Hi
My dad recieved a letter today with his Gleason score which is 4+3 =7 with 5 out of 5 cores and 40%diseased
And a Gleason score of 3+3=6 and 10% diseased, he has an emergency bone scan next Wednesday,
Does anyone have any info they could share on a Gleason score of 4+3=7 please it would be greatfully appreciated ?
Viv
X
Edited by member 04 Jun 2016 at 14:37
| Reason: Not specified
The only time you should look back is to see how far you have come
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My maths is fine - doubling time from first post-op PSA to next test was 3 months and if it had stayed at the same doubling rate this most recent test would have been 0.12 but it was only 0.09 so the growth rate has slowed from 100% increase (first 3 months) to 50% increase (2nd 3 months). Oncos and uros rebase at each test to calculate doubling time. I would agree with you if we were measuring something along a line or ruler - the rate of increase would be steady - but we are measuring replicating cells so the growth is in multiples rather than linear.
My instinct is that at these tiny numbers, doubling time is not necessarily reliable anyway - it could now flatten out I suppose.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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Hi,
Dad's Gleason score is not the worst..... ( 4+ 3 ) = 7 does indicate that there is more glandular fusion present suggestive of G4 than G3
( intermediate risk )
A score of ( 3+ 4) ) = 7 would suggest that there are more G3 cells present than G4 which would be slightly better in terms of how aggressive the cancer 'may' behave.
There are many things to take into account when the medics give a diagnosis... 40% volume would indicate that the disease has been present for some time on one side of the prostate..
The 10% volume and G6 (3+3) = on the other side would suggest that the disease is not so advanced on that side...
A clinical staging of T2c is not the end of the world... ( check out my profile )
I would think that the 'emergency bone scan' is merely normal procedure for the hospital dealing with dad and not to worry too much about it...
Dad has every chance of a successful outcome whatever treatment path he chooses..
Best wishes
Luther
Edited by member 23 May 2016 at 19:23
| Reason: Not specified
User
I know we have said this to you before but with a T2/T3 which the doctor believes has already breached the gland, it is important that dad doesn't set his heart on one treatment plan until he has full diagnostic results and has either seen an oncologist or has been reviewed by a multi-disciplinary team. He has seen a surgeon who of course will recommend his own specialism but there are questions your dad might need to ask such as "if it has already escaped out of the gland, what is the likelihood that I would need salvage RT/HT after the operation anyway?" There isn't often much benefit to having the op if they know beforehand that surgery isn't going to get it all. He will also want to know whether they can offer nerve-sparing or if the whole lot will be removed - that will make a difference to the likelihood of incontinence as well as impotence.
One of the best bits of advice we had after diagnosis was to delay the op and go for a nice holiday somewhere - if your dad has a partner then he might want to go away and have a last fling, so to speak.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Good to hear from you, Vivienne, but sorry that dad may be heading towards radiotherapy.
I had my prostatectomy 13 months ago and after very promising PSA results, it has been decided I should go for radiotherapy. I always knew this was a strong possibility, but it is still a disappointment. That said, even though I'm T3b and a Gleason 9 (4+5), my oncologist has said a 'cure' is still possible. So, I'll remain positive and face this next challenge head on. Me and your dad have everything still to fight for.
They're going to do a scan on me to see if they can get a more complete picture of what is going on and then they'll plan my radiotherapy based on that.
Best wishes to you and your dad.
Ulsterman
User
Hi Vivienne
My understanding is that as Dad's PSA is under 0.1 then he is still regarded as undetectable. The benchmark is normally 0.2 when salvage RT is considered. This was certainly so in my case but he needs to be guided by his team. If RT is used on it's own then they need to know where to target it so they might suggest HT as well if dad gets to the point of needing any salvage treatment and if they don't know where the cells are.
All the best to Dad.
Kevan
User
They tend to do adjuvant or salvage RT much earlier when they already know there were positive margins, Kevan. The NHS definition of biochemical recurrence after RP is a PSA over 0.2 or three successive rises over 0.1 but many hospitals would have given Vivienne’s dad adjuvant RT as soon as the lab report came back.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
V
My post op PSA was 0.03. 18 months post op my PSA had crept up to 0.05, everyone was optimistic it would remain below 0.1. My PSA still kept creeping up and 4 years after my RARP my PSA was 0.27 and I started 33 session of salvage RT. I had positive margins and extraprostatic extension.
Thanks Chris
User
If each of those results is a three month gap, then actually the rate of rise is slowing down which is a good thing - might be worth talking to the onco and then trying to get him to agree to one more PSA test just to make sure it is necessary. John would not accept that SRT was needed until he went up to 0.16 or something like that - fortunately, the uro and onco were okay with waiting for him to be convinced!
If RT is the way forward, you could ask on Friday whether SpaceOar might be available and whether it would help with the diverticulitis?
Edited by member 16 Apr 2018 at 23:47
| Reason: Not specified
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Oh dear, Lyn, amongst your many fine qualities is not mathematics. The rate of PSA growth is constant, an arithmetic progression with constant intervals. Only if you rebase the calculation at each step could it be said to be slowing down in percentage terms.
