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Can G6 be agressive?

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Posted 1/21/2015 8:26 PM (GMT 0)
We have found out some new information so want to run something by you guys that have researched and been on the board longer than I. Before I start I want to clarify that we are above the moon happy w/ Bob's results thus far and I'm not borrowing trouble, I'm just curious and like to stay on top of things. After my complaining several times that Bob was having issues and none of his doctors had ran PSA. I came across a medical bill from 2009 that listed PSA as a charge. (No mention of this test or the results were given to us at the time). Called previous doctor and told them we wanted the results from the 2009 test. His PSA at the end of 2009 was 1.9 So in four years his cancer had taken up 30% of prostate and one positive margin. To me that sounds fast growing but surgical path was a G6 which usually takes years to go anywhere(from my understanding). So can G6 be an aggressive cancer? The more I know it seems the less I know. Anyone want to weigh in on any research they have read on this subject or know from experience? Also do you think doctors should inform patients when they run this test and why they are running it or do you think that just causes more panic? I really wish the doctor had said he was running a PSA test at the time and as to why and what it would tell, that way we would have at least been educated a little bit about prostate cancer and when problems persisted could have requested another one. We had never even heard of a PSA test until Aug. 2014. ~Miki~
Posted 1/21/2015 8:30 PM (GMT 0)
Short answer: No

There might be more to know and understand about your question, however...
Posted 1/21/2015 8:42 PM (GMT 0)
Gotta agree with Jack on this one. Also, the definition of aggressive comes into play.

Cheers, Doug
Posted 1/21/2015 8:51 PM (GMT 0)
A Gleason 6 is not considered an aggressive cancer. As I understand it, it also doesn't survive in an environment outside the prostate. But before you take that to the bank, let's let the smarter guys here check me on that statement.

As to your question about whether doctors should inform patients they're having their PSA checked, the whole idea of whether doctors even should examine PSA is controversial. Not that I want to start that discussion here.
Posted 1/21/2015 8:54 PM (GMT 0)
I am defining aggressive as fast growing/ fast moving. I don't know if that's the technical definition but that's what I had in my head when I asked the question.
Posted 1/21/2015 8:58 PM (GMT 0)
Looks to me like it took 5 years to go from 1.9 to 4.1. That's just a little over doubling every 5 years. I don't know what is typical, but doesn't sound any faster than mine was growing.

as to your other question - yes doctors should tell you why they are ordering tests and provide the results. Often they don't. Some just don't take the time. Some don't think their patients want to know about tests results that are in the normal range. Some don't think their patients understand the results. However, my doctor has been very good about explaining what tests she orders and what she's looking for. Test results are delivered to me and the doctor directly from the lab via secure email and there is a history page I can log into to get past test results. They even have links for each test back to a medical encyclopedia that explains what the test is for and what is considered normal. Wish more doctors and hospitals offered that service.

Andrew
Posted 1/21/2015 9:04 PM (GMT 0)
I'd go with "no" too. Actually, Bob's post-op pathology report may be the best one possible. His cancer was serious enough to need treatment but not likely to cause him much trouble after his surgery. If his cancer was much lower-risk he might second guess his decision to seek treatment and be tempted by regret.
Posted 1/21/2015 9:05 PM (GMT 0)
Thank you Andrew for pointing out the doubling time on the PSA. I hadn't even taken that into account. I think the 30% of prostate was throwing me and giving me tunnel vision instead of looking at the entire picture. That's why I love this board so much!
Posted 1/21/2015 9:14 PM (GMT 0)
We had a pretty good discussion on this topic in November 2012, in particular with respect to G6 recurrence possibility (not exactly what you're asking, but the numbers cited below are still encouraging and somewhat relevant). Here are some probably helpful statements from that discussion:

There is a very rare chance of a G6 reoccurring after a long period. In 17000 surgeries on G6 patients not one case of metastasis was found. G6's rarely metastasize, but they can grow large enough to affect local organs such as the bladder and rectum as the tumor grows and is not treated. Since you don't have a growing tumor this would be almost impossible in your case. Many oncologists like Scholz and Strum believe that G6 stays a G6 and doesn't morph into a higher grade and that any future higher grade tumors are different tumors from the original G6. A reoccurrence after a long period would be extremely rare, but not impossible. 10% of all reoccurrences after surgery occur after 10 years, but all of these are in the higher gleason grades not in true G6s.Your chances of getting another unrelated cancer or a heart attack are far greater than your chance of a reoccurrence.

and

According to a Johns Hopkins study if you are G6 organ confined your chance of recurrence is .4% That's 4/10 of 1% by the way. And the people that did recur did not progress to metastatic disease and no patient died of PCa.

