I'm interested in conversations about and I want to talk about
Know exactly what you want?
Show search

Notification

Error
12>

Gleason score 3+4=7

Email this conversation Print this conversation
User
Posted 04 Nov 2021 at 12:24

Hi, I am 65


Summary of my tests:


PSA= 12.5 


Biopsy = 7/23 - Gleason score 3+4=7


              Grade Groups 2 


MRI scan = bilateral properal zone PIRADs 4 lesions query small early T3a disease.


Bone scan - negative for malignancy but mild uptake at T7 –


so to have another scan of spine


 


Conclusion: If T7 was benign (in new scan) then have Active treatment


 


Questions:


1- Small early T3a disease? what it means? What are the categories?


     Mild vs what?


     Early vs what?


2- What mild uptake means?


3- If Gleason is 7 + there is small early T3a disease + Grade Group 2, 


          then how likely is uptake at T7 not be benign?


4- If T7 is not benign, then how fast will be the other spread? 


5- What are the treatments if T7 was not benign? What are the outlooks?


Thanks for your attentions.

Edited by member 04 Nov 2021 at 14:24  | Reason: The title was too long, misleading and not as others titled

User
Posted 24 Feb 2023 at 17:14
1. it was in America where people are perhaps more motivated to recommend treatment if they are going to be paid for it
2. it was 2013 - whatever that consultant had heard, more recent research on PSA post-op has not led to recommendations that men should have RT post-op just in case
3. Having said that, we did have a national trial pre-Covid whereby men with clear margins and good post-op pathology but at least one risk factor were offered adjuvant RT. I think they had trouble recruiting to the trial because who wants to take on additional side effects if they don't need to. Also, the results were not great and the conclusion was that there was no benefit
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Aug 2023 at 14:32

Histology on a removed prostate is still sampling that can miss something more significant. It's typically about 6 slices through the prostate so it's a bigger sample than the biopsy, but it could still miss something that a biopsy found, or indeed they could both miss something more significant.

User
Posted 20 Aug 2023 at 14:47
Where did you get that info Andy? Pathology lab procedures typically examine a minimum of 18 slices and up to 76 slices based on 3mm slicing with 4 um sectioning for examination under the microscope. Some work has been done on sampling the slices (1 in 2) in order to reduce lab workload but I don't believe that has been adopted.
User
Posted 04 Nov 2021 at 14:49

I was Gleason 3+4, possible t3a.  Turned out as Gleason 4+4, t2a.  The only way to be pretty certain is to have the op and get your prostate in the lab.


If you've only one stray then they might treat it with radiotherapy or perhaps another form of intervention, I'm not sure if HIFU or something else is available.


They'll possibly offer radiotherapy for the prostate as well although it might be limited. You'll likely get hormone treatment as well.


So many ifs. 


A nurse said to me take it as it comes and don't get ahead of yourself.  It might be something else.  Easier to say than do I think. Diagnosis is always a worrying time.  Hold on we're with you.


All the best, Peter


 

User
Posted 05 Nov 2021 at 08:28
An MRI and a nuclear bone scan look for different things.

In a bone scan, areas of the body where cells and tissues are repairing themselves most actively take up the largest amounts of tracer. Nuclear images highlight these areas, suggesting the presence of abnormalities associated with disease or injury. An MRI, on the other hand, is looking to image mets directly. You can get increased "uptake" in a bone scan, therefore, for reasons other than mets.

Best wishes,

Chris


User
Posted 06 Nov 2021 at 01:09
3- If Gleason is 7 + there is small early T3a disease + Grade Group 2,
then how likely is uptake at T7 not be benign?
4- If T7 is not benign, then how fast will be the other spread?
5- What are the treatments if T7 was not benign? What are the outlooks?

*****************************************************************************************

3. spread to bone is completely unrelated to the T staging. Grade group 2 and Gleason 7 (3+4) are the same thing - a G7 can spread to bone just as easily as a G10. The staging can be T2a (fully contained) and still already be in the bone.

4. If T7 is not benign, they will put you on hormone therapy. It may not spread any further for many years

5. Hormone therapy, possibly with early chemo. If it is just in the prostate and one bone met, they may try radiotherapy although you will generally be considered incurable. Just in prostate and bone, you could still be here in 10-15 years, depending how well you respond to the hormones. If there are mets to soft organs or the skull or jaw, maybe only a few years. Some men unfortunately don’t respond to the HT and live for only a very short time, but this is less common.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 11 Nov 2021 at 17:53
Yes there are some qualified in both fields - uro-oncologists.

I think you have muddled up benign and not benign (cancerous) - if the grey area on your spine is cancer he is only offering long term HT but if it is benign he is willing to do surgery or RT. More waiting for you :-(
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Nov 2021 at 20:59

Originally Posted by: Online Community Member


Hi again.


Repost on my spin MRI is negative for metastatic.


I am given the option between hormones + radical radiotherapy verses robotic approach (surgery?). The suggestion as to robotic is vague? Does it mean there is not going to be any other follow up treatments?  


I wonder advanced prostate cancer (t3a, G3+4=7) means that the cancer bits are out in circulation and even if it is not settled down somewhere, the surgery on its own is not going to get ride of it and has to be followed by radiotherapy and/or hormones to suppress it. So why one should with diagnosis as mine should go along with robotic surgery?


