Gleason Score (4+3=7). Any hope?

Hi Tom,

I think my dad (as well as the rest of my family) is anxious because we don't know the extent of the cancer, if it has spread, how aggressive it is, what stage the cancer is at, etc.

I know I'm repeating myself here, but after my father's diagnosis, I researched his 7 Gleason score (4+3), which is considered much more aggressive than a 7 score based on a (3+4). Apparently the difference in these scores is signficant, with my dad's score being much more aggressive and likely to spread (and we don't know if it has yet).

So at this point, we're quite frustrated because, despite being advised of my dad's prostate cancer in early November, and our doctor's emphasis on this 4+3 =7 Gleason score, the doctor even alluded to not knowing whether the cancer has spread and initially, was considering booking my dad's PSA test for early February, 2020 and then providing my dad with the results a week later. I then expressed concern over having to wait until then, and then the doctor agreed to move the appointment to January, 2020. My dad then contacted the doctor about the possibility of having his prostate removed, in which case they bumped my dad's appointment up for the PSA test and results to December, 2019.

When we were informed of my dad's prostate cancer diagnosis a few weeks ago, the doctor did NOT want to conduct a PSA test too soon after my dad's prostate surgery, which he just had done in early October, 2019. My dad had BHP; hence the prostate surgery. The doctor advised that my dad's PSA results would be elevated soon after prostate surgery. So now, we play the waiting game until December.

The doctor advised that we need the PSA test in order to know the extent of the cancer, at which time, depending on the PSA test results, they MAY send my dad for further tests and imaging.

I don't know - this whole experience just isn't adding up to me. I mean, why aren't they conducting MRI's, bone tests, cat scans, etc. regardless of not having the PSA tests done yet.

Also, in terms of the injections I referred to above, I'm referring to hormonal therapy where my dad would receive a needle in his behind. Apparently hormone therapy is intended to stop the body from producing testosterone or to block testosterone from reaching cancer cells. It's my understanding that testosterone feeds cancer cells and causes them to grow & spread, so these injections will often block and control the growth of the cancer and/or help with symptoms. It's also called Androgen Deprivation Therapy.

Francesca,

OK - now I understand what the doctor was talking about when he referred to "injections". You asked "why aren't they conducting MRIs, bone tests, cat scans, etc..." The likely answer is that the tissue coming back from the lab with a Gleason 7 is very common, and in almost all cases prostate cancer is slow growing and your dad has plenty of time to get the analysis and treatment he needs. I am surprised your urologist isn't doing a 12 core biopsy. This tells you not only the grade but the number of cores with the cancer and percent of each core. This, combined with a 3T MRI pretty much tells you almost all you need to know to make a treatment decision. When most people hear the word "cancer" panic sets in. Prostate cancer is almost always confined to the prostate, and in advanced stages may escape, but that's relatively uncommon. When I first got my diagnosis I read everything I could about prostate cancer. This is what you are doing now. Your family is in "panic mode" - completely unnecessary. It's obvious that your urologist isn't in any hurry as well - a good sign. If the Gleason grade was 8 or 9, then you would have something to be concerned about, but a 7 is just not worthy of a high level of anxiety at this point. Some concern, yes. But, it's highly likely that once all the tests come back you will be able to sit down with the urologist and come up with a treatment plan, or even go on active surveillance. Don't dismiss the Oncotype DX genomic test - it will tell you if the cancer is aggressive or relatively passive. But, please, please, turn off the panic switch. Absolutely no need at this point. Been there - done that.

My very best,

Private message me if you want,

Tom

Thank you so much for this information, Tom!

You have no idea how relieved I felt when I read your message!

I know what you mean (since you're speaking from experience!) - But it's difficult to control the panic and anxiety, to be honest. Despite taking care of himself, my dad has had a fair amount of challenges health-wise over the last few years and as a result, it's difficult to stay positive. Every time we maintain some level of positivity, and hope for good news, we seem to hear the worst.

I will definitely be asking the doctor about the 3T MRI and a 12 core biopsy. I asked my dad the other night about contacting the doctor this week and requesting an MRI asap (because I don't understand why this hasn't been done yet), and he responded, "What's the point? I"m getting my PSA test done in 1.5 weeks, and then I'm going in for the results a week later. Nothing is going to happen between now and then". It's really difficult trying to get my dad to help himself under the circumstances. He detests hospitals, doctors, dealing with health issues, etc.

I'm also worried because my dad had a hemorrhoidectomy just over a week ago, and he basically needed thrombosed hemorrhoids removed, which he's been dealing with for months, along with constipation (which he's never experienced before), and therefore, it's making me question whether these are symptoms of the prostate cancer spreading/metastasizing.

Furthermore, I don't trust my dad's urologist (mainly because he initially told us it wasn't cancer, and I think I have a general distrust of some doctors after having watched other loved ones go through various experiences). Don't get me wrong, I know there are some great doctors out there. But, I just have this feeling that my dad's doctor should be doing more and acting more quickly. I just don't know if this there is any merit to this feeling, or if it just stems from general concern and anxiety over my dad being sick, and me not being able to do anything about it.

Anyway, now I'm rambling. But thank you so much for your helpful and calming advice! You have no idea how it's helped me!

Francesca,

Urologists see so many patients, that some of them don't seem to understand what it feels like to be on the patient side, especially when tissue samples come back showing prostate cancer. When I had my first 12 core biopsy the results came back positive, but I knew how many cores had the cancer, the Gleason grade, and the percent of each core. My PSA at that time was in the 4-5 range. The extent of the PCa was low, so I went on active surveillance. A year and a half later I had a second biopsy, and more cores were positive and the percent of each core had increased, but the grade was still Gleason 6. I decided to have treatment because knowing I had the cancer cells (if they were cancer cells) caused me anxiety. After my treatment, my anxiety level really dropped.

Another important factor here is your father's age. If prostate cancer is detected when the patient is younger than about 60, it's possible that the cancer is more aggressive, then if the patient is older. This is because prostate cancer is slow growing and the slow growing and less aggressive cancer cells tend to show up later in life. My first biopsy came back positive when I was 66, about average. Some men who get the same diagnosis in their 70's never bother to have treatment. If a patient is in his 50's he has a long life ahead of him and it's more likely he should have treatment.

In another post you asked about diet and cancer. It's always good to have a diet of vegetables, fruit and whole grains, and less processed meat, but that is a good diet for overall health at any age. There is a minor positive correlation between high calcium intake (such as dairy products) and prostate cancer, but I still love my cheese. I did switch over to soymilk from cow's milk, but since my cancer is now gone, I don't think it makes much difference.

Prior to the TURP did your dad have a digital rectal exam (DRE)? I am a bit surprised that he didn't have a PSA test before this time. Anyway, from everything you are reporting here, it just sounds like a low level of risk at this point, and it also sounds like the doctor (or urologist) has things under control. Before my treatment I consulted with several urologists who did alternative treatments so when you have a better idea of what you are dealing with it wouldn't hurt to get a second or third opinion.

Tom