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Is Gleason 6 really cancer?

User
Posted 04 Apr 2023 at 20:02
Brachytherapy is generally only available for early stage prostate cancer, Greg, because it directs radiation to tumours inside the prostate. When the tumour has breached the capsule (T3) as in your case, I don't think it'll be on offer. It can, however, be combined with EBRT, which may be an option.

All the best,

Chris

User
Posted 04 Apr 2023 at 20:15

Ahh I see, that makes total sense Chris. 
Thank you

cheers

Greg. 

Edited by member 04 Apr 2023 at 20:16  | Reason: Not specified

User
Posted 04 Apr 2023 at 20:17

I thought I hadn’t heard of EBRT but that’ll be External Beam RT I’m guessing. 
Cheers Chris

Greg 

User
Posted 04 Apr 2023 at 20:51

Like someone has already said….how accurate is the biopsy? Many men’s Gleason score gets changed when they have the whole prostate removed. We always assumed my husband was 4+3=7 then after his op he was upgraded to Gleason 9….I think I always assumed 4+5 but we actually haven’t been told which way around.

User
Posted 04 Apr 2023 at 21:02

I was diagnosed Gleason 7 (4+3) (biopsy result) but after prostatectomy  was upgraded to Gleason 9 (4+5).

Gleason 6 needs a good eye kept on it in case there's a bit of pattern 4 that hasn't yet been seen.

My critical illness cover paid out but would not have done so for Gleason 6.

User
Posted 04 Apr 2023 at 21:57

Wow, Elaine and Ulsterman, I thought there would be maybe an increase of 1 in the Gleason after removal but I never would have imagined a jump of 2. 

User
Posted 04 Apr 2023 at 22:07

Originally Posted by: Online Community Member

I thought I hadn’t heard of EBRT but that’ll be External Beam RT I’m guessing. 
Cheers Chris

Greg 

Yes, exactly. Sorry - lots of acronyms around here 😁

User
Posted 04 Apr 2023 at 22:16

Haha yeah thanks Chris. 
I’m trying to learn them as quickly as I can 😁

Cheers

Greg 

User
Posted 05 Apr 2023 at 10:38

Hi Greg

I've also had a Gleason 6 diagnosis recently (PSA3.4) and am on Active Surveillance.

I seem to switch between being very concerned and then feeling like a complete fraud. As you know, it's quite something when a Urologist sits you down and tells you they've found cancer in your biopsy and then follows it up with "but don't worry too much"!

It confuses me when I read things like "it's not really cancer", if it isn't then why was I told that it was? I do consider myself very fortunate that it's not more advanced and I pray that it stays that way.

Similar to yourself, after 6 decades of excellent health the last 12 months or so have been a nightmare. I'm waiting for quite a serious operation which should take place in May, the PC was only found by accident following a PET scan. I have no prostate symptoms at all.

I had an unpleasant experience a week or so ago. I'm a member of a book group which meets up once a month. They're a lovely bunch of blokes. They asked me if I had any news about my upcoming abdominal aortic aneurysm surgery and I replied no but I've had a prostate cancer diagnosis and then explained it was Stage 1 etc so the outlook is pretty positive. One of the group is a GP (and a bit of an arse, it has to be said) and he was instantly very dismissive. "Don't be a drama queen,  you can't call that cancer". And when I urged the others to get themselves checked out, the good doctor piped up with "PSA Tests are a waste of time, don't bother". His wife recently told my wife that he gives himself a PSA test at home every month!

I felt totally dismissed and about 6 inches tall. I went home quite angry and upset. 

Rant over!

Anyway, I hope your appointment goes well tomorrow, Greg.

All the best

Nick

Edited by member 05 Apr 2023 at 10:53  | Reason: Not specified

User
Posted 05 Apr 2023 at 11:19

Hi Nick

It was great to read your post as that is exactly the way I feel.
I know some people are so much worse off than I am and I also do exactly as you do, I bounce from anxiety and worry to also feeling a complete fraud. I feel that I’m wasting the care teams time and I don’t deserve to have their attention wasted on me. It’s a terrible feeling to wrestle with and I feel for you. 