Would robotic (especially if followed with H +RR) will give me a better and longer life as compare to H + RR?


I also wonder why none of respected members (above) in previous messages did only mentioned hormones and radiotherapy as an option.  


You may excuse me if I may have muddled up.



You don't have advanced prostate cancer; you have locally advanced PCa which is a completely different thing. With a T3, your chance of full remission is exactly the same regardless of whether you have radiotherapy with hormones or just surgery.  So the choice comes down to your personality, lifestyle and your view of the risk of side effects of each treatment. 


I think I did mention surgeryvin a previous reply but generally, we were responding to your initial data with the suspected bone met. Now you have had confirmation that it is not a bone met, your options are wider. 


With a T3, any treatment has a small chance of being unsuccessful but that is true of any cancer patient. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 01 Dec 2021 at 23:59

Training of new surgeons is essential, maybe we should accept that the new guy gets to have go. Future generations will need top surgeons, so they need to practice on someone. Maybe us baby boomers having spent the next generations money, taken first dibs on the houses, and upset Greta Thunberg; should at least ensure they have a chance of decent health care.


I spent a bit of time teaching people how to fly gliders, you do have to let the student try and land, and obviously there first few attempts are heading for disaster so as an instructor you take over before it gets dangerous but not much before, as the student needs as much experience as possible.


It would seem some surgeons do more than 700 operations a year. Now assuming they take weekends off and have eight weeks holiday (when you are on that sort of money you need time to spend it) and play golf with the drugs company rep every Wednesday. They must be doing four operations a day. I guess with robotic surgery they don't need to scrub up before each operation, and perhaps due to modern internet technology, he may be able to do a few ops from the clubhouse bar after the golf. However I would assume that the top surgeon supervises four underlings per day, he is putting his name to the job so he will make sure his underlings are top notch, and will have all four screens up in front of him (plus one other to watch tiktok...can you believe it a cat playing piano 😸).


When you buy a painting by Leonardo Da Vinci, you are actually buying one from his workshop, most of it probably done by an apprentice, but with a few strokes by the master ("hey Giuseppe, next time you do a passport portrait of that Mona Lisa women tell her to say Cheese. Never mind, give the brush here I'll try and paint a smile on her).


So perhaps when they are selling prostatectomies they should be described as "in the style of Mr X", "attributed to Mr Y".


 

Dave

User
Posted 02 Dec 2021 at 00:18

"It would seem some surgeons do more than 700 operations a year. Now assuming they take weekends off and have eight weeks holiday (when you are on that sort of money you need time to spend it) and play golf with the drugs company rep every Wednesday. They must be doing four operations a day."


Agreed, the maths doesn't add up. Average robotic RP is 4-5 hours and open RP is 3-4 hours so unlikely to be doing more than 2 per day directly. John's ended up being nearer 8 hours!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 05 Dec 2021 at 09:59
What you have been reading about is spinal cord compression. However, it happens to men with profound mets to their spine and your bone scan is negative so you are not at risk. Also, it doesn't usually cause pain in the lower legs.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Feb 2022 at 15:41

Hi Fred, 


Did it have a < (less than sign)?


I know my OH post op PSA was <0.03


even at 0.06 that seems low to me (I’m sure someone else will be able to tell you better though) but I hear a lot that if it spoken to you a lot seem to miss the less than not realising it’s significance.


Great news how things have gone post surgery 👍🏽

User
Posted 23 Feb 2022 at 16:00

Fred , some medical experts may consider 4 weeks to be too early for a post op PSA test. Nice guidance is the first blood test at least 6 weeks after surgery. The < symbol in front would be better but i don't recall seeing many <0.06. <0.03 or <0.1 are common. are you sure it is not 0.006.


Your histology may give you a better understanding of your situation. 


Thanks Chris 

User
Posted 23 Feb 2022 at 20:39
The next one is important OR if you listen to the "anti ultrasensitive brigade" on here you are already in the clear as 0.06 is less than 0.1. 😁


User
Posted 16 Dec 2022 at 12:07

Originally Posted by: Online Community Member
UPDATE + Queries

I understand that there are two choices I could take, wait and see when PSA increases or have early Radiotherapy at the bed of prostate to lower the chance of remission.
Which one is better?




I have never heard of anyone being offered SRT with an undetectable PSA just in case of future recurrence. Have you really been offered this choice?


Best wishes,


Chris


 

Edited by member 16 Dec 2022 at 12:08  | Reason: Not specified

User
Posted 16 Dec 2022 at 22:21

Hi Fred,


Sorry I can’t help with all of your queries.


Just wanted to say that my husband was similar, although PNI was never mentioned at biopsy it was on the post histology report, he also had one lymph node which had cancer in out of 14 removed. 


It’s 12 months next week since his op and his PSA is still undetectable. He was always told it was very likely he would need RT but we will be waiting until his psa indicates as much. We pray it will never happen but know of course it’s a real possibility.


