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Old 07-13-2010, 06:33 PM   #1
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grade 4 prostate cancer

hello,
I am only new and not sure if I am even posting this in the correct section but I am just asking for help...
my father had psa of 9 took a course of antibiotics, had a heart bypass operation in the mean time and then went on to have a prostate byopsy..his results are Adenocarcinoma composit gleason score 4+3 high grade 4 carcinoma:greater than 90% location R2-5, infiltration not seen in perineural, vascular or capsular
PIN present
intraduct carcinoma not seen
dad is having a bone scan and abdo ct scan, today and tomorrow.....
is there a chance that it hasnt spread with such a high grade??
i am so worried about him, could some one please help with some information, prognosis...I am trying to remain positive
thanks so much
helen

 
Old 07-14-2010, 08:20 AM   #2
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Re: grade 4 prostate cancer

hello again,
just wanted to share that Bone scan came back ok!!!
tomorrow is his abdo ct scan so I am hoping that its ok as well, still not really sure what the prognosis is so any info would be greatly appreciated.
thanks so much

 
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Old 07-14-2010, 09:52 AM   #3
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Re: grade 4 prostate cancer

Hello Helen,

