Re: Gleason 6 and 7 in the same biopsy?

[Guest guest]

Sounds to me like you are doing the

correct thing in my opinion. Keep watching it but with only a couple of cores

that are positive there is no reason to subject yourself to all of the side

effects that the treatments offer.

From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of lasalandramj

Sent: Tuesday, June 01, 2010 2:34

PM

To: ProstateCancerSupport

Subject:

Gleason 6 and 7 in the same biopsy?

I have been doing watchful waiting for 7 years. I have had 4 biopsies. The

first three all showed pretty much the same thing. 2 of 12 cores positive,

small percentage each of the two was cancerous, always Gleason 6.

I recently had a 20-core biopsy. Again, two samples were positive, small

percentage each was cancerous, but one was deemed a 6 and the other a 7. Any

thoughts?

[Guest guest]

,

It is not at all unusual for different

samples to have different grades and Gleason Scores. What you need to be aware

of is the fact that there have been significant changes in the interpretation

of grades and scores. Here’s the piece I wrote on the subject for my

information booklet – A Strange

Place:

In January 2010, announcements were made in

the United States

that significant changes had been agreed by the International Society of Urological Pathology in the way in

which prostate cancer tumours were graded internationally.

The key points of these changes were:

Gleason grades 1 and 2 will

" rarely if ever " be classified from a needle biopsy - they might be

from " chips " resulting from a TURP (transurethral resection of the

prostate)

Some prostate cancers that would

originally have been classified as a Gleason grade 2 cancers should now be

graded 3 cancer

Some prostate cancers that would

originally have been classified as a Gleason grade 3 cancers should now be

graded 4 cancer

More attention should be paid to any

tertiary Gleason grade 4 and 5 cancers in all specimens

It is not clear how the tertiary grades will

be used since the value of this information in making clinical decisions is

still controversial. The recommendation is that when biopsy cores show

differing grades of prostate cancer, the pathologist should report the Gleason

grades for each core individually, and the highest individual Gleason grade

should be used in making decisions about treatment - regardless of the

percentage of the involvement of that grade overall. (In other words if the

patient has one core with Gleason 3 + 3 = 6 disease in 60 percent of the core;

a second core showing Gleason 3 + 3 = 6 disease in 48 percent of the core; and

a third positive core showing Gleason 3 + 4 = 7 disease in just 5 percent of

the core, he should still be managed as though he has Gleason 3 + 4 = 7

disease.)

These announcements codified the changes that

had been occurring since 2002 - the so called " Gleason Migration " -

which saw very few diagnoses with Gleason Scores lower than 3+3=6. The

immediate effects of the changes are:

The range of Gleason Scores,

previously a scale of 2 - 10 is now a scale of 6 - 10

A diagnosis of Gleason Score 6 is

therefore the lowest grade of prostate cancer

There will be an increase in Gleason

Score 7 diagnoses

There will be more focus on the

differences between what have been termed Gleason Score 7a -3+4=7 and Gleason Score 7b - 4+3=7

There will be further subdivisions of

'risk' taking into account PSA levels and the size and number of positive

biopsy specimens - termed Very Low Risk:

Low Risk: Intermediate Risk: High Risk for the present

Care must be taken in interpreting

data from nomograms (such as the Partin's Tables) which are used to estimate

various probabilities of outcomes based on the specifics of diagnosis.

Initially these nomograms will use old data.

The National

Comprehensive Cancer Network (NCCN) has also announced updates to

the NCCN Clinical Practice Guidelines for Oncology™ for Prostate Cancer

which incorporate these revisions to the Gleason Grading and Scoring system.

Hope this helps

All the best

Prostate men need enlightening, not

frightening

Terry Herbert - diagnosed in 1996 and

still going strong

Read A Strange Place for unbiased information at http://www.yananow.net/StrangePlace/index.html

From:

ProstateCancerSupport

[mailto:ProstateCancerSupport ] On Behalf Of lasalandramj

Sent: Wednesday, 2 June 2010 4:34

AM

To:

ProstateCancerSupport

Subject:

Gleason 6 and 7 in the same biopsy?

I have been doing watchful waiting for 7 years. I have had 4 biopsies. The

first three all showed pretty much the same thing. 2 of 12 cores positive,

small percentage each of the two was cancerous, always Gleason 6.

I recently had a 20-core biopsy. Again, two samples were positive, small

percentage each was cancerous, but one was deemed a 6 and the other a 7. Any

thoughts?

[Guest guest]

> I have been doing watchful waiting for 7 years. I have had 4 biopsies.