Our consultant said he would do a PSMA pet scan if his psa rises to 0.3 


Thanks 


Elaine

User
Posted 17 Dec 2022 at 06:23
I don't think any oncologist in the UK would put a patient through RT "just in case" of future recurrence; a course of RT is by no means a trivial treatment and it can have life-changing consequences. The majority of men (two out of three) who have a prostatectomy do not require salvage RT; just wait and see what happens in the future. It's early days yet.

Best wishes,

Chris
User
Posted 17 Dec 2022 at 08:12

Originally Posted by: Online Community Member
I don't think any oncologist in the UK would put a patient through RT "just in case" of future recurrence; a course of RT is by no means a trivial treatment and it can have life-changing consequences. The majority of men (two out of three) who have a prostatectomy do not require salvage RT; just wait and see what happens in the future. It's early days yet.

Best wishes,

Chris


If you have some form of recurrence it will be essential to know exactly where it is and at this stage there's not enough to go on. If, for example, there's cancer is a lymph node, targeting that with RT is specific rather than general.


No fun waiting to see what might show up obviously but it's the best path to dealing with any actual recurrence as against possible recurrence.


Jules

User
Posted 24 Feb 2023 at 12:06

I read the article you referred to and I found it rather peculiar [others might comment]. I can only say what I said above, there has to be a specific target for RT. I would have expected that before giving RT that patient would have had some sort of investigation to find out firstly if he was having recurrence and secondly, if that was the case, where the recurrence was so that if he needed RT it could be targeted.


One difference between 2012 and now is that PSMA PET scans are now available and are a useful tool for accurately locating small areas on cancer.


As Cheshire Chris says, it would be very unlikely for an oncologist to put someone through RT "just in case". I think there might be some key information missing from the yananow story.


Jules

Edited by member 24 Feb 2023 at 19:50  | Reason: Not specified

User
Posted 10 Jun 2023 at 09:50
Fred, your PSA is fine - the actual reading in February could have been 0.0094 and in June 0.0095. These tiny changes could simply be machine noise, or just different times of the day. PSA can be slightly higher first thing in the morning, for example. At the moment, your PSA is about the same as a woman who is breastfeeding - small amounts of PSA are produced in other parts of the body.

Free PSA is not relevant to a man who has had his prostate removed. It is a test that helps doctors predict whether a man might have prostate cancer when his PSA is between 4-10 and whether or not to do a biopsy
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Jun 2023 at 11:20

I had my prostate removed late December 2021 and for the first 2 quarters after that Addenbrookes tested my PSA down to  0.04. Mine was always less than 0.04. Subsequently, my further quarterly PSA tests was "only" tested down to 0.1 and mine came out then to less than 0.1. My next test in July  is my first 6 monthly PSA test and I have no doubt my PSA will only be tested down to 0.1. Addenbrookes told me that testing to less than 0.1 was causing unnecessary worry in patients as small movements under that figure were mostly meaningless. And as mentioned by Lyn, even without a prostate small amounts of PSA are produced by the body.


 


Ivan

User
Posted 09 Jul 2023 at 12:41
Because usually you need to be able to hold a full bladder during the RT zapping. Sometimes, an onco prefers to do the RT with a completely empty bladder but it isn't a common approach.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 20 Aug 2023 at 12:02

I agree with Fred, the logic says a Gleason score could never go down. To have a G7 biopsy there must have been at least one tiny bit of Gleason pattern 4 in the samples. In the path lab they can now examine all of the prostate, they 'must' see that area of pattern 4 again so it cannot go down, and if they happened to see some pattern 5 it would go up. You might say well if they spotted a lot of pattern 1 or 2 that would bring it down? No, Gleason score is about the maximum and secondary maximum in two samples it is not about averages.


So now if we follow the mathematical logic, we have to ask. Was the pattern 4 in one place and tiny, and completely removed by the biopsy needle? Extremely unlikely, about 0% chance that that is the reason. Maybe the cancer just got better? Again extremely unlikely, yes the immune system attacks cancer, but only in the early stages once it has got hold it won't die on its own, about 1% chance this is the explanation.


So our maths and logic has not given us the answer.


Now if you go on the internet and look up pictures of biopsy samples you will see how ordered Gleason patter 1 is and how disordered pattern 5 is. If you then look at more samples you can start saying what you think the pattern is, and then check with what the expert says. 80% of the time you will agree with the expert on what a pattern 2,3 or 4 looks like, but some will be marginal, maybe pattern 3 maybe pattern 4.


So I would guess that all the samples from biopsy and pathology looked about the same and it was a bit more disorders than patten 3 but not quite as bad as a typical pattern 4. One pathologist decided to call a 4 the other called a 3. Hence Gleason score 8 and 6, because of the difference in the person looking at the sample not the samples themselves.

Dave

User
Posted 20 Aug 2023 at 12:55
... and very much depends on the skill and accuracy of the surgeon performing the biopsy. The sample gun is guided by a human being even though the plot of targets is displayed on the echo screen.
User
Posted 14 Sep 2023 at 14:01
Hi Fred

It would seem that the biopsy cores were not examined to the extent that the lab did to the removed prostate which would make some sense given that it is a sampling and not definitive.
The T2c indicates that the cancer had progressed to the gland wall but had not penetrated it - as you said, it could be a few cells away from doing so, in which case you caught it just in time :)
User
Posted 10 Nov 2023 at 22:10

Originally Posted by: Online Community Member


My PSA, 22 months post prostatectomy is still undetectable.



