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2nd opinion on biopsy elevated to Gleason 8 - need advice!
I am 52 years old and got a biopsy in August 2008. My urologist took 12 cores. The cancer was Right mid gland Gleason 3 4 20%, Mid Apex 3 4 80% and Left Apex 3 4 30%.
I wanted a second opinion from another pathologist hoping for a lower Gleason score to support my decision for Active Surveillance.
So - I got an email from my urologist last night that that the cores from the apex were actually a higher grade, Gleason 4 4 according to the 2nd pathologist.
I plan to seek a 3rd opinion on the biopsy but I really need people's advice on the best path to treatment and the prognosis of this higher Gleason score as all of my research to date has been assuming Gleason 3 4. I know Active Surveillance is now out of the picture.
What would you do in my shoes right now? Really need some honest advice.
Re: 2nd opinion on biopsy elevated to Gleason 8 - need advice!
Al S,
This is a difficult position. What has your PSA been doing? Mine went from 9 to 14 over 4 to 5 months and with all 12 of my biopsy samples showing 5 to 70%, I was urged to do something before the PC (potentially) came out of the prostate. No one can tell you what to do, we can just relate to where you are now, to where we were then. Getting as many professional opinions as possible, even if you got to pay a little extra is well worth it.
Hang in there,
Joe Mac
Re: 2nd opinion on biopsy elevated to Gleason 8 - need advice!
Hello Al,
Sorry to hear you also got the bad news on this disease. At 59 I had 10 cores taken, 4 of which showed cancer with a Gleason of 4 3=7, no sign of extraprostatic extension nor perineural invasion . My PSA at the time was 4, having increased from 2.8 over two years. Nothing could be felt on DRE. I opted for surgery as the biopsy is just an indication (albeit a fairly good one)of the extent of the tumour. Post surgery pathology was changed to Gleason 4 4=8 with greater volume of tumour than indicated by biopsy, with extensive perineural invasion and a close call on margin. Recovery has been very good with no continuing incontinence (alas ED is a different story)and PSA less than 0.01 (undetectable)
Despite the cost (physically) I am pleased that I had the surgery and would adopt that same course if faced with the decision again. The only advice I would offer was to carefully look at each course of action and weigh up the possible consequences in each case so that you are sure of your ground once the decision has been made.
Bill Mac (Australia)
Re: 2nd opinion on biopsy elevated to Gleason 8 - need advice!
Hi Al,
Sorry to hear of your continuing worries over this biopsy.
For some reason my Gleason score was never properly measured. At first I was told by the urologist it was 3 + 3, but MRI scans revealed cancer spread to the seminal vesicles and pelvic wall, so the oncologist told me it was probably much higher.
It turned out that my samples had been lost or damaged in pathology!
Anyway,the cancer grading was most definitely T4 and I was given a pretty bleak prognosis. I opted for hormone therapy and 37 radiotherapy treatments.
For me, it has worked far better than I could have expected. The HT was intended to last three years but I asked to come off it at the 30 month mark. By then I'd seen a PSA of <0.1 for just over a year.
I have now gone one full year with no medication and my PSA last week was an incredibly low 0.94 while the testosterone was high and healthy. I had started from a PSA of 182 at diagnosis in April 2005.
Looking back, I have to say that I am glad surgery was never an option for me. Yes, I know there are some successful outcomes from surgery, but there is always a high risk of side effects such as impotence and incontinence.
Maybe I am one of the lucky ones, but I have come through the HT and RT with neither of those damaging effects.
I found the RT very easy, and the HT very tiring - but it was all worth it.
Al, be very involved in your treatment, and agree only to what you feel will be right for you. Never hesitate to ask all the questions you want of your oncologist.
You have a very important choice to make and I am sure you'll make it wisely.
Wishing you the very best of luck, and willing a hugely successful outcome for you.
Re: 2nd opinion on biopsy elevated to Gleason 8 - need advice!
Al,
Sorry. Welcome to the club. I think you need more information before you make a decision. First you need to know how your PSA has been increasing. Then you need a CAT scan and a bone scan to see if the cancer has left the prostate. These are important to know. Assuming that the cancer is confined to the prostate, the general feeling is that surgery is the way to go. If the disease is more advanced, hormones and radiation are the usual treatments. Whatever you choose, make sure you know all of the side effects. Also, choose the most experienced doctor you can find. I've had both surgery and hormone/radiation so I got the worst of both worlds. You might want to read my story to see some of the pitfalls:
http://www.yananow.net/Mentors/PaulA2.htm
That being said, do your homework, find a good doc, get into shape as much as you can (including kegels, and have as much sex now as you can (you may not have that option again for awhile).
Re: 2nd opinion on biopsy elevated to Gleason 8 - need advice!
Al,
Several things come to mind.
First, because one of the cores is evaluated as Gleason 4 4 does not mean your biopsy result is also an 8. Cause the overall result encompasses all the cores, hence I believe you are still a 7.
Second, even though one of your cores has an 80% cancer finding, dont assume that the cancer volume is large overall. I had two cores with cancer as high as that and after surgery (2 months later) my pathology report was 10 to 15% cancerous tissue overall. Likely your urologist and mine were both skillful in taking the cores where cancer volume was highest.
Third, I do not agree that you should request bone scans and such. With your low PSA you can be assured that they will come up negative. Even on the off chance that some cancer has left the area you can not expect it to show up on the bone scans yet. Of course if your doctors want it you should comply.
Finally, I would do some research on the Internet or wherever on the implications of having the stronger cancer finding in the apex area. I don't know much about that myself, but I do think there are some implications, and you might as well understand them.
Best wishes
