Dan0 said...
I don't post often, and I don't want to seem unappreciative. I have learned much since I joined this forum, and that information has helped me make tough decisions, thank you.
However, I have read many post that state things like, gleason 6 never metastasizes, or progresses to g7, or g8 etc. Quite frankly, I have read the studies that most of you post to support these statements, and the great majority of these studies are for "pathologically confirmed" g6, not clinical g6. There is a huge difference! (25 to 30%) My take on these studies is that g6 is unlikely to metastasize or progress, if it is removed! Well duh! This seems like a great argument for treatment to me, not AS.
I have also read studies that clearly show some untreated g6's do progress to higher grades, and even metastasize. To say that g6 "never" metastasizes or progresses is not a position taken by medical academia, and should not be encouraged here, IMHO.
I know I am low risk (thank goodness), and I am glad that I have been able to avoid treatment so far, but please do not minimize my disease.
Naturally any study of G6 cancer should involve only pathological G6 because clinical G6 is only an "educated guess" that there are not more aggressive tumors in there. The basic studies do indicate that what begins life as a G6 will stay a G6. In other words, a prostate cancer cell of whatever Gleason grade does NOT progress to a higher grade.
The 25 to 30% reference is to biopsies that showed only Gleason 6. While the Gleason 6 clinical diagnosis IS correct, that does not mean that there is not more aggressive cancer present that was not detected. This is sad whenever a patient plans his future treatment (or AS) on the assumption that only G6 is involved. The 25-30% refers to the percentage of surgery patients who entered surgery under the assumption of G6, but later found out (through post-op pathology) that there was G7 (or higher) also inside their prostate.
Until we have a definitive, non-surgical test that can truly determine if there is any higher Gleason cancer present, aside from the G6, I believe that AS will always be a dangerous roll of the dice.
As for G6, Johns Hopkins did a study a few years ago involving 17,000 G6 (confirmed G6 in post-op pathology) patients. Out of that number, not one single case involved any metastatization. Not even one.
However, one thing unnerved me a bit during my 2-year checkup at Mayo Clinic last month. When I mentioned that G6 never spreads, she told me that they indeed HAVE seen some spreading of G6 in the past. We did not go into further detail on this, but I'm assuming she meant migrating out of the prostate into the prostate bed -- but not actual metastitization to other areas of the body. Not sure about
this though.
EDIT: DanO, I forgot to mention that you were very wise to have a saturation biopsy in conjunction with your AS. In your case, I would assume that AS is very safe since you've had much more than a standard 12-core biopsy. You should be fine as long as you continue checking PSA, annual biopsies, etc. Good luck!
Take care,
Chuck
Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Post Edited (HighlanderCFH) : 10/5/2013 10:25:40 PM (GMT-6)