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Gleason 6 Recurrence

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Posted 7/27/2018 3:30 AM (GMT 0)
Even if a little bit of Gleason pattern 3 was left behind, you don't necessarily have to act on it:

/pcnrv.blogspot.com/2017/11/myth-gleason-6-never-progresses.html

I changed my mind - I think it's a good idea to have Epstein re-slice the whole mount pathology. It may give you more peace of mind. You might also consider a Decipher test.
Posted 7/27/2018 3:35 AM (GMT 0)
Hi TA.

The tissue was re-cut and examined by Dr Loda at Dana Farber. He saw only 6. But Epstein could shed light. Decipher came in at... .12 so that is instructive.

I think Dr. Kaplan is pulling on the other end of the same string that Nguyen is. Treat it at a lower psa and no ADT and Dr. Nguyen wait until .1 or so and use 6 months ADT, which you have pointed out is not supported by data, just seems to be a kitchen sink approach given my age.
Posted 7/27/2018 3:43 AM (GMT 0)
Yes, wait and confirm the rise.

Andrew
Posted 7/27/2018 5:42 AM (GMT 0)
If it has already been re-cut at Dana Farber, there is little point. Also, it is in your favor that your PSA was undetectable for a year. There is no clear pattern of rise over the 0.03 level. That, together with your very low Decipher score should give you confidence in the wait-and-see approach. What is clear is that your cancer is not "on the move" today.

I know that every doctor has a different threshold at which they add ADT. Howard Sandler picks 0.5, but his own RCT says 0.7 - so even at that he is being conservative. I have a lot of respect for both your doctors, but I think you see how much is judgment. In the end, it's whatever you feel most comfortable with.
Posted 8/22/2018 4:16 AM (GMT 0)
Third time is not a charm...met with Dr. Zeitman at MGH for a consult. Very nice guy. Unbeknownst to me...they reviewed my pathology from Dana Farber and...they found some G7 and close margins...so I think we now have the explanation for the rising PSA...Dr. Lee (MO) said he would still be comfortable skipping the ADT. We'll see what PSA is in 2 weeks. Another rise and i am going to act... this was the pathology report from review....

Prostatic adenocarcinoma Gleason Grade 3 and 4 of 5, Score 7 of 10, confined to
gland on 3 slides sent for review. (See note).

Note: There is perineural invasion. Carcinoma is exceedingly close to the
inked margin focally and fraying of tissue makes interpretation of the margin
status unreliable in one area. The grade 4 component is very minor but I think
it focally present. Vessel invasion not seen.
Posted 8/22/2018 11:41 AM (GMT 0)
I suppose that discovering the Gleason 4 in your slides changes everything, and the creeping PSA is no longer so mysterious. Like everyone here, I had been quietly rooting for your PSA to hold steady. I'm not an expert but it looks like RT is probably in your future. I was just finishing my IMRT almost exactly a year ago. As many people here have said, it was mostly an endurance test. After the first few sessions I asked the technicians if they could prove to me that radiation was actually being administered, since I could not detect anything myself.
Posted 8/22/2018 12:12 PM (GMT 0)
Hogo, well, thats not the best turn of events you had hoped for. I guess the silver lining is that its no longer a mystery. So you know what you are dealing with. I think (obviously) that you are wise to act soon. I look forward to your future postings and following your progress. Who knows maybe its the g6 that caused the blip in PSA and it doesn't rise from here. We've seen that happen here before.

Hoping for the best for you
Posted 8/22/2018 2:26 PM (GMT 0)
Knowledge is power hogo. It’s good that you’re prepared to act quickly. As TA said, a lot of medical judgement is uncertain, and we must go with what we’re finally comfortable with. I think you’ll do fine!
Posted 8/22/2018 2:51 PM (GMT 0)
"I think you’ll do fine!"

me too. but that said i'd do ADT.
Posted 8/22/2018 7:05 PM (GMT 0)
Agree with F8. JMHO, i feel like if this is the last chance for cure, you go all the way.

But clearly its a very personal decision
Posted 8/23/2018 1:36 PM (GMT 0)
Hugo, you are few years older than me and it sucks that those buggers are still trying to stir up trouble. If your docs agree - Go with the kitchen sink. ADT+SRT in my opinion works better on 4s than the 3s. Since they found some 4s , you have nothing to loose.
Posted 8/23/2018 2:09 PM (GMT 0)
Since there are some 4s, I personally would ask for a blast of radiation. Kill it, kill it, kill it.
Posted 8/24/2018 12:24 AM (GMT 0)
I had recurrence at 3 yrs. Had SRT and have been undetectable for 10 yrs.
Posted 9/5/2018 2:11 AM (GMT 0)
Had my 3-month test and its still at .04 (since March). So i'm going to stand pat until there is another rise and then I will act. I see my uro/surgeon tomorrow for a little hand holding. He will I'm sure, encourage me to stretch out the tests a little longer just to keep the anxiety down.

What say you? With a low decipher score am I ok to push it out 4-6 months, knowing that the next rise i get SRT?

thanks as always.
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