> The first three all showed pretty much the same thing. 2 of 12 cores

> positive, small percentage each of the two was cancerous, always Gleason 6.

>

> I recently had a 20-core biopsy. Again, two samples were positive, small

> percentage each was cancerous, but one was deemed a 6 and the other a 7.

> Any thoughts?

Yes: A Gleason 7 (was it 4+3 or 3+4? This and the percentage of

each are important) is on the cusp of " serious, " and it will

never get better. BTW, what is the PSA history?

Seven years on WW (or AS, Active Surveillance) is a good run, but

I recommend treatment. It's time.

Regards,

Steve J

" There is NOWHERE in oncology where waiting for the tumor cell

population to increase (and to mutate) is in the better interests

of the

patient. "

-- B. Strum, MD

Medical Oncologist

PCa Specialist

[Guest guest]

Doug,

I am not in a position to make any

informed comment on YOUR decision. We must each make the decision that suits

our diagnosis and our paradigm. I just believe strongly that men should be well

informed BEFORE making their decision and are not rushed into treatment that

might not be in their best interests.

My decision in 1996 differed significantly

from yours. That does not make my decision ‘right’ or yours ‘wrong’.

All the best

Terry Herbert

in Melbourne

Australia

Diagnosed ‘96: Age 54:

Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony

Metastasis:Started ADT Aug '07: May '08 - stopped ADT. May '10 PSA 8.20 :

Recommenced ADT

My site is at

www.prostatecancerwatchfulwaiting.co.za

It is a

tragedy of the world that no one knows what he doesn’t know, and the less a man

knows, the more sure he is that he knows everything. Joyce Carey

From:

ProstateCancerSupport [mailto:ProstateCancerSupport ]

On Behalf Of Doug Archer

Sent: Wednesday, 2 June 2010 9:54

AM

To:

ProstateCancerSupport

Subject: Re:

Gleason 6 and 7 in the same biopsy?

Hi Terry:

Considering the information in this E-Mail,

My prostate Cancer DX on October 25, 2004; The day before

my partner's 40Th birthday;

With Gleason score of 3 + 3=6 in the year, 2004, do

you think I over reacted with surgery on December 15, 2004?

Thank You,

Doug Archer, San

Diego

[Guest guest]

Doug,

I am not in a position to make any

informed comment on YOUR decision. We must each make the decision that suits

our diagnosis and our paradigm. I just believe strongly that men should be well

informed BEFORE making their decision and are not rushed into treatment that

might not be in their best interests.

My decision in 1996 differed significantly

from yours. That does not make my decision ‘right’ or yours ‘wrong’.

All the best

Terry Herbert

in Melbourne

Australia

Diagnosed ‘96: Age 54:

Stage T2b: PSA 7.2: Gleason 7: No treatment. Jun '07 PSA 42.0 - Bony

Metastasis:Started ADT Aug '07: May '08 - stopped ADT. May '10 PSA 8.20 :

Recommenced ADT

My site is at

www.prostatecancerwatchfulwaiting.co.za

It is a

tragedy of the world that no one knows what he doesn’t know, and the less a man

knows, the more sure he is that he knows everything. Joyce Carey

From:

ProstateCancerSupport [mailto:ProstateCancerSupport ]

On Behalf Of Doug Archer

Sent: Wednesday, 2 June 2010 9:54

AM

To:

ProstateCancerSupport

Subject: Re:

Gleason 6 and 7 in the same biopsy?

Hi Terry:

Considering the information in this E-Mail,

My prostate Cancer DX on October 25, 2004; The day before

my partner's 40Th birthday;

With Gleason score of 3 + 3=6 in the year, 2004, do

you think I over reacted with surgery on December 15, 2004?

Thank You,

Doug Archer, San

Diego

[Guest guest]

Doug Archer wrote:

> Considering the information in this E-Mail,

> My prostate Cancer DX on October 25, 2004; The day before my

> partner's 40Th birthday; With Gleason score of 3 + 3=6 in the

> year, 2004, do you think I over reacted with surgery on

> December 15, 2004?

There are many factors that go into determining whether treatment

is warranted. Gleason score is one. Others include:

PSA.

PSA velocity.

Number of positive cores.

Percentage of cancer in each core.

Whether a palpable tumor is found (i.e., the urologist can

feel it with his finger.)

Whether it's on both sides of the prostate or just one.

Age and life expectancy (apart from cancer) of the patient.

What the patient wants.

