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Husband diagnosed this week

User
Posted 09 Dec 2018 at 10:13

Hi there

My hubby was diagnosed with prostate cancer this week.

He had PSA of 6.9 in September (aged 66). He was sent for a specialist MRI scan followed by a targeted biopsy under general

Of 17 samples 12 were clear the rest a mix of 6 and 7. He was given a Gleason score of 7 (3+4). He was told that it is localised.

The treatment options discussed were active surveillance, key hole surgery and radiotherapy

Initial thoughts are active surveillance and revisit every three months after PSA tests

Reading through posts on here today many mention bone scans. This has not been suggested in our case, is this because it is considered localised?

All very new so any views appreciated re choice of options etc

Thank you 

User
Posted 09 Dec 2018 at 13:36

MLG,

I can agree with Luther.

My hospital didn't suggest a bone scan as my PCa appears to be contained. Only a pathology report, of the surgically removed prostate, will confirm this.

Mri and biopsy give a good indication of the gleason and staging. However, after surgery, a percentage of cases are upgraded on pathology.  I think it's around 25%-30%.

This is something to consider in your decision making.

Neil.

 

User
Posted 09 Dec 2018 at 17:17

MLG

Just to confirm earlier note. The PDF document is worth a read.

Conclusions: Approximately one in three patients with Gleason 3 + 4 FIR harbored disease of higher grade or stage. Younger patients with low percentage PBC and PSA and cT1c disease have a lower risk and may be candidates for active surveillance. However, widely available clinical information is insufficient for predicting the risk of more advanced disease, and the development and incorporation of additional tools, including magnetic resonance imaging and genomic tests, are necessary.


Patient summary: Nearly one-third of patients with Gleason 3 + 4 favorable intermediate-risk prostate cancer harbor disease of higher grade or higher stage than their biopsy and clinical
examination suggest. These patients would therefore be poor candidates for active surveillance.
© 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

 

Link to pdf:

https://www.google.com/url?q=https://www.eu-focus.europeanurology.com/article/S2405-4569(17)30148-7/pdf&sa=U&ved=2ahUKEwiBiuidnpPfAhWQzqQKHUNACR0QFjAFegQIAhAB&usg=AOvVaw17HohHj4Z50QVx-DjgyZDX

 

Edited by member 09 Dec 2018 at 18:54  | Reason: Not specified

User
Posted 09 Dec 2018 at 18:36
If the people who have all the diagnostic info are saying that AS is an option, I would assume they have good reason for saying so. It may be that the element of G4 is a very small proportion of the cancerous material and/or the % in each core was very low.

At our hospital, a national centre of excellence in oncology and urology, men only get a bone scan if there is reason to suspect it is necessary. Seems barmy to me :-/

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

User
Posted 09 Dec 2018 at 18:49
How soon a man has treatment or stays on AS can be influenced by how well contained his cancer is. So this is worth inquiring about.

With a Gleason component of 3 the cancer has changed significantly less from normal cells than where Gleason 4 component cells have been identified. In this latter case the risk posed is higher, particularly as the percentage of Gleason 4 increases. Having said that, spread with a Gleason 3 has happened in a few cases. Whilst a man does not wish to rush into treatment and it's potential side effects unthinkingly, it is important that he is properly monitored on AS so as not to miss the best opportunity of curative treatment.should his situation change. Some men go with AS for as long as possible whilst others who are more risk averse will seek treatment immediately or much sooner.

Barry
User
Posted 09 Dec 2018 at 18:55

My husband was diagnosed via BUPA ( consultant surgeon works in the NHS as well). This was in December 2016.

He send my husband for a MpMRI scan which came back PIRAD 4 so he did a template biopsy which found a large volume of G6 (3+3) and did not think a bone scan was necessary.

My husband was offered same options:

AS

RP

RT

 

so no bone scan via the BUPA diagnostic pathway in our situation. 

 

Good luck with everything

Clare

 

 

Show Most Thanked Posts
User
Posted 09 Dec 2018 at 12:37

As we say to all newcomers here, order or download the ‘Toolkit’ information folder which is packed with information.

https://prostatecanceruk.org/prostate-information/our-publications/publications/tool-kit?_ga=2.51656809.1373981939.1543270425-27600520.1543270425

Cheers, John.

Edited by member 09 Dec 2018 at 12:39  | Reason: Not specified

User
Posted 09 Dec 2018 at 12:52

MLG

Some hospitals do not automatically carry out bone scans if the clinical staging and PSA levels are considered to be reasonably low... 

