New Gleason 8

Hi Mike. I had a TURP for BPH also; however, my path then was good and my cancer didn't appear until three years later. Imaging will give you and your doc some idea as to whether your cancer is confined to the prostate or has grown out of the prostate capsule or, possibly, to adjacent structures. The tissue removed in a TURP is from the core of the prostate surrounding the urethra, but not from the outer area (cortex), where tumors more often form. So you are "lucky" that your cancer was found. You can't judge the extent of the Gleason pattern 5 from the TURP (and you could consider a second opinion on your pathology by Dr. J. Epstein at Johns Hopkins to confirm the pattern 5), but it appears you are looking at treatment for your cancer.

If you had had an MRI and the likely biopsy that would have followed, you could have avoided the TURP with a RP, resolving both your PCa and BPH. Be that as it may, if you opt for a RP, the path exam will establish a definitive Gleason score, which neither a biopsy or TURP report can establish. That report will also establish whether the cancer is prostate-confined. If it is, and your post-op PSA is undetectable, your prostate cancer could be in your rear-view mirror.

Depending on your new prostate size, BPH, and bladder cancer history, some RT treatments might be ill-advised. How was your bladder cancer treated?

Stay calm and keep us posted.

Djin

Sorry to hear about your diagnosis. I'm not well-versed to know enough if a formal prostate biopsy would be helpful at this point...possibly not, given that you have evidence of a G5 pattern. But Dijn's recommendation to have a second review from Epstein at JHU makes 100% sense as a next step.

If a G8 diagnosis is confirmed, you have lots of options...surgery and several types of radiation. Even those of us that are G8 and above tend to do well, so don't freak out. (Although I did upon my diagnosis 8 years ago...) My recommendation is to 1) try and get a more definitive diagnosis from Epstein and 2) talk to experienced surgeons and radiation oncologists to learn what your options are. Go into this with as much knowledge as possible.

I'm curious why you write: "So should I just get a RP?" Have you considered other treatments, esp. radiation? Or is there something about your medical history that makes surgery a clear choice?

Mike Cather said...
Hi All,
Thanks for all the well wishes and the direction. I'll definitely look into the JHU path and figure out how to do that.

I have been given Valium before the MRI but it doesn't work for me. I'm looking into a Gen Anesthesia MRI to see if I can do that. I'll get more info from my surgeon when I have the cystoscopy to recheck the bladder Sept 18. During surgery they did do a contrast for my kidneys and they were clear of cancer. Have a stone in there though.

I'm definitely open to radiation if that's the best choice. I've never had radiation. I just had a mastectomy and chemo for my breast cancer. When I read the word "cure" connected to RP, I'm attracted to that. But I definitely will listen to my options. How is radiation administered? Is that in a tube? I have no idea.

PC seems different than Breast Cancer in that there was great urgency put upon me to get it taken out as it was aggressive Her 2 pos and was pretty rare for a male. But I'm GD anxious about PC for sure as I learn more.

Thanks,
Mike

Hi Mike,
Don't be too anxious about the PC, not yet. Usually, PC is a very slow grower compared to most cancers. Autopsies have shown that most older men- who have died of everything from a heart attack to car wrecks- have PC and do not even know it. At least this was common in the days before PSA, which tends to alert us to PC very early compared to the old days. The older they were, the higher the % that had PCa and never even became aware of it before they died of something else.

Though your samples are not from a biopsy, so it might be hard to directly compare( I don't know ), your volume of cancer cells appear to be quite low, which probably means you are still very early in the game. Have they suggested a biopsy?

Next, your rising PSA could be primarily from the same thing that caused you to need a TURP, too much prostate tissue. Maybe, maybe not, could go either way.

Clear something up for me: when you say "one had a 3, another had a 5", are you saying that was a 3+5 = Gleason score 8 for one sample? And has been mentioned, a 2nd opinion on the Gleason scores will probably be a good idea. Obviously, if it is a total of 8 rather than a 6, then you need to be in a bit more of a hurry. But still, if you are low volume, you still have plenty of time to figure all of this out.

And RT is an excellent option compared to RP, there are pros and cons to each approach, but either will get the job done. I sort of wish I had RT for my G9 6 years ago rather than surgery, but again, pros and cons. Both have potential bad side effects (SEs), but different SEs. And the SEs of RP tend to be sudden, and more common I think, while the RT problems tend to appear later. But you can worry about all of that when you get that G8 confirmed or not. And if it turns out to be a low volume G6, you might choose to do nothing but keep an eye on it. Many do. I would if I had been a G6, personally.

Post Edited (BillyBob@388) : 9/2/2020 8:06:33 AM (GMT-6)

I am another "non-4+4" G8 that also was not detected in biopsy but in the path report after prostatectomy. Pathology jargon is difficult to understand, probably it is difficult to know from your TURP report but it is important to know if the G3 and the G5 are coexisting in the same tumor or not. If you have a tumor that is purely G5 you are not a G8, it would be a different story. And if they coexist, it is also interesting to know if it is 5+3 or 3+5 (which type is majoritary). Also, it is interesting to know which type of G5 you have, maybe it is related with some genomic abnormality that also caused your previous breast tumor. I have re-read a few times my inform and, though it clearly states ir is a 5+3, I still have doubts about some of these points.
There are different forms of radiation and also combined treatments that other people will probably explain you in detail. As said by others, it is better you have more clues about whether it is contained in the prostate or not, which may be learnt after a MRI test, if you decide to follow the surgery route. It is also true that, since the G5 chips have been detected form the TURP tissue, it is more probable the tumor does not affect the most external part of the prostate or is beyong its capsule. Good luck.

Regarding your radiation question, most types are administered with you lying on a table while something rotates around you and zaps your prostate--think external radiation. But there is also brachytherapy, in which the radiation is directly inserted into the prostate--think internal radiation. There are two types: low-dose radiation, which uses permanent radioactive seeds to kill the cancer. Over time those seeds lose their radioactivity, so you don't spend the rest of your life glowing in the dark. Then there's high-dose radiation, in which radiation is inserted into your prostate via tubes and then withdrawn. All of these can be effective and can also give you a "cure" depending on the exact nature of your diagnosis. (They can also be combined...I had external radiation and brachytherapy.)

I think the first thing you need to do is get a better handle on your diagnosis, but it's also not too early to start thinking and learning about treatment options.

Thanks, All
I learned a lot today.
m

Post Edited (Mike Cather) : 9/2/2020 5:49:13 PM (GMT-6)