I think I probably side with the pathologist in the video, in that G6 is a cancer as it shows the same characteristics as other cancer cells. I understand that although not common it can still spread, as in my case they believe it has breached the capsule, but they think it is unlikely to have spread to other areas of the body. 

I have just finished a phone call with one of the CNS, who was absolutely brilliant. I said I have about 18 questions written down to ask In tomorrow’s appointment and is that ok? Will he have time to answer? Her response was “the patient comes first and he’ll just have to make time!” .. which we chuckled at. She followed it up with “he is very good and will be able to advise you with all your concerns and help you decide on a treatment, with your other health conditions in mind. We have a lot of people come to see us and most have many other conditions too. There’s always a plan”

That definitely reassured me for tomorrow’s appointment. 

The aortic aneurysm must be a real worry for you and I feel for you greatly. That will obviously be the first thing that needs tackled and I hope you get treatment and relief soon so you can cope with what might need done with your PCa in the future. 

I think that GP’s attitude is like many out there. I was talking to a friend who has just been through his RP and he told me about his neighbour who’s father and brother both had PCa. My friend said to him that he really should get checked. He went to his GP and he refused to do a PSA test as he did not have symptoms! That is shocking in my opinion and probably a cost saving exercise? 
When I was placed on my biological injections for arthritis I had weekly, then fortnightly, then monthly and now quarterly blood tests to measure inflammatory markers and liver and kidney function. After around a year my nurse said that they would only be checking liver and kidney from now on as they had been instructed to reduce “unnecessary” blood tests as a cost cutting measure. I said that this surely runs the risk of something being missed in someone who is already vulnerable? All she could say was… yes.

I am looking forward to tomorrow’s appointment … and dreading it at the same time. Each appointment just cements the fact that “sh*t’s getting real!” 🥴😊

Thanks for the encouragement Nick and best of luck with your aortic aneurysm OP 

Look after yourself 

Best wishes

Greg. 

User
Posted 17 Apr 2023 at 15:42

Hi Greg

How did your appointment go?

All the best

Nick

User
Posted 17 Apr 2023 at 16:03

Hi Nick

 I hope you’re keeping well. 

The bone scan was clear, thank goodness, so the urology consultant was writing to the Freeman Hospital in Newcastle to arrange a meet with the surgeon and anaesthetist. 
I’ve just this minute come off the phone with the surgeons secretary and I’ve to go over to see him at 11am this Thursday. 


It’s a 2 hour drive from where I live and I’ve not been there before, think it’s a massive hospital, so I best set off about 3 hours before to make sure I get there and find the right outpatient dept. .. that should be fun! 🥴

I’m getting more nervous as things progress but just trying to take each step at a time and see where it leads. 
I’m getting a bit sick of feeling like a rabbit in the headlights. Constant butterflies in the stomach and mind racing. 😞

Hopefully he’s great and will put my mind at ease a little. I’ll update my progress thread once I’ve seen him. 

Thanks for asking, take care

cheers

Greg. 

User
Posted 17 Apr 2023 at 16:54

Hi Greg

That's good news regarding the bone scan. Yes, I think you're right, take things one step at a time. I'll have a look at your other thread!

All the best

Nick

User
Posted 21 May 2023 at 17:44

This is exactly the position i am in.

No symptoms. I started having regular blood tests and part of that was PSA measurement. Whilst it was just over 4 for a couple of years suddenly increased to 6. Was sent for MRI which revealed a small growth. Biopsy subsequently diagnosed Gleason 3+3, grade I.

I was shocked that the Urologist immediately suggested surgery. When pressed he said radiation could be an alternative.

 When asked about active surveillance to start with he dismissed this on the grounds that I'm "too young" at age 64!

 

I've discussed with my GP who said there's a divergence between urologists who are aggressive and go for surgery and those prepared to consider AS.

 

He's agreed to work with me and I'm going down the Active Surveillance route. It might turn out to be a massive mistake, but having read about the risks I'm prepared to take my chances. After all it's not like AS is doing nothing.

