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Thread: Gleason 5+4, bone scan clear, PSA 27, MRI shows tumour confined to prostate...

  1. #1
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    Gleason 5+4, bone scan clear, PSA 27, MRI shows tumour confined to prostate...

    Results back today for bone scan and biopsy --


    Gleason 5+4, bone scan clear, PSA 27, MRI shows tumour confined to prostate, no involvement of lymph nodes around prostate

    Talking to Chris Ogden, UK super star for DaVinci on 2nd of May.
    Last edited by donelson; 04-23-2013 at 12:54 AM.

  2. #2
    Senior User FeatherBoy's Avatar
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    Hi,
    I'm winging it a bit here and others with more experience may disagree but with a 5+4 and a PSA of 27, I would seriously consider brachy (seeds) with full pelvic radiation regardless of the scan results. Go for the cure, not the sex life. G9 is a BAD cancer.
    No HDT at this point as it will mask the results of the radiation.
    This should be discussed with your surgeon.
    Best of luck in whatever you decide. --- Dave
    Age At Diagnosis: 59
    Pre-Op PSA: 4.5
    Diagnosis: Prostatic Adenocarcinoma
    Surgery: Retropubic Radical Prostatectomy (RRP) 07/16/2012
    Stage: pT2c,pNO,PMX
    Gleason Grade: 4+3=7 (Not-So-Good Cancer)
    Extraprostatic Extension: Neg.
    Lymph Nodes: Neg.
    Seminal Vesicles: Neg.
    Positive Margins
    Tumor Quantitation: <5% Of Prostate
    Tumor size: 1.1cm.
    High-Grade PIN
    Perineural Invasion: Present
    Post-Op PSA: 0.4
    Completed 35 sessions adjuvant IMRT on 12/13/2012
    PSA as of 01/10/2013: 0.2
    PSA as of 04/12/2013: 0.1
    PSA as of 07/10/2013: <0.1
    PSA as of 10/08/2013: 0.1
    PSA as of 01/15/2014: 0.2
    PSA as of 05/23/2014: 0.2


    願你的生活充滿了幸福和吉祥。

  3. #3
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    Not panicking, just asking: With Gleason 9, how much delay before treatment?

    Will hormone treatment slow Gleason 9 cancer? Or is it unaffected by removing testosterone?

    Is DaVinci not wise for Gleason 9?

    Thanks to all.

  4. #4
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    Certainly not an expert here, but with a Gleason 9 and PSA above 20, I'd bet you already have micromets which will NOT be caught with a DaVinci surgery. If you DO decide to continue with the surgery, you're probably looking at a secondary treatment as well. Unless that MRI was a 3T, I doubt if it could show mets that small. Hormone therapy will slow your cancer, at least for a while and maybe longer.

    mkane09
    PSA 6.48, biopsy Gleason 3+4, robotic prostatectomy 9/17/08, pathology Gleason 4+5, pathologic stage T2c, positive margins, SRT completed May 22, 2009. 1st post-radiation PSA, 8-4-09, <0.06. 2nd post-radiation PSA 12-22-09 <0.06. PSA, July 23, 2010: <0.06. PSA, January 10, 2012: 13.90. Re-test, February 6, 2012: 16.47. April 6, 2012: 25.6. PSA, May 2, 2012: 37.74. PSA, May 27, 2012: 37.4. PSA, June 17, 2012: 51. PSA, Sept 27, 2012: 110.24. PSA, January 28, 155. May, 2013, Well, you get the idea...

  5. #5
    Moderator Top User HighlanderCFH's Avatar
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    Yes, a Gleason 9 almost demands action pretty soon after it is diagnosed, so you do not want to waste any time. Remember that even a highly aggressive PC like a G9 is still curable if found before it can spread to other areas of the body.

    I would try to meet with several radiation oncologists and several uro/surgeons -- only those having performed on over 300 cases -- and ask them what the chances are of the cancer still being contained within the prostate or, at the very least, confined to the seminal vesicles or extraprostatic tissue. Even in the lymph nodes might be okay if caught in time.

    But that is the trick -- to roll the dice and hope it has not spread to distant parts of the body.

    Speak to these experts and find out the pros & cons of ALL types of treatment and how it might apply to your personal situation.

    If they are relatively certain that the cancer has not yet gone beyond the aforementioned areas, then surgery could be the ticket -- even if followed by some salvage radiation treatments. Removing the prostate will give a definitive answer on how widespread the cancer is within the prostate and would confirm (or reclassify) the Gleason score. Not often, but sometimes Gleason scores are actually LOWERED in post-op pathology. Looking at a removed prostate through the pathologist's microscope is the only real way of knowing this.

    Probably a good thing to ask radiation oncologists and surgeons would be, "If this was YOU, what would be your course of action?"

    Wishing you the VERY best,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, 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 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1
    Firmer erections finally surfacing in August, 2014.