Great news Fred.


I'm in a pretty similar position, but a year behind you. My three post op PSA tests have been undetectable. Let's hope that they remain that way.  I suppose if they increase above 0.2 they'll start a further treatment plan and that would involve reviewing our previous records including the histology of our removed prostates.

Show Most Thanked Posts
User
Posted 04 Nov 2021 at 13:36
I'd strongly advise you to wait until the diagnostic process is complete. You'll know where you stand then. Asking "What if..." questions is not helpful to anyone.

Best wishes,

Chris
User
Posted 04 Nov 2021 at 13:44
Thanks Chris
But I am puzzled with some of the present results and need to know q3 to q5 partly out of curiosity.
User
Posted 04 Nov 2021 at 14:10
Excuse me Chris:
Conclusion: If T7 was benign (in new scan) then have Active treatment
should be read
Recommendation (made by MDT): If T7 was benign (in new scan) then have Active treatment


Furthermore:
I can not resist asking how MRI be negative for malignancy but yet mild uptake at T7?

User
Posted 04 Nov 2021 at 14:49

I was Gleason 3+4, possible t3a.  Turned out as Gleason 4+4, t2a.  The only way to be pretty certain is to have the op and get your prostate in the lab.


If you've only one stray then they might treat it with radiotherapy or perhaps another form of intervention, I'm not sure if HIFU or something else is available.


They'll possibly offer radiotherapy for the prostate as well although it might be limited. You'll likely get hormone treatment as well.


So many ifs. 


A nurse said to me take it as it comes and don't get ahead of yourself.  It might be something else.  Easier to say than do I think. Diagnosis is always a worrying time.  Hold on we're with you.


All the best, Peter


 

User
Posted 04 Nov 2021 at 15:18

Thanks for you and other being there

User
Posted 05 Nov 2021 at 08:28
An MRI and a nuclear bone scan look for different things.

In a bone scan, areas of the body where cells and tissues are repairing themselves most actively take up the largest amounts of tracer. Nuclear images highlight these areas, suggesting the presence of abnormalities associated with disease or injury. An MRI, on the other hand, is looking to image mets directly. You can get increased "uptake" in a bone scan, therefore, for reasons other than mets.

Best wishes,

Chris


User
Posted 05 Nov 2021 at 09:13

That makes good sense for us Chris, thank you. My OH had his MRI which didn’t show up METs, he had a bone scan where he was told the cancer had spread to his pelvis. We got a second opinion and PSMA pet scan that said the lesion in pelvic bone was benign, but did confirm lymph node previously picked up on CT scan.

User
Posted 05 Nov 2021 at 12:04

Thanks Chris.

User
Posted 06 Nov 2021 at 01:09
3- If Gleason is 7 + there is small early T3a disease + Grade Group 2,
then how likely is uptake at T7 not be benign?
4- If T7 is not benign, then how fast will be the other spread?
5- What are the treatments if T7 was not benign? What are the outlooks?

*****************************************************************************************

3. spread to bone is completely unrelated to the T staging. Grade group 2 and Gleason 7 (3+4) are the same thing - a G7 can spread to bone just as easily as a G10. The staging can be T2a (fully contained) and still already be in the bone.

4. If T7 is not benign, they will put you on hormone therapy. It may not spread any further for many years

5. Hormone therapy, possibly with early chemo. If it is just in the prostate and one bone met, they may try radiotherapy although you will generally be considered incurable. Just in prostate and bone, you could still be here in 10-15 years, depending how well you respond to the hormones. If there are mets to soft organs or the skull or jaw, maybe only a few years. Some men unfortunately don’t respond to the HT and live for only a very short time, but this is less common.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 06 Nov 2021 at 09:24

Dear LynEyre


Many thanks.

User
Posted 11 Nov 2021 at 17:16

Hi


I just had meeting with MDT representative (consultant) who said he is an urologist + oncologist + prostate robotic surgeon.


1- Could one be specialized in all these field?


 


We had a pre-arranged meeting. He said he has not received the result of MRI scan of spine. So he went through option that I could have.


He said I could have Radical Prostatectomy (+ radiotherapy) if T7 is not benign?


I know if is still there but am very down and puzzled as his suggestion is not in line with above suggestions of radiotherapy and hormone therapy.


2- Could kindly anyone elaborate further?


 


He also said that if benign then it would all hormone therapy consisting of 2 months of tablet and injection followed with injection every six months.


I was too down to know what was the details of hormone therapy? but again


4- Could anyone explain what this might be?


 


Thanks for your helpI


p.s I still have to wait two weeks to have next meeting.

User
Posted 11 Nov 2021 at 17:53
Yes there are some qualified in both fields - uro-oncologists.

I think you have muddled up benign and not benign (cancerous) - if the grey area on your spine is cancer he is only offering long term HT but if it is benign he is willing to do surgery or RT. More waiting for you :-(
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 12 Nov 2021 at 09:30
Hi Lyn
Many thanks for your prompt reply and helpful comments.
User
Posted 23 Nov 2021 at 18:34

Hi again.


