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Upgraded tumour in pathology report

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User
Posted 28 Jan 2023 at 10:06

My husband recently had his prostate removed, at biopsy we were told it was Gleason 7, 3+4 but the full pathology report found Gleason 9, 4+5 so he had a much more aggressive cancer than first thought. At first, I was just relieved he’d had it removed and even more so that his PSA is now undetectable, I’m so grateful for that but as time goes on I’m finding myself worrying more and more about the next test in just over 2 months time. How much more likely is a reoccurrence because of a Gleason 9 tumour? 
Probably this is a normal anxiety anyway no matter what grade the tumour has been?
Is there anyone else here whose tumour was upgraded? I’d love to hear your stories 

Thank you and good luck to you all 

User
Posted 29 Jan 2023 at 18:16

Just because the pathology stated G4+5 doesn't mean that every cell they looked at was 4+5 ... just that there were more 4s than anything else and then the second most common score was 5.

So imagine that there are 100 cell clusters under the microscope. 55 of them are pattern 4, 23 of them are pattern 5 and 22 are pattern 3 - that would be a G4+5. Let's say another 100 samples under the microscope from the biopsy, they were 55 at pattern 4, 30 at pattern 3 and 15 at pattern 5; a G4+3. Easy to see how Gleason can change post op?

Edited by member 29 Jan 2023 at 18:17  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jan 2023 at 13:19
If that tumour is all on a petrie dish in a hospital lab, it makes no difference whether it was a 7 or a 9. Try to put the thoughts away in a box; PSA anxiety will always be there for you so best to not let it spoil the times in between tests.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jan 2023 at 14:16

PSA testing anxiety is a thing that many of us get. My next test is Tuesday, my anxiety levels are currently through the roof. Keeping busy - music, walking and most importantly caring for my wife fills the void.

User
Posted 30 Jan 2023 at 08:55

PSA test anxiety is very real. No 4 test for us on Wednesday. I get anxious, my husband is a bit more laid back! As a few have said, you can’t change the outcome and in my opinion you have removed the source which I believe is always the best thing to do! Hang on in there and try not to worry too much (says she!). Best wishes x

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User
Posted 28 Jan 2023 at 13:19
If that tumour is all on a petrie dish in a hospital lab, it makes no difference whether it was a 7 or a 9. Try to put the thoughts away in a box; PSA anxiety will always be there for you so best to not let it spoil the times in between tests.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 28 Jan 2023 at 14:16

PSA testing anxiety is a thing that many of us get. My next test is Tuesday, my anxiety levels are currently through the roof. Keeping busy - music, walking and most importantly caring for my wife fills the void.

User
Posted 28 Jan 2023 at 14:33
PSA anxiety affects a lot of us on here. I'm okay between seeing my Oncologist and my next blood test but the few days between the blood test and subsequent result I'm ashamed to say I'm a complete wreck, total write off.🤢
User
Posted 28 Jan 2023 at 16:50

T, there is a line from a Tom Hanks film. 

- Aren't you worried?

- Would it help?

It doesn't help to worry so I don't , I just take my results in my stride. My latest rise was disappointing but I am focused on the next possible solutions.

Take care, thanks Chris.

 

User
Posted 28 Jan 2023 at 17:16
Where the Prostate is examined in the lab and Gleason differs from Pre op figures, it is more frequently upgraded than downgraded. However, if all the cancer is removed with the Prostate this is academic. Nevertheless,, there is the possibility that a few cancer cells have escaped and may establish themselves over time into a new tumour, hence the need for subsequent PSA tests over a considerable time after Prostatectomy, just in case.
Barry
User
Posted 28 Jan 2023 at 23:10

My husband was also upgraded post op from Gl. 4+3 to Gl. 4+5

As Lyn says if they got it all then the Gleason score won’t matter. I think I worry more as Rob’s cancer had already spread to one lymph node so I worry there will be micro mets hanging about at Gleason 9.

He is over 13 months post op now and has always had an undetectable PSA. His next one is due in just over a week and of course I’m already starting to worry. It is so normal though and I think everyone is the same. 

