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doubling time and gleason

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User
Posted 02 Jun 2017 at 18:03
Hi folks

Simple question.....is doubling time largely related to the Gleason score?

Thanks

David

User
Posted 10 Mar 2018 at 20:00

Despite Lyns superior knowledge , I was told by my first Onco that DT remains mostly the same whether it is your original cancer or a recurrence after surgery or RT or HT or whatever. My DT has always been consistent at roughly 3 months with a G9 T4 PCa and is expected to be nearly 24 next week. No one would suspect I was I’ll at all. So if your DT is 5 yrs you could be 400 before you die of it. Sorry just being flippant. Just keep monitoring and make life choices based on research and latest developments. Many people just jump into life changing treatments that were only a 50/50 chance of cure at most yet go for it because it is a standard treatment plan offered. I’m so glad my Onco made it clear that in my case RT was probably not a chance for cure which is why I rejected it. My new Onco feels it was a good decision not to have it and save it for pain management later

User
Posted 07 Jun 2017 at 10:13

I was told doubling time roughly stays the same. My pre op doubling was 8 weeks. Wherever the cancer is now it is doubling ten weekly

User
Posted 01 Mar 2018 at 12:36

My original Onco said the doubling rate is normally consistent. Indeed mine has stayed at roughly 12 weeks since spotting it and throughout all treatments. However my new Onco is now looking for a significant change in velocity to highlight metasteses.

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User
Posted 02 Jun 2017 at 20:05

No - doubling time is linked to how quickly the cancer cells are multiplying. A G7 wth a doubling time of 3 months would be just as high risk as a G10 with 3 month doubling time.

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

User
Posted 02 Jun 2017 at 20:09

I'm no expert but the higher your Gleason score then generally the more aggressive your cancer is and hence its growth / replication. I am G9 and was psa 48 at surgery. My doubling time was roughly 8 weeks which is quite severe. Post op my doubling time was still 8 weeks. After one year of HT and then coming off it , my doubling time is now approx 10 weeks.

User
Posted 02 Jun 2017 at 20:13

Aggressive (or some medics prefer to use the term 'high risk') prostate cancer is defined by NICE as G8 or above, any individual G5 (whether that is in the two main elements or as a tertiary score such as G4+4 with tertiary 5) T3 or above and / or a doubling time of less than 6 months I think.

Edited by member 02 Jun 2017 at 20:18  | Reason: Not specified

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

User
Posted 07 Jun 2017 at 09:25

And does doubling time tend to stay roughly the same? In other words if doubling time was, say, a year when diagnosed, and followed up, is that the rate where it tends to stay?

David

User
Posted 07 Jun 2017 at 10:13

I was told doubling time roughly stays the same. My pre op doubling was 8 weeks. Wherever the cancer is now it is doubling ten weekly

User
Posted 07 Jun 2017 at 13:39

I think its quite difficult to answer and depends on the situation, if the PSA is entirely caused by cancer than maybe but pre op you just don't know.  My consultant told me doubling time / velocity isn't reliable and that I was a case in point.  I had no cancer in the end but my psa tripled in 7 months, PSA can rise for many reasons.  Score, staging and with surgery margins are more important from what I have read and understand.

User
Posted 07 Jun 2017 at 16:39

In some cases doubling time my be fairly constant or for at least a time but spread and mutation can cause this to change very significantly over time. Doubling time therefore becomes an important indicator for progression of the disease in many cases, although paradoxically the disease may still progress with a low PSA in some situations.

Barry
User
Posted 07 Jun 2017 at 20:49

Doubling time that is already short and then gets shorter and shorter is a very worrying indicator.

When dad's cancer came back his doubling time was 3 years and the urologist predicted that it would take 20 years to kill him. Within 2 years it was a dt of a year and now it is about 6 months which tells us that he is probably not going to have another 20 years unless he actually does something to slow it down.

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

User
Posted 08 Jun 2017 at 17:52

It's just that I'd always been told g8 or above is more aggressive ie. Grows quicker. Sounds like this may be wrong....

User
Posted 08 Jun 2017 at 20:18

Aggressive isn't always the right word. High risk is more precise.

G8 or more is high risk. Doubling time of 6 months or less is high risk. T2c or above is high risk.