User
Posted 21 May 2023 at 19:33

Good luck Gobbo

My initial investigations were for chronic pelvic pain, the cancer was found as an afterthought, if you know what I mean. My PSA was always low and I didn’t have many urinary symptoms. If I didn’t have the abdominal and pelvic pain I wouldn’t have even gone to the doctors or had the initial blood tests. 

My surgeon believes that the urologist has overestimated my stage 3 too, he thinks it’s more likely to be stage 2. Won’t know until it’s out and investigated. 
I think I probably agree with the pathologist in the video in that the cells look and behave like cancer so they do need to be “called” cancer. If it looks like a duck, walks like a duck and quacks like a duck … it’s got to be a duck…..just maybe a very slow and friendly duck. 😊

Good luck with your AS, I hope it behaves over the years. 👍

Cheers

Greg. 

User
Posted 22 May 2023 at 11:36

The diagnosis of prostate cancer has improved greatly since I had my surgery in 2011 but in my view to to say that Gleason score of 6 means it is not cancer is not scientific and has to be assessed on the basis of other data, for example the rate of rise, MRI assessment etc

 'Physics is like sex: sure, it may give some practical results, but that’s not why we do it.'                    Richard Feynman (1918-1988) Nobel Prize laureate

 

 

User
Posted 31 May 2023 at 08:33

Thanks for posting this Greg.

I have been diagnosed with Gleason 6 (3+3) T1. Four weeks after my biopsy now.

So I've also been reading and researching what this means online and came across similar discussion amongst urologists.

If my understanding is correct, a grade 3 does not always mean inevitable progression to grade 4. Some men can live for the rest of their natural with Gleason 6. Question is am I one of them? 

I'm based in Spain and have access to private healthcare (due to Brexit/residency requirements). It has been useful for queue jumping if Im honest , I can see a GP within a day, specialist within a couple of weeks. But I also have reservations, read on...

Unlike you Greg I had no symptoms whatsoever, but alarm bells rang when the annual routine blood test showed an increase in PSA from the usual 4.0 to 6.0. The subsequent MRI showed a small growth contained within the prostate.

The GP gave me the dreaded 'C' diagnosis and said I'd need to see a Urologist who'd do a biopsy and then I'd be 'in their system '. He also warned me urologists vary in approach and most were very aggressive ( meaning quick to carry out radical surgery). All the ones he knew of in the private clinic were like this! So he sent me to one he didn't know anything about.

The urologist said absolutely nothing could be decided before a biopsy, which was carried out 10 days later. Fair enough.

Before going to see the Urologist to discuss the biopsy result (which I was able to get from the clinic in advance) I thought I knew exactly what to expect (active surveillance -AS).

I was shocked when he immediately recommended surgery! When asked about alternatives he said radiation was as effective. But both would have side effects.

I had to raise the suggestion of Active Surveillance myself. He dismissed this patronisingly as inappropriate in my case, due to my youthful age of 64.

I didn't like his attitude and got the impression that he had his set ways of doing things and I was just another candidate for his knife. 

Maybe I'm cynical but wonder if the fact that he's in the private sector means they're happy to carry out surgery as the insurance then pays the bill, ££££ kerching!!

That put the fear of losing her husband into my other half and persuading her that AS was a sensible option at my stage, and not simply to whip out my prostate ASAP as the 'expert' recommended. I was aided by the NHS treatment diagnostic tool (which supports my AS preference), thankyou NHS!

I fully appreciate there are risks involved, for example the biopsy may have missed something nastier than a 3, but I'm prepared to take that risk. With AS I can take the decision to have treatment in the future, if things appear to be getting worse. I can at least delay the side effects of impotency and incontinence. Maybe for decades.

Yes there's a small chance the cancer will be far more radical than expected and I miss the chance to cut it out and stop the spread early on. I'm aware of the risk.

Fortunately my GP is fully supportive of AS and has booked me in for my next PSA test in a few weeks time. If the level has risen significantly it'll be another MRI scan and then we'll see.

In the meantime I'm trying to find a Urologist here in Spain who'll take the AS approach. There's surely one out there somewhere, perhaps in the state system where there's no potential conflict of interest?

I do stress that I have no symptoms other than extra nightime loo visits, but as my prostate is enlarged it can be down to that.