  6. #6
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    My Gleason was 3+4 =7 post biopsy and 4+5 =9 post-surgery, but my PSA at that point was only 6.48. My cancer had already metastasized to the lymph nodes after surgery. My initial 6 weeks of radiation proved to be a waste of time because the cancer had already spread (although we didn't know that at the time) outside the radiation area of my pelvis. With what I've read, a PSA above 20 means your cancer has "probably" already metastasized. If you decide to go ahead with surgery, I would urge you to get to Sand Lake Imaging, Dr. Bravo, in Orlando, FL and have them scan you head to toe to see what is left. Better yet, have that done before surgery, to know if surgery would also be a waste of time. I still think you are looking at hormone deprivation at some point, either now or later. Good luck with your decisions!

    mkane09
    PSA 6.48, biopsy Gleason 3+4, robotic prostatectomy 9/17/08, pathology Gleason 4+5, pathologic stage T2c, positive margins, SRT completed May 22, 2009. 1st post-radiation PSA, 8-4-09, <0.06. 2nd post-radiation PSA 12-22-09 <0.06. PSA, July 23, 2010: <0.06. PSA, January 10, 2012: 13.90. Re-test, February 6, 2012: 16.47. April 6, 2012: 25.6. PSA, May 2, 2012: 37.74. PSA, May 27, 2012: 37.4. PSA, June 17, 2012: 51. PSA, Sept 27, 2012: 110.24. PSA, January 28, 155. May, 2013, Well, you get the idea...

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    Hello all, and thank you.

    Yes, I am concerned about the high PSA. I guess I will have to wait until 2nd May to get some straight answers - I think the Urologist and Cancer Nurse are probably having trouble expressing their opinions, deferring to the higher skill/knowledge of the surgeons etc.

    With the high PSA and the Gleason 9, my feelings of being able to beat this for "15 years" are drastically reduced. I am in the UK, not sure about Sand Lake Imaging techniques... It seems that we should get the prostate removed in any case, to reduce the load if more metastasis occurs.

    I worry a bit about hormone deprivation, but only as it might affect my ability to work. For me, no work = no pay. Mostly I do programming, sitting in front of a computer, etc. Sometimes I need to go out into the field for a few days of photography.

    Since I am done with kids, and living is a bit higher score than having sex for me, I am willing to do whatever is available (radiation, seed, DaVinci, HDT) to extend my life as long as the quality/pain is not bad.

    Reading the internet and here, its hard for me to gain an idea of how long I probably can survive with reasonable quality. (Of course, the longer you can go, the higher the chance that a radical new medical technology will come along)

  8. #8
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    Great idea from mkane09 to get scanned and find out more before deciding which one to go with.
    PSAs: 4.76 (May '12) 4.23 (August '12) 3.98 (October '12) 4.9 (February '13) 2.9 (June '13) 2.7 (Nov. '13) 1.31 (March 2014) 1.07 (July 2014)
    Biopsy right prostate: Benign tissue
    Biopsy left prostate: Prostatic adencarcinoma, Gleason score 7 (4+3), Tumor involves 2 of 10 cores and 5% of total tissue sampled, Positive for perineural invasion
    TRUS measured prostate volume 19.36 cc
    Stage T1c
    66 Pd-103 seeds implanted (March '13)

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    Can you have RP then radiation? Should you? I assume I can do HDT with either or both...

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    Quote Originally Posted by donelson View Post
    Can you have RP then radiation? Should you? I assume I can do HDT with either or both...
    Yes but if the probability of radiation after RP is high, like your case, why not just go for radiation, which is equal in cure rate? In addition, a number of studies indicated adjuvant HDT helps radiation patients but not surgery patients. Walsh's book had a page discussing that aspect too.

    Also, with an aggressive cancer, do not delay any further, pick your treatment and go, ASAP.

    Best of luck to you.
    PCa Dx at 65. PSA 2.5 in 2000, 8.4 in 6/09. Three negative biopsies in between. 6/10 PSA 10.7, biopsy 1 of 12 cores 5% cancer, Gleason 3+3
    CT, bone scans & MRI all negative
    Da Vinci 8/10; nerve sparing, catheter out in 7 days; no incontinence, no ED
    Post Op Pathology pT2N0Mx: organ confined; negative margins; lymph nodes & seminal vesicle not involved but PNI present; cancer extensive within prostate, multifocal G 3+3 and tertiary G 4+
    9/10, 12/10, 3/11, 6/11, 6/12, 6/13, 12/13 PSA <.1

  11. #11
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    If your doctors are willing to do it, do all three...Surgery, hormones, radiation....Surgery might get it all, but it will at least get 98% of it giving the follow-up radiation much less work to do...ADT for a year or two will make the radiation more effective..

    With G-9, you hit it as hard as you can with everything you have...
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5.

 
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