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Is Gleason 6 really cancer?

User
Posted 06 Jun 2023 at 10:17

Hi Greg,

Going back to your first post, my view is that Gleason 6 should very much still be called cancer because it is by definition, abnormal cells growing.

I feel this way because last Friday I got my biopsy results which were G6, grade 1 with only 1 core of 21 showing cancer. I’m 55 and was told that the preference of the medical team is AS probably for all the reasons covered in the various replies above BUT my MRI showed two areas of concern, one Pi-RAD 3, the other Pi-RAD 4. The one cancerous core was in area 3.

I have not yet received the TNM score nor had access to the MRI report or pathology and there was no discussion about them during my results meeting. Nor the % of cancer in the core or the location.

From my perspective therefore, as things stand, either the MRI grade was wrong or the biopsy failed to pick up any of the cancer that is “likely” to exist in area 4. If the latter, then my current 3 & 3 grade 1 based on just 1 core, could be higher and that could alter the team’s recommendation for AS.

The issue I think is that perhaps anything with a score of 6 is over half way between 1 and 10 and yet we are told that the prognosis for a 6 grade 1 is nowhere near half as serious (in the short term at least) as say a G8. That is I gather one of the factors behind the introduction of the CPG score/grade. With all of the public messaging around cancers generally being of the “find it early, can do something about it” type, it is highly counter-intuitive to then go along with being told that the best thing to do is just to monitor it, especially when my father has PCa (albeit it only surfaced when he was 80) also had lung cancer which my brother has too and which has spread to secondary brain cancer plus my mother died from oesophageal cancer aged 63.

Maybe I am over sensitive to the C word given family experience and maybe my Specialist Nurse or another member of my medical team will be able to explain things fully and give me confidence that my biopsy result is accurate but, for now, I would not want my “pussy cat” cancer being re-defined when the balance of probability (subject to getting the full information that I should have been given in the results meeting) seems to be a false negative is involved.

Jon

 

 

User
Posted 06 Jun 2023 at 10:38

Hi Jon

It’s understandable that you feel as you do about cancer because of your family history. I am similar as my dad died of pancreatic cancer and had a secondary bowel cancer. My mother has had breast cancer and we have lost relatives on my mothers side to various cancers. 

I do feel that G6 is cancer and as such needs very close monitoring or radical treatment. My PIRADS were 5, one very close to or breached the capsule so the urology team felt that radical treatment was necessary and AS was out of the question. The surgeon thinks it is still contained within the prostate though and believes the operation “should” be a text book success. 

 

As I was never offered AS I’m not sure how I would cope with living with it. That’s one of the cons of AS as far as I can see, dealing with the mental issues of knowing you have cancer but that nothing is being done to cure it. 

Wish you the best on your journey and I hope everything goes well and smoothly for you. 
All the best

Greg. 

User
Posted 06 Jun 2023 at 12:28

Hi Greg,

We are both very justified in being nervous things I think.

In April you were saying you would need to go to Newcastle for surgery. Is that where you will be having the op? - My wife is a Geordie and through her brother I am in touch with someone who he knows who had robotic removal last October and has extremely high praise about his experience there.

Jon

User
Posted 06 Jun 2023 at 12:34

Hi Jon

Yes it will be The Freeman hospital at Newcastle where my op will be. 
I’ve spoken to a couple of guys who’ve had the DaVinci op there and they both say the same as you, great care and (for them) great outcomes. 
I’m hoping mine will go as smoothly. 🤞

Cheers

Greg. 

User
Posted 06 Jun 2023 at 15:57

Hi Greg,

Hope it all goes well for you and the side-effects are minimal.

From things I have read about DaVinci and chatting with my new Geordie contact, I had settled on Robotic RP route before I had my results meeting and was blindsided by the AS recommendation. If I end up down the treatment road, it is still my preferred option, thankfully they have one at our West Midlands hospital.

Very best wishes,

Jon

User
Posted 06 Jun 2023 at 16:25

Thanks Jon and good luck 😊👍

Greg

User
Posted 06 Jun 2023 at 16:38
I just caught up on this thread. Post biopsy I was Gleason (3+4)7 and was given the choice of procedure. I opted for RARP which took place on May 12th and it has been far, far better than I ever expected. A couple of days of discomfort in the shoulders from the CO2 inflation of the abdomen and 7 days with the catheter and now regaining some urine control as well as experiencing a floppy penis orgasm and I would encourage anyone who has the opportunity to get RARP to jump at it. The dam cancer is out of my body and I can relax (more so after the histology reports on the 24th June) and the symptoms have been mild and perfectly acceptable.

If I could I would name my firstborn "Da Vinci" but those days have long gone.

I wish I had known then what I know now as I would have been far less afraid and worried in the weeks leading up to it!

User
Posted 06 Jun 2023 at 17:52

Thanks for your success story Steve, it helps. 
The anxiety is definitely growing whilst I wait for the date …gulp. So reading your post has helped 😊👍

Cheers

Greg. 

User
Posted 06 Jun 2023 at 19:15

Hi Steve,

As someone yet to make the formal decision between AS and RARP but who was favouring RARP (the “just get it out of me” approach), it is also a comfort to hear your positive experience that not everyone gets 2 years of incontinence and erectile disfunction or worse. Being 55, the main priority is hopefully still being here in 20 to 25 years but if it is possible to be cancer-free and not have the side-effects for that length of time, that would be so much the better. 

Best wishes,

Jon

 

User
Posted 06 Jun 2023 at 22:26
Good luck Jon

As I said, I would recommend the RARP based on my experiences and after less than 4 weeks I am getting good pee control and it gets better every day. As for erections then I know I am going to have to wait but there are plenty of ways of enjoying a fun sex life without penile penetration - that's all I'll say on the subject but remember that you don't need an erection to enjoy an orgasm.

The fact that I am not sitting here thinking "I wonder if the radiation is working" makes it a no brainer for me. I'm 62 by the way.

 
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