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 3 123 LastLast
Results 1 to 10 of 26

Thread: Pathology report for Biopsy shows Gleason 10. Any advice?

  1. #1
    Newbie New User
    Join Date
    Jul 2019
    Posts
    5

    Pathology report for Biopsy shows Gleason 10. Any advice?

    Just got path report back from biopsy. All cores Show Gleason 10 rating. 1 spot shows suspicion of extraprostatic extension. Comments indicate tumor shows no perineural invasion. PSAs shows r value 97.20. I have all the bone scans, ct’s, etc. scheduled for Monday. I am age 52. PSAs from 2 years ago was 4.2. One year ago 4.6. 1 month ago 10.2. I am currently reading Dr. Walsh’s book and have found out how incredibly ignorant I was regarding this issue. My thoughts thus far based on Dr. Walsh’s book is this is really really bad. However, Dr. Walsh appears to give hope for no matter your current situation. Does anybody have any words of advice or encouragement for me moving forward?

  2. #2
    Senior User
    Join Date
    Jun 2014
    Posts
    122

    Keep your chin up...

    Quote Originally Posted by Jessew View Post
    Just got path report back from biopsy. All cores Show Gleason 10 rating. 1 spot shows suspicion of extraprostatic extension. Comments indicate tumor shows no perineural invasion. PSAs shows r value 97.20. I have all the bone scans, ct’s, etc. scheduled for Monday. I am age 52. PSAs from 2 years ago was 4.2. One year ago 4.6. 1 month ago 10.2. I am currently reading Dr. Walsh’s book and have found out how incredibly ignorant I was regarding this issue. My thoughts thus far based on Dr. Walsh’s book is this is really really bad. However, Dr. Walsh appears to give hope for no matter your current situation. Does anybody have any words of advice or encouragement for me moving forward?
    ...although a Gleason 10 is not the news you want, focus on some of the other points in your pathology report: no perineural invasion is good news. suspicion of extraprostatic invasion tells me it's not for sure so even if it is confirmed it is at the beginning stage and so can still be resected with wide margins. The key will be the CT scans. If those are negative, I believe surgery can offer a cure....
    I know how hard the waiting is....but hang in there until you have all the details and then your doctors will be able to provide you with the best treatment options possible for you case....

    We are all here for you, keep us in the loop.

    Best of luck with the next steps....
    Dad's stats:
    Biopsy: 2/13 cores positive(+DRE)
    G both positive cores4+4)+8.
    Adenacarcinoma(acinar)
    Lymph/vascular or perineural invasion:not identified.
    Pelvic ultrasound:unremarkable.
    Transrectal ultrasound: 9mm tumor left lateral peripheral zone. contact with capusle is about 7mm
    No definite ECE noted
    Seminal vesicals: normal
    Jun30/2014 clear CT scan
    Aug21/2014 clear bone scan
    30Sep2014: open radical prostatectomy
    Post-op Path Oct 9/2014:
    G:4+3=7 (mostly4);left pelvic lymph nodeN0
    surgical margins: all negative
    perineural invasion: present
    vascular/lymphatic invasion & seminal vesicles: not identified
    ECE:established,extensive, left posterior aspect (pT3a)
    % prostate involved by tumor: 5%
    Distant metastisis: not applicable
    19Nov2014, 3Feb2015, Sep2015: ≤ 0.01
    2017:PSA rising: 0.015, 0.027, 0.040, 0.044
    35 sessions SRT completed Dec2017
    PSA dropping post SRT: 0.024 (5wks), 0.009 (3months), ≤ 0.008 (sep201, ≤ 0.008 (Mar2019)

  3. #3
    Hi and Welcome to the Forum, Jesse!! We were all shocked by our prostate-cancer diagnosis. I know first hand what it is like to have a biopsy return with Gleason 10. Doctors today have an arsenal of treatments for PCa at any stage. First things first. You will learn to relax, take one step at a time, and not get ahead of yourself. There is a good chance your cancer can be controlled for a long time!

