Gleason 6 recurrence

A friend of mine had open surgery nine years ago and has been undetectable until recently, but now his numbers have suddenly started going up. He was a Gleason 6.

I don't know exactly what his PSA is at this time, but I was surprised and dismayed to hear this news.

I'm two weeks out from my five-year anniversary, and I was a Gleason 7 (3+4), so I suddenly am not quite so optimistic about what the future might hold for me. If this can happen to a 6, it surely can happen to a 7, right?

But, here's my question. I've read here on HW many times that Gleason 6 doesn't metastasize. If that's true, what's going on with my friend?

I've often wondered, since we know that it's possible for a small amount of benign prostate tissue to be left behind by the surgeon, is it possible for a new cancer to develop in that now benign prostate tissue? Just a thought, may or may not be valid, but with a Gleason 6 after nine years, it makes me wonder even more,

Here is my opinion....The widely held belief that G6 does not metastasize was based on a study from Epstein at Johns Hopkins that looked at over 14,000 or so cases of OC G6 cancers. Not one case was found to have spread to the lymph nodes. A small amount of the cases had BCR. Something like 27 cases. Epstein went back and reviewed these cases. Every case was subsequently upstaged to a higher Gleason score or found not to be organ confined.

One more note about the lymph node thing....the lymphatic system is not the only way for cancer to spread. It can also move through the blood stream as we are all aware. So, even if not 1 OC G6 case was found to have PCA cells in lymph nodes how can you completely rule out spread through the blood stream....But all of this withstood Walsh put out a study of all his cases over the 30 years he had been practicing and not 1 of his OCG6 cases ever died of PCa. So, I am guessing that this is why they came to the conclusion that OCG6 does not spread.

So, 1st if I were your friend having had my pathology read 9 years ago I would ask to have it re-read just to be sure he was OC G6. If so, then I would tend to agree with Pratoman.....I have always had the opinion that if your surgeon was sloppy and left tissue behind then it is very possible that the tissue is a new prostate cancer.

Either way salvage SRT is probably where he is headed to try to stop it again.

P.S. Tim G. How are you...nice to see your post....

Post Edited (ChrisR) : 8/6/2015 10:22:32 PM (GMT-6)

clocknut said...
A friend of mine had open surgery nine years ago and has been undetectable until recently, but now his numbers have suddenly started going up. He was a Gleason 6.

I don't know exactly what his PSA is at this time, but I was surprised and dismayed to hear this news.

I'm two weeks out from my five-year anniversary, and I was a Gleason 7 (3+4), so I suddenly am not quite so optimistic about what the future might hold for me. If this can happen to a 6, it surely can happen to a 7, right?

But, here's my question. I've read here on HW many times that Gleason 6 doesn't metastasize. If that's true, what's going on with my friend?

For sure, many if not all of us will spend years waiting for the other shoe to drop. But even in the case of G6- at least as far as Bx is concerned, it is always possible that a G9 is missed. But, is it not possible for the path report to also be in error in either direction? Or subject to a different # based on another opinion? Is it also possible(even if very unlikely) for an aggressive batch of cells to be missed by the pathologist? Human error and all of that?

Finally, if some G6 cancer cells can be left behind and take 9 years to become detectable and even increasing at some unknown level, does that maybe indicate that- finally detectable or not, it is a very non-agressive cancer? Or, what if some benign tissue was left behind? Wouldn't we be expecting any normal prostate to be getting larger and produce more PSA over the 9 years? If so, would that not apply also to any benign tissue accidentally left behind? I really don't know, but all of the above seems quite possible to me.

But, as far as not knowing what the future holds or even our odds, no doubt none of us ever really know.
Trailguy said "I also recall that you are not actually called "cured" until you have made it 15 years without the cancer returning". For all of us above age 63, waiting on that 15 years puts us at or above the average age of death for males. So, many of us who are waiting for that 15 years so we can finally relax will die of something else while waiting to be declared PC free.

clanda, I think the answer is just to do the right things, keep our doctor appointments regularly, appreciate every single day and minute, and try as best as possible to live in the moment.

I know as well as anyone that last point is way easier said than done. But it's all we can do. It's something I'm trying to learn.
Sounds simplistic I know, and maybe even Pollyanna-ish. But what else can we do?

We are all vulnerable. Many of us (me being one of them) felt invincible before this PC thing happened. So we learned that not to be the case. And life goes on,

Well said, Pratoman.

Thanks to everyone for your thoughts and suggestions.