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Posted 10/17/2017 11:00 AM (GMT -5)
Is it possible to be classified as Clinical Stage T1c and have a Gleason Score of 8 (4+4)?
Posted 10/17/2017 11:41 AM (GMT -5)
MacroMan-

I'm sorry to hear this diagnosis, but welcome to our lousy club. First, I want to assure you that this is probably curable and that you have plenty of time - several months - to explore your options and make a cool-headed decision.

Yes, it is very common for Gleason 8s to be stage T1c. The stage just means the doctor didn't feel any lumps when he gave you a DRE, and that is by far the most common staging across all risk categories. It's especially unsurprising given that you had only one positive core.

The first thing you'll want to do is to confirm with the best second opinion available that the Gleason scores are correct. That would be Epstein's pathology lab at Johns Hopkins. Just call your urologist and ask him to send the slides. It will cost you $250US but is well worth it.

I hope you will read the sticky for the newly diagnosed - it explains the terminology and the basic options.

You have several treatment options open to you, including surgery and several different kinds of radiation. I have come to believe that for high risk men, brachy boost therapy is a superior option to all others in assuring a lasting cure. This article explains why:

/pcnrv.blogspot.com/2017/03/brachy-boost-gold-standard-for.html

I notice that you are in BC. The Vancouver Prostate Centre is excellent and has some of the best doctors anywhere. In fact, they were the ones that established brachy boost therapy as the new gold standard for oncological control with their ASCENDE-RT trial:

/pcnrv.blogspot.com/2016/08/external-beam-radiation-therapy-ebrt.html
Posted 10/17/2017 11:42 AM (GMT -5)
Yes.

T1c is: can't been seen on a scan and can't be felt by a DRE, and was found by a needle biopsy.

The clinical stage can change as treatment proceeds.

at this point staging is less important than Gleason score.

Andrew
Posted 10/17/2017 11:52 AM (GMT -5)
Thanks to both of you, Tall Allen and InTheShop.

My urologist suggested that I decide on my treatment soon, as in a month.

Tall Allen your comments regarding the "Vancouver Prostate Centre" and "brachy boost therapy" are MOST encouraging!

Post Edited (MacroMan) : 10/18/2017 8:03:59 AM (GMT-6)

Posted 10/17/2017 7:56 PM (GMT -5)
Sorry about your diagnosis and that you have to be here. I was a Gleason 8 (later upgraded to a Gleason 9 on the second opinion of the biopsy) and took two months to start treatment. For what it's worth, I'm doing fine although I do remember how anxious I was to get started. I was prepared to be told I had cancer, but I wasn't prepared to be told I was "high risk."

Re Tall Allen's comment about brachy boost therapy, that's what I had along with several other high risk guys here. Do see a good RO so you can hear what they say compared to a urologist, who is a surgeon by training.

Good luck to you--you can certainly do well!
Posted 10/17/2017 8:54 PM (GMT -5)
Macroman,

I'm from BC also. As you research your options, you may discover that some of your choices are more limited than in the US.

At this point, I just wanted to clarify that there are two different types of brachytherapy, low dose rate (LDR) and high dose rate (HDR). The trial referenced by Tall Allen used LDR, Michael _T's treatment used HDR.

I also chose HDR for the brachytherapy component of my treatment. HDR brachytherapy is currently offered in BC in Kelowna only.

Post Edited (Astronut) : 10/18/2017 6:55:18 PM (GMT-6)

Posted 10/18/2017 9:02 AM (GMT -5)
Thanks Micheal_T and Astronut

I will be requesting a referral to a RO today.

The urologist most definitely favoured surgery but I've always preferred brachytherapy. I didn't know there were two varieties LDR and HDR.

Minor update: After looking at my pathology report I noticed "Mid transition zone x 3 " and thus I'm assuming I had 13 cores taken rather than 11. I was told during the biopsy that they were going to biopsy 13 times.

Also, my prostate biopsy was delayed by about 2 weeks due to the fusion equipment not working. I'm now wondering that in the first three 'fusion' biopsies that two might have missed the lesion. The other ten biopsies were blind (taken at random) and found nothing.
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