This forum is for the discussion of anything to do with Prostate Cancer. There are only four rules:
No fundraisers, no commercials (although it is OK to recommend choices of treatment or medical people based on your personal research; invitations to participate in third-party surveys are also acceptable, provided there is no compensation to YANA);
No harvesting e-mail addresses for Spam;
No insults or flaming - be polite and respectful at all times and understand that there may be a variety of points of view, all of which may have some validity;
Opinions are OK, but please provide as much factual evidence as possible for any assertions that you are making
Failure to abide by these simple rules will result in the immediate and permanent suspension of your posting privileges.
Since this is an International Forum, please specify your location in your post.
That sounds like a sad case, Thomas, but not a surprising one. I don't know if you say the recent study shwoing that 25% of surgeries in the US were carried out by surgeons who do only one procedure in a year ? Seems you friend might have met up with one of these and a local pathologist.
He was told by several concerned people to get a second opinion. He, being in a state of shock, did not, and depended on his uro. He now knows he did not get proper treatment.
To anyone reading this, always get a second opinion. You may not change your choice of treatment, and you may not have anything to lose - except your quality of life.
I recently had a biopsy, after which I was told all the cores were "clean".
I inquired further as to whether there were any abnormalities below the "official" 3+3 Gleason 6.
Such as PIN or significant inflammation.
I was told there was no PIN and only fairly normal inflammation.
I took this to mean there were no 3's in my samples.
What I did not ask and what I do not completely understand is whether that means all my readings were either 1 or 2 ?
Thus, I assume my Gleason score was from between 2 and 4 total. But given your description it might allow for a 2+3 to be reported as non-cancerous but it would still seem that one wouldn't be told it was "entirely clean".
I assume "entirely clean" would mean no "3" readings were found.
It would seem like a person walking down the street with a 3+2 core, where the 3 is 90% of a core that is 80% of the sample length, is in more dangerous territory than a person who has a 3+3 core that only makes up 10% of the entire sample.
BTW, does PIN (high grade) have any relationship to 2's on the verge of being 3's, leading to the eventual 3+3 Gleason 6 ?
You say in part What I did not ask and what I do not completely understand is whether that means all my readings were either 1 or 2 ? Thus, I assume my Gleason score was from between 2 and 4 total. But given your description it might allow for a 2+3 to be reported as non-cancerous but it would still seem that one wouldn't be told it was "entirely clean".
It is not clear from your post why you think that ANY of the cells should be identified as adenocarcinoma of any grade. Why do you think that you might have had cancer? And did you get a copy of your pathology report? That might clarify some of the issues you raise, which should certainly be discussed with your medical people.
As I said in my post, it is not clear to me whether cells with the grade patterns previously identified as grades 1 and 2 were now said to be atypical cells (or, in your case – “fairly normal inflammation” - or some other nomenclature, or whether they were re-graded as grade 3. That is what I am trying to get more information on. The consensus of opinion from other non-medical men is that ANY adenocarcinoma that is not clearly grade as 4 or 5 is graded as 3. IF that is the case, then you have no identified adenocarcinoma else you would have been given a score of GS 6.
The relationship of PIN (prostatic intraepithelial neoplasia) to PCa has not been clearly identified. There is a correlation between men reported to have PIN samples in their biopsy and men who are subsequently diagnosed as having PCa, but I believe there is an even greater correlation between men with BPH (Benign Prostate Hyperplasia) and men who develop PCa, but that is not regarded as a risk factor.
CW,
It is not clear from your post why you think that ANY of the cells should be identified as adenocarcinoma of any grade. Why do you think that you might have had cancer? And did you get a copy of your pathology report? That might clarify some of the issues you raise, which should certainly be discussed with your medical people.
Thank you for the reply.
I don't think any of my cores were cancerous.
Rather I have always assumed that every cell, even a normal cell, would start as a 1 and go up from there.
Thus in a perfectly normal core the reading would be 1+1 Gleason 2.
I was unaware that there could be such a thing as a Gleason 0.
In other words I did not think Gleason scoring was confined to abnormal or cancerous cells, other than it being the scale on which to identify them.
So I assumed every core has some reading even if they never report the 1+1 or the 2+2, etc.
That is why I was wondering if a "completely clean" response could, in fact, still be as high as a 2+2, Gleason 4.
I'm not concerned, but just trying to understand where pre-abnormal turns into diagnosed cancer.
Seems its at Gleason 6, but it also seems you could have a very marginal 2+2 just on the edge of being a 3+3, and yet possibly being called "entirely clean" since no 3 has been found in the 10 to 12 samples.
I've always tried to explain to people that this is not like a pregnancy test were you either are or aren't, with no "almost".
I may not have a clear understanding of Gleason in the under 3 category.
As you have surmised, healthy cells do not carry a Gleason grade - only cancer cells exhibit the patterns that have, until now, been graded from 1 - 5.
You might like to go to http://www.yananow.net/diagnosis.htm to read up some of the aspects of Gleason grading and to follow the link to http://www.prostatelab.com/grading.htm - which is outdatd now.
I will be writing up a better description of the current position once I have been able to get some clarification, but I think that for now you can rest assured that you do not have an aggresive PCa, if you have PCa at all.
I can`t answer your original questions, but the following link might give you all an idea of what a good pathologist could/should do with your biopsies, and what information for therapeutic options could be infered from them.
http://www.prostapath.org
The home page is in German with a reduced US version. If you go to links & downloads in the German version you will find a paper in English: "A Proposal and the Identification, Histologic Reporting, and Implication of Intraductal Prostatic Carcinoma", that should be of special interest to people considering AS.
