psa 23 gleason 4+5=9 what now?

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

just got the bad news
what treatment possibilities apply to this?
anyone with personal experience with similar statistics?

Good health to all of us!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 173

If you know your clinical stage, you can use the Partin tables at the Johns Hopkins website to estimate whether or not your cancer is organ-confined.

I have put your numbers in, and even in the most optimistic staging in the tables, T1c, your probability of having cancer confined to the prostate is 34%. T1c would be if you had a needle biopsy following an elevated PSA score (in other words, there was nothing felt on DRE). Also, with T1c, PSA over 10, and Gleason over 8, your probability of extraprostatic extension is 39%, seminal vesicle involvement 17%, and lymph node invasion 9%.

At the other end of the spectrum on the Partin tables, T2b (involves both lobes of prostate and is probably felt on DRE) or T2C (involves both lobes and is felt on DRE), your probability of organ-confined disease is 12%, extraprostatic extension 33%, seminal vesicle involvement 28%, and lymph node invasion 26%.

Check it out for yourself on the Partin Table Lookup page on the webpage of the urology department at Johns Hopkins.

In a nutshell, your chances of the cancer having escaped at least the capsule of the prostate are substantial (66% to 88% depending on the stage). Some doctors will advise against prostatectomy for guys with your numbers--others will argue for it, based on the idea that it MIGHT still be confined to the prostate, and even if it is not, there might be some value in "debulking" the tumor.

Sometimes a doctor will advise a patient with numbers like yours to try external beam radiation (probably IMRT) and maybe add hormone therapy as well. Or maybe your medical team will decide it's best to go straight to ADT right away.

In any event, if you haven't consulted oncologists in addition to your urologist, you should soon. If I were in your shoes, I would be talking to a radiation oncologist AND a medical oncologist at this point. One or both specialties may have something to help you. In my layperson's opinion, it looks like you have aggressive disease that needs to be met aggressively.

Good luck!

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Replicant-
That really helps put things in perspective- thank you for taking the time to explain!
DRE was palpable- all hardened- guess we won't be having an operation...
I am only 56- this thing must have been growing inside of me for years...
Will be having bonescan and CT shortly...

brainman

badtrip, I am so sorry about your Prostate Cancer. I agree with the information that Replicant gave you. I can only add one comment. Prognosis is just a statistical probability. If my prognosis had been correct, I would have died at least 5 years ago. The odds at the time of my original diagnosis was only a 10% chance of surviving more than 10 years. The odds are much better now for my type of cancer and I did have a recurrence in 2005. They tell me it will most likely return within the next 5 years. I say that I will outlive that prognosis too.

You are in my thoughts and prayers.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Jim-
Appreciate your encouraging words!
Certainly we don't live from statistics...
Still, it all makes the horizon seem a lot closer than it was just a day ago...

Menachem

brainman

[quote="badtrip"]Jim-
Certainly we don't live from statistics...
Still, it all makes the horizon seem a lot closer than it was just a day ago...

Menachem[/quote]

Menachem, cancer does indeed make the horizon look a lot closer. I almost always say to people that I do like to know my prognosis only so that I can prioritise the things that I still want to do with whatever time I have left. After that, I try not to dwell on the prognosis but to live one day at a time working to achieve those priority goals. It is not easy.

I remember the night in 1992 when I was first diagnosed. My symptoms were significant enough for me to know that something major was happening in my brain. Despite this, when me oncologist (who is also a close personal friend) walked in and said: "Jim, it looks like you have a brain cancer...........". The rest of what he said seemed so surreal. Was Larry speaking to me? Did he say I have brain cancer?

At that point, I had no future or past. I became fully aware that all that I had was that very moment. Over the years, I have claimed back my future, but I am much more aware of how tenuous the future is.

My best wishes to you.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Jim-
Good advice- will try to internalize it... thanks...

Menachem

johnw100

The most important consideration is choice of a top doctor. as that will greatly influence your prognosis.

Especially when it's relevant to their situation, I suggest reading the publications by Dr Lee Nelson or Dr Charles Myers who is a highly regarded PC expert. As mentioned in other recent posts here, Dr Myers used radiation and hormone treatment for his own PC since his diagnosis 8 years ago. It would be well worthwhile consulting a top person like him if possible.

You'll find one thing common to most PC publications including the ones I mentioned, is that most of them also cover the subject of lifestyle changes, exercise, diet and supplements. These are are also worthwhile considerations which can improve overall health and help cope with potential treatment side effects.

When considering the relevant treatments suggested, like radiation and hormone therapy for example, it's also informative to look at the yananow site which has lots of mentors experiences. These are listed under the various treatment options, and can also be grouped under Gleason score where there are well over 100 stories you can click on. From memory there are probably 40 men with Gleason scores of 8 and higher who give their story and details of their treatment over various timeframes.

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

Thanks John,

The yana site site looks excellent, the case stories gave a feeling for various possibilities- treatments and results...
I now have a number of questions for my Urologist (meeting later today) that I would not have thought of before.

Menachem

sequoiaranger · Posted: Mon Dec 03, 2007 7:15 pm Post subject: Similar Stats With Me, but...

