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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2004Father in law; gleason 5+5 PSA 18
My father in law had an elevated PSA reading of 18 at his last regular test about 6 weeks ago. two years ago it was 4 and one year ago it was 5 (but alas no advice to get further check up). He has had xrays and nuclear medicine scans to check for metastasis but that looked Ok. finally had the biopsy (had to come off his blood thinning tablets for a spell first) biopsy shows a gleason score of 5+5. Cancer in all 8 specimens i believe. This looks like a very serious situation from everythign i can read about prostate cancer, and clearly if it has gone outside the prostate itself then he should be put onto hormonal treatment and radiation therapy. Am i correct? we have been referred to another specialist but the appointment is feb 10th. i find this absurd when the cancer is clearly aggessive, so i guess tomorrow we start pushing for more rapid action. Any other advice the group can offer? I had no idea the result would be so serious, but i prsume there is still hope. he shows no signs of illness and in all respects we considered him as fit as a fiddle. Strong man, healthy history and 63 years old. My PSA was 20.7, my biopsy came back at 4+5 with about 20 samples. Bone Scan and MRI/MRSI negative, biopsy found extension into the seminal vesicles. I was immediately placed on Lupron. @ months later I started 5 weeks of 3D conformal EBRT followed by 2 High Dose Internal radiation treatments. That finished 1 3/4 years ago. MY PSA is now 0.03 and I am scheduled to go off of Lupron in March. Your father should be placed on HT as soon as possible. > My father in law had an elevated PSA reading of 18 at his last regular > test about 6 weeks ago. two years ago it was 4 and one year ago it was [quoted text clipped - 20 lines] > illness and in all respects we considered him as fit as a fiddle. > Strong man, healthy history and 63 years old. i agree with louis - there's absolutely no reason why he can't go on lupron right away. then let the lupron do it's job and shrink the tumors - then hit it with radiation. i at a lost as to why they are not acting on it faster knowing his gleason score and psa.....but that's me. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional > My father in law had an elevated PSA reading of 18 at his last regular > test about 6 weeks ago. two years ago it was 4 and one year ago it was [quoted text clipped - 15 lines] > 10th. i find this absurd when the cancer is clearly aggessive, so i > guess tomorrow we start pushing for more rapid action. I am not a physician, but it is my impression that even very aggressive forms of prostate cancer are relatively slow growing, in comparison to other cancers. That is why the usual kind of chemotherapy, which attacks rapidly growing cells, doesn't work very well. It would certainly seem advisable to start hormone suppressing therapy fairly soon, but a couple of weeks may not make any difference. Since the people here, including me, are not physicians, you should really check with medical experts about such matters. > Any other advice the group can offer? I had no idea the result would > be so serious, but i prsume there is still hope. he shows no signs of > illness and in all respects we considered him as fit as a fiddle. > Strong man, healthy history and 63 years old. > > My father in law had an elevated PSA reading of 18 at his last regular > > test about 6 weeks ago. two years ago it was 4 and one year ago it was [quoted text clipped - 25 lines] > Since the people here, including me, are not physicians, you should > really check with medical experts about such matters. It's true that it is slow growing. But there must be some specific point when the first distant metastasis establishes itself, after which the disease becomes terminal. I agree with the alarmists. Why not at least start HT immediately. One of the awful problems of medical treatment is that it is done at the leisure of the medical establishment. If they have a reason to consider something not an emergency, then it's okay to not worry about it for two weeks. Why should they worry? Nothing bad will happen to them. Me, I'd be worried. The usual procedure is to start Casodex or equivalent anti-androgen pills to immediately suppress testosterone. Then in a week, get an injection of Lupron or equivalent for long range hormone suppression. Radiation would follow some time after that. >Subject: Re: Father in law; gleason 5+5 PSA 18 >From: "Alan Meyer" ameyer2@yahoo.com [quoted text clipped - 49 lines] > >Radiation would follow some time after that. The doubling time is about 9(nine) months, and if there are any mets they are not yet large enough to be visible on the scan. Radiation to the prostate and bed might get what is there. The hormones may make the cancer more susceptable to the radiation. Lupron causes a testosterone surge before it causes the testosterone to drop below castrate levels. The Casodex is used to block the PCa's use of testosterone until the surge is gone. I used Casodex and Proscar for 18 months before anyone told me to stop... long after the PSA had dropped to below 0.5 First, he needs to read Dr. Patrick Walsh's Guide to Surviving Prostate Cancer. If you are helping him in his decisions, you should read it too. I will give you a small blurb on what you will find it the book. The biopsy results are extremely serious. 