Repost on my spin MRI is negative for metastatic.


I am given the option between hormones + radical radiotherapy verses robotic approach (surgery?). The suggestion as to robotic is vague? Does it mean there is not going to be any other follow up treatments?  


I wonder advanced prostate cancer (t3a, G3+4=7) means that the cancer bits are out in circulation and even if it is not settled down somewhere, the surgery on its own is not going to get ride of it and has to be followed by radiotherapy and/or hormones to suppress it. So why one should with diagnosis as mine should go along with robotic surgery?


Would robotic (especially if followed with H +RR) will give me a better and longer life as compare to H + RR?


I also wonder why none of respected members (above) in previous messages did only mentioned hormones and radiotherapy as an option.  


You may excuse me if I may have muddled up.

User
Posted 23 Nov 2021 at 19:06

Great news Fred 👍🏽


My husband is Gleason 4+3=7 psa 8.3 and T3a N1. He has opted for RARP even though it is extremely likely he will need ART (barring a miracle 🙏🏼). He wants to get the majority of the cancer out so they will remove tumour and affected node(s). He is on HT already…so will have triple the side effects (although doing ok with that at the mo) 


We don’t know if it’s the correct decision, but have to go with our gut and have no regrets. 


Best of luck with making your decision, it’s not easy but I think it’s a relief when you’ve decided.

User
Posted 23 Nov 2021 at 20:59

Originally Posted by: Online Community Member


Hi again.


Repost on my spin MRI is negative for metastatic.


I am given the option between hormones + radical radiotherapy verses robotic approach (surgery?). The suggestion as to robotic is vague? Does it mean there is not going to be any other follow up treatments?  


I wonder advanced prostate cancer (t3a, G3+4=7) means that the cancer bits are out in circulation and even if it is not settled down somewhere, the surgery on its own is not going to get ride of it and has to be followed by radiotherapy and/or hormones to suppress it. So why one should with diagnosis as mine should go along with robotic surgery?


Would robotic (especially if followed with H +RR) will give me a better and longer life as compare to H + RR?


I also wonder why none of respected members (above) in previous messages did only mentioned hormones and radiotherapy as an option.  


You may excuse me if I may have muddled up.



You don't have advanced prostate cancer; you have locally advanced PCa which is a completely different thing. With a T3, your chance of full remission is exactly the same regardless of whether you have radiotherapy with hormones or just surgery.  So the choice comes down to your personality, lifestyle and your view of the risk of side effects of each treatment. 


I think I did mention surgeryvin a previous reply but generally, we were responding to your initial data with the suspected bone met. Now you have had confirmation that it is not a bone met, your options are wider. 


With a T3, any treatment has a small chance of being unsuccessful but that is true of any cancer patient. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 29 Nov 2021 at 12:12

Hi Lyn


Fully appreciate your ever informative comments. My apology for not thanking you earlier.

User
Posted 01 Dec 2021 at 20:04
I am to have Radical Prostatectomy in one of NHS hospital.
I wonder NHS hospital also being a training center for universities;
allows important surgery as Radical Prostatectomy to be done partly by a trainee
and/or
patient has the right to demand the operation to be done wholly by main surgeon.

User
Posted 01 Dec 2021 at 22:46

Of course everybody wants their surgery done by a well experienced surgeon but this is clearly not always possible as they retire and new surgeons take over. I doubt a very inexperienced surgeon would be allowed to do the operation unsupervised. I would expect that the new surgeon would gradually be permitted to do more of the op closely supervised until s/he achieved good results. However, if you find this possibility unacceptable, you could ask to go on the list of a more experienced surgeon, although you might well have to wait longer unless you go private.

Edited by member 01 Dec 2021 at 23:43  | Reason: Not specified

Barry
User
Posted 01 Dec 2021 at 23:59

Training of new surgeons is essential, maybe we should accept that the new guy gets to have go. Future generations will need top surgeons, so they need to practice on someone. Maybe us baby boomers having spent the next generations money, taken first dibs on the houses, and upset Greta Thunberg; should at least ensure they have a chance of decent health care.


I spent a bit of time teaching people how to fly gliders, you do have to let the student try and land, and obviously there first few attempts are heading for disaster so as an instructor you take over before it gets dangerous but not much before, as the student needs as much experience as possible.


It would seem some surgeons do more than 700 operations a year. Now assuming they take weekends off and have eight weeks holiday (when you are on that sort of money you need time to spend it) and play golf with the drugs company rep every Wednesday. They must be doing four operations a day. I guess with robotic surgery they don't need to scrub up before each operation, and perhaps due to modern internet technology, he may be able to do a few ops from the clubhouse bar after the golf. However I would assume that the top surgeon supervises four underlings per day, he is putting his name to the job so he will make sure his underlings are top notch, and will have all four screens up in front of him (plus one other to watch tiktok...can you believe it a cat playing piano 😸).


When you buy a painting by Leonardo Da Vinci, you are actually buying one from his workshop, most of it probably done by an apprentice, but with a few strokes by the master ("hey Giuseppe, next time you do a passport portrait of that Mona Lisa women tell her to say Cheese. Never mind, give the brush here I'll try and paint a smile on her).


