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Re: Anyone on AS with a Gleason 7?

Walt,

I am not sure what you mean when you say, with reference to the study in your post .....this could apply to me soon, if the 2nd opinion on my pathology slides confirms a 3+4. What do you mean by "THIS"?

In another post you say:

my biopsy result was good & bad. :( Positive cores were down to 2/12 (down from 3/12) and the tumor percentages were the same or less. However the Gleason increased to a 7 (3 + 4). sending pathology slides out for a 2nd opinion today. I need some prayers. :-) Walt

Mike Scott's commentary on the study you refer to says, in part:

Clearly, active surveillance is not going to be a wise strategy for men with high-volume Gleason 7 disease, a long life expectancy, and a PSA >10 ng/ml. However, there is a very real question about whether active surveillance may be appropriate for men with only small amounts of localized Gleason 3 + 4 disease.

I don't know much about your life expectancy, or your PSA history but you certainly miss out on the main criterion - you do NOT have a high volume Gleason 7 disease. I'd put money on a guess that you do NOT have a PSA greater than 10 ng/ml either.

If you hunt around for Active Surveillance studies, you will find that many of them admit men with a Gleason 7a (3+4) and that the conclusion they have come to is that there is very little,if any, difference in outcome between men with a 7a who choose AS and men with a 6. Some urologists insist that if there is ANY material with a grade of 4, even if it is a very small amount of secondry or even tertiary focus, AS is not appropriate. But the studies do not support this view.

Added to that is the question of accuracy of the grading system which has been changing for the past ten years. When I was diagnosed back in 1996 (with a GS7a) a man with a Gleason Score of 5 was labelled as having cancer. That has changed. GS 5 is no longer 'cancer' but of course one of the consequences of taking GS5 off the menu is that a lot of GS 5 men were shifted to GS 6 and many GS 6 men went to GS 7a - and so on up the line. If you haven't seen it before, you might find this article of interest - Gleason Grade Migration

Oh! And in answer to your question Anyone on AS with a Gleason 7? if you go along to the Survivors Stories page and enter the relevant data you will find there are eight of us who chose AS with a Gleason 7. Two of us go back to 1996 and we're still here.

Good luck on whatever path you choose,

Terry in Australia

Re: Anyone on AS with a Gleason 7?

Terry thanks for the thoughtful reply! By "this" I meant active surveillance. i.e. being on AS with a Gleason 7a could be me.

my PSA's have NEVER been above 2.8 (and that was only once, and I think it was a false high based upon a DRE and sex within a 72-hour window of the test!).

my PSA's back to Summer 2011 are: 1.0, 1.6, 2.8 (biopsy & diagnosis), 1.7, 1.25 (!!), 1.5 and 1.6.

not too shabby, eh? ;-)

Re: Anyone on AS with a Gleason 7?

I am on AS but with G6. With the help of my Uro, we just ordered a Prolaris Test to predict the aggressiveness of my PCa.

Perhaps before you decide on AS ask your Uro to order a Prolaris Test. Also Oncotype Dx has just come on the market. However, Prolaris (Myriad) has a program to not test if it is going to cost you more than $375 (retail cost $3,750). They may also negotiate your cost if your insurance does not cover the test. Please call them to find out more detail. Oncotyp DX is new and perhaps not approved by insurance companies yet.

Akai

Re: Anyone on AS with a Gleason 7?

I think it may well be good news at some time in the future that some of the new tests do give us more accurate information and I certainly would never suggest that anyone misses an opportunity to add more data to help their decisoin making process, BUT.....there is a good deal of spin about how the results of the rather small studies are presented - and the way in which the data has been accumulated.

As regulars of this Forum and my E-Letters will know, I believe that Mike Scott who moderates the The "New" Prostate Cancer Infolink presents a very balanced view of the PCa industry, so it may be worth reading this piece which he wrote following the ASCO meeting earlier this month The real clinical utility of tests like Prolaris and Oncotype DX in management of prostate cancer

As I say, by all means use these tests, but please be aware of their potential limitations.

All the best
Terry

Re: Anyone on AS with a Gleason 7?

Terry, I totally agree, I do visit the newprostatecancerinfolink site daily. I did read the article on Prolaris and Oncotyp Dx. Since there isn't anything else better, and staying on AS isn't always easy, it may just either help to ease you r mind or push you to get treatment. It reduces your anxiety (at least for me). I am also waiting for PHI test to be available, another piece of date for me to help me make a decision.

akai

Re: Anyone on AS with a Gleason 7?

Akai, I'll look into that Polaris test. thanks for the tip.

I'm ALREADY on AS for the past year. My annual biopsy (5/18/13) showed a drop in volume (2/12) but an increase to Gleason 3+4. My PSA's remain extremely low (latest 1.6).

So, for me, if the Gleason 3+4 is confirmed, it's a tough decision. It would be easier if either of the other two measurements raised along with the Gleason since last year (more volume, more percentage, increased PSA, etc).

Then, it would be an easy call. But, since it's only the one area of increase. I don't know what to do.......

Re: Anyone on AS with a Gleason 7?

Walt:
I received my test result yesterday, my score was -0.1 which is right in the middle of the scale (54 % of patients in the AUA low risk category have a lower Prolaris score).
My 10-year mortality risk is 2% if managed conservatively (managed conservatively not defined).

My anxiety level is a little lower today. I think I will stay the course. Still have not decided if I should have another biopsy at my first anniversary coming up Aug 3rd.

Re: Anyone on AS with a Gleason 7?

congrats on the good test result!!

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