No reason why your husband shouldn’t be just fine. Best of luck to you both 

User
Posted 29 Jan 2023 at 06:43

I was upgraded too from Gleason 7 to 9.  I did require salvage radiotherapy and hormone therapy.  But my PSA since then has been <0.006, the lowest my hospital machine can measure. 

Try not to worry too much.

User
Posted 29 Jan 2023 at 12:04

Originally Posted by: Online Community Member

I was upgraded too from Gleason 7 to 9.  I did require salvage radiotherapy and hormone therapy.  But my PSA since then has been <0.006, the lowest my hospital machine can measure. 

Try not to worry too much.

 

You have done great Ulsterman, long may it continue.

Just a question, when you had your RARP did you have any lymph nodes removed because of your original N1 diagnosis?

Thanks

Elaine

User
Posted 29 Jan 2023 at 13:44

Originally Posted by: Online Community Member

I was upgraded too from Gleason 7 to 9.  I did require salvage radiotherapy and hormone therapy.  But my PSA since then has been <0.006, the lowest my hospital machine can measure. 

Try not to worry too much.

Also significant that your post-op pathology wasn't the best, Ulsterman, so your urologist was probably already mindful of the possibility of recurrence?  It would be useful to know from Tryingtokeep whether her husband's pathology was okay apart from the upgraded Gleason. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jan 2023 at 13:47

Originally Posted by: Online Community Member
I think I worry more as Rob’s cancer had already spread to one lymph node so I worry there will be micro mets hanging about at Gleason 9.

 

Just a thought, Elaine. Even if there are micromets lurking, they could be the 4+3s identified in biopsy rather than the 4+5s found in pathology. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jan 2023 at 14:01

Originally Posted by: Online Community Member

 

Just a thought, Elaine. Even if there are micromets lurking, they could be the 4+3s identified in biopsy rather than the 4+5s found in pathology. 



Thanks Lyn, never thought of it like that just always assumed they would be G9. I suppose there must have been some 3’s in there x

User
Posted 29 Jan 2023 at 18:16

Just because the pathology stated G4+5 doesn't mean that every cell they looked at was 4+5 ... just that there were more 4s than anything else and then the second most common score was 5.

So imagine that there are 100 cell clusters under the microscope. 55 of them are pattern 4, 23 of them are pattern 5 and 22 are pattern 3 - that would be a G4+5. Let's say another 100 samples under the microscope from the biopsy, they were 55 at pattern 4, 30 at pattern 3 and 15 at pattern 5; a G4+3. Easy to see how Gleason can change post op?

Edited by member 29 Jan 2023 at 18:17  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 29 Jan 2023 at 22:51

Elaine, I did have some lymph nodes removed but they were clear.

My original N1 was downgraded.

But a year later, two nodes were identified in my psma scan.   This widened my proposed SRT treatment field. 

As Lyn said, my pathology was pretty dire, so my Oncologist always suspected I'd need more than just a prostatectomy.

PSA result tomorrow....it's been a full year

. .

User
Posted 30 Jan 2023 at 08:52
Ulsterman - everything crossed 🤞
User
Posted 30 Jan 2023 at 08:55

PSA test anxiety is very real. No 4 test for us on Wednesday. I get anxious, my husband is a bit more laid back! As a few have said, you can’t change the outcome and in my opinion you have removed the source which I believe is always the best thing to do! Hang on in there and try not to worry too much (says she!). Best wishes x

User
Posted 30 Jan 2023 at 10:14

Originally Posted by: Online Community Member

Elaine, I did have some lymph nodes removed but they were clear.

My original N1 was downgraded.

But a year later, two nodes were identified in my psma scan.   This widened my proposed SRT treatment field. 

As Lyn said, my pathology was pretty dire, so my Oncologist always suspected I'd need more than just a prostatectomy.

PSA result tomorrow....it's been a full year

. .

Thanks Ulsterman for your response.

Wishing you the very best today for your PSA results.

 
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