G8 is more distorted and would often but not always grow quicker than a G6

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

User
Posted 09 Jun 2017 at 18:28

This sounds like Gleason is almost irrelevant. I mean, it's the rate of growth that kills isn't it? So If it's G8+ but slow doubling, and low G but fast doubling, the G isn't relevant?

User
Posted 09 Jun 2017 at 22:42

The Gleason score is relevant. For example, a man assessed with a Gleason of 3+3 if the cancer is contained may well be recommended the option of AS. It is much more unlikely that a man with a 4+4 or higher Gleason is going to be recommended AS which reflects the relative concern. Also, cancer cells can produce varying degrees of PSA as they develop and this can be influenced by treatment. I believe spread to be the most important aspect regardless of PSA or Gleason.

Barry
User
Posted 01 Mar 2018 at 12:05

Long time gap for me to come back to this!

I've been told, by a PCUK nurse today, that my doubling time before surgery should be about the same, later, if it happens at all. My cancer was diagnosed before and after surgery as G3+4 and, as such, it is not a particularly aggressive strain of cells, and that the DbTime before surgery was about 5 years should stay roughly the same afterwards. But hey, who knows. Some comments above suggest it can speed up....I wonder how often it changes, and how often it stays about the same. Crucial, of course, as to how progression happens.

Cheers everyone.

David

User
Posted 01 Mar 2018 at 12:36

My original Onco said the doubling rate is normally consistent. Indeed mine has stayed at roughly 12 weeks since spotting it and throughout all treatments. However my new Onco is now looking for a significant change in velocity to highlight metasteses.

User
Posted 01 Mar 2018 at 14:55

why am i high risk gleason 7 3+4 t3b no mo  been off zoladex  18 months,i have read people with higher gleason than me had surgery i didnt get a choice.

User
Posted 01 Mar 2018 at 21:50

Radar, regardless of your 3+4=7 Gleason, it is your staging that makes you not a good candidate for surgery. I was also a 3+4=7 but with 3TA and I was steered away from surgery by a surgeon reporting the MDT opinion. He introduced me to the RT department as he didn't think he could remove all the cancer but there was a chance that RT could eradicate it.

Barry
User
Posted 01 Mar 2018 at 23:53

I think there is a bit of confusion here David. Once you had RP, the issue of doubling time should be irrelevant as the PSA should be undetectable and therefore not increasing. Once you have a detectable PSA and therefore a biochemical recurrence, the doubling time is used to monitor how active the cancer is and thus whether or not action should be taken or whether treatment is failing. Doubling time in an incurable situation will therefore have nothing to do with whatever was going on with the PSA before the RP.

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

User
Posted 10 Mar 2018 at 18:22

Well my surgery has not cured me, and it seems neither has SRT, so doubling time will become very relevant. I know you can't get a true picture about doubling time until we get into whole numbers. But like I said, before surgery, my DT ie the growth of my cancer, appeared to work out at about 5 years. My onco yesterday said it is unusual for the aggressiveness to change radically from what it always has been. RP and SRT didn't get it all, so there has always been a bit of my original PSA 13 that escaped before treatments. Undetectable but actually a tiny amount which is now apparent at 0.11.

My only hope is the cancer that I have, and that was growing very slowly, will continue to grow very slowly, rather than speed up and need HT rather soon. I know it may change, but I have to be hopeful that at G7 it does not.

User
Posted 10 Mar 2018 at 19:50

Whilst we are discussing Gleason scores etc, I've have always been confused about Gleason scores, say if one was diagnosed with a Gleason score of 7 and one was to do nothing for years could it increase to say G9 or 10. The answer to this would help me understand my initial years.

I never bother with doubling time, too frightening to think of.

Stu

User
Posted 10 Mar 2018 at 20:00

Despite Lyns superior knowledge , I was told by my first Onco that DT remains mostly the same whether it is your original cancer or a recurrence after surgery or RT or HT or whatever. My DT has always been consistent at roughly 3 months with a G9 T4 PCa and is expected to be nearly 24 next week. No one would suspect I was I’ll at all. So if your DT is 5 yrs you could be 400 before you die of it. Sorry just being flippant. Just keep monitoring and make life choices based on research and latest developments. Many people just jump into life changing treatments that were only a 50/50 chance of cure at most yet go for it because it is a standard treatment plan offered. I’m so glad my Onco made it clear that in my case RT was probably not a chance for cure which is why I rejected it. My new Onco feels it was a good decision not to have it and save it for pain management later

 
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