5+5 is as high as it gets for Gleason. However, PSA 18 isn't all that far afield. Mine was 16 and I'm still here. If the nuclear med scan was a bone scan and if it was negative, he might have dodged that bullet... at least for now. With a 5+5=10 Gleason, I suspect that a prostatectomy is not going to be offered him as a viable solution. Given that, I suspect that a combination of radiation treatment (RT) and hormone treatment (HT) will indeed be offered. RT will reduce to a negligible amount the PCa in his prostate and prostate bed. HT will ordinarily reduce almost all PCa cells in his body. HT will often work for a few years then go "refractive". Then more aggressive treatments will be needed. I am very sorry for you and your father and the rest of your family. This is a bitter pill to swallow for everyone involved.  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 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 > My father in law had an elevated PSA reading of 18 at his last regular > test about 6 weeks ago. two years ago it was 4 and one year ago it was [quoted text clipped - 20 lines] > illness and in all respects we considered him as fit as a fiddle. > Strong man, healthy history and 63 years old. > RT will reduce to a negligible amount the PCa in his prostate and prostate > bed. HT will ordinarily reduce almost all PCa cells in his body. HT will [quoted text clipped - 3 lines] > I am very sorry for you and your father and the rest of your family. This > is a bitter pill to swallow for everyone involved. It may not be necessary to swallow the pill yet. With no evidence of metastasis, it's possible that the disease has not spread and can still be cured with radiation. That's why I urge Clive to get his father-in-law on HT ASAP. That will slow or temporarily stop the progression of the disease and give everyone some time to work out a treatment plan. Alan Forgive me if I came across that this was a fatal scenario. The "bitter pill" that I meant was the cancer, not impending, iminant, or otherwise irreversible death. Clive: I hope to clarify. With modern medicine, you father has an excellent outlook for years of living and a good to fair outlook to see 70. Other than that, we all wait for a cure that might come in 5-10 years. 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 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 > > > RT will reduce to a negligible amount the PCa in his prostate and prostate [quoted text clipped - 14 lines] > > Alan thanks for trying to reassure steve...i think i understood your language....but i guess you have to be careful when emotions are running high. > Forgive me if I came across that this was a fatal scenario. The "bitter > pill" that I meant was the cancer, not impending, iminant, or otherwise [quoted text clipped - 24 lines] > > > > Alan Thanks Alan and others We've been working the phones and using connections to find an alernative specialist. We think we are going to get something tomorrow. Lets hope we can get him on some form of treatement asap. thanks for your time in responding. > > RT will reduce to a negligible amount the PCa in his prostate and prostate > > bed. HT will ordinarily reduce almost all PCa cells in his body. HT will [quoted text clipped - 13 lines] > > Alan Where do you live? Here's my Uro: Dr. Douglas Dahl, Massachusetts General Hospital 617-726-0875. I'm sure Lisa (Dr. Dahl's assistant) will help you find a good person for your Dad wherever you live. Say Hi to her for me. -john > Thanks Alan and others > [quoted text clipped - 24 lines] > > > > Alan Hi, I am sorry to hear about the results.It is a shock and that's why 2nd.opinions and info gathering are so important.The first suspect I have is usually hmo slowness and wastefulness.There is a MAGIC word to use with HMOS it's called FIDUCIARY as in a fiduciary duty,works wonders.On a less angry note is the possibility that they are not being clear.My uro-surgeon the dinosaur,opted for RP w/a Gof 3+4 that turned into 4=3,less serious than your dad's but I am not a