So perhaps when they are selling prostatectomies they should be described as "in the style of Mr X", "attributed to Mr Y".


 

Dave

User
Posted 02 Dec 2021 at 00:18

"It would seem some surgeons do more than 700 operations a year. Now assuming they take weekends off and have eight weeks holiday (when you are on that sort of money you need time to spend it) and play golf with the drugs company rep every Wednesday. They must be doing four operations a day."


Agreed, the maths doesn't add up. Average robotic RP is 4-5 hours and open RP is 3-4 hours so unlikely to be doing more than 2 per day directly. John's ended up being nearer 8 hours!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 02 Dec 2021 at 10:25

Before my RALP with Neurosafe on the NHS, I asked the surgeon (clinical lead at the hospital and in that area) if he was personally going to perform my op. He said he would, primarily because I had a previous TURP and that could make life a little more difficult. When I received the post op report, I noticed a second surgeon was present. He was an FRCS, not a surgical student. Perhaps he was training on da Vinci, perhaps a second surgeon is always required? Bit like there is always a co-pilot on commercial aircraft, just in case?

User
Posted 02 Dec 2021 at 21:17
Many thanks everyone
User
Posted 03 Dec 2021 at 16:32
As you are most probably aware before surgeons move on to robotic surgery they have to have been accomplished doing open surgery. In the event of a problem with the robot during surgery which is rare fortunately, a surgeon has to be able to use his skills to carry on the op using open surgery or involve somebody else who more frequently uses open surgery.
Barry
User
Posted 05 Dec 2021 at 09:10

Hi again


I had a panic attack 2 weeks ago and called for emergence, went to hospital and had some general test and came back home without any prescription or warning about my general health.


Since then I have a kind of numbness, mainly in sole of left leg to begin with and now on both leg which is more at nights with some kind of pain on lower part of my legs. I went to GP, after some physical testing on my legs said nothing except that it could be due to my anxiety and stress.


I checked internet it says in numbness  extreme cases it could be related to spread of prostate cancer.


 

User
Posted 05 Dec 2021 at 09:59
What you have been reading about is spinal cord compression. However, it happens to men with profound mets to their spine and your bone scan is negative so you are not at risk. Also, it doesn't usually cause pain in the lower legs.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 06 Dec 2021 at 13:14

Many thanks Lyn.


I had just revived a letter detailing additional information (ones that I missed earlier) as regard to my test result:
Biopsy:: PNI positive, cibriform pattern not seen.
Earlier MRI stated “bilateral small peripheral zone PIRARDS 4 lesson query T3aN0M0
I wonder in light of these findings further complication is to be due?


I also noted the letter points out that further treatment (to that surgery) at a later date if required radiotherapy of hormonal’
Taking my test result into consideration how early might be the RT.


If surgery is going to follow early with that of RT, then would it not be better to go straight for RT + Hormonal?


 

Edited by member 06 Dec 2021 at 13:40  | Reason: Not specified

User
Posted 27 Dec 2021 at 08:04

URGENT REPLY IS APPRECIATED


 


My radical prostatectomy surgery scheduled for end of January at a NHS hospital.


I had result of T3a in June and Gleason 3+4 in October.


 


I wonder by the time of surgery will there be:


1- Upgrading of T3a or G7,


2- Undermining of the surgery succession and recurrence


 


What will be the situation if I decide to change my treatment to Radio therapy and  hormone therapy?


 

User
Posted 27 Dec 2021 at 11:02

I underwent RALP surgery on 21/12 and had no more PSA tests or scans after early October. Once you have had your prostate removed it undergoes a histology and it is then that the original Gleason score etc is confirmed or upgraded. In my case, I should know in around 6 weeks time whether my cancer is still category 2 (Gleason 3+4=7, with only 5% Category 2, the rest being category 1(Gleason 3+3= 6)).


 


I was given the choice of having either surgery or RT but opted for surgery because  my cancer was confirmed to still be within the prostate and because I liked the idea of it being totally removed. Though, obviously, time will tell whether this is actually the case. I was told that RT and surgery would be broadly similar in life expectancy outcomes. 

User
Posted 27 Dec 2021 at 11:27

Originally Posted by: Online Community Member


URGENT REPLY IS APPRECIATED


 


My radical prostatectomy surgery scheduled for end of January at a NHS hospital.


I had result of T3a in June and Gleason 3+4 in October.


 


I wonder by the time of surgery will there be:


1- Upgrading of T3a or G7,


2- Undermining of the surgery succession and recurrence


 


What will be the situation if I decide to change my treatment to Radio therapy and  hormone therapy?


 



If, following surgery, the cancer is upgraded from T3a it will not be because of the delay; the scans are not absolute so it is possible that what is found is different to what was seen on the screen. My husband was diagnosed with T1 but when they operated it turned out to be T3 - it was 5 weeks from dx to surgery. Prostate cancer actually grows very slowly.


Similarly, the Gleason grade doesn't usually change- it isn't the case that a man starts with a G3+3 and then over time, it becomes a G3+4 then G4+4 then eventually G5+5. A man diagnosed with a G3+4 will still be a G3+4 when he dies, even if the cancer has recurred and become advanced. If, following the op, your Gleason is changed, it will simply be because they have been able to grade the whole prostate rather than just a few tiny samples - not because of the delay. 


