Dad just diagnosed. Need advice and direction

lolynn · New User Joined: 12 Apr 2008 Posts: 2

My dad is 75 and in very good overall health and very active. He had a biopsy with 15 samples taken. One came back showing cancer and two ASAP. His PSA is 5.2 (it was 3.0 two years ago). Gleason score 3+3=6 and 18% tumor. Tumor is not palpable.

Could someone please explain this to me in layman's terms and the steps we need to be taking.

Should I have his slides sent for a second opinion?

At his age, what treatments are generally recommended?

He has a doctor's appointment to discuss his results on Wednesday. (I had them faxed to my dad so we could review them prior to his visit. We had no idea he had pc so we were shocked when he received the fax.)

brainman

Hi lolynn. I am very sorry about your father's Prostate Cancer. I am sure you will get a lot of good information on this forum to help you with your father.

Prostate cancer has a very high number of "false negative" biopsies. That is why they took 15 samples but only one was positive.

PSA is a protein produced primarily by Prostate Cancer cells. It is significant that your father's PSA has almost doubled in two years. In fact, I am surprised that it took this long for PC to be diagnosed... PSA of 3.0 is high.

The Gleason score is a measure of how aggressive the cancer is. The pathologists looks at the cells under the microscope and counts the number of abnormal cells. The pathologist "grades" the cells from 1-5 in terms of how abnormal (1 being almost normal looking and 5 very abnormal). Pathologists take the top two and add them together. In your father's case, the number 1 abnormal cell was given a grade 3 as was the number 2 abnormal cells. A Gleason Score of 6 is considered moderately aggressive (slowly growing but growing nevertheless).

There is one other thing about your father's cancer that you should find out: What is its stage? Has it spread (metastasized)?

Learn as much as you can. It will help you understand what is happening to your father.

You and your father 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/

lolynn · New User Joined: 12 Apr 2008 Posts: 2

Brainman, thank you for the thorough explanation. I understand it much better now.

I don't see the cancer grade on the report anywhere. I will need to contact his doctor's office. On the report, it does say "periacural invasion - no". Is that an indication if it has metastasized?

Thank you again for your response and kind words

brainman

I do not know what "periacural" means... sorry. But taking that is is not a very aggressive cancer, the fact that there is no invasion of whatever it is must be a good sign Wink

. Maybe someone else will be able to fill in the gaps.
_________________
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/

Replicant · Moderator Joined: 01 Nov 2006 Posts: 220

I think the writer meant "perineural". That would be an invasion of the nerve bundles surrounding the prostate. So there was no indication of that. That's a good sign, but no more than that. Remember, this is based on a relatively small amount of samples.

A second opinion is a very good idea. Urologists are used to this. You might have to pay for it yourself, though. Bostwick is a lab well-known for specializing in prostate biopsy examination.

3+3 indicates the cancer is only moderately aggressive. The PSA doubling time also appears to be low. So you APPEAR to be dealing with more of a smoldering brush fire than a raging wildfire.
The Gleason at this point should be thought of as an estimate only, because most men find out their tumor was a little different if they have surgery and the whole thing is examined.

Don't be too shocked--autopsy studies have shown that a sizeable portion of the male population has prostate cancer by the time their in their 70's, but very few go on to develop problems from it. By the time they hit their 80's, it's very common but since most of us keel over from a spectacular cardiovascular event before 90, it usually doesn't come to the forefront unless it reveals itself through PSA.

As far as treatment goes, for men around this age Patrick Walsh (leading, pioneer urologic surgeon) actually leans away from surgery and towards radiation. My dad is in the same age range and is also very healthy and active. But I wouldn't want to see him go through an operation like a prostatectomy, even though many men in their mid-70's do. I would be exploring radiation in the form of the usual photons (IMRT or IGRT) which is done at many, many medical centers, protons (done at only a few places like Loma Linda), brachytherapy, or some combination of the above.

I went through IMRT as a secondary (salvage) treatment. The treatments were a breeze. I have had some side effects that were minor and transitory compared to those from surgery. From what I've read, that's par for the course for external radiation these days.