dr. and anything that breaks out is serious, anyway my doc insisted we wait 3weeks plus for a clear surgical field.Seems like biopsies do damage themselves and surgeons need clearing to operate although again the high of 5and 5 make make this piece moot for RP.God Bless. thanks everybody just to be clear, we are in sydney australia. We fortunately (unfortunately?) have a geat network of specialists in various disciplines, as my wife has had a lot of medical challenges hereself, over the last couple of years, and we are well covered with private insurance. So we've leveraged friendships with various doctors and their one degree of separation with the appropriate specialists. .... result? after working the phones we've got an appointemtn with someone we know to be a very well respected expert in the field, and the appointment's on Monday next week, so only two days to wait. i'll keep you informed. > Hi, I am sorry to hear about the results.It is a shock and that's why > 2nd.opinions and info gathering are so important.The first suspect I have is [quoted text clipped - 8 lines] > clearing to operate although again the high of 5and 5 make make this piece moot > for RP.God Bless. I am 43 years old and was diagnosed with prostate cancer in mid November 2003. My PSA was only 5.4 & the urologists were treating me unsuccessfully for prostatitis and an obstructed urinary tract. I had to have a catheter put in in order to function. It was only by my insisting that they do the biopsy that my cancer was found. The doctors were flabbergasted when the results came back as they were just humoring me because they felt I was being paranoid. The Gleason score came back 5+4 and all twelve biopsy samples were totally cancerous. He immediately started me on monthly lupron injections and casodex tablets daily. Then came the CAT scan and the bone scan, neither of which showed any detectable metastasis outside of the prostate area. Next I met with three specialists at Duke University Hospital; an urologist, oncologist, and radiation oncologist. They determined my cancer is inoperable and my best treatment option is to continue the hormone therapy for three years and have eight weeks of targeted radiation after three months of the hormone therapy. Seed Implant Radiation Therapy is not recommended for cancer this advanced. There was some discussion of a round of more traditional chemotherapy following the hormone therapy as a prophylactic measure as opposed to waiting for the cancer to recur metastatic, but no firm conclusion as there is no clinical evidence as yet determining if there is any benefit. Clinical trials are still being done. Then I met with the local radiation oncologist and set up the radiation therapy schedule at the local hospital after he consulted with the Duke doctors. After two months of the hormone therapy I noticed a difference in how the prostate area felt (especially when sitting on a firm surface) and asked the urologist if the catheter could come out. He seriously doubted it but said it certainly wouldn't hurt to try. I've now been free of the catheter for a week and a half. The first couple of days I had serious doubts as to whether I was going to leave it our as I had NO bladder control whatsoever. With the aid of Ditropan XL I was able to retrain my bladder with pretty good and have had no "accidents" after the third day. I still wear the Depends undergarments when I know I will be away from convenient restrooms but have been lucky so far and only had a couple of close calls. I start the radiation on March 20, 2004. I am somewhat concerned about the possibility of radiation damage to the nerves responsible for erectile function, but those chances are considerably less than they are for a radical prostatectomy. I suspect that your father-in-law's treatment will be similar sans catheter. Hormone treatment in conjunction with radiation therapy is the current state-of-the-art. I was offered two forms of radiation. The more traditional targeted radiotherapy and new high-yield rod that is implanted for twelve hours and then removed, followed by a short series of targeted radiation. The down-side to that is you basically have to be isolated for a couple of weeks afterwords and cannot be around children as you are radioactively contaminated. I chose the more traditional approach since the other option left me feeling "dirty" (pun intended). I don't see that the delay in starting the hormones should be of any concern, but I'm not a professional. I am, however, glad my urologist took the aggressive approach and started me on them immediately. I've been really lucky so far with the hormone treatments. The only side-effect I have noticed is hot flashes. I still have to make sure I get extra calcium