My initial diagnosis was Gleason 6, PSA 6. It's possible that

the urologist discussed the other information above, but if he

did, I didn't hear it. When he told me I had cancer, my jaw

dropped, I went into a state of shock. All I could think was,

I'm still young (57) and I'm going to die! He also told me I

needed surgery and I needed it soon. Don't wait he said, or I

could face a horrible death.

I was plenty scared and couldn't wait for treatment to start. It

seemed to me that the cancer must be growing every day and I

wouldn't live to see my grandchildren. I never really considered

not getting treatment and no one told me it was an option to do

so.

I believe that most men do exactly what you and I did, under the

same kind of pressure that I (and probably you too) was under.

Did we make the best decisions? Who knows? We did what we did.

We followed the advice of medical experts. We made the best

choice we could given the information we had, the expert advice

we were getting, and the ideas we had about what cancer is.

Second guessing after the fact won't change anything or make us

feel better one way or the other. There's no point beating

ourselves up about whether we did the best thing.

For the record, in my particular case I did hold out long enough

to get second opinions and find other doctors. I mainly did it

because I didn't like the urologist, not because I thought he was

wrong. A second opinion on the biopsy said I really had 4+3, not

3+3, and my PSA was going up. So, knowing what I know now, I

think I might have needed treatment before too many years passed.

But even if the Gleason were 3+3 and my PSA stayed at 6, feeling

as I did then, I just wasn't mentally prepared to consider

watchful waiting.

Alan

[Guest guest]

Doug Archer wrote:

> Considering the information in this E-Mail,

> My prostate Cancer DX on October 25, 2004; The day before my

> partner's 40Th birthday; With Gleason score of 3 + 3=6 in the

> year, 2004, do you think I over reacted with surgery on

> December 15, 2004?

There are many factors that go into determining whether treatment

is warranted. Gleason score is one. Others include:

PSA.

PSA velocity.

Number of positive cores.

Percentage of cancer in each core.

Whether a palpable tumor is found (i.e., the urologist can

feel it with his finger.)

Whether it's on both sides of the prostate or just one.

Age and life expectancy (apart from cancer) of the patient.

What the patient wants.

My initial diagnosis was Gleason 6, PSA 6. It's possible that

the urologist discussed the other information above, but if he

did, I didn't hear it. When he told me I had cancer, my jaw

dropped, I went into a state of shock. All I could think was,

I'm still young (57) and I'm going to die! He also told me I

needed surgery and I needed it soon. Don't wait he said, or I

could face a horrible death.

I was plenty scared and couldn't wait for treatment to start. It

seemed to me that the cancer must be growing every day and I

wouldn't live to see my grandchildren. I never really considered

not getting treatment and no one told me it was an option to do

so.

I believe that most men do exactly what you and I did, under the

same kind of pressure that I (and probably you too) was under.

Did we make the best decisions? Who knows? We did what we did.

We followed the advice of medical experts. We made the best

choice we could given the information we had, the expert advice

we were getting, and the ideas we had about what cancer is.

Second guessing after the fact won't change anything or make us

feel better one way or the other. There's no point beating

ourselves up about whether we did the best thing.

For the record, in my particular case I did hold out long enough

to get second opinions and find other doctors. I mainly did it

because I didn't like the urologist, not because I thought he was

wrong. A second opinion on the biopsy said I really had 4+3, not

3+3, and my PSA was going up. So, knowing what I know now, I

think I might have needed treatment before too many years passed.

But even if the Gleason were 3+3 and my PSA stayed at 6, feeling

as I did then, I just wasn't mentally prepared to consider

watchful waiting.

Alan

[Guest guest]

I would agree..and I would opt for the hormone..external radiation treatment. WORKING FOR ME! And side effects annoying..but certainly manageable! Would not have elected anything

different..and half done... JIM ...WISCONSIN!> I have been doing watchful waiting for 7 years. I have had 4 biopsies.> The first three all showed pretty much the same thing. 2 of 12 cores> positive, small percentage each of the two was cancerous, always Gleason 6.>> I recently had a 20-core biopsy. Again, two samples were positive, small> percentage each was cancerous, but one was deemed a 6 and the other a 7.> Any thoughts?Yes: A Gleason 7 (was it 4+3 or 3+4? This and the percentage of each are important) is on the cusp of "serious," and it will never get better. BTW, what is the PSA history?Seven years on WW (or AS, Active Surveillance) is a good run, but I recommend treatment. It's time.Regards,Steve J"There is NOWHERE in oncology where waiting for the tumor cellpopulation to increase (and to mutate) is in the better interests of

thepatient."-- B. Strum, MDMedical OncologistPCa Specialist------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it