So--in a nutshell, get a second opinion on the biopsy, and think carefully about options, especially non-surgical options.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

johnw100

With more extensive screening, most men are now diagnosed with early stage, Gleason 6, low volume, low risk cancers.

LOW RISK is often defined as PSA 10 or less,
Gleason score 6 or less
Clinical stage T2a or less (meaning a tumor which can not be felt by DRE in large areas of the prostate)

With more men now found in this category, it often raises the dilemma of how to treat, or whether to agressively treat when they are often small slow growing cancers which might not cause problems.

Johns Hopkins and others have undertaken considerable research and published criteria for watchful waiting or active surveillance.

PSA is naturally produced by the prostate, and a large prostate (usually associated with ageing) produces more PSA. The PSA rise could be an association of this normal process and PC.

"steps to take": Firstly send the slides for the 2nd opinion you mentioned.
Biopsy readings are subjective: what looks like cancer to one person could look normal to another. They should be sent to an expert pathologist at Johns Hopkins for example. It's surprising how often someone has a PC diagnosis, only to find a 2nd reading finds a normal diagnosis, or a different grade, which obviously can change your view about treatment options.

Read the book by Lee Nelson MD "Prostate Cancer Prevention and Cure". It's objective, very comprehensive, includes diagnosis, stages, choosing a top doctor, treatment options, lifestyle changes, diet, nutrition, supplements etc. There are other informative books, depending on what treatment you consider but this is the best I've read for an overall objective view.

"what treatments": Mainstream treatment options of radiation / hormone therapy /proton , surgery or active surveillance are the main ones usually considered for low risk PC. Surgey is a major operation and usually not considered by older people.

"perineural?? invasion" is not regarded as being of great importance.

"cancer grade" is the Gleason 6 which is in the low risk category. High risk cancers are gleason 8 and higher.

"metastases" can be difficult to gauge, depending on quality of the equipment available. It is not usual to find bone involvement until PSA is above 20 and most doctors will not suggest them for PSA below 10.

In one respect you are fortunate to have found this at an early treatable stage. I trust all goes well.

johnw100

Replicant,

Sorry to have repeated a lot of your good advice. I did not realise that you had posted in the meantime.

John W

Replicant · Moderator Joined: 01 Nov 2006 Posts: 220

Gleason scores indicate the aggressiveness of the tumor. According to the Mayo Clinic ( http://www.mayoclinic.com/health/prostate-cancer/PC99999/PAGE=PC00006 ) :
Gleason 2-4: tends to be slow growing
Gleason 5-7: moderately aggressive
Gleason 8-10: fast growing, high chance of spreading

I am just trying to explain my use of the term "moderately aggressive." In the bigger picture, with your father's low PSA, Gleason, and negative DRE, it is true he is in the "low risk" group--in spite of the "moderately aggresive" Gleason. Men in this group are very unlikely to die of prostate cancer within 10 years. John is correct, and my earlier post was misleading about the nature of the risk.
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prostate/Management/LowRisk.htm
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

interval · Regular Joined: 11 Apr 2008 Posts: 35

Hi lolynn,

First of all I want to say I am sorry for your father PC. I am new here but I've learned that your father illness in not on aggressive stage, that means you should do two things.

1. Ask for a second opinion.
2. If the first opinion is confirmed, don't panic, wait an see. Your father has 75 years. Prostate tumor is a slow developing cancer, more people die with it, than on it. Ask doctors about your father life expectancy and decide after. A surgery (RP) is out of question. Considering age of patient and stage of tumor you should have an option for a 'light' treatment to maintain your father condition in good survival shape.

interval · Regular Joined: 11 Apr 2008 Posts: 35

And very important is to learn about prostate cancer.

There are a lot of good informative books as well as good websites. This forum is a good opportunity too. You must know as much as you can about treatment options, lifestyle changes, diet, nutrition, supplements etc. At least to know what to ask a professional.

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