So, Vivienne, I suspect the onco will be guided by your dad's wishes but if I were he, I would not fear RT at this stage. Equally, the numbers are very low and another three months probably would not affect matters greatly. The oncos tend to look at PSA doubling time. In your dad's case, it is six months. I have had worse!
AC
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Hi Vivienne
This is not a definitive explanation but I hope it will alleviate some of your immediate anxiety. The Gleason score normally gives an indication of how aggressive the Pca is likely to be. The lowest score would be a 3+3=6 indicating that this a slow growing cancer. Most aggressive would 5+5=10.
So a 4+3 means that the majority of samples were just a moderate growth rate with a smaller amount being slow growing. This is not the total picture but I hope that it will help to put things into context a little bit for now. It simple terms the Gleason seems to be indicating that it is at the low end of the aggressive scale
Kind regards,
Kevan
User
Hi Kevan
Thank you very much for your comments it has helped me have a bit more understanding of what's the Gleason score is all about. It's not a great score but it's not the worst, I'll take that,
Take care
Viv
The only time you should look back is to see how far you have come
|
User
Hi,
Dad's Gleason score is not the worst..... ( 4+ 3 ) = 7 does indicate that there is more glandular fusion present suggestive of G4 than G3
( intermediate risk )
A score of ( 3+ 4) ) = 7 would suggest that there are more G3 cells present than G4 which would be slightly better in terms of how aggressive the cancer 'may' behave.
There are many things to take into account when the medics give a diagnosis... 40% volume would indicate that the disease has been present for some time on one side of the prostate..
The 10% volume and G6 (3+3) = on the other side would suggest that the disease is not so advanced on that side...
A clinical staging of T2c is not the end of the world... ( check out my profile )
I would think that the 'emergency bone scan' is merely normal procedure for the hospital dealing with dad and not to worry too much about it...
Dad has every chance of a successful outcome whatever treatment path he chooses..
Best wishes
Luther
Edited by member 23 May 2016 at 19:23
| Reason: Not specified
User
Thankyou for the info Luther, Very much appreciated, I think I'm starting to get my head around what the Gleason score is all about, Fingers crossed for the bone scan and MRI to come back clear, My dad is opting for surgery so the sooner we get scan results the better, Once again thank you
Take care
Viv
The only time you should look back is to see how far you have come
|
User
I know we have said this to you before but with a T2/T3 which the doctor believes has already breached the gland, it is important that dad doesn't set his heart on one treatment plan until he has full diagnostic results and has either seen an oncologist or has been reviewed by a multi-disciplinary team. He has seen a surgeon who of course will recommend his own specialism but there are questions your dad might need to ask such as "if it has already escaped out of the gland, what is the likelihood that I would need salvage RT/HT after the operation anyway?" There isn't often much benefit to having the op if they know beforehand that surgery isn't going to get it all. He will also want to know whether they can offer nerve-sparing or if the whole lot will be removed - that will make a difference to the likelihood of incontinence as well as impotence.
One of the best bits of advice we had after diagnosis was to delay the op and go for a nice holiday somewhere - if your dad has a partner then he might want to go away and have a last fling, so to speak.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Hi guys
It’s been a while since I’ve had anything significant to post regarding my dad since his R/P 18 months ago, Although I do check in on the site to see how you are all keeping,
My dads PSA has been undetectable since his operation but following today’s PSA results he has had a slight rise to 0.06 which the consultant had said could happen since my dads cancer had spread out of the capsule and he is to be tested in three months time and if he has another rise they have suggested R/T. So back on the cancer roller coaster we go after an 18 month break,
The only time you should look back is to see how far you have come
|
User
Good to hear from you, Vivienne, but sorry that dad may be heading towards radiotherapy.
I had my prostatectomy 13 months ago and after very promising PSA results, it has been decided I should go for radiotherapy. I always knew this was a strong possibility, but it is still a disappointment. That said, even though I'm T3b and a Gleason 9 (4+5), my oncologist has said a 'cure' is still possible. So, I'll remain positive and face this next challenge head on. Me and your dad have everything still to fight for.
They're going to do a scan on me to see if they can get a more complete picture of what is going on and then they'll plan my radiotherapy based on that.
Best wishes to you and your dad.
Ulsterman
User
Hi Ulsterman
Thanks for your reply, I keep my fingers crossed for my dad and yourself that radiotherapy will be successful. Keep us posted on how you get on, And you both defenitly have so much to fight for !!
Good luck with everything 👍🏼
Viv
X
The only time you should look back is to see how far you have come
|
User
Hi Vivienne
My understanding is that as Dad's PSA is under 0.1 then he is still regarded as undetectable. The benchmark is normally 0.2 when salvage RT is considered. This was certainly so in my case but he needs to be guided by his team. If RT is used on it's own then they need to know where to target it so they might suggest HT as well if dad gets to the point of needing any salvage treatment and if they don't know where the cells are.
All the best to Dad.