[Guest guest]

I would agree..and I would opt for the hormone..external radiation treatment. WORKING FOR ME! And side effects annoying..but certainly manageable! Would not have elected anything

different..and half done... JIM ...WISCONSIN!> I have been doing watchful waiting for 7 years. I have had 4 biopsies.> The first three all showed pretty much the same thing. 2 of 12 cores> positive, small percentage each of the two was cancerous, always Gleason 6.>> I recently had a 20-core biopsy. Again, two samples were positive, small> percentage each was cancerous, but one was deemed a 6 and the other a 7.> Any thoughts?Yes: A Gleason 7 (was it 4+3 or 3+4? This and the percentage of each are important) is on the cusp of "serious," and it will never get better. BTW, what is the PSA history?Seven years on WW (or AS, Active Surveillance) is a good run, but I recommend treatment. It's time.Regards,Steve J"There is NOWHERE in oncology where waiting for the tumor cellpopulation to increase (and to mutate) is in the better interests of

thepatient."-- B. Strum, MDMedical OncologistPCa Specialist------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it

[Guest guest]

Hang in there, Jim. And don't be completely surprised if the side effects get worse (although I hope they don't). Mine did, and the oncologist gave me several days "off," which lengthened my timeframe for 44 radiation treatments, but before the end of last year I completed the regimen, and, thankfully, have a PSA of <.1 to show for it.

Tom, formerly PSA of 5.7, 1 out of 12 samples malignant, 3+3, 65. Lupron & IGRT.

Re: Gleason 6 and 7 in the same biopsy?

I would agree..and I would opt for the hormone..external radiation treatment. WORKING FOR ME! And side effects annoying..but certainly manageable! Would not have elected anything

different..and half done... JIM ...WISCONSIN!> I have been doing watchful waiting for 7 years. I have had 4 biopsies.> The first three all showed pretty much the same thing. 2 of 12 cores> positive, small percentage each of the two was cancerous, always Gleason 6.>> I recently had a 20-core biopsy. Again, two samples were positive, small> percentage each was cancerous, but one was deemed a 6 and the other a 7.> Any thoughts?Yes: A Gleason 7 (was it 4+3 or 3+4? This and the percentage of each are important) is on the cusp of "serious," and it will never get better. BTW, what is the PSA history?Seven years on WW (or AS, Active Surveillance) is a good run, but I recommend treatment. It's time.Regards,Steve J"There is NOWHERE in oncology where waiting for the tumor cellpopulation to increase (and to mutate) is in the better interests of thepatient."-- B. Strum, MDMedical OncologistPCa Specialist------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it

[Guest guest]

Hang in there, Jim. And don't be completely surprised if the side effects get worse (although I hope they don't). Mine did, and the oncologist gave me several days "off," which lengthened my timeframe for 44 radiation treatments, but before the end of last year I completed the regimen, and, thankfully, have a PSA of <.1 to show for it.

Tom, formerly PSA of 5.7, 1 out of 12 samples malignant, 3+3, 65. Lupron & IGRT.

Re: Gleason 6 and 7 in the same biopsy?

I would agree..and I would opt for the hormone..external radiation treatment. WORKING FOR ME! And side effects annoying..but certainly manageable! Would not have elected anything

different..and half done... JIM ...WISCONSIN!> I have been doing watchful waiting for 7 years. I have had 4 biopsies.> The first three all showed pretty much the same thing. 2 of 12 cores> positive, small percentage each of the two was cancerous, always Gleason 6.>> I recently had a 20-core biopsy. Again, two samples were positive, small> percentage each was cancerous, but one was deemed a 6 and the other a 7.> Any thoughts?Yes: A Gleason 7 (was it 4+3 or 3+4? This and the percentage of each are important) is on the cusp of "serious," and it will never get better. BTW, what is the PSA history?Seven years on WW (or AS, Active Surveillance) is a good run, but I recommend treatment. It's time.Regards,Steve J"There is NOWHERE in oncology where waiting for the tumor cellpopulation to increase (and to mutate) is in the better interests of thepatient."-- B. Strum, MDMedical OncologistPCa Specialist------------------------------------There are just two rules for this group 1 No Spam 2 Be kind to othersPlease recognise that Prostate Cancerhas different guises and needs different levels of treatment and in some cases no treatment at all. Some men even with all options offered chose radical options that you would not choose. We only ask that people be informed before choice is made, we cannot and should not tell other members what to do, other than look at other options. Try to delete old material that is no longer applying when clicking replyTry to change the title if the content requires it