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Posted 5/12/2012 2:38 AM (GMT 0)

I noticed on one's signature or their stats that after several negative biopsys there was finally a DX of a G6. After a color doppler it seemed to be upgraded to a G7.

Isn't AS usually recommended for a G6?

So if this is the case what is this saying about doing AS if it can be upgraded??

Am I missing something?

Thanks,

BOOGEE

Posted 5/12/2012 4:08 AM (GMT 0)
Each case is slightly different and everybody's choice is different. And there is more than just the gleason score to consider.
Posted 5/12/2012 4:50 AM (GMT 0)
Boogee'
I think that would be me. The issue was that on my 12th biopsy a small core G6 was found, but since my psa was 40 it was well outside any AS recommendation. I went to an oncologist for a 2nd opinion and he was absolutely certain that the biopsy did not reflect my real condition because of my psa history, consistant rise in psa for 10 years. He felt there was a much larger tumor that was not yet found and he was correct. In this case psa kenetics and a history over time reflected the correct diagonosis and not the biopsies.
Not all G6s aqualify for AS. If you qualify for AS: g6, less than 30% positive cores, no core over 50%, psa density less than 1.5, psa less than 10, then you watch it and get psa tests every 3 months and a follow up biopsy within a year. Any psa rise or a biopsy that falls out of the criteria you would get treatment. In 30% of these cases a follow up biopsy results in a higer grade or psa continues to rise and the person gets treatment with the same results as he would have if treated immediately.
Hope this clears up any confusion.
Posted 5/12/2012 2:15 PM (GMT 0)
Andrew and John,

O.K. that makes more sense now and I should have considered that.
However we just joined a local support group and have realized each case is sooooo different.
There is one guy who was on HT for 1 year intermittenly and has been off for 7 years and is doing fine. Will address his stats next meeting. Another guy has high stats and has done absoultly nothing for 10 years and just had a lung removed due to cancer, they think unrelated to PC and is strong as an OX.

We viewed Snuffy Meyers Nov 11-2011 guest lecture CD from our support group meeting here at El Camino hospital in Mt. View, Ca. and he believes in most cases AS is advised when a G6 is DX.

I guess my question is: Doesn't the fact that one has PC, as being DX with a G6, wouldn't one expect that it will eventually advance to higher PSA's and need attention?
Why not do something about it before it gets so out of control ? I do understand each ones PC is their own journey, just tring to understand the G6 DX.

Thanks,

BOOGEE
Posted 5/12/2012 4:31 PM (GMT 0)
Boogee,
There are many different forms of prostate cancer. Most men by the time they are 60 have some prostate cancer. The vast majority of these are what they call the indolant variety, where the cancer does not grow or grows so slowly as it will never harm you in your lifetime. Given the criteria I wrote in my above post those having these stats are most likely to have the indolant variety. Most men have PC and never know it. If the procedure to remove the cancer was simple like removing an appendix or tonscils there would be no issue in treating all PC found. Any treatment has major risks of side effects such as incontinenance and ED and other complications, so many doctors feel that the harm from treatment far outweighs any benefit a patient would receive from being treated. Many men, especially older men, feel the best treatment is to monitor it any only seek treatment when the cancer is no longer indolant.
There is a common misconception that all prostate cancer will grow. This is not the case as the majority are so small that they will never grow to the point that they will escape the capsul. Prostate cancer that is contained in the capsul will never harm you and is only dangerous when it gets into other parts of the body. There are reliable indicators, not 100%, that these cancers can be identified and watched thereby avoiding treatment or at the very least delaying it for years.
Posted 5/12/2012 4:42 PM (GMT 0)
Boogee,
There are many different forms of prostate cancer. Most men by the time they are 60 have some prostate cancer. The vast majority of these are what they call the indolant variety, where the cancer does not grow or grows so slowly as it will never harm you in your lifetime. Given the criteria I wrote in my above post those having these stats are most likely to have the indolant variety. Most men have PC and never know it. If the procedure to remove the cancer was simple like removing an appendix or tonscils there would be no issue in treating all PC found. Any treatment has major risks of side effects such as incontinenance and ED and other complications, so many doctors feel that the harm from treatment far outweighs any benefit a patient would receive from being treated. Many men, especially older men, feel the best treatment is to monitor it and only seek treatment when the cancer is no longer indolant.
There is a common misconception that all prostate cancer will grow. This is not the case as the majority are so small that they will never grow to the point that they will escape the capsul. Prostate cancer that is contained in the capsul will never harm you and is only dangerous when it gets into other parts of the body. There are reliable indicators, not 100%, that these cancers can be identified and watched thereby avoiding treatment or at the very least delaying it for years.
A comment on the patient that was on HT: Another misconception by many is that HT is not a cure. about 30% of advanced patients have a complete remission with 1 year of HT. Dr Liebowitsz in LA has used HT on patients who have contained or low risk PC and has acheived a 93% remission with a 13 months course of HT. Yes it is a strange disease and there are a lot of misconceptions about it floating around. I feel that a medical oncologist specializing in PC is a patient's best chance of determining exactly what type of PC a patient has and then matching the appropriate treatment to the disease. There is much more to this disease than just a psa and a gleason score. Keep asking question as the more one knows and his is own advocate the more favorable the outcome will be.
Posted 5/12/2012 8:54 PM (GMT 0)
John,

To determine what type of cancer a person has would that be considered gene profiling, or gene sequencing to determine therapy needed. Is this also considered 2nd line therapy and has it been approved or still in clinical trials.
I have read about Feraheme, I believe it's called to determine where the cancer is in the lymph nodes, but some say they wouldn't use it due to SE, and that is not approved????
The lymph nodes is possibly where my husbands PC is due to his isolated met. I heard Dr. Snuffy Meyers say find the cancer and get rid of it.

So again is the above all considered gene profiling?

BOOGEE
Posted 5/12/2012 11:12 PM (GMT 0)
No, gene profiling and having a pathologist do tumor markers to better identify the type of PC is entirely different. In the above method of AS you use psa and time to figure out what the cancer is doing.
When Dr Myers uses scans to find the cancer this is part of "staging". Gene profiling can also be considered a part of "staging". With advanced staging a doctor uses many different methods to determine where the cancer is and how agressive it is.
I know nothing about gene sequencing, so I don't know if it is valuable or not or whether it is approved for PC.
Posted 5/13/2012 4:09 AM (GMT 0)
What AS does, when it is safe to use , it postpones the side-effects and quality of life loss associated with most PC treatment..How long treatment can be safely postponed is different in each case...The thinking here is if treatment can be postponed, sometimes indefinitely, why subject PC patients to treatment side-effects and expense any sooner than necessary..Careful studies have shown that delaying treatment (when appropriate) does not increase mortality at all..

Problems can arise when the needle biopsy discovers a small G-6 tumor but misses a more aggressive tumor that requires prompt treatment but was undiscovered by the biopsy..That's why those going on AS should have a complete set of tests and scans performed to make sure there is no undiscovered high-grade cancer lurking..
Posted 5/13/2012 5:01 AM (GMT 0)
John,

To do tumor markers does the pathologist use our path report from our post-surgery report, or are tumor markers found from scans performed only?

We have an appt. with a Medical Oncol. this Monday (about the 5th one we have seen).
I now feel we are better armed to ask pertinent questions to the Dr. after picking everyone's brains here!

Thanks ,

BOOGEE
Posted 5/13/2012 8:22 PM (GMT 0)
Boogee,
Send me an email (in my profile if you click on my name). I'll send you a paper by Dr Bronkhoff on all the tumor markers.
JohnT
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