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Gleason score

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Posted 7/20/2011 4:58 PM (GMT 0)
hi,

my dad 57, underwent a surgery,PSA13, his gelason score form the biopsy was 8(4+4), after the pathology report it`s 8( 3+5) and  invasion of the vesicles plus positive margins on both the left and right hemispheres of the gland.

i did read a lot of good stories about people with gleason 6 and 7, but with 8 i keep reading high risk, aggressive...

my question is, does every person s body react different to the cancer cells? is there anyone with gleason8?

i would like to hear your opinions please,

thank you

Posted 7/20/2011 5:04 PM (GMT 0)
Laila,

I am a G 4+5, upgraded from a biopsy with G3+4 and G4+4 samples. My SV / Lymph nodes were not involved, but I did also have positive margins in several areas.

Yes, G8 -G10 is considered more aggressive. I went straight to adjuvant Radiation (did not wait for a PSA rise), because of the G5 component and the positive margins.

Not sure what else I can tell you right now, except that I am still out here

smilewinkgrin  

(I was 56 at DaVinci surgery)

Posted 7/20/2011 7:05 PM (GMT 0)
Even though it is more aggressive, many people have done very well with the treatments that are available. Recent studies show advantages for adjuvant treatments as opposed to sequential treatments. In other words, hit it with as much as you can all at once to weaken and kill more of the cancer early on and the likliehood of a longer more durable remission is improved.

In my case my doctors treated me as high risk due to my PSA and tumour volume. I had two different radiation treatments and hormone therapy from the start.

I suggest that you seek out a medical oncologist that does a lot of work with high risk prostate cancer patients to direct the treatment. The urologist has basically done his job as a surgeon, now is time to get some more specialists.

Your dad will probably need radiation and hormone therapy. The advantage is with his age as he will be better able to tolerate the aggressive treatment better than the more elderly men. I am a few years older and have done very well only missing three days of work from my treatments.
Posted 7/20/2011 7:44 PM (GMT 0)
thanks guys for your answers,
i would like to ask about the cells grade, when we say gleason 6(3+3) , does that mean that the only cells found are grade 3?? or that there is cells 4 and 5 but they are less than the cells grade 3 ???
Posted 7/20/2011 7:54 PM (GMT 0)
I'm Gleason 8 (4+4). My PSA was 3.8 at the time of biopsy. I had extra prostatic extension meaning the the cancer was outside the gland but I did have negative margins because my surgeon removed tissues beyond where the extension was. So far I have been cancer free fro 2.5 years. Good luck for your Dad,
Posted 7/20/2011 9:25 PM (GMT 0)
Gleason score gets reported in the order of highest % + lower %.

So if you have more G5 and less G4, it is 5+4. So in my case (G4+5) it is a little better. Not much, but its something.

Some labs have reported tertiary scores, meaning there was a third grade, but not so much of it. It would be important if you were a G3+4 with tertiary 5, for example. A G3+3 should mean that was all they found.

The Gleason scores are determined by looking at the cells under a microscope, so we suggest second opinions on biopsies. For the pathology report, it is a little different, as they have entire slices of the prostate gland to look at, not just a small needle sized core.

Posted 7/21/2011 1:49 AM (GMT 0)
Laila sorry you have to be here for your dad, hope all works out well for him.

You pretty much hit it, everyone seems to be different.

I'm G-8 + a bit of tertiary 5 in there for good measure, pT3b with seminal vessicle invasion and a focal positive margin. I had open RP 3-1-10 and as of my last test am still pulling "0"s i.e. <0.04. That may change at next week's test who knows. With luck all may be well for your father, if his PSA starts to rise there are secondary treatments that can help.

There will also probably be decisions to be made about follow up radiation (adjuvant) soon, help him get educated and make his decision, there is much to be said for hitting PCa hard right from the start.

Best of luck to you both
Dave
Posted 7/21/2011 5:11 PM (GMT 0)
Hi Laila:

Good question! I am a GS 4+5 just diagnosed with one bone met already but no symptoms. I am slowly learning what it all means, and I have the same question as you. The terms "aggressive" and "high risk" in the literature are not readily explained.

So far, I have found this site to be very informative. Keep digging, and good luck to your Dad!

In the above replies, JNF referred to recent studies supporting adjuvant therapy to hit the PC hard up front. Can somebody refer me to these studies, please? My advice from John Hopkins Medical oncology was to receive ADT alone for the next two years.

However, I note that there is a Phase III trial ongoing now (E3805) testing Chemo plus ADT versus ADT alone. Entry is confined to advanced cancer with at least 4 bone mets.

houseboy
Posted 7/22/2011 12:54 AM (GMT 0)
The Gleason 8,9, 10 are more aggressive and more likely to metastasize and spread...Positive margins and vesicles means the treatment recommended by most Prostate cancer doctors is surgery, radiation and hormone...Even if the 8 week post surgery PSA test drops to zero, (a good sign) many doctors believe the risk of the cancer metastasizing is too great and they recommend followup treatment as soon as possible after surgery. Recent studies with high risk men have shown that by combining hormone therapy with the radiation therapy, the chances of a re-occurrence is greatly reduced and overall survival is improved...

The Gleason 8,9,10 patients make up about 20% of the total and they are treated somewhat differently than the G-6 and G7 guys....
Posted 7/22/2011 1:44 AM (GMT 0)
Hi folks,

Another high Gleason fellow here : 4+5. One study mentioned last year in the press about adjuvant treatments for high risk cases has only been reported in abstract form, the study itself not yet having been published. The title is "Intergroup randomized phase III study of androgen deprivation therapy + radiation therapy in locally advanced prostate cancer." The abstract was read at the American Society of Clinical Oncology convention last year. See: http://www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confid=74&abstractid=49170 and http://www.ascopost.com/articles/august-2010/combined-modality-therapy-extends-survival-in-patients-with-high-risk-prostate-cancer/

A couple of interesting papers about high risk cases are (do a web search on the title):

"Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges." Choo, 2010

"Role of surgery in high-risk localized prostate cancer,"

"Treatment strategies for high-risk locally advanced prostate cancer,"

and "Surgery Found Effective for Patients with Aggressive Prostate Cancer," a press release from Mayo, Rochester.

A decent place to go to see how one prostate cancer specialist deals with high risk cases is: "Newly Diagnosed Prostate Cancer: Evaluating the Options Part 3 of a 3 Part Series," by Dr. Mark Scholz, published at the Prostate Cancer Research Institute site.

Take care all,
Nellie
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