Kevan
User
They tend to do adjuvant or salvage RT much earlier when they already know there were positive margins, Kevan. The NHS definition of biochemical recurrence after RP is a PSA over 0.2 or three successive rises over 0.1 but many hospitals would have given Vivienne’s dad adjuvant RT as soon as the lab report came back.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Thanks Kevan and Lyn for your input, it’s much appreciated. My dads last PSA test 6 months ago was 0.03 (undetectable in the words of the consultant) and this one 0.06. These sensitive PSA tests got me worrying Arrgg !!
I thought 0.06 was still classed as undetectable, Guess I’m still learning about this disease eh
Thanks
Viv
X
The only time you should look back is to see how far you have come
|
User
V
My post op PSA was 0.03. 18 months post op my PSA had crept up to 0.05, everyone was optimistic it would remain below 0.1. My PSA still kept creeping up and 4 years after my RARP my PSA was 0.27 and I started 33 session of salvage RT. I had positive margins and extraprostatic extension.
Thanks Chris
User
Chris
Your numbers seem identical to my dads: We will now have to wait to see what his next PSA test will be in 3 months time
Thanks for your reply
Viv
X
The only time you should look back is to see how far you have come
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0.06 is classed as undetectable and many hospitals have stopped doing the ultra-sensitive PSAs since they were shown to be unreliable in lab tests. However, it may be that your dad's doctors are so clear about the positive margins that this rise is the excuse they need to persuade dad to swing into action. I have forgotten, did they offer him RT immediately which he declined or did the surgeon say 'let's monitor the PSA and then decide'?
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
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User
Lyn
My dads post op pathogly results were that he had clear margins ( so I Naively thought that they had got all the cancer out) So the rise in PSA was a concern
It was a joint decision by my dad and the team to go down the R/P route after diagnoses.
My dad was adamant to have surgery and the team didn’t seem to try to pursuade him to go down the R/T route
It’s now a waiting game......
Thanks
Viv
X
The only time you should look back is to see how far you have come
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Hi
My post op PSA was 0.06. Surgeon told me I had a 30% chance of recurrence. I asked for a referral to the oncologist to discuss the Radicals trial. My PSA rose to 0.087 within 5 months of my RP so the oncologist recommended adjuvant RT. However I did have a focal breech of the prostate which may have contributed to that clinical decision
Bri
User
Hi guys and girls
My dads PSA has been slowly rising from post op PSA of 0.03 then 0.06 and last weeks results were 0.09 so if the trend of it going up in 0.3’s continues would the next result be 0.12 ( it just sounds like a big jump) I sound really thick when I’ve read this back lol !!
He see’s the consultant on Friday to discuss salvage R/T
He has diverticulitis and was worried this may be a problem with having R/T although he isn’t having trouble with it at the moment. Does anyone have any experience of this please ?
Viv
X
The only time you should look back is to see how far you have come
|
User
If each of those results is a three month gap, then actually the rate of rise is slowing down which is a good thing - might be worth talking to the onco and then trying to get him to agree to one more PSA test just to make sure it is necessary. John would not accept that SRT was needed until he went up to 0.16 or something like that - fortunately, the uro and onco were okay with waiting for him to be convinced!
If RT is the way forward, you could ask on Friday whether SpaceOar might be available and whether it would help with the diverticulitis?
Edited by member 16 Apr 2018 at 23:47
| Reason: Not specified
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Thanks for the advice Lyn. I will try and pursuade my dad to wait another 3 month if the onco is all right with it, He’s only actually had 2 rises as the first one was his post op PSA, I thought it was 3 consecutive rises
Will definitely mention SpaceOar and see what they say
Thx
Viv x
The only time you should look back is to see how far you have come
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User
Oh dear, Lyn, amongst your many fine qualities is not mathematics. The rate of PSA growth is constant, an arithmetic progression with constant intervals. Only if you rebase the calculation at each step could it be said to be slowing down in percentage terms.
So, Vivienne, I suspect the onco will be guided by your dad's wishes but if I were he, I would not fear RT at this stage. Equally, the numbers are very low and another three months probably would not affect matters greatly. The oncos tend to look at PSA doubling time. In your dad's case, it is six months. I have had worse!
AC
User
My maths is fine - doubling time from first post-op PSA to next test was 3 months and if it had stayed at the same doubling rate this most recent test would have been 0.12 but it was only 0.09 so the growth rate has slowed from 100% increase (first 3 months) to 50% increase (2nd 3 months). Oncos and uros rebase at each test to calculate doubling time. I would agree with you if we were measuring something along a line or ruler - the rate of increase would be steady - but we are measuring replicating cells so the growth is in multiples rather than linear.
My instinct is that at these tiny numbers, doubling time is not necessarily reliable anyway - it could now flatten out I suppose.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
|
User
Hi Viv,
My OH has had a very similar path to your dad.
Psa 9, surgery in Dec 14 -, Gleason 5 plus 4 but clear margins. All well until May 16, when psa went from undetectable to 0.05 to 0.06 to 0.08 in six months.
Our surgeon decided that it would be sensible not to wait until it rose further, and my oh had radiotherapy 12 months ago.
He has had no bowel symptoms apart from a bit of urgency during and immediately after. However, his incontinence, which plagued him from the surgery but had significantly improved took a backward turn, and is now back to square one.
It’s not an easy disease, but he knows he’s luckier than some.