Guest guest Posted June 2, 2010 Report Share Posted June 2, 2010 I had a Gleason 7 (3 +4) while on Active Surveillance for 2 and 1/2 years as determined by 2 biopsies from Bostwick labs, the first in August 2007 was a Gleason 6 (3+3) and the second about a year ago was the Gleason 7 (3 +4). Back in September 2009 had samples sent to s Hopkins which scored it a Gleason 6(3 +3).Sy Wed, Jun 2, 2010 at 11:56 AM, <ProstateCancerSupport > wrote: Prostate Cancer Support Messages In This Digest (12 Messages) 1a. Gleason 6 and 7 in the same biopsy? From: lasalandramj 1b. Re: Gleason 6 and 7 in the same biopsy? From: Larry Helber 1c. Re: Gleason 6 and 7 in the same biopsy? From: Terry Herbert 1d. Re: Gleason 6 and 7 in the same biopsy? From: Steve Jordan 1e. Re: Gleason 6 and 7 in the same biopsy? From: Doug Archer 1f. Re: Gleason 6 and 7 in the same biopsy? From: Terry Herbert 1g. Re: Gleason 6 and 7 in the same biopsy? From: Alan Meyer 1h. Re: Gleason 6 and 7 in the same biopsy? From: Jim Hoppe 1i. Re: Gleason 6 and 7 in the same biopsy? From: Tom Lauterback 2. Biopsy accuracy From: ccnvw@... 3a. Re: PSA anxiety From: ccnvw@... 3b. Re: PSA anxiety From: Alan Meyer View All Topics | Create New Topic Messages 1a. Gleason 6 and 7 in the same biopsy? Posted by: " lasalandramj " lasalandramj@... lasalandramj Tue Jun 1, 2010 12:00 pm (PDT) 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? Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (9) 1b. Re: Gleason 6 and 7 in the same biopsy? Posted by: " Larry Helber " lhelber@... larryhelber Tue Jun 1, 2010 12:37 pm (PDT) 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? Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (9) 1c. Re: Gleason 6 and 7 in the same biopsy? Posted by: " Terry Herbert " ghenesh_49@... terry_hrbrt Tue Jun 1, 2010 2:43 pm (PDT) , 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 OncologyT 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? Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (9) 1d. Re: Gleason 6 and 7 in the same biopsy? Posted by: " Steve Jordan " mycroftscj1@... mycroft1958 Tue Jun 1, 2010 3:44 pm (PDT) > 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 Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (9) 1e. Re: Gleason 6 and 7 in the same biopsy? Posted by: " Doug Archer " marston5000@... marston5000 Tue Jun 1, 2010 4:53 pm (PDT) 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 ________________________________ To: ProstateCancerSupport Sent: Tue, June 1, 2010 2:43:27 PM Subject: RE: Gleason 6 and 7 in the same biopsy? , 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 Placefor unbiased information at http://www.yananow. net/StrangePlace /index.html ________________________________ From:ProstateCancerSuppo rtyahoogroups (DOT) com [mailto:ProstateCan cerSupport@ yahoogroups. com] On Behalf Of lasalandramj Sent: Wednesday, 2 June 2010 4:34 AM To: ProstateCancerSuppo rtyahoogroups (DOT) com Subject: [ProstateCancerSupp ort] 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? Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (9) 1f. Re: Gleason 6 and 7 in the same biopsy? Posted by: " Terry Herbert " ghenesh_49@... terry_hrbrt Tue Jun 1, 2010 5:11 pm (PDT) 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 Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (9) 1g. Re: Gleason 6 and 7 in the same biopsy? Posted by: " Alan Meyer " ameyer2@... ameyer2 Tue Jun 1, 2010 6:39 pm (PDT) 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 Back to top Reply to sender | Reply to group | Reply via web post Messages in this topic (9) 1h. Re: Gleason 6 and 7 in the same biopsy? Posted by: " Jim Hoppe " jimmydaduck@... jimmydaduck@... Wed Jun 2, 2010 7:48 am (PDT) 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 cell population to increase (and to mutate) is in the better interests of the patient. " -- B. Strum, MD Medical Oncologist PCa Specialist ------------------------------------ There are just two rules for this group 1 No Spam 2 Be kind to others Please 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 reply Try to change the title if the content requires it Quote Link to comment Share on other sites More sharing options...
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