Father Recently Diagnosed, Need Info Please

lauram

Hello
This is my first post, and I am glad to find such a useful forum.

My father was diagnosed a few months ago with prostate cancer, but until recently chose to keep this to himself. He has now decided to tell me and my sisters about his situation. Naturally, we are in a state of shock and scared of what the future holds for him.

He is 75, and has always been very fit up to now. He has shown us some information from his doctor that mentions that his PSA test is 9, and has a Gleason of 7.

I have never heard of these terms before. Does this mean that his cancer is advanced or fast growing? Are these figures good or bad? He is having hormone therapy, is there anything else he should be doing? What are his prospects likely to be, and how will the cancer progress? Does anyone else have, or has had a similar situation to my father?

Sorry for so many questions. Perhaps the worst part for me is the uncertainty and lack of knowledge. Any information or advice would hopefully make me more useful to my father when he needs my help most.

Laura

brainman

Laura, I am very sorry about your father's cancer. Do you know if it has gone beyond his prostate? The PSA is low... above normal but still low compared to others who have PC. His Gleason Score is not too high either. A Gleason Score is really made up of to numbers. Is your father a 4+3=7 or a 3+4=7? Believe it or not, this does make a difference. In any ever, your father's cancer would be characterized as moderately aggressive.

You and your father are in my thoughts and prayers. Keep us informed.
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Replicant · Moderator Joined: 01 Nov 2006 Posts: 271

Hi--the most important information you mention so far--in regards to answering your question--is the Gleason score.

After biopsy, the pathologist examines the cores of removed tissues. He or she then assigns a GRADE to the most common tumor, and a second grade to the next most common tumor.
The highest possible Gleason GRADE is 5. The cells in Gleason 5 are very poorly differentiated and are not recognizable as glandular.

The two grades are added together to get the Gleason SCORE. For example, if the most common tumor was grade 3, and the next most common tumor was grade 4, the Gleason score would be 3+4 = 7.

You could also have 4+3=7. That would be worse than 3+4. 4+3=7 tends to act more like Gleason 8, while 3+4 tends to act more like Gleason 6. So you should find out the component grades to his score.

You can get a ton of information from his medical record, which is his for the asking (and probably a processing fee).

Gleason scores of 6 and 7 are very common at diagnosis. Score of 6 or 7 indicate moderately aggressive disease. It's possible to have Gleason 10, but today with earlier diagnoses, it's more common to see 5, 6, or 7, and occasionally 8 or 9. Gleason 8 and above would indicate fast-growing cancer.

For more on Gleason, see the Mayo Clinic page at:
http://www.mayoclinic.com/health/prostate-cancer/PC99999/PAGE=PC00006

It is important to know the clinical stage (T1c, T2a, etc) --also from the medical record. Or we can get a good idea of it by your dad's answer to this question--how was the cancer discovered, and did the doctor feel anything abnormal on the rectal exam (DRE)?

With PSA, Gleason, and stage, you can use the Partin tables on the Johns Hopkins website, http://urology.jhu.edu/prostate/partintables.php , to see how serious the threat is.

I'm curious as to the reason behind the strategy of hormone therapy only . While this MAY, all by itself, buy your father enough time that he lives a normal lifespan, hormone therapy is palliative and not curative (although you could argue I guess that it's all semantics if the therapy works long enough).

If the cancer appeared to be localized, your dad could--maybe still can--try for a cure. And the treatment does not have to be invasive.

If the cancer appeared to be non-localized, then the current strategy makes perfect sense.

These are just my layperson's musings on your questions--please don't take them as anything more than that.

If you would like to educate yourself more on the topic, I recommend "Dr. Patrick Walsh's Guide to Surviving Prostate Cancer" (2007 ed.).

Best of luck--
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

johnw100

" He is having hormone therapy, is there anything else he should be doing? What are his prospects likely to be, and how will the cancer progress? Does anyone else have, or has had a similar situation to my father? "

I have several friends currently on hormone treatment, and have given details about two of them in some of my previous posts here: both had considerably higher PSA readings than yours, one had higher Gleason score (9), and probably more advanced disease than yours when they were first diagnosed with bone involvement. In both instances their PSA has reduced to, and remained stable at under 1.

They have both done well on the therapy, and both continue to lead active lifestyles, which is very important. I know it's sometimes easier said than done, but do all you can to keep him as active as possible.
Diet and supplements are also important, and in many cases it can be improved.

As Replicant suggested, it's difficult to know exactly how long this therapy will continue to be effective for in any given situation, but it can often be more effective for longer than previously thought.
The detail you've outlined indicates an earlier stage less agressive PC than most men who use hormone treatment, which suggests that he could respond well.

Where applicable, I always suggest reading the book by Dr Charles Myers, " Beating Prostate Cancer: Hormonal Therapy & Diet" which is very relevant to your situation. Dr Myers is one of the few experts on this subject, and provides a wealth of information in his book.

Don't hesitate to post again should you have any specific questions.

Best wishes,

John

Otago · Regular Joined: 20 Jan 2008 Posts: 28

Laura, One thing you may not know. Lots more men die with prostate cancer than from prostate cancer.

My father was diagnosed with prostate cancer and died 25 years later at age 88 of something else. While he did have some initial radiation, his main treatment for the last 24 years was hormonal.
Who knows what worked and what made him last so long.

You need to find out more info, but don't be thinking he necessarily needs some aggressive "cure" type treatment to last the next 10 years.
In some patients, especially older ones, the cure could be worse than just having the disease muted for years.

Otago

lauram

Many thanks for your replies and taking the time to help me understand my father's cancer a little more.

The information has helped me be a little less farful for the future. Being better informed is part of the battle, I hope I can now be more use to my father.