There is absolutely nothing to stop you changing your mind about surgery if, having had time to think about it, you have decided that it is not your preferred option. But don't change your mind just because of timeliness... by the time you have contacted the hospital, arranged an oncology appointment, got the first set of hormone tablets and arranged the first hormone injection it is going to be end of January anyway, I think. 

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 17 Feb 2022 at 14:40
Hi Fred. S

As I understand it it's better to have Gleason(3+4) than Gleason(4+3) because the first instance is the most prevalent.

Since you have g3+4 has anyone suggested "Active Surveillance"?

BTW I have T1C g3+3 and I'm following an "Active Surveillance" path at the moment.

Regards

Steve
User
Posted 17 Feb 2022 at 22:26
T3a isn't suitable for active surveillance - usually only T1 or (at a pinch) T2a. T3 means it is already breaking out of the prostate gland.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 23 Feb 2022 at 15:23
Concerned about PSA post surgery


Hi,

I had my surgery on Jan 21.
Catheter was removed 12 days later,
No incontinence from day one
Waiting for pathology results
PSA one month after operation 0.06.
Is this high?

User
Posted 23 Feb 2022 at 15:41

Hi Fred, 


Did it have a < (less than sign)?


I know my OH post op PSA was <0.03


even at 0.06 that seems low to me (I’m sure someone else will be able to tell you better though) but I hear a lot that if it spoken to you a lot seem to miss the less than not realising it’s significance.


Great news how things have gone post surgery 👍🏽

User
Posted 23 Feb 2022 at 16:00

Fred , some medical experts may consider 4 weeks to be too early for a post op PSA test. Nice guidance is the first blood test at least 6 weeks after surgery. The < symbol in front would be better but i don't recall seeing many <0.06. <0.03 or <0.1 are common. are you sure it is not 0.006.


Your histology may give you a better understanding of your situation. 


Thanks Chris 

User
Posted 23 Feb 2022 at 17:31

Hi LynEyre, we had a meeting with the consultant and nurse on Monday and were told that my husbands RP would take about 3 hours as the surgeons in the hospital are very experienced 

User
Posted 23 Feb 2022 at 20:12

Originally Posted by: Online Community Member


Fred , some medical experts may consider 4 weeks to be too early for a post op PSA test. Nice guidance is the first blood test at least 6 weeks after surgery. The < symbol in front would be better but i don't recall seeing many <0.06. <0.03 or <0.1 are common. are you sure it is not 0.006.


Your histology may give you a better understanding of your situation. 


Thanks Chris 



 


The reading : erum prostate specific antigen level 0.06 ug/L

User
Posted 23 Feb 2022 at 20:39
The next one is important OR if you listen to the "anti ultrasensitive brigade" on here you are already in the clear as 0.06 is less than 0.1. 😁


User
Posted 16 Dec 2022 at 09:05
UPDATE + Queries

Hi everyone
I am back with updates and obviously some questions.

The histology post operation letter by Consultant sugary says
G7 (3+4) - Grade group 2
The local excision was complete
pTC2 with negative margin

Also told one bundle of nerves were saved.

Diagnosis
PSA 12.5
MRI bone scan/MRI Spine staging T3aN0M0
Biopsy 7/23 = Gleason Score 3+4 (7/23 – 7a) – Grade 2 Prostate cancer
PNI (PeriNeural invasion ) positive, cibriform pattern not seen.
MRI scan = bilateral small peripheral zones PIRADs 4 lesions query early T3a disease

My PSA post-surgery for last 10 months remains <0.005


Two months after operation I left UK for a 3 years contract job overseas. Recently I tried to contact my urologist doctor who performed surgery for follow up consultation at NHS hospital but was told as I am overseas he could not give me any consultation until I am back and my GP refer me back to care of my consultant?
I am also not able to get further details of my post operation histology for the same reason. NHS apparently does not provide patients records (information) from outside UK.

I am relying on helpful advice on above queries and followings:

I was reading about what follow up treatment might be needed incase PSA started rising.

I am a bit puzzled as where at diagnose stage it say “PNI (PeriNeural invasion ) positive” while histology says “The local excision was complete and pTC2 with negative margin.
Does histology rules out PNI indicated in diagnoses?

What are the chances of remission?

I understand that there are two choices I could take, wait and see when PSA increases or have early Radiotherapy at the bed of prostate to lower the chance of remission.
Which one is better?

Again and as before many thanks for your helpful consultation

Fred

User
Posted 16 Dec 2022 at 12:07

Originally Posted by: Online Community Member
UPDATE + Queries

I understand that there are two choices I could take, wait and see when PSA increases or have early Radiotherapy at the bed of prostate to lower the chance of remission.
Which one is better?




I have never heard of anyone being offered SRT with an undetectable PSA just in case of future recurrence. Have you really been offered this choice?


Best wishes,


Chris


 

Edited by member 16 Dec 2022 at 12:08  | Reason: Not specified

User
Posted 16 Dec 2022 at 22:21

Hi Fred,


Sorry I can’t help with all of your queries.