If I had other symptoms perhaps, and a gleason 7, I'd be more inclined to go for treatment.

 

Edited by member 31 May 2023 at 08:37  | Reason: Not specified

User
Posted 31 May 2023 at 08:57
Other risk factors are family history and proximity to the edge of prostate. You don't mention these?

I was a G6 T2B my NHS Urologist recommended prostatectomy based on the proximity to the edge and my family history. Turned out mine had chewed through the edge and become a T3A by the time it was removed. I still have a lingering PSA.

Otherwise active survielance sounds like the way to go in your case.

User
Posted 31 May 2023 at 09:57

”If my understanding is correct, a grade 3 does not always mean inevitable progression to grade 4. Some men can live for the rest of their natural with Gleason 6.”

I think you are imagining that the 3s eventually turn into 4s and then into 5s - but that is not how it usually works. A man can be diagnosed with a 3+3 and then remain a 3+3 for the rest of his life, even if the cancer metastisises. A man with a 4+4 will generally remain a 4+4 for the rest of his life even if the cancer becomes more aggressive and eventually kills him. Those cells that were pattern 3 will stay a pattern 3.

When a Gleason score changes, it is because of the unknown cell patterns. Your G3+3 means that when they looked at the cells under a microscope, the most common pattern observed was a 3 (your first number) and the second most common pattern was also a 3 (your second number). It may be that there is a very small amount of pattern 4 but it is not the most common or second most common pattern seen. What can happen over time is that all the 3s remain as they are but those few 4s (being more aggressive) replicate and divide until there are more of them than there are 3s - so the Gleason score changes. The trick on AS is to have a regular biopsy to ensure that any increase in the 4s is monitored.

If a man had any 5 pattern in the original biopsy, that would usually be reported in the biopsy results as something like G6(3+3) (tertiary 5) to flag up that the G3+3 is unlikely to stay that way for long.

We have men on here who have been successful with AS for years. However, as Franci says, suitability for AS is not just determined by the Gleason score. If the biopsy cores and / or MRI indicated that your cancer is close to the outer edge or close to the urethra, AS would be too risky. There are at least 27 types of prostate cancer; if your cancer is not the most common type (adenocarcinoma) but one of the rarer ones, AS would be madness. Did the urologist explain to you your exact results - or do you have a print out?

Edited by member 31 May 2023 at 09:57  | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 02 Jun 2023 at 22:35

Did the urologist explain to you your exact results - or do you have a print out?

Thank for your replies...

I got a printed copy of the biopsy and a CD copy of the MRI scan.

The Urologist explained little. In fairness English was not his strong point, and my Spanish isn't good enough yet to discuss medical issues in depth, but he certainly didn't attempt to explain much, we had to prompt him.

My OH has a friend who's a nurse in a cancer ward in Germany and kindly offered to ask a urologist there for an opinion . Based on the data I provided (biopsy and MRI results) he agreed AS was a reasonable approach.

The Spanish urologist also suggested a PET scan, which the German urologist said was too early at this stage. You can't have them too often due to radioactivity so best kept for later if things get worse is I suppose the reasoning?

Meanwhile I got an appointment with a GP in the Spanish State system. After explaining I'd like a second opinion as surgery seemed too radical at this stage she was very unsympathetic. Her attitude was "you have cancer, of course you need treatment" , with an inference of "why are you here wasting my time?".

Anyway she accepted it was her obligation to refer me to a urologist but said they'll all say the same thing anyway, treatment, not active surveillance. At least I'm now in the state system.

One curious thing about the biopsy was there was no information about what was in each of the individual 12 samples. They were all lumped together as sample A & B, with less than 10% cancer in A and =10% cancer in B. When I asked a GP about that he said sometimes the samples break up and it's not possible to separate them. He said it happens quite often in the lab? Anyone else had this experience? After reading about biopsies I understood knowing how many of the samples were 'positive' was quite an important piece of the puzzle?

As to family history, my father was never diagnosed with prostate cancer, though he died aged 70 of other causes, so who knows? Mother died aged 93 with cancer.

 

 

 

 

Edited by member 02 Jun 2023 at 22:41  | Reason: Not specified

 
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