Grade 3 Prostate Cancer
Posted , 9 users are following.
My husband, who is 61 years old has recently been diagnosed with Grade 3 Prostate cancer. His PSA was 5.31, before being diagnosed. The biopsies showed 2 suspicious areas. One had a Gleason score of 3-3 (no worries), but the other one had a score of 4-3, with a clinical stage of T1. They also do not think it has spread to the lymph nodes . The Urologist ordered a bone scan to make sure it had not spread to the bones. There were two areas that showed up as suspicious. One was on his knee and the other one is on one of his ribs. The doctor then ordered an x-ray of his knee and a CT scan of his chest area. The x-ray of the knee does not show any finding consistent with cancer. However, the CT scan does show an abnormality in the left 5th rib adjacent to the spine. They said it has the appearance consistent with metastatic disease. He said it is still not 100% certain. They may do a needle biopsy of the rib area. He said a negative finding could be a false negative, due to technical difficulties with a bone biopsy. The doctor is going to discuss my husband's situation with a Multidisciplinary Genitourinary Tumor Board group to get more input. Has anyone been through this before and are there any other tests he should have done? Thinking of getting a second opinion. Thanks for any help. I was feeling positive about all of this and his prognosis, until this came up on the bone scan. Now, I'm scared.
0 likes, 15 replies
patrick1952 Tracyx4
Edited
Tracy, I was diagnosed 5 years ago. psa 6 to 7....gleason 4+3. had rp. what i have learned is if Prostate Can. has metastasized the psa number will be in the 100's. You should get a second opinion before doing anything. pat
Tracyx4 patrick1952
Edited
Thank you, Patrick1952 . Sounds like your numbers were very similar to my husbands. Depending on what they say are the next steps, we are talking about getting a second opinion.
tom86211 Tracyx4
Posted
Tracy,
You definitely need a second opinion. Normally a PSA of 5.3 with one area showing Gleason 4+3 is very common, and the treatment is normally either radiation of the prostate or removal (RRP). I am very surprised that the uro ordered a bone scan. Maybe there was something else that showed up that you aren't mentioning. Anyway, get a second or even a third opinion. Sounds like your uro is being very aggressive here. Possibly that's a good thing.
Tom
Tracyx4 tom86211
Posted
tom86211, the doctor did say that he normally does not order a bone scan with the numbers my husband has. My husband did mention to the doctor that he had been feeling some discomfort on one side of his chest, when moving his arm (like a pulled muscle). He had done some work in our garden, using a tiller, and we thought he might have pulled a muscle. He also plays a lot of golf. Something else he just remembered recently is that he was playing golf one day and someone on another hole hit their ball. It bounced on the cart path and hit my husband somewhere on his back side. He thinks it happened about 2-3 months ago. It was enough to make him jump, but he didn't feel like he was injured. He sent a note to his doctor yesterday to tell him about it. Not sure if this could cause what they are seeing on the bone scan and CT scan. I don't know what thus terminology means, but the CT scan said it was sclerotic (thickened calcifications), mildly expansile (slightly stretching the bone shape), and there is "minimal" soft tissue component (characteristic of some tumors that grow outwards from bones). This is the wording on the CT scan report.
tom86211 Tracyx4
Posted
Tracy,
From everything you have said and based on a PSA of 5.3 it's highly unlikely that the cancer has spread outside of the prostate - not impossible, but statistically a very low probability. I am assuming the uro did a 12 core biopsy. The results come back with a Gleason grade, number of cores positive and percent of each positive core with lesions. There are all factors that determine the next step in treatment, or if treatment is even recommended at this point. If your husband decided on treatment then at his age the most recommended procedure is RRP (robotic removal). The prostate is sent to the lab and checked to see if the cancer has spread outside the prostate - they check the "margins". In most cases this report comes back negative. The other alternative is active surveillance and another biopsy in a year and a half. Most men just want the prostate removed so they can move on with their life and not worry. Hope all turns out well.
Tom
Tracyx4 tom86211
Posted
Tom, thank you for your reply. I hope I'm not bothering you. You seem to be very knowledgeable, and that is what i am looking for...that and other's experience. My husband did have a 12 core biopsy at Vanderbilt Medical Center, in Nashville. I looked at the Pathology report. The 2 that were not normal showed the following:
Left Mid Biopsy:
Prostatic adenocarcinoma, Gleason score 4+3=7 (grade group 3, 80% pattern 4), involving 10% of 1/2 cores.
Left Base Biopsy:
Prostatic adenocarcinoma, Gleason score 3+3=6 (grade group 1), involving <1% of 1/2 cores.
