A website to provide support for people who have or have had any type of cancer, for their caregivers and for their family members.
Page 1 of 5 123 ... LastLast
Results 1 to 10 of 46

Thread: New diagnosis - Gleason 9, psa 20

  1. #1
    Regular User
    Join Date
    Dec 2018
    Posts
    20

    New diagnosis - Gleason 9, psa 20

    My husband received result today from his biopsy. See above. I donít have a copy of the specifics yet. The doctor told us it is an aggresive cancer. He wants to do a bone scan and an MRI quickly. However, my husband developed an infection from the biopsy and is running 102-103 temp. Doc said he needs to clear up before tests can be done. If temp is not down by tomorrow, dr may put him in hospital to treat it.

    We are considering going to MD Anderson for assessment. Would appreciate any advice on

    a. Should we go ahead and do bone scan and mri before MD Anderson? It might be faster. Or, would it be better to wait and have MD Anderson do testing?

    b. Anyone had experience with aggressive prostate cancer and can share how you handled it?

    Really lost right now and just looking for some ideas for direction.
    Thanks so much.

  2. #2
    The purpose of the bone scan and MRI is to stage his disease. If there are no metastases detected on the bone scan- they can go to curative treatments such as surgery and radiation. PC generally spreads first to the bones.

    If the disease is determined curable, they usually wait a minimum of 6-8 weeks to do surgery. They have to wait for the prostate to simmer down after being biopsied.

    There is sufficient time to get the tests done before surgery, considering the mandatory waiting time.

    Radical Prostatectomy, whether done open or robot assisted, is one of the most technically challenging operations commonly done nowadays. There is really a lot to be said for going to a top academic medical center like MD Anderson, particularly if you are looking for treatment for a complex case like your husbands sounds like it is. MDA is definitely a good choice.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3

  3. #3
    Regular User
    Join Date
    Dec 2018
    Posts
    20
    Thank you. Your input is appreciated. I suppose the equipment used for the scan and mri would be comparable to MD Anderson? And they can read those results?

  4. #4
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    6,985
    Hi Garden,

    Welcome to the forum. We are sorry that his biopsy results turned out so disappointing.

    The key now is whether or not the cancer has had a chance to spread to the bones or abdominal organs. That is what the nuclear bone scan and abdominal scan is for.

    If the disease has NOT spread yet, then, as Southsider noted, they will look at curative treatment. This could be either surgery OR radiation, or a combination of both. Looks like things are leaning toward surgery at this point, but he should also consult with a top radiation oncologist who specializes in prostate cancer.

    Unless your local facility is a very busy, very large clinic, I would let MD Anderson handle all of that so that they can have a direct hand in every step of this process -- including having them giving a second opinion on the biopsy slides.

    Remember that if the disease is still confined to his prostate, it is very curable no matter how aggressive it is. While I tend to lean toward surgery because of certain advantages it brings, it is important to know that the cure rates between surgery and radiation are the same.

    Please let us know how things are going. Glad that you have joined us -- and now there are a LOT of people who are "in this" with you both.

    Take care,
    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.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  5. #5
    Top User
    Join Date
    Aug 2016
    Posts
    1,255
    Moving your care to a cancer center specializing in prostate cancer for a team approach makes sense.

    Prostate cancer is treatable. Not all prostate cancer is the same. You have a very serious case of an aggressive form with a head start that may require multidisciplines over an extended period of time.

    Once that decision is made let the new team perform their own tests and scans. Their expertise extends to both performing and interpreting the scans and tests. Surgeons, radiologists and medical oncologists will confer together for your husband's treatment.

    He will most likely be considered for all three. His fitness, age, general health, and extent of cancer and aggressiveness will determine if he is a candidate for starting with surgery. If it has progressed beyond surgery, or he is not fit for surgery, then radiation and hormone deprivation therapies (ADT) are used, and many options and combinations are available. Sorting them out and choosing the best for a specific case is an advantage to the team approach.

    Completing his signature will allow those here with similar experiences to comment. They are here and will support you.
    Last edited by Another; 12-01-2018 at 12:36 PM.

