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New Guy Question-Am I a Gleason 8 or 7? --or is it a moot point now.

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Posted 12/20/2010 1:46 AM (GMT 0)

    Michael F--age 67

  This forum has been immensely beneficial  in helping me make my initial treatment decision and  in handling some minor post-op problems.

   The posts from you guys about "arriving" on the "other side" after surgery were a great  comfort to me going into that final week. It really helped me realize that I was not the first , nor will I be the last guy to have to face this. I had to play the hand I was dealt , and hopefully join up with that group on the "other side".

   Thanks for being here. :-)

   Been lurking long enough, time to jump in and share a couple of points that have been concerning me.

      First , my pre-op biopsy done by Bostwick Labs was pretty bad:

  6 of 12 cores positive

  Gleason 8 (2% in 1 core) Gleason 7(3+4 in 4 cores) Gleason 6 (1 core)

       The post-op Path Report (done by a local Pathologist) came back as simply a Gleason 7 (4+3) with 20% of Prostate involved.

    Clear Margins /classified T2C pN0  pMX

    A down-grade? Probably not? Still a lot  of Gleason Grade 4 in that gland. Second Pathologist could have missed a little Gleason 8 maybe.

    Do I plug in a Gleason 8 or 7 when calculating nonograms?

Or is it just an "academic" moot point at this stage of the game?

  The prostate is gone / only job left is to watch PSA for BCR.

Fortunately my 1 month PSA was <0.1

      Intermediate Risk or High Risk ? The next 5  or 10 years of PSAs is all that really counts I guess.    

   This got a little lengthy for a newbie , so I will post my other concern  on a later post.        Good luck to all !!

    In  case my "signature" doesn't follow this post---

     I was a  PSA 5    1 year PSA velocity of 2.1 :-(     Scans negative  

    Had a non-nerve sparing RALP  :-(    with wide  surgical margins    on Oct 13, 2010

 

  

Posted 12/20/2010 1:58 AM (GMT 0)
Hi Michael, welcome aboard, as they say sorry you had to join us, but we are pleased you found us. In answer to your two questions, I do believe you are a gleason 4+3=7 guy, like myself. Your risk factor would be considered "Intermediate Risk" again like myself. Although you have 20% of pca within the gland, it is probably not all grade 4, and there will be a percentage of grade 3 involvement. Normally the grade 4 content is listed on the pathology report.
This will then give you an accurate percentage.
I am two years down the track and doing just fine, keep positive, and keep those questions coming. Education is the best therapy I find...................Cheers Kev

Post Edited (NotHard) : 12/19/2010 7:09:01 PM (GMT-7)

Posted 12/20/2010 2:38 AM (GMT 0)
Hey Michael-welcome to the club.

I think the post surgical pathology is technically a downgrade from your biopsy report.

That was pretty intense velocity.  Good job for being on top of it.  It sounds like you got it taken care of just as it was trying to take off.

I'm curious about the non-nerve sparing and the wide surgical margins.  Was that a decision you and your surgeon made prior to the surgery, based upon the gleason and the velocity? 

 

Dave

Posted 12/20/2010 5:44 AM (GMT 0)
Hey Dave, I sent a reply earlier but AOL was acting up, so I guess it didn't go thru. I will try again & maybe if the other one shows up the Mods can delete it.

    Thanks for the question because that was the "other concern" I did not have room for in my initial post.

    The Non-Nerve Sparing Decision went down this way:

  When I asked my surgeon if he would be sparing my nerves, he did not hesitate when he said No.

    He looked me in the eye & said, "If I try to save your nerves I am afraid I will leave a positive margin,

and I do not want to give you that bad news when I get the Path report back."

    I assume he based that decision on my PSA velocity of 2.1 (3 to 5.1 in a year) / 6 of 12 cores positive/ and the Gleason 8. We did no imaging to determine location of Ca in Prostate(if there is such a test routinely done)

  He has a good reputation,I trusted him, I liked him, and I concurred with his decision.

    I had been fighting ED because of BP meds for years. Oral ED meds were still working , but were getting less and less effective. I am 67 and had to weigh "going for a cure"  v/s keeping Willy "partially" active on Oral Meds for a few more years.

   The Partin Tables only had me at a 39%  chance of  still being Organ Contained--I think that was a big factor in my decision. I was on thin ice.

     Also nerve-sparing surgery was no guarantee of good erectile function post-op.

     I am sure if I had insisted on nerve-sparing, he would have reluctantly gone along. When he said he was not only going to take the nerves but he was going to take as wide a surgical margin as possible , it got my attention.

    If my disease later goes systemic I wanted to be able to look back and KNOW I had done all I could.

     But When the post-op Path came back with a slight downgrade to Gleason 7 (4+3) and only 20% tumor involvement, I have to admit I thought for a minute I might could have spared those nerves, but the Partin numbers are still a bad risk with a 4+3 Gleason 7. So who knows??

    That was the decision process. If I had been 55 without ED from BP meds, I am sure I would have

looked at things a little different.

    Having those nerves gone is not a pleasant

feeling--feels like it is not part of my body. It sucks and is depressing!!

   I listed Golf, hiking, and remembering sex as my  favorite past-times on my profile.

     But the 1 month <0.1 PSA is real nice for now.

And knowing I have done all I can is real nice for now.  I still have to worry about about BCR , Radiation and HT , but I don't have to  add to my worry list  that I was too passive with my  initial treatment.

Any opinions are appreciated.

                                                          Best to all!

