Prostate Cancer Survivors






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Urgency of Treatment

I read a post that indicated a May biopsy and the following September treatment. From what I gathered there were multiple Gleason scores, the highest was a 9. Puzzling to me because I thought you only got one score. This post indicated that surgery was scheduled 9/15 of that year but the patient ended up choosing hormone therapy starting on the same date. Seems the doctor in that case had a much higher sense of urgency for treatment than I experienced.

Consequently I am searching for information relative to urgency of treatment if you have a Gleason of 7 (4+3). I elected RP. It took 355 days from discovery to surgery. My Gleason post-op was 9 (5+4). I maintain that had the surgery been a lot more timely the post-op Gleason might not have elevated at all. Unfortunately my only health care option is the VA. There were several delays for either logistical issues or lack of personnel.

Any feedback on 'normal' sense of urgency by medical professionals would be appreciated.

Re: Urgency of Treatment

Gonzo; I am prone to guess that time had very little to do with your Gleason findings. The initial biopsy simply didn't sample the more serious area of cancer. Time does effect cancer spread however. About thirty percent of Gleasons are upgraded after examination of the gland post op. This is not a "luxury" one gets from treatments that do not remove the gland for examination. My opinion is that a Gleason of six gives an option of some wriggle room, a Gleason seven should be taken seriously, and anything over that needs prompt attention. Different areas of cancer "infestation" in the gland can have differing Gleason values. Earlier treatment for you very well might have come up at a Gleason of nine also and sorry to say that earlier treatment might have been beneficial in your case due to the accelerated spread rate of a Gleason nine cancer. Done is done however and crying over spilled milk and remorse over what was done or not done is not helpful. Don't fall into that trap as there is nothing you can change at this point anyway. Best to move on and, like most of us, hope for the best results. Think of it this way, after removal, a Gleason nine is no more serious than any other Gleason as long as it has all been removed. I hope that is the case for you. Jon R.

Re: Urgency of Treatment

As you know your initial Gleason score was based on a sample. When the entire gland is examined post surgery the Gleason score is often different, and I suspect in most if not all cases more accurate. None of us will ever know whether or not had your treatment been provided at an earlier date whether your Gleason outcome would have been determined to be at a lower number.
The fact that the VA did not provide you treatment in a more timely manner is most regrettable. SHAME ON THE VA! Do your best to put "what might have been" to rest and focus on the here and now and on what the future holds.
Best wishes Don O.