The full discussion if you want to read it is at:

www.healingwell.com/community/default.aspx?f=35&m=2553228
Posted 1/21/2015 11:08 PM (GMT 0)
Psa is a good indicator of cancer growth. It went from 1.9 to 4.1 in 5 years, slightly less than a 5 year doubling time. This would not appear to be aggressive as any cancer takes about 44 doublings to cause death. I'de venture that no one would consider a cancer that took 220 years to kill you would be aggressive.
Posted 1/23/2015 12:56 AM (GMT 0)
I have not been up on this board for sometime but felt I should add my 2 cents. My take on this is every case is different and there is no set of rules that relates to all.
Case in point. I have been fighting the cancer for only 4 years and really don't know where i am headed.
My PSA when diagnosed was 2.1. Nice and low and the family doctor said not to worry with a PSA that low you don't have Cancer. Age was 69. My uro did a digital and said it felt funny and wanted to do a biopsy. I was thinking he just wanted me to help pay for his equipment. Came back with cancer on both sides and a gleason score of 6. That's good but let's do a bone scan just to be sure. WOW cancer spot on the skull, ribs, shoulder and on the lower spine. Of course I could not beleve this was true so went to rad onc and he said I could do seeds but it was cancer then on to one of the top 20 cancer centers for a meeting with a rad and med onc. They reread the slides and did the scans and a MRI of spine it all come out the same. They both said could do the seeds but there was no hope of a cure because it spread to far. I figured the side effect of the seeds were more than I want so I turned them down, Lupron only for the rest of my life unless they find a cure.
After a year on Lupron Psa was .2 and stayed there for another 2years so I talked my med onc into putting me on intermitent ADT.
So here I an almost a year and still have hot flashes and no sex.
I know this is long and drawn out but the point here is no two cancer is the same and there is no rules.
Live for today and try and not look back.

God bless

Retired tech

Diagnosed 4/2011
G6 and mets so stage 4
PSA now is .2 and will be retested in May of 2015
Posted 1/23/2015 1:22 AM (GMT 0)
Sorry to hear your diagnosis Retired tech. More than the G6, it's the fact that you had mets with a PSA of 2.1 that stands out to me. I'm glad you seem to be responding to HT and that, in fact, you've moved to intermittent HT. That said, it doesn't sound like there's not much of a vacation for you.

Wishing you all the best.
Posted 1/23/2015 3:33 AM (GMT 0)
Retired tech, I am not arguing with you about your stats. or what you were told......but if you are truly a G6 with mets. everywhere you are the 1st case of it in any literature or study I have ever read about in the last 7 years. Even Patrick Walsh in his 30 years at Johns Hopkins has never seen a case of G6 do what yours is doing. And that's directly from him in an email to me. And that 30 years included 10 years of patients from the pre-PSA period who were all dx. based on symptoms or DRE.

Something does not sound right about your pathology. I would wager another biopsy would discover higher grade.

Again, I am not arguing with you, but something does not seem right with your dx. I wonder why your doctors are not more pre-plexed about it.

Again, I haven't even read of a case like yours....anywhere ever.....

But to answer ARangle14 question. G6 dx. today is not aggressive at all.....In time you will learn to stop even thinking about it.
Posted 1/23/2015 3:44 AM (GMT 0)
It is extremely rare for G6 to spread...

http://urology.jhu.edu/newsletter/2009/prostate_cancer_2009_7.php

And more recent...
http://urology.jhu.edu/newsletter/2014/prostate_cancer_2014_19.php

"
In other news, Epstein and colleagues recently took a closer look at the behavior of Gleason score 6 prostate cancer; their findings were published in the American Journal of Surgical Pathology. Although Gleason score 6 cancer is considered slow-growing and not aggressive, it has been found – rarely – in studies of prostate specimens after radical prostatectomy, to have spread outside the prostate. Could Gleason 6 cancer ever spread to the pelvic lymph nodes? Good news: The answer is no. "We performed a search of the radical prostatectomy databases at four large academic centers," says Epstein. "In more than 14,000 radical prostatectomies, there was not a single case of a Gleason score 6 tumor ever spreading to lymph nodes." It takes a Gleason score of 7 or higher for prostate cancer to become aggressive enough to spread far beyond the prostate. Under the microscope, Gleason score 6 cells appear uniform, "and they have a more predictable, excellent prognosis," Epstein notes. Gleason score 6 disease has such a good reputation as being "indolent" – slow-growing and wellbehaved, as cancers go – among pathologists that some of them have questioned whether it should still be considered cancer. Yes it should, Epstein says. One important reason why is that the biopsy Gleason score is often adjusted after radical prostatectomy, when the prostate is studied by a pathologist, "because the biopsy often underestimates disease grade and extent." Also, "if men think that Gleason 6 tumors are not cancer, this could result in a missed opportunity for cure."
Posted 1/23/2015 3:07 PM (GMT 0)
Sounds like a variant. Variants sometimes look like g6, but are very aggressive.
The tip off is the low psa with mets, which is exactly how a variant acts. Did you have your slides read by an expert? Dr Bronkhoff in Germany is the expert on variants and you might want to have him read your slides. He can also match a treatment to the type of variant discovered.
Posted 1/23/2015 3:18 PM (GMT 0)
JohnT can you confirm the 44 doubling time for death is for a cancer that is from the "start" untreated and/or from a recurrence "start: after primary tx, with no additional tx? thanks
Posted 1/23/2015 4:30 PM (GMT 0)
Pratoman