because long-term hormone therapy can cause calcium depletion and osteoporosis. Dr. Walsh's Guide to Surviving Prostate Cancer is indeed an excellent resource. He's one of the nation's foremost authorities on the subject. Another good book is "Prostate & Cancer: A Family Guide to Diagnosis, Treatment, & Survival" by Sheldon Marks, MD. Both of these books can be found on half.com or ebay.com for considerably less than the bookstore price (I never pay retail price if I can help it). Here is a wonderful web site where one man tells of his experiences living with prostate cancer: http://tinyurl.com/2wcnv Good luck to your family. Be part of a good support system for your father-in-law. Encourage him to talk about his experiences and keep a daily journal. Seek out a local prostate cancer support group and go with him. Help him to keep his faith and his sense of humor. Encourage him to get his church involved and pray for him. If he becomes depressed, encourage him to talk to his doctor about his depression. Two key words for your entire family and friends: Encourage and Support. Kenny Ellenburg Stanly County, NC > First, he needs to read Dr. Patrick Walsh's Guide to Surviving Prostate > Cancer. If you are helping him in his decisions, you should read it too. I [quoted text clipped - 42 lines] > > illness and in all respects we considered him as fit as a fiddle. > > Strong man, healthy history and 63 years old. > I am 43 years old and was diagnosed with prostate cancer in mid > November 2003. My PSA was only 5.4 & the urologists were treating me [quoted text clipped - 5 lines] > score came back 5+4 and all twelve biopsy samples were totally > cancerous. It is amazing to me that urologists can still be missing PCa. I guess it's not as exacting as it seems. It sounds like you have done a considerable bit of research which, I don't have to tell you, is your best defense to this disease. Welcome to the NG. 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 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 BAD NEWS ...well we've seen the radiation oncologist and gotten onto a program of lupron followed by the external beam therapy in six weeks or so. happy about that. the big worry is that the radiation specialist told us to get another PSA test so that we could use that as a new baseline immediately before starting the lupron. well we've just heard its up to 53, and we are devastated by the rapid ascent. anyone have any comment. Is this as grave as it sounds? > > I am 43 years old and was diagnosed with prostate cancer in mid > > November 2003. My PSA was only 5.4 & the urologists were treating me [quoted text clipped - 13 lines] > > Welcome to the NG. hi - the psa numbers are as grave as they sound. i wish i could sugar coat it, but this situation is such as to not afford that luxury. a 53 is a 53. the only thing you can do is hope that the test was done wrong. if it comes back higher, then you also know that the diagnosis of a gleason of 10 was correct and to act accordingly. talking in the positive, the good news is that it is still caught somewhat early. by catching it like this has added years to his life. and these years, i might add are quality years. he's in good health and will still enjoy the good health. the lupron along with the radiation should drop his psa is <.1 in short order and that's also a good sign. i'm not a doctor, but that is the way it normally goes, so you will know what to look for. also, it should be brought out that a gleason of 10 is total cell breakdown and the amount of psa being produced is not as much as a prostate cell with cancer, because the cell structure is so damaged, it can't produce the psa in that amount. so if the number is up as fast as has been indicated, then there are a lot more prostate cancer cells and they have amass in number to give the rise. i hope this makes sense so far. the lupron will starve them and put them to sleep which is why he was have a good quality of life. there are two type of prostate cancers cell. those that are affected by the lupron and those that aren't the ones that are not, usually are slow growing, which also is a good sign. look for and see if you can get him into a clinical trial. all the best, ~ curtis knowledge is power - growing old is mandatory - growing wise is optional Curtis thanks for the response. i'm not sure i followed your flow in terms of the production of the psa. > hi - the psa numbers are as grave as they sound. i wish i could sugar > coat it, but this situation is such as to not afford that luxury. [quoted text clipped - 32 lines] > > knowledge is power - growing old is mandatory - growing wise is optional hi clive - this is going to be a simplified response on the explanation of this. cancer cells did