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Re: Inconsistent results?

well said Sir.

Re: Inconsistent results?

Greetings Don,

Thanks for providing thoughts about my situation.

I appreciate your two proposed, possible reasons for the increase in my PSA. I had thought about the possibility of more cancer cells being present, i.e. the tumor(s) having grown in the intervening 10 yr. That is why I was surprised that the biopsy did not show much higher volume of cancerous cells in the recent biopsy than the one in 2003. However, as Terry pointed out, the biopsies may not be sampling all the tumor(s) present. Regarding your second point, I was unaware that the Gleason score of a given tumor can change over time. Is this known to occur routinely? My thought was that the 3+3 had "changed" to 3+4 either because of the "Gleason migration" that has come about in the scoring by pathologists between 2003 and 2013. Or the possible differences among pathologists in their scoring. There has to be some variability in the scoring, otherwise the same biopsy cores would not lead to different Gleason scores when analyzed by different pathologists. If you can direct me to some studies that have shown increasing Gleason scores for a given tumor over time, I would definitely like to read more about that.

Thanks for suggesting the book by Bob Marckini. I am most interested in learning more about the pros and cons of various possible treatments. The CONS I have read about thus far certainly are of concern to me! It appears that ALL the treatments come with considerable, possible risks.

Thanks again.

Nelio

Re: Inconsistent results?

Nelio:
Don't rightfully know if Gleason scores actually change over time. I guess I just assumed that was the case. I do know that pathologists differ in their analyses. Marckini emphasizes the need for second opinions on biopsies. I also know that results from a biopsy often differ from an analysis of the dissected gland following a prostatectomy.
Whether or not some cancers actually become more aggressive over time poses an interesting technical question. Perhaps someone following this thread can educate us both.
Best wishes Don O.

Re: Inconsistent results?

An after thought: How rapidly your PSA is rising is an indication of the aggressiveness of your cancer.

Re: Inconsistent results?

Don, Terry, et al:

I picked up this article which deals with the progression of Gleason grade/score for a tumor over time. What are your thoughts?
http://prostatecancerinfolink.net/2013/08/13/how-low-is-the-risk-for-gleason-score-progression-over-time/

Nelio

Re: Inconsistent results?

I reviewed the article fairly quickly. My initial reaction is as follows:
1.Excellent article.
2.Stongly suggests Gleason scores are stable over time.
3.Double whammy for guys like me with an initial diagnosis of 4+3 (subsequently judged to be 4+4 after first-line treatment, same biopsy slide, different pathologist).
You did a great job locating information the two of us (and possibly many others) wondered about.
Best wishes Don O.

Re: Inconsistent results?

saw that article as well. make sure to read the comments at the bottom, as it is fleshed out even more and has some great information in it.

Re: Inconsistent results?

Walt:
Yes! I agree. I suspect Terry will too.
Don O.

Re: Inconsistent results?

Don it was somewhat ironic that I read this study last week while I was in hospital after my recent procedure and just before I rerceived the pathology results.

When I was diagnosed back in 1996 I had four pathology labs examine my biopsy cores and got results oof 3+3=6, 2=3=5 and 3+4=7. My latst result seventeen years later was a surprising 5+4=9!

So....some tumours may well progress!! Full details to be published.

All the best
Terry in Australia

Re: Inconsistent results?

Exception to the rule? One wonders.*
All of us will be looking for the details Terry. To be published in your YANA story line?
Best wishes Don O.
* Are you tuned in Nellio?

Re: Inconsistent results?

Greetings Don (and Terry),

I have read the latest comments regarding Gleason grade progression. The results of the Penney study and Terry's most recent biopsy would indicate that once again with PCa "There Are No Rules". This disease must be as extremely frustrating for researchers and clinicians, as it is for patients.

Have a Great Day!

Nelio

Re: Inconsistent results?

I would like to comment on having a MRI to find the location of your cancer. While a conventional MRI is not very good at seeing prostate cancer. A multi-modal MRI is very good at finding prostate cancer. Here is a link to a article that says the accuracy of detection cancer with a multi-modal MRI is more than 90%. http://www.umcn.nl/Zorg/Afdelingen/Radiologie/Documents/MRI%20in%20PCa%20PCRI%20Insights%20short%20(2).pdf

Mitch

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