

However, I've read that one of the disadvantages of neoadjuvant androgen deprivation prior to RP is that the pathologic interpretation may be "obscured."

I saw a paper that says this: "Androgen deprivation therapy (ADT) produces distinct histopathologic changes in both neoplastic and nonneoplastic prostate tissue. A pathologist not familiar with these alterations may misinterpret the specimen, resulting in inappropriate tumor grading or missed tumor foci; thus, the urologist should convey to the pathologist any information regarding therapy that might cause histopathologic changes."

reference: http://emedicine.medscape.com/article/455994-overview

Sorry, I don't know enough in this space to say whether this is meaningful for you or not...but I thought it was close enough to share with you.

best wishes...
Posted 3/8/2010 4:29 PM (GMT 0)
Just a guess, a friend of mine I posted on here whom did ADT3 for 13 months, quit and used only proscar for monitoring...had rebiopsies done within a few years later at different times and no cancer found in those biopsies(but was found originally before using ADT3), because of the hormone therapy. Does not mean 100% no cancer, but big remission atleast for quite a while. So, maybe they cannot detect anything or if they did it would be so skewed as to little or no real value...I don't know...this was a maybe.

Maybe some else has alot more to say on this. I believe the stem cells of the PCa are just something that is usually not going to be killed off and they regenerate at some point...theory I have heard elsewhere.
Posted 3/8/2010 11:27 PM (GMT 0)
Casey 59: Thank you for the article. A little deep for me, but I printed it and hopefully after reading it a few times, I'll be able to ask my oncologist for another path. report.

Jerry.
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Posted 3/8/2010 11:42 PM (GMT 0)
It would be my guess that as androgen therapy deprives the tumour cells of the testosterone they need to survive (well most of them anyway), which is reflected in the falling PSA as they are killed off, the physical appearance of tumour cells would also be markedly changed by that same therapy making the normal(?) appearance of grade 3 or 4 etc very difficult to differentiate.
Bill
Posted 3/9/2010 1:27 AM (GMT 0)

JB,  I'm afraid my experience will only add to the confusion.  I started Eligard about two months prior to my surgery.  My post op path Gleason score was unchanged but the tumor volume was about twice that of the original biopsy.  My surgeon did not believe the Eligard had any impact.

Carlos

Posted 3/9/2010 4:01 AM (GMT 0)

JB:  My path report said the same thing.  I had my surgery done at the University of Washington and then had a second opinion afterwards at M.D. Anderson.  Both institutions are about as good as you can get.  My surgeon at the U said that the Lupron ravaged the cancer so bad that there was no way to establish a Gleason score, M.D. Anderson agreed.  I guess that's good and bad, I know that Lupron works for me but there's always that question as to what my true Gleason was.  My path report from my biopsy had me at a Gleason 8 and then I got a second opinion that downgraded to a Gleason 7 but it was a 4+3=7 so not much difference.

I personally believe that a lot of guys on this sight split hairs over a lot of this stuff.  My PSA began to rise a year after surgery so it was time for me to do SRT, seemed pretty easy to me. 

I don't believe it will do you any good to try for a second opinion it's not that whoever did your path is no good it's just that its impossible to tell.  I'm not saying that everyone who does Lupron first can't have a true path report done but its obvious that you and I can't.  I moved on to the next bend in the trail.

Good luck

David  

Posted 3/9/2010 2:23 PM (GMT 0)
Thank you, David. So there are at least two of us without knowing what our post surgery gleason might have been.

I guess we can say: so what ? Although I'm back on Lupron, I'm a bit concerned they plan to start radiation so soon after surgery, without even waiting for the first PSA.

Jerry.
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Posted 3/9/2010 5:39 PM (GMT 0)
Sorry but I had Lupron 3 months prior to surgery and the lab didn't seem to have any problem with determining a Gleason score. If the Lupron toned it down a notch or five then the tertiary 5 cells they found will really cause me to worry.
Posted 3/9/2010 6:43 PM (GMT 0)
Hi Jerry,

First, if you put my PCa knowledge on a scale with all of the others on the site, the rest would be standing on top of me.

However, I live a rich fantasy life, and I'm not modest, so I make this comment.

While it's all very nice to have a Gleason after surgery, and is the reason I went with surgery rather than HIFU, now that I'm out the other side I've come to realize what I'd been told before, understood, but didn't internalize. Before treatment the Gleason is a critical number. After surgery, it's history --- the only number that matters is your PSA in three months, then six months, then ....... well, you get the picture.

My post surgery Gleason was 3 + 4 and it could be 2 + 2 or 4 + 4 and not a thing would be different. The only number anyone is interested in is the PSA. Either alll the 3+4 went away in a little da Vinci bag, or it didn't, and the only way to know is watching the PSA. There may be statistical inferences to be drawn from a Gleason post surgery, but even if the suggestion is you're 99% cured, or likely to have it back, the reality is for you as an individual it's 100%. Either you're in the 99% or the 1% and the only way you're going to know is by the post op PSA.

I too would be fussed if I didn't have a post op Gleason, but in reality, I'm not sure it's of any particular value.

Sheldon AKA Sleepless
Posted 3/10/2010 3:27 PM (GMT 0)
Thank you Sleepless.

Your response is exactly what I needed. Feel much better now about the missing Gleason numbers but you are right, it's out the door, in the garbage can with the prostate.

It's the PSA that's going to count for the rest of my life.

Jerry.
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