i have been told by 5 different dr's that i am special and it is very rare that g6 goes to the bones. i have biopsy of the spine and they all come back the same. There was a spot on my lung but has gotten very small with 3 years of lupron. The back pain is hard to take, after moving thur the different pain killers i now use morphine to keep it manageable. The back pain is from a few slipped discs which no dr will touch due to the cancer on the spine.
I Will be 73 and my wife has gone thur menopause and sex is no longer of any interest to her. The sex part was the hardest to except and crying and depression were really bad the first 2 years.(mainly due to lupron).
I now have a great team of doctors which include a med onc, rad onc, stress doctor, a pain and palliative dr, a ED dr, and they all make my QOL as good as possible. I wanted to see my 50th wedding anniversary which will be in 2017 and think that is very possible.
From all this tell the men in your life to get that psa done ever year and watch the psa rise not the number. If you catch it early you have a better chance of extending your life. I truly feel sorry for you younger guys because the loss of your sex life is not anything any man should have to go thur.
With a loving wife and a great team of doctors i have a great QOL.(spend my winters in florida where it is warm.)
I feel better that i got that off my chest and hope i did not bore you guys.
god bless.
retired tech

Diagnosed 4/2011
G6 and mets so stage 4
PSA now is .2 and will be retested in May of 2015
Posted 1/23/2015 5:14 PM (GMT 0)
Retired Tech, I had no intention of disputing your comments about your own situation, I hope you didn't take it that way, but just in case, I wanted to make that clear. My purpose in posting that data was in hopes of giving Miki, the original poster, some piece of mind.

Very sorry that you find yourself in that situation with a G6, sounds like you have a great medical team watching over you though, and it bodes well for you seeing your 50th anniversary .

Oh, and nothing here bores anyone, I think. I appreciate you posting your story
Posted 1/23/2015 8:57 PM (GMT 0)
ok
i think i made my point so i will continue to monitor healingwell and only post when i have something to benifit all.

god bless
Posted 1/23/2015 9:14 PM (GMT 0)
I appreciate you sharing also Retired Tech. I think your situation would be rare but one of the reasons I originally posted the question was I remembered in Walsh's book a part about a low PSA aggressive cancer that did not produce a high PSA which was one of my fears, however I did not remember the Gleason score on these cancers that do this. 30% of prostate from a G6 was throwing me for a loop but as others pointed out his PSA doubling time was at 5 years. This disease is so individualized that it's hard to imagine what's next in the grand scheme of things. I am a worrier by nature and I think if we have 0's from now on I will still in the back of my mind wonder if it's going to come back. Also, we had no bone scans before surgery for the simple fact that his PSA and biopsy didn't show anything that would indicate a spread and bone scans can throw a false positive and we didn't want to have to worry about that. We thought at the time it would be useless information. Apparently w/ stories like yours maybe it was something we should have done but I guess the numbers will tell the story as we progress in our journey.
Posted 1/23/2015 9:18 PM (GMT 0)
Retired Tech, I'd agree that your case seems rare/odd.  Specifically the combination of low PSA yet distant mets.  Glad to hear that despite all that you report your QOL is "great"...congratulations! 

Your clinical biopsy sampling of G6 is also somewhat surprising, given the advanced progression.  A 12-core biopsy from an average sized prostate samples only about 1% of the prostate material, so it is not all together surprising that your biopsy (did you only have one prostate biopsy?) did not find the cells that had obviously developed into a more aggressive pattern.


 

Best wishes for your upcoming 50th!

Posted 1/23/2015 9:36 PM (GMT 0)
Logo,
The doubling is from the first cell that mutates into cancer. My guess is that there is somewhere between 20 and 30 doublings before it becomes detectable.
Posted 1/24/2015 2:15 AM (GMT 0)
So the clock does not reset after primary treatment and the psa is now <,01? I think it does and you covered that aspect in your response. Thanks JohnT. I tend to over analyze words. Ps the doubling times to detectable raises other questions, but I can afford to let that them alone. thanks again
Posted 1/24/2015 3:45 AM (GMT 0)
A needle biopsy does not reliably detect all the cancer in the prostate...After surgery, when the entire gland can be biopsied, 30% of the time the pathologist upgrades the Gleason score to a higher figure...You can never be SURE you have 100% G6 tumor unless the entire gland is biopsied...
Posted 1/24/2015 3:50 AM (GMT 0)
As a quick answer, I would say "no" as well as most of the others, assuming it was truly a G6 situation. I do know of G7's that have developed mets, and there are some very aggressive G7's, that can be more troublesome to control than even some G8's. My oncologist has talked about this for years.

Only guessing, but would make me wonder if this G6 case was actually a G7 or higher, and was misread by one or more, that's always possible. Or as someone else has mentioned, there are rare variants, which can be problematic
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