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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2005Well - sh.t !!!!
My urologist just phoned with the laboratory results of the examination of the prostate and the edges. After the biopsy my Gleason score was 3+4=7. Now it is 4+3=7. The biopsy indicated that only about 5% of the prostate was involved with the cancer cells. Now, the indications are that about 25-30% is involved. He did state that he felt that there was no need for alternative treatments at this time and that "we" should wait until my initial post-op. PSA test around the end of April. Comments? Charlie. > My urologist just phoned with the laboratory results of the examination of > the prostate and the edges. [quoted text clipped - 8 lines] > > Comments? The PSA tests (and there will undoubtedly be a series of them) are the common method of checking on post-op status. If there's a PSA recurrence, which would not be evident for some time, salvage treatment would likely be radiation. But that's a local tx. It is imperative to inquire what the margin status is: positive or negative? That will indicate the likelihood of capsular penetration. The latter poses a risk of metastasis, but this does not necessarily follow. It might be helpful to do some reading at the website of the Prostate Cancer Research Foundation, http://prostate-cancer.org/index.html and the support group Us Too! Int'l, http://ustoo.com/ Regards, Steve J Stephen Jordan wrote...snip... > It is imperative to inquire what the margin status is: positive or > negative? That will indicate the likelihood of capsular penetration. Steve...It is my understanding that margin status and ECE are distinct events with different origins; I think they are called out separately on the path report...Best wishes and good health, Ron > Stephen Jordan wrote...snip... > [quoted text clipped - 4 lines] > events with different origins; I think they are called out separately > on the path report...Best wishes and good health, Ron Oops! You're right, of course. Back to the books. Mea culpa. Regards, Steve J What am I missing here? Sounds like the finding was "organ-confined." Mine was also found to be "extensive," but organ-confined. So what, it's gone now. jimhoney standard RRP age 52, cured, no significant aftereffects > My urologist just phoned with the laboratory results of the examination of > the prostate and the edges. [quoted text clipped - 10 lines] > > Charlie. Confinement, schminement. That chunk of Gleason 4 has been pumping nasty cells throughout Charlie's body for years. It can't be discounted just because the source is confined, and it changes the prognosis and thus may factor into threatment choices. I.P. > What am I missing here? Sounds like the finding was "organ-confined." > > Mine was also found to be "extensive," but organ-confined. So what, > it's gone now. > > > After the biopsy my Gleason score was 3+4=7. Now it is 4+3=7. >Confinement, schminement. That chunk of Gleason 4 has been pumping nasty >cells throughout Charlie's body for years. It can't be discounted just >because the source is confined, and it changes the prognosis and thus may >factor into threatment choices. > >I.P. Scary but true! I have 4 x G8 (4+4) just from the TRUS Biopsy and 2 of them are around 80%, with "poor differentiation", which in essence means the nasties are free to flow in the bloodstream. My Staging was lifted from a T2A to a T2C without intervention. The Rad Oncologist did it from the Biopsy report. As the needles sample 16mm at best, who knows what's where they didn't go? Entry PSA 21.0 ----- 6 wks 2.4 ----- 12 wks 0.45. Testosterone now below Castration levels! I'm on dual ADT, reduced to single ADT at 10 wks and up for EBRT March 27 for 23 doses over 5 wks then a spell of nearly 2 months before HDR Temp Brachytherapy, 3 fractions in 48 hrs, reverting to ADT for bal of 18 mths Dx'd Oct 2004 @ 69 yrs old. Also NIDD, OA, IBS, HT & overweight. -- Reader to complete... -- Please reply to this ng as my email adress is fake: -- Regards -- CC From: camcq@shaw.ca (Charlie) My urologist just phoned with the laboratory results of the examination of the prostate and the edges. After the biopsy my Gleason score was 3+4=7. Now it is 4+3=7. The biopsy indicated that only about 5% of the prostate was involved with the cancer cells. Now, the indications are that about 25-30% is involved. He did state that he felt that there was no need for alternative treatments at this time and that "we" should wait until my initial post-op. PSA test around the end of April. Comments? Charlie. ========= hi charlie - don't get upset. it's almost aways upgraded after the prostate hits the path table. this is because they can truly see what they are dealing with. take my case. T1c. sounds good, but path report said T2c. is it bad? no, organ confined. and if you were to have to have radiation later, you've still are in the curable stage. bottom line is - while the path report may not be the best, it could have been a lot, lot worse. i think it's about par. and your psa??? it should come back as undetectable. wish you the best. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional "Many more men die with prostate cancer than of it. Growing old is invariably fatal. Prostate cancer is only sometimes so." http://community.webtv.net/PALMER_ENT/doc c palmer wrote...snip... > it's almost aways upgraded after the prostate hits the path table Hi Curtis...A number of studies have been done on this subject and numbers do vary, but generally speaking, about 40-50% of biopsy GSs match those from post-RP pathology. Of the remainder, about 35% were initially undergraded and 15% overgraded. This suggests that having your biopsy slides read by a PCa expert can help close the gap...Best wishes and good health, Ron > From: camcq@shaw.ca (Charlie) > My urologist just phoned with the laboratory results of the examination [quoted text clipped - 13 lines] > > take my case. T1c. sounds good, but path report said T2c. T1c before surgery means the dcotor couldn't feel anything on digital rectal examination. After surgery, if there was cancer present, then the staging has to be at least pT2(something). (The 'p' stands for "pathological" and relfects the fact that it was done after surgery.) That is because the pathologist can now see where the cancer is. It will be pT2a if cancer is only in one lobe and pT2b or pT2c, depending on which classification scheme is being used, if the cancer is in both lobes. Going from T1 to pT2 doesn't mean the cancer was more serious than originally diagnosed. There is no such thing as a pT1c staging after surgery. > is it bad? > no, organ confined. [quoted text clipped - 14 lines] > invariably fatal. Prostate cancer is only sometimes so." > http://community.webtv.net/PALMER_ENT/doc ... > He did state that he felt that there was no need for > alternative treatments at this time and that "we" should wait > until my initial post-op. PSA test around the end of April. Charlie, Learning that your cancer was worse upon inspection than previously detected is very common. It seems that a lot of the people reporting pathology results after RP see the same thing. It doesn't mean that your treatment was inappropriate or ineffective or not the best one for you. It doesn't even mean that your diagnosis was badly done - just that it was done on the basis of less information than was available later when the entire prostate could be examined. As for further treatment, i.e., radiation, if it turns out you don't need it, then you are definitely better off without it as it does additional damage to the body. If it turns out that you do need it, many doctors like to wait until the damage done by the surgery is healed before they hit you again with more trauma. So many (my sense is, most) doctors would prescribe exactly the course that your doctor has prescribed - wait and see if the PSA rises before taking further action. Now, as to the subject line of your posting, what can I say? It's exactly what I think every day since I got this damned disease. Alan > My urologist just phoned with the laboratory results of the examination of > the prostate and the edges. > > After the biopsy my Gleason score was 3+4=7. Now it is 4+3=7. It is not unusual for the Gleason score to go up in this way. The pahtologist can examine the entire prostate. > The biopsy indicated that only about 5% of the prostate was involved with > the cancer cells. Now, the indications are that about 25-30% is involved. This is also not unusual, for the same reason. According to Walsh, on the average, pathology after surgery shows an average of 7 cancer sites within the prostate. > He did state that he felt that there was no need for alternative treatments > at this time and that "we" should wait until my initial post-op. PSA test > around the end of April. You didn't mention it, but if the cancer was contained within the prostate, that is the important news. It means you have an excellent chance of a complete cure. > Comments? > > Charlie. At this point, it merely means they found more cancer than they knew before and, obviously, more of the 'extra' cancer is Grade 4 than Grade 3. It's worse, but not terribly so. I would have expected your Stage to change too. Maybe to T2c. Did it? The most important parts of the reports are capsular penetration, organ confined, seminal vesicle involvement, lymph involvement. What were the results with those?  