    One decision that you and your docs will make after the imaging results is decide what treatment or combination of treatments is best for you. This could involve surgery followed by some type of radiation, or radiation plus hormone therapy. Or perhaps some treatment before surgery (called neoadjuvant); or perhaps just surgery or radiation and hormone therapy. This is all based in part on whether your cancer has spread out from the prostate and, if so, where else it is. For very advanced metasatic cancer doctors hold in reserve chemo- and immunotherapy.

    The Walsh book is an excellent overview. Peruse and search this forum for other threads that pertain to your situation, and post questions as you have them. There is a "Sticky Post" near the top of the main page ("How to list my stats...") with instructions on creating a signature file that will be appended to all your posts. That will save you from repeating info and help Forum Brothers focus their replies to your situation. There is also a Subforum near the top of the main page with abstracts from medical journals arranged by topic. As you learn more about your particular cancer, you'll probably want to read more about treatment options and outcomes.

    One suggestion is that since your case is serious, look into transferring your treatment to a Center of Excellence for prostate cancer near you, if you aren't currently at one. That way you are ensured of access to the best current knowledge and treatments.

    All the best,

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3 -
    7-05-13 TURP (90→30 g) path neg. then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE BNI LVI SVI LNI(16): negative, PNI+, nerves spared
    pT2c pN0 pMX acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5x5x4 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 wk) PSA <0.1
    LabCorp uPSA, Roche ECLIA:
    11-28-17 (3 m ) 0.010
    02-26-18 (6 m ) 0.009
    05-30-18 (9 m ) 0.007
    08-27-18 (1 yr.) 0.018 (?)
    09-26-18 (13 m) 0.013 (30-day check)
    11-26-18 (15 m) 0.012
    02-25-19 (18 m) 0.015
    05-22-19 (21 m) 0.015
    08-28-19 (2 yr. ) 0.016
    Avg. = 0.013

  4. #4
    Dr. Walsh was the dean of pre-robotic surgery. His book is still the best for PCa fundamentals and what to expect from surgery. But, Walsh did not write the chapters on other treatments. A medical writer provided those.

    For a complete spectrum of all the current treatment options for prostate cancer, at any stage, I would recommend Dr. Mark Scholz' new book The Key to Prostate Cancer. Scholz interviewed 30 well-known prostate cancer experts, and presents their descriptions of the treatments that they provide for men at different risk levels. Scholz is probably the most prominent medical oncologist specializing in prostate cancer, and provides a balanced overview of each treatment modality.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA 4.4, fPSA 24, PHI 32
    Hopefully, I can remain untreated. So far, so good.

  5. #5
    Hi & Welcome Jessew! Glad that you have found The Forum and sorry that you have joined "The PCa Club!"

    A couple of questions:

    - Are you certain that the latest PSA is 97.2 and not 9.72?

    - Have you been on any kind of Testosterone supplementation in the last year? If so, be sure to let your URO MDs know.

    - In what city are you being treated?

    - Have your MDs advised to start Hormone Therapy (HT) to put the brakes on your PSA progression?

    I agree with Dj's recommendation regarding being treated at a "PCa Center of Excellence." If not already in such a setting, find the nearest academic teaching center and at least make an appointment for an immediate consultation. You need to be in a center with expert MDs who specialize in treating PCa and can provide the full spectrum of treatments and longitudinal care.

    The reality is: you need to proceed quickly. If your current MD(s) are not top experts who specialize in PCa, get them to refer you to the appropriate institution. There is only 1 opportunity to get this correct from the start.

    You are taking the right steps by learning about PCa. Good job!

    Keep asking questions and demand correct answers!

    Your objective is CURE. Seek expert MDs who will get you there! Move quickly!

    Keep us updated. And keep in mind that we are with you every step of "The Journey."

    MF
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  6. #6
    You definitely have a risky case here, no doubt about it. But there is still a decent chance that it is curable with Surgery and/or radiation as well as ADT. They will probably want to do surgery if the bone scans and that come back clear, unless you're really fat or there is another contraindication for surgery.