                                                       

     

 

Posted 12/20/2010 3:45 PM (GMT 0)
Micheal, welcome to HW. thanks for delurking and for sharing your story and questions with us.You say:
I listed Golf, hiking, and remembering sex as my favorite past-times on my profile.

Having read here a while, you know there's a whole new wonderful world of assisted erections awaiting you. Don't think that just because they took nerves that your sex life is over. Injections will literally bring the dead to life. When you decide it's time, a bunch of us here will be ready to advise you... tongue
Posted 12/20/2010 4:39 PM (GMT 0)
Thanks for the reply James C,
At my one month post-op visit I mentioned
"shrinkage" due to urethra shortning and the fact that I now looked qiute un-circumsized.
He had poo-pooed this on pre-op talks-
I insisted it was real--He related that if there was such a thing he felt it was related to decreased blood flow to said appendage--he displayed a drawing that showed the object being discussed was actually "attached" to a boney area in the pubic region and could not be drawn up & in very far. He thought the lost urethra length was relieved by the bladder coming down a tad.
With the shrinkage I was describing, he thought VEDs would cause me frustation, and he was ready to schedule an injection consult whenever I was ready.
Posted 12/20/2010 6:10 PM (GMT 0)
Yeah, that's what most doctors say. They say it doesn't happen, but we got guys lined up here who says it does. Including myself. I have pumped for 3 plus years and haven't regained any lost length, but I do see it ( the full length erect) again when erect. They can say what they want, but unless it happens to them, they really aren't qualified to say. Just my opinion... devil

I recommend early and regular use of the pump, even before injections. While the injections can give you dramatic results, sadly you can only use it 2 or 3 times a week. Pumping twice a day, and making it erect then deflated several times, will do much to keep things inflated and healthy. A reasonably priced pump, in the $80 to 100 range is just as well as one of the $550 jobs, again in my opinion. I do have a couple links buried somewhere in my Bookmarks folder that say that injections do the most of the major 3-pills, pumps, and pricks, to repair and stimulate regrowth. So a combo of pump twice daily and injections twice a week might just be the ticket. An added benefit is your penis will remain somewhat 'fluffy' for hours afterwards, reducing the shrunken appearance, which is a real ego booster to the soul. cool You are over 2 months out, so you're ready for the pump, if you decide. The pump is only a mechanism to maintain health while healing, not anything sexy about it, so don't expect miracles, then your doctors expectations of frustration won't apply.

As far as pills, sadly, the trend is-if you were having trouble before, you will have as much or more trouble after treatment. So the pills may be a complete failure for you. smilewinkgrin
Posted 12/20/2010 11:32 PM (GMT 0)
Based upon the advice of your surgeon, IMO you made the correct decision regarding the non nerve sparing and the wide margins. 

If you were already having  ED issues, even with nerve sparing it's likely the ED would be a fair amount worse after surgery.

Without the nerves, I think the pills would be useless to you.  But the injections and the pump make sense.

Dave

Posted 12/21/2010 4:07 AM (GMT 0)
Wellcome Michael, Hopfully your decision was justified, but the way I look at it, once the sugrey is over it doesn't matter. Life starts over with the new you. I hate the way I ended up side effect wise but that is what I got and we have to work with what is left. Like James and others said there are ways to wake up of mister wood. I had bad ED before and I knew that the surgery would kill me off, it did completely. During the last 5 or 6 years pre RRP I was using the pump or VED. When I first started with the VED I was able to have good errections BUT the sex with my wife was never the same. Fooling around with the equipment and not her and later worrying if the errection would be good or would it last made sex less enjoyable for us. So post op I decided not to even try the injections, While they might have worked for a while it would still the focus on errections not intimacy that had escaped us some years ago. I decided to have the penile implant, I may not have had the courage to make this decision except for the fact I ended up needing an Aritficial sphincter as well and I added this proceedure to that surgery that I felt I must have. I am scheduled for these implants 1/11/11.
I am not saying you should take this final step in restoring you function but it is available should you need it. I have been encouraged by the experiences of some of the members who have gone before in having the IPP and AUS. So no matter now bad your ED is you can still have that favorite past time back. I hope you continue to recover and get some good psa numbers. And I think you can now join the PSA anxitey club.
Ron
Posted 12/21/2010 4:43 AM (GMT 0)
Micheal,

Welcome to HW. Have you considered having your path slides re-read by Bostwick ? Pretty unusual on here to have a downgrade. The difference between a 7 and an 8 is really about how much you need to watch it in the future.

As a G9, I will be watching this thing like a hawk for the rest of my life. I expect a reoccurence. If I had a G7, I could probably relax a little.

Good luck on your journey. Life is good, and we need to enjoy it every day. Hopefully you will find a satisfactory way to utilize your thrid appendage in a way that is satisfactory to you and your partner.
Posted 12/21/2010 4:54 AM (GMT 0)
Gleason 8 is 4+4=8..Your 4+3=7 just means the pathologist, with the entire organ to look at, found a patch of 3-grade cancer to go along with the 4 grade..You had a high velocity, an abnormal DRE...Trying to assign a rick factor to that situation would be difficult..Some docs would call that high-risk, some would not..Time will tell....I sure hope you are done with it..

My surgeon spared both my nerve bundles (to no avail) but my post op PSA was 0.9...No incontinence issues thank God..yes, I lost an inch too...And I agree, they cut more than nerves. They cut many blood vessels too and that is the kiss of death for normal erections...You might have sex again but it's never going to be the same....
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