I went ahead with the prostatectomy. As it turned out, I had JUST missed keeping the cancer from metastasizing. Another month or so earlier...?? I am grateful to NOT have a malicious, malignant entity in my crotch, but much to my despair I have suffered complete E.D. (no incontinence). Life's a Bi*ch sometimes!

In general I have my health, other than knowing I have a secret assassin inside me willing to torture me literally to death.

I chose to have Eligard hormone therapy, and the 6-month shot worked for about 4 months. I went on Casodex and dropped my PSA back to "imperceptible" (LOVE hearing that word!!) and then tried Eligard again just a few days ago to be monitored monthly in case it ceases prematurely again (the first batch might have been mislabeled--I hope).

With luck I will have 20+ years (I'm 59) or better. A year ago I had no idea I might have a year or so to live--now life seems even more precious and enjoyable.

Cheers and good luck!
_________________
T-3, Gleason 9+
RRP 2-26-07
Using Eligard Hormone Therapy--
working Sometimes!!

brainman · Posted: Mon Dec 03, 2007 9:49 pm Post subject: Re: Similar Stats With Me, but...

[quote="sequoiaranger"]
A year ago I had no idea I might have a year or so to live--now life seems even more precious and enjoyable.

Cheers and good luck![/quote]

It is interesting (or maybe amazing) how cancer can change our perspective on life. I know that it has for me.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

badtrip · Regular Joined: 02 Dec 2007 Posts: 33

sequoiaranger-

Thanks for sharing. Good to hear that things are working out for you!

Since I may very soon be faced with a similar decision concerning an operation: when they told you that:
"I had JUST missed keeping the cancer from metastasizing. Another month or so earlier..."
Do you believe them?
I am having a big problem just now believing some of what the doctors are telling me...

Menachem

sequoiaranger · Posted: Tue Dec 04, 2007 3:07 am Post subject: My Own Summation

In my case ("documented" in another thread) there was a good possibility (about 80% by study of similar cases) that my cancer was still contained exclusively in the prostate and had NOT metastasized, so the prostatectomy was scheduled.

the "first cut" on the operating table is shallow to examine the lymph nodes and seminal vesicles. If a sample cut of these two organs reveals cancer cells, the "main event" is usually canceled because there is now "proof" that the cancer has metastasized. The main reason for taking out the prostate, especially in "younger men" in their 50's, is that the cancer was most likely confined to the prostate and taking out the prostate effectively kills the cancer. Once the cancer is metastasized, it is everywhere, so why bother with the invasive surgery? The normal other treatments of Chemo, hormone, and especially, radiation, are then used to reduce the prostate tumor.

In my case the first-cut examination of organs revealed no cancer cells, so the prostatectomy proceeded. It was only later, after more intense and thorough investigation of the cut-out organs, that only a very few, and very minute cancer cells were detected in my lymph nodes. So that means that the cancer has definitely metastasized and thus spread around my body, but had JUST STARTED and the cancer cells should not be numerous. I was SPECULATING that some short time earlier (a month, three months?) such an operation might just have nipped the tumor before metastasis. The doctor shrugged at my suggestion, and said, "Perhaps". Cancer stuff is, if you haven't already figured it out, NOT strictly "science" and cut-and-dried by numbers and formulae.

I am NOT SORRY that that ugly, malignant THING is out of my body. I had a difficult recovery, but I have recovered, and the only thing really "wrong" is my E.D. (and under my hormone therapy, a COMPLETE lack of libido). I have now "aged" twenty years sexually, but the rest of me is "current". I can live with that, sad as it is for me and my wife. "WE" accept it as a "cost of living".

Whatchagonnado?
_________________
T-3, Gleason 9+
RRP 2-26-07
Using Eligard Hormone Therapy--
working Sometimes!!

brainman · Posted: Tue Dec 04, 2007 3:28 am Post subject: Re: My Own Summation

[quote="sequoiaranger"]Cancer stuff is, if you haven't already figured it out, NOT strictly "science" and cut-and-dried by numbers and formulae.[/quote]

That is why Univercities have "Medical Arts" buildings Very Happy

.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

sequoiaranger · Posted: Tue Dec 04, 2007 11:24 am Post subject: "Medical Arts" Buildings

That's a good one!

Come to think of it, I suppose "medicine" is one of the original "arts", as practiced by shamans throughout the ages. It is only recently, in terms of human evolution, that "science" has been applied to this "art". Of course each progression in science finds its way into some application of the art of medicine, just as in war.

So far, cancer cells have "foxed" the body's immune system into believing that the affected cell is OK, and the body does not recognize that cancer cells are a threat. Chemical "tags" on the outer cell wall are being read by the immune system, and the cancer cell has a "fake ID" that fools the immune system when queried.

Now what we need "science" to do is to somehow "train" the immune system to spot the "fake ID"s, or clandestinely "code" cancer cells so the immune system can see past the "fake ID" and "arrest" the cell while the cancer cell sputters..."But...But...But I have my ID!"
_________________
T-3, Gleason 9+
RRP 2-26-07
Using Eligard Hormone Therapy--
working Sometimes!!

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