    Hopefully you'll be cured, but if you unfortunately aren't, you will probably still live for many, and perhaps many, many years. New treatments to extend life and treat PC are being developed all the time. Guys with PSA scores in the thousands to start have survived for decades. You can still buy green bananas with confidence
    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, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  7. #7
    Top User
    Join Date
    Aug 2016
    Posts
    1,687
    Stay focused. Stay with conventional medicine. Don't go into the weeds. This disease is treatable and managable with a long history of experience and understanding on how to treat it.

    If using testosterone for a non-medical use - stop -and tell your doctor.

  8. #8
    Newbie New User
    Join Date
    Jul 2019
    Posts
    5
    HI Michael. Thanks for your reply. Regarding your questions:

    A couple of questions:

    - Are you certain that the latest PSA is 97.2 and not 9.72?

    I was wondering about the latest psa as well. The path report states "Your value R97.20 elevated psa." However, the psa test from one month ago was 10.2. I'm thinking the 97.2 is a typo? Can it go from 10.2 to 97.2 in one month?

    - Have you been on any kind of Testosterone supplementation in the last year? If so, be sure to let your URO MDs know.

    I have never been on any kind of testosterone supplementation.

    - In what city are you being treated?

    I am being treated in Milwaukee WI at the Froedert Medical College I checked per suggestions, and fortunately it is a PCa Center of Excellence.

    - Have your MDs advised to start Hormone Therapy (HT) to put the brakes on your PSA progression? There has been no HT suggested or done to date. My first visit with a oncologist is next Tuesday. I'm thinking Hormone Therapy would be a good idea to start ASAP?



    Also to everyone else who replied-thanks for your advice and encouragement!

  9. #9
    Jessew! A couple of more questions regarding your latest reported PSA:

    - How did you get this result? A phone call / a patient portal / an email?

    - Have you discussed this result with your MD? What was his/her impression?

    - Where was the blood drawn? At a Lab or in the MDs Office

    - Do you have any idea where the blood was analyzed? It is common for a PSA to be drawn at a local Lab but then sent to a large regional lab for analysis.

    - Ask for a copy of The Original Lab Report. This will have all of the essential info including the result. You may have to work your way back upstream to get the original report. If your MD's office will not request it, then go to the Lab where it was drawn and speak to the Lab Supervisor. If they won't release it to you, instruct them to send a copy to your MD.

    - If the Original Lab Report states 97.2, ask to have another blood drawn for a PSA level.

    When results are reported over the phone or transcribed from a report or telephone call, it is very easy to misplace a decimal point.

    Very glad to learn that you are in the Medical College of WI System! Their multidisciplinary approach should cover all bases. Congrats!

    Stay Strong! You are going to get through this!

    MF
    Last edited by Michael F; 07-10-2019 at 07:36 PM.

  10. #10
    It would seem pretty unlikely for PSA to go from 10 to 97 in a single month. I suppose if you had the blood drawn right after the biopsy? Trauma to the urinary system can cause a temporary, astounding leap in PSA?

    But your PSA score is definitely not 9.72, as that would indicate they used an expensive ultra sensitive PSA test- which would be pointless before treatment.
    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, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

 

Similar Threads

  1. Replies: 13
    Last Post: 07-28-2017, 07:00 PM
  2. Biopsy for Prostate and PSA report shows some bad things.
    By prasanta_panda in forum Prostate Cancer Forum
    Replies: 16
    Last Post: 03-15-2016, 02:34 AM
  3. Pathology report, Gleason upgraded from 7 to 8
    By Samie in forum Prostate Cancer Forum
    Replies: 16
    Last Post: 01-21-2016, 09:53 PM
  4. PSA 38, Biopsy Shows Gleason 7
    By goatts in forum Prostate Cancer Forum
    Replies: 8
    Last Post: 02-28-2015, 07:00 PM
  5. Old 1974 pathology report after prostate biopsy
    By Otago in forum Prostate Cancer Forum
    Replies: 0
    Last Post: 11-10-2013, 07:49 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
  •