I've never had a bone scan and my consultant was confident that I didn't need one.... I wasn't so sure at the time...but he was proved to be right 

If active surveillance is an option on offer they must be pretty sure there is no spread to the bones ...

My post Da Vinci histology  was pT2c N0 Mx .....the Mx denoting that metastasis wasn't checked!  

Best Wishes 

Luther

 

User
Posted 09 Dec 2018 at 13:27

Thank you 😀

User
Posted 09 Dec 2018 at 13:29

Thank you, I was just intrigued as so much information was offered but I didn’t recall the bone scan

Much appreciated 😀

User
Posted 09 Dec 2018 at 13:36

MLG,

I can agree with Luther.

My hospital didn't suggest a bone scan as my PCa appears to be contained. Only a pathology report, of the surgically removed prostate, will confirm this.

Mri and biopsy give a good indication of the gleason and staging. However, after surgery, a percentage of cases are upgraded on pathology.  I think it's around 25%-30%.

This is something to consider in your decision making.

Neil.

 

User
Posted 09 Dec 2018 at 14:17
My PSA was a bit higher at 10.8 before treatment and I did have a bone scan (all clear). Mine was contained so little risk of spread but my urologist thought it was worth doing. My Gleason was 3+3. After a short while on A.S. rapidly rising PSA level resulted in my having to make a treatment choice, after advice on here and lots of deep thought I opted for Brachytherapy, it has gone well with only minor side effects so far, if it's not offered locally it might be worth moving out of area, I did and have not regretted it.

John

Gleason 6 = 3+3 PSA 8.8 P. volume 48 cc Left Cores 3/3, Volume = 20% PSA 10.8 Feb '19 PSA 1.2 

User
Posted 09 Dec 2018 at 14:33

Thank you that is a really useful angle 😀

User
Posted 09 Dec 2018 at 14:35

Thank you, we will talk to Team about that tomorrow 😀

User
Posted 09 Dec 2018 at 17:17

MLG

Just to confirm earlier note. The PDF document is worth a read.

Conclusions: Approximately one in three patients with Gleason 3 + 4 FIR harbored disease of higher grade or stage. Younger patients with low percentage PBC and PSA and cT1c disease have a lower risk and may be candidates for active surveillance. However, widely available clinical information is insufficient for predicting the risk of more advanced disease, and the development and incorporation of additional tools, including magnetic resonance imaging and genomic tests, are necessary.


Patient summary: Nearly one-third of patients with Gleason 3 + 4 favorable intermediate-risk prostate cancer harbor disease of higher grade or higher stage than their biopsy and clinical
examination suggest. These patients would therefore be poor candidates for active surveillance.
© 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

 

Link to pdf:

https://www.google.com/url?q=https://www.eu-focus.europeanurology.com/article/S2405-4569(17)30148-7/pdf&sa=U&ved=2ahUKEwiBiuidnpPfAhWQzqQKHUNACR0QFjAFegQIAhAB&usg=AOvVaw17HohHj4Z50QVx-DjgyZDX

 

Edited by member 09 Dec 2018 at 18:54  | Reason: Not specified

User
Posted 09 Dec 2018 at 18:36
If the people who have all the diagnostic info are saying that AS is an option, I would assume they have good reason for saying so. It may be that the element of G4 is a very small proportion of the cancerous material and/or the % in each core was very low.

At our hospital, a national centre of excellence in oncology and urology, men only get a bone scan if there is reason to suspect it is necessary. Seems barmy to me :-/

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

User
Posted 09 Dec 2018 at 18:49
How soon a man has treatment or stays on AS can be influenced by how well contained his cancer is. So this is worth inquiring about.

With a Gleason component of 3 the cancer has changed significantly less from normal cells than where Gleason 4 component cells have been identified. In this latter case the risk posed is higher, particularly as the percentage of Gleason 4 increases. Having said that, spread with a Gleason 3 has happened in a few cases. Whilst a man does not wish to rush into treatment and it's potential side effects unthinkingly, it is important that he is properly monitored on AS so as not to miss the best opportunity of curative treatment.should his situation change. Some men go with AS for as long as possible whilst others who are more risk averse will seek treatment immediately or much sooner.

Barry
User
Posted 09 Dec 2018 at 18:55

My husband was diagnosed via BUPA ( consultant surgeon works in the NHS as well). This was in December 2016.

He send my husband for a MpMRI scan which came back PIRAD 4 so he did a template biopsy which found a large volume of G6 (3+3) and did not think a bone scan was necessary.

My husband was offered same options:

AS

RP

RT

 

so no bone scan via the BUPA diagnostic pathway in our situation. 

 

Good luck with everything

Clare

 

 

 
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