SignatureProstate Cancer Survivor (so far), not a doctor PSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron (1 mo) 07/21/2003 @ 48 PSA .07 .05 .06 Lupron (4 mo) 8/03 (48), 12/03, 4/04 (49), 09/04 (50) non Illegitimi carborundum > My urologist just phoned with the laboratory results of the examination of > the prostate and the edges. [quoted text clipped - 10 lines] > > Charlie. Finally became decatheterized today around noon. YAHOO !!!! It is now just after 7.00 PM and I've had a couple of major whizzes since than and no leakage. I guess one of the major checkpoints will be what happens overnight. Regarding the pathology report on my prostate. The report did indicate that about 25% of the prostate was cancerous, the Gleason score was amended to 4+3=7, and that the margin nearest the bladder was positive for cancer cells. None of that was really different from the earlier telephone call, other than it was the margin nearest the bladder that was positive. What really surprised me was the urologist's statement that if the results of my first post-op PSA blood test, and all subsequent tests, are less than .4 (point 4) then "we" are in reasonable shape. I had believed that the 'magic number' was .01? Time for a positive outlook and start working on my golf swing. Charlie. > Regarding the pathology report on my prostate. The report did indicate that > about 25% of the prostate was cancerous, the Gleason score was amended to > 4+3=7, and that the margin nearest the bladder was positive for cancer > cells. > What really > surprised me was the urologist's statement that if the results of my first > post-op PSA blood test, and all subsequent tests, are less than .4 (point 4) > then "we" are in reasonable shape. I had believed that the 'magic number' > was .01? The magic number, if indeed one exists, is 0.1 (point 1). Or, on ultra-sensitive tests, maybe .04 (ron knows more about those than I). I've heard of magic numbers including 4.0 for dx, 2.0 or 1.0 for salvage radiation, but never 0.4. on 2/21/2005 9:17 PM Charlie said the following: > None of that was really different from the earlier telephone call, other > than it was the margin nearest the bladder that was positive. What really > surprised me was the urologist's statement that if the results of my first > post-op PSA blood test, and all subsequent tests, are less than .4 (point 4) > then "we" are in reasonable shape. I had believed that the 'magic number' > was .01? I faced the same thing. Gleason 7=3+4 going in, Gleason 7=4+3 coming out. One positive margin and even that was questionable. Dr. Catalona suggested considering adjuvant radiation therapy after six months time to allow for healing. Forewarned of the possible side effects of same, I asked if we could conduct "watchful waiting" on the follow-up PSAs before moving to radiation, would the efficacy of the adjuvant radiation be as good as if we just started it at 6 months, and, finally, would he do that if HE were in my shoes. Yes, yes, yes and yes was his response. Had a bit of a bump up with the hyper-sensitive PSA they were using back then. Had a nice <0.03 on the first two and then scored a 0.07 on the third at 8 months post-op. Talk about a kick in the stomach (or lower). Called Dr. C immediately in panic mode. He calmed me down and said that was the trouble with the hyper-sensitive assays. They are too erratic (at least then) at the lowest levels. He told me to have another PSA test in 3 months and relax. He said that even if it subsequently rose again, he would not consider recommending further treatment until there was a clear and consistent pattern of increasing PSA and/or the PSA reached 1.0 or 100 times your 0.01 level. That was the only bump I saw. All the rest have come in at <0.03 or <0.1 which is the lowest the the current assay used by Dynacor labs (or whatever they're called now) goes. > Time for a positive outlook and start working on my golf swing. Damn straight, Charlie. It's already been a helluva winter. Enjoy all that follows! Bob RRP 03/16/2000 You're within pissing distance of 5 years. That's fantastic! SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3bN0M0 Seminal Vesicle involvement, Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05 PSA .07 .05 .06 .05 non Illegitimi carborundum > on 2/21/2005 9:17 PM Charlie said the following: > > None of that was really different from the earlier telephone call, other [quoted text clipped - 35 lines] > Bob > RRP 03/16/2000 > You're within pissing distance of 5 years. That's fantastic! Tell me about it. Best thing is that I CAN piss almost that far and can hold it until I WANT to let fly. Got a good feeling that I just might have beat this sucker.<g> I'm so close that when I had my last PSA test in October I actually forgot about getting the results for about two weeks. Suddenly dawned on my that I hadn't received them so, quite nonchalantly, I stopped by one afternoon to pick up my copy of the test results rather than have the office fax them to me. ;) Hopefully, many more here will have the same good fortune to be detected early and treated properly. Cured or not so cured, all of us that wear the "Been there, done that" T-shirt that nobody wants can help others along the path we're forced to take. Guess that's why so many of us "old-timers" (both young and old) stick around. Surely it isn't because of the refreshments. They suck! Bob |
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