not die off as regular cells, that is the problem with cancer. now, since they reproduce because they are hormone driven, then that presents a problem. the more psa available, the faster they reproduce. the psa test measures the amount of psa in the blood. since there are more of them, a higher level of psa than normal. but as the prostate cell structure is damaged, then it can not produce the same amount of psa - per cell - as it has done in the past. the more damage is done to the cell structure, the less psa is being produced. when you get to the extreme cell structure damage almost no psa is being produced per cell that is cancerous. now, using a psa test as a guideline, one may be able to see why they say the prostate cancer was upgraded on the path report as compared to before the surgery. if i person has a gleason of 5, then chances are a better representation of cancer growth, but as that number rises, then, it turns into more and more a crystal ball effect. since we are talking about a gleason of 10 - the maximum. my question back to you would be, "how predictable would the level of psa be, if very little psa per cancer cell is being made? also, look at how much damage could be done to the human body without tripping any alarms because of excessive psa level until it is too late. and also how great is the prostate cancer inside the body?" as anyone in the newsgroup can tell you, the higher the number, the more surprises can happen. it would be nice if one doesn't have these surprises, but it happens. to prove my point, and maybe someone else can chime in on this. take two cases - both of them are a gleason of 7. one is a gleason of 3 + 4, and the other is 4 + 3. the psa level is the same for both them. are the cancer equally as aggressive? i hope that explained what i was trying to say. ~ curtis knowledge is power - growing old is mandatory - growing wise is optional >Subject: Re: Father in law; gleason 5+5 PSA 18 >From: PALMER_ENT@webtv.net (c palmer) [quoted text clipped - 46 lines] > >~ curtis Just a clarification- psa does NOT produce or feed PCa, that is done by testosterone. We almost never see Gleason 10 that is not associated with large PSA scores, but you are right that the actual number of PCa cells may be much higher than suggested by the PSA number if the Gleason score is 10. The relationship is not as linear as when the Gleason is only 5 or so. Of course, the Gleason score is old history after RRP, since the prostate ain't there anymore. Biopsy on mets is rarely done. Clive, It's way too early to get terribly excited about this. After a month or two of Lupron, the PSA will likely be undetectable. None of what you've told us is a good sign, but Lupron will take care of all that for awhile. 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 PSA .1 .1 .1 .3 .4 .8 EBRT 05-07/2002 @ 47 PSA .3 .2 .2 .2 .3 Erection 05/12/2003 @ 48 HTbegins 07/21/2003 @ 48 PSA .1 Lupron 7/03, 8/03, 12/03 > BAD NEWS ...well we've seen the radiation oncologist and gotten onto a > program of lupron followed by the external beam therapy in six weeks [quoted text clipped - 24 lines] > > > > Welcome to the NG. BAD NEWS ...well we've seen the radiation oncologist and gotten onto a program of lupron followed by the external beam therapy in six weeks or so. happy about that. the big worry is that the radiation specialist told us to get another PSA test so that we could use that as a new baseline immediately before starting the lupron. well we've just heard its up to 53, and we are devastated by the rapid ascent. anyone have any comment. Is this as grave as it sounds? > > I am 43 years old and was diagnosed with prostate cancer in mid > > November 2003. My PSA was only 5.4 & the urologists were treating me [quoted text clipped - 13 lines] > > Welcome to the NG. >Subject: Re: Father in law; gleason 5+5 PSA 18 >From: croberts2@mac.com (Clive R) [quoted text clipped - 11 lines] >well we've just heard its up to 53, and we are devastated by the rapid >ascent. anyone have any comment. Is this as grave as it sounds? Lupron causes a testosterone surge and consequent increase in PSA if something like Casodex is not used for a while to block PCa absorbtion and use of that extra testosterone. I don't know how long the surge lasts. But still, a PSA of 53 seems a bit high even for that. danny he had the blood test, then the lupron injection and then got the blood test result....so the lupron wouldn'tt have had any impact on htis > >Subject: Re: Father in law; gleason 5+5 PSA 18 > >From: croberts2@mac.com (Clive R) [quoted text clipped - 16 lines] > extra testosterone. I don't know how long the surge lasts. But still, a PSA > of 53 seems a bit high even for that. |
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