We heard today, that a Multidisciplinary Genitourinary Tumor Board group will meet on Wednesday to get more input about management.
tom86211 Tracyx4
Posted
Tracy,
From my experience this report is good news. The percent of the cores positive is very low - much better than my first biopsy report. Gleason grading is an art and not an exact science, so it's possible that the 4+3 could be regraded to 3+3 by a second look. You can always request this. One of the reasons I decided on treatment after my second 12 core biopsy was that my 3+3s might have missed a 4+3, and also there was "progression" in my second 12 core - more cores and higher percent positive. So, my cancer was growing and I decided to move forward with treatment (radiation) because of the anxiety I was having knowing that I had the cancer. After treatment I felt much better. This was in 2014. For a few years my PSA was 0.1 and now it's 0.3. My uro says this is completely normal. I hope he is correct.
Back to your husband, I am not a urologist, but from the first lab test that showed my PSA at >4.0 until my radiation I basically spent most of my time researching this topic. Now, if I had it to do all over again I would have had the RRP. Here's why. I have developed what is called radiation cystitis. My bladder has become very sensitive and I have to go to the bathroom about every hour. This also wakes me up several times per night. Also, I still had my prostate in place so have been battling BPH issues. Once the prostate is removed, no cystitis, and no BPH. A small percentage of men do have issues with incontinence after RRP, but almost all recover after 12-13 months. The first few months can be challenging. Once you go down this road there are always challenges.
I hope my discussion will help you with questions for your urologist. As has been suggested by others, a second opinion is always good. I consulted several urologists before deciding on treatment. Each one was a specialist in different methods of treatment. I used the time between my first 12 core and my second to get referrals to the different doctors. It was a very interesting and useful experience.
Tom
henry53420 Tracyx4
Posted
good morning Tracy
Dealing with prostate cancer is not easy . I am a firm believer that you should get any test that you can
and see a few doctors until you decide what road you are going to take . A bone scan is a great test to have done .
I also recommend to keep a diary and get all your records and scans and mri disc
and to do a lot of research on what your husband is going to decide on what side effects he is will to deal with. I wish you the best and you could private message me if you wish
stay well
Henry
Tracyx4 henry53420
Posted
Thank you, Henry. We will probably get a second opinion, especially if they want to treat what they think is bone cancer.
henry53420 Tracyx4
Posted
tracy
dont panic do a lot of research
see a few doctors
what state are you in
and think of all side effects
henry
Tracyx4 henry53420
Posted
Henry, trying not to panic, but I'm a worrier. We are in Nashville, and my husband is seeing a Vanderbilt Urologist. Trying to stay positive.
ES28567 Tracyx4
Edited
I totally agree with the posts you have received from the others here. Definitely get a second and if needed third opinion. Also, for prostate cancer options, consider things other than radiation or a radical prostatectomy. There are other options with less severe to no side effects. Most importantly, you and your husband mist be his strongest advocate. Trust but verify all procedures and recommendations given to you from the medical community.
henry53420 ES28567
Posted
es
great advice
i agree lots of options out there today
p3t3r Tracyx4
Posted
There are several treatments for PCa, and all of them have side effects. Having just had RRP (11 weeks ago) I have very recent experience of looking at this.
Both RP & RT are likely to "cure" the cancer. That is to say they both have high chances of stopping the cancer and it not recurring. The chances are about equal.
RP can have side effects on continence and erectile dysfunction. At 68 I am already fully continent, and from discussions with other sufferers, most people are, although some take longer - I think BMI is a factor here, so if hubby needs to lose weight then this is a very good reason to do so. Also smoking is a factor in good outcomes (basically stop). ED is more a result of where the tumours are - if the nerves can be spared both sides (which given the low number of affected cores seems distinct possibility) then at 61 there should be a good outcome. After surgery PSA should be pretty much undetectable, so it's fairly easy to monitor success.
RT will also involve Hormone Therapy. HT has its own side effects, but they are definitely short lived. RT can affect the bowel. If you go this route you will want to get SpaceOAR, which helps protect the bowel. If you have RT then surgery is not usually a future option, because the RT affects the prostate and makes it much harder to operate on. After RT there is often a little residual PSA, and I know that this can cause people some concern (mostly unnecessary).
There are other treatments, like Brachytherapy, which have much fewer side effects. These are generally only effective if the cancer is very localised (which it may well be here). The other issue is that the cancer can come back, which is quite possible at 61.
Obviously the surgeons prefer surgery and the oncologists RT, so if they both recommend the same treatment (as they did in my case) then you have to listen. Otherwise there will be a difficult decision to make.
joshuapryce1987 Tracyx4
Posted
Its possible to have bone marrow cancer, but its painful and life lasting, because it means the bone will have to be removed. I wish you and your people all the best.