Just wanted to say that my husband was similar, although PNI was never mentioned at biopsy it was on the post histology report, he also had one lymph node which had cancer in out of 14 removed. 


It’s 12 months next week since his op and his PSA is still undetectable. He was always told it was very likely he would need RT but we will be waiting until his psa indicates as much. We pray it will never happen but know of course it’s a real possibility.


Our consultant said he would do a PSMA pet scan if his psa rises to 0.3 


Thanks 


Elaine

User
Posted 17 Dec 2022 at 05:56

Thanks Chris,


No one offered such choices. I probably misread some reports by patients in YANANOW community. However, not knowing (having) details of my histology report, I just thought whether it could be possible to have RT at early stages post operation rather than waiting for PSA rising? Would it not be better to catch and kill the possible remaining left beast cells that might escape later on?


 

User
Posted 17 Dec 2022 at 06:23
I don't think any oncologist in the UK would put a patient through RT "just in case" of future recurrence; a course of RT is by no means a trivial treatment and it can have life-changing consequences. The majority of men (two out of three) who have a prostatectomy do not require salvage RT; just wait and see what happens in the future. It's early days yet.

Best wishes,

Chris
User
Posted 17 Dec 2022 at 08:12

Originally Posted by: Online Community Member
I don't think any oncologist in the UK would put a patient through RT "just in case" of future recurrence; a course of RT is by no means a trivial treatment and it can have life-changing consequences. The majority of men (two out of three) who have a prostatectomy do not require salvage RT; just wait and see what happens in the future. It's early days yet.

Best wishes,

Chris


If you have some form of recurrence it will be essential to know exactly where it is and at this stage there's not enough to go on. If, for example, there's cancer is a lymph node, targeting that with RT is specific rather than general.


No fun waiting to see what might show up obviously but it's the best path to dealing with any actual recurrence as against possible recurrence.


Jules

User
Posted 24 Feb 2023 at 07:29

Hi Chris and Jules,


 


Many thanks for your comments especially the last one with regard RT post operation even when PSA is undetectable.


 


I found the reference I quoted being in Yanan (https://www.yananow.org/display_story.php?id=1151) which says


“(I listed "other" under my sub-treatment because I don't know.) Spring 2013 my surgery urologist who did my robotic laparoscopic prostatectomy who had been saying that as long as my PSA stayed at .1 or lower, I was good to go) said that new information pointed out that men who had an ongoing .1 PSA (I had been .1 for 9 month), sometimes had improved outlooks if they had followup radiation treatments. It has been my inward determination that I will work to do the things that will give me the best outlook, so I told him "to hook me up please". I did 39 treatments from 7/11/13-9/6/13. My 2 main complaints have been fatigue and bowel irregularities.”


 


I did read your reply but just wondered on the light of above statement (finding) could anyone elaborate on the issue.


 


Best wishes to all


 


Fred


 

User
Posted 24 Feb 2023 at 12:06

I read the article you referred to and I found it rather peculiar [others might comment]. I can only say what I said above, there has to be a specific target for RT. I would have expected that before giving RT that patient would have had some sort of investigation to find out firstly if he was having recurrence and secondly, if that was the case, where the recurrence was so that if he needed RT it could be targeted.


One difference between 2012 and now is that PSMA PET scans are now available and are a useful tool for accurately locating small areas on cancer.


As Cheshire Chris says, it would be very unlikely for an oncologist to put someone through RT "just in case". I think there might be some key information missing from the yananow story.


Jules

Edited by member 24 Feb 2023 at 19:50  | Reason: Not specified

User
Posted 24 Feb 2023 at 17:14
1. it was in America where people are perhaps more motivated to recommend treatment if they are going to be paid for it
2. it was 2013 - whatever that consultant had heard, more recent research on PSA post-op has not led to recommendations that men should have RT post-op just in case
3. Having said that, we did have a national trial pre-Covid whereby men with clear margins and good post-op pathology but at least one risk factor were offered adjuvant RT. I think they had trouble recruiting to the trial because who wants to take on additional side effects if they don't need to. Also, the results were not great and the conclusion was that there was no benefit
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard
User
Posted 10 Jun 2023 at 08:03

Hi,


I had my radical prostatectomy 01-2022


I have just got my last PSA results. Slight but gradual increases from previous ones?


1- What does these increases could mean?


2- Is 0,01 still counted as undetectable?


3- Do I need to have every 3 or 6 months PSA checking?


4- Is Free PSA and its ratio means anything ? is their a need to measure free PSA for monitoring after operation?


Looking for you repoly


Many thanks


Fred


 


Date                             Totla PSA        Free PSA          Ratio            


01.22 (after operation) <0.03


05.22                          <0.006             0.001                 0.16              


08.22                          <0.008             `                                             


11.22                           0.005               0.001               %22.3            


02.23                            0.009               (0.008                                    


06.23                            0.01                 0.002               15-25%                       


 


 

User
Posted 10 Jun 2023 at 08:41

I'm in exactly the same boat thanks for the info Yes I feel get it away with surgery 

 
Forum Jump  
12>
Email this conversation Print this conversation

Join the online community now.

Click through to become a member and gain access to support, information and real time replies.




MenuTop ▲
©2024 Prostate Cancer UK