Replicant, you mentioned that it is important to know his clinical stage. I will try to find this out, and post later. As for how the cancer was discovered, it was suggested that he had a PSA test during a routine doctor's appointment, due to his age.

Thank you again, I will post again when I have more information.

Laura

interval · Regular Joined: 11 Apr 2008 Posts: 39

Laura,

I am sorry to hear about your father problem.
But the good news is that the Gleason score indicates that the cancer is moderately aggressive.

As prostate cancer is a very slow developing disease (not like other cancers) doctors say that main part of prostate cancer patients die with this disease not because of it.

So a watch and wait approach is the best for the moment. To learn more about treatment options, diet, nutrition and more I suggest to visit
http://www.prostate-report.org.

I also suggest to read about how men can stay healthy here
http://www.askmenhealth.org/__men_stay_healthy_at_any_age.php
because, in my opinion, you should also take care of other condition and disease that could influence your father life expectancy.

May God bless you and your father.
_________________
men health questions
http://www.askmenhealth.org

lauram

I now have a couple more details about my father's prostate cancer.

His Gleason of 7, is based on 4+3. His clinical stage is T1c. His last PSA was 9.2, slightly up on his last one.

If anyone can decipher this data, I would be very grateful. At this stage I am trying to learn as much as I can about his condition.

Laura

Replicant · Moderator Joined: 01 Nov 2006 Posts: 271

The 4+3=7 indicates moderately aggressive disease. Combined with T1c (see http://www.phoenix5.org/staging.html for an explanation of staging) and a PSA in that range, here are the statistical probabilities:

Organ confined: 47% chance
Extraprostatic extension: 42%
Seminal Vesicle Invasion: 8%
Lymph Node Invasion: 3%

(Extraprostatic extension is where the cancer has escaped the capsule of the prostate, and may or may not have gone further)
Source: Partin Tables at Johns Hopkins: http://urology.jhu.edu/prostate/partintables.php

The nomograms site at Memorial Sloan Kettering is more optimistic: 62% chance of organ confined disease, 28% chance of extraprostatic extension, 15% seminal vesicle invasion, 3% lymph node involvement, using the current model. The historical model provides probabilities closer to the Partin Tables at Johns Hopkins. (See http://www.nomograms.org )

To me, this means that your father has roughly a 50/50 chance of localized cancer. He could talk to doctors about trying curative treatment, like radiation. IMRT, IGRT, and protons may sound frightening, but the treatments are very easy to take. They do have potential side effects, but they're usually mild and transitory. And hormone therapy has its own side effects--depression, heart disease, diabetes, and so forth. A recent article questioned the wisdom of giving hormone therapy to older men with LOCALIZED disease:

"Compared with conservative management of the disease, androgen deprivation therapy does not appear to be associated with improved survival in elderly men with localized prostate cancer, according to a study in JAMA (2008; 300:173-81)....'The significant adverse effects and costs associated with ADT, along with our finding of a lack of overall survival benefit, suggest that clinicians should carefully consider the rationale for initiating ADT in elderly patients with T1-T2 prostate cancer,' concluded the authors, led by Grace L. Lu-Yao, MPH, PhD, of the Cancer Institute of New Jersey and UMDNJ-Robert Wood Johnson Medical School.'"
http://www.modernmedicine.com/modernmedicine/Enews/Androgen-deprivation-does-not-improve-survival-in-/ArticleStandard/Article/detail/529329

The full text--for FREE! under new guidelines--is available here:
http://jama.ama-assn.org/cgi/content/full/300/2/173

There are no clear-cut answers here, nor can you definitively ascertain whether or not the cancer is localized at the current time. IF his cancer were systemic, it would probably not show up on scans at a PSA level of 9.

I wish you the best.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

johnw100

Laura,

I obtain copies of all reports, (biopsy PSA etc) and keep them in a folder as it's easy to forget the detail later.

A few points to consider and discuss with the doctor:

Especially if alternative treatment or approach is being considered, you should look at a full copy of the biopsy report which will contain additional information, the number of positive cores and % of cancer in each sample. This is relevant and can make a significant difference. Also ask about the prostate size if it's not indicated.

BIOPSY AND GLEASON SCORE: Biopsy readings are subjective; what looks like cancer to one person might look more normal to another. If you havn't already done so the slides should be sent to an expert pathologist for a 2nd reading.

PSA: There is no such thing as a normal PSA number: the prostate naturally produces PSA, and an enlarged prostate (associated with age) produces more PSA. For a PSA # to have any meaning, size of the prostate needs to be factored in.
A lot of the PSA # can often relate to a large gland.

T1c: Most men are now diagnosed with this early stage due to PSA screening, not with lumps detected by DRE.

HORMONE TREATMENT: Some men do experience side issues as mentioned . These can be kept to a minimum with lifestyle changes, remaining active, changes to diet and supplements. If someone has problems with one kind of treatment, often one of the alternative medications will be more effective.
Some men use Intermettent approach where the treatment is discontinued after a time and PSA readings monitored.

You'll find stories from many men who have used this and various treatment options at the yananow site under mentors' experiences.

Best wishes.

lauram

Once again, many for taking the time to give me advice on my fathers condition.

As johnw100 suggested, I will try to get a copy of his biopsy report.

I know that my father is looking at alternative treatments, as I am afraid that the national health service in The UK is a bit of a lottery depending on where you live, and which doctor and hospital you use.

Laura

interval · Regular Joined: 11 Apr 2008 Posts: 39

Hi Laura,

If your father is looking for alternative treatments is good. As his condition is moderately aggressive this option is the best for the moment.

If you need to know about chinese treatments, you may start visiting here
http://www.prostate-report.org/__alternative_treatments_for_prostate_cancer.php

All the best for him, family and friends
InterVal
_________________
men health questions
http://www.askmenhealth.org

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