  6. #6
    Welcome to the Forum! I would only emphasize the excellent advice Another gave you to have a major cancer center take over your husband's care, scans and imaging included. A radiologist might see something immediately on an image and wants to take additional x-rays to resolve something equivocal, such as deciding whether a finding is an old bone injury or a recent metastasis (as in my case). After the evaluation is done the treatment options will be narrowed down for you by your docs. Keep us posted and we'll be happy to answer your questions.
    Last edited by DjinTonic; 12-01-2018 at 12:42 PM.
    69 yr at Dx, BPH x 20 yr, 9 (!) negative biopsies, PCA3 -
    2013 TURP (90→30 g) then PSA 2x/yr, DRE yearly
    6-06-17 DRE nodule R, last PSA rise, on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
    Bone scan, CTs, X-rays: negative
    8-7-17 Open RP, neg. frozen sections, Duke Regional, my Uro, 8-20 RPs/mo. x 25 yr.
    SM EPE LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0, bilat. adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
    11-10-17 Decipher 0.37 Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 weeks) PSA <0.1; Pomi-T (2 cap/day)
    LabCorp uPSA (Roche ECLIA):
    11-28-17 (3 mo. ) 0.010
    02-26-18 (6 mo. ) 0.009
    05-30-18 (9 mo. ) 0.007
    08-27-18 (1 year) 0.018
    09-26-18 (13 mo) 0.013 (checking rise)
    11-26-18 (15 mo) 0.012

  7. #7
    Regular User
    Join Date
    Dec 2018
    Posts
    20
    Wow! Your comments have been so supportive. I’ve discussed your responses with my husband and we are both appreciative. His fever is finally down this morning. We will contact MD Anderson and get him in as soon as possible. Your knowledge and willingness to share is a blessing. Thank you for your specific advice. Yes, it is good to have people who have an idea of what we are going through share with us. Will update you when we know something.

  8. #8
    Regular User
    Join Date
    Dec 2018
    Posts
    20
    Another, thank you for your comments and support. What do you mean by “completing your signature”? I would like all the support we can get!

  9. #9
    Top User
    Join Date
    Aug 2016
    Posts
    1,255
    See the sticky at the top of the forum page, "How to list your stats...."

    Your stats will be listed as your signature on each of your posts. Or, members can check your profile and see them. See other signatures to see how to do it succinctly. It helps us, but more importantly it helps you keep the salient facts front and center.

    There is a habit our mind has to focus on the facts that support denial or delay, the two demons of cancer. Your signature is in essence your medical chart. Keep it updated and front and center in all your considerations. It is purposefully limited in size to avoid hiding the facts among irrelevant stuff. It's a useful tool to aid you in beating this. You will continue to refine it as you learn what facts about yourself and the disease are the important ones in your choices as you move forward.
    Last edited by Another; 12-01-2018 at 02:25 PM.

  10. #10
    Quote Originally Posted by Garden View Post
    Thank you. Your input is appreciated. I suppose the equipment used for the scan and mri would be comparable to MD Anderson? And they can read those results?
    The equipment is likely to be the same, but the team is different, for consistency doing it all in one place has its advantages. BTW, X-rays are read-- MRI's are "interpreted".
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3

 

Similar Threads

  1. Great Article about Gleason 6, New Gleason Groups
    By HighlanderCFH in forum Prostate Cancer Forum
    Replies: 29
    Last Post: 08-14-2018, 08:45 PM
  2. 3T mpMRI missed ALL 3 of my Gleason 6 and One of my Gleason 7 hot spots
    By OldTiredSailor in forum Prostate Cancer Forum
    Replies: 4
    Last Post: 08-10-2018, 02:14 PM
  3. Replies: 13
    Last Post: 07-28-2017, 07:00 PM
  4. Replies: 4
    Last Post: 04-24-2015, 06:06 PM
  5. Gleason Scale - Who has Gleason 2 ???
    By Hawk in forum Prostate Cancer Forum
    Replies: 4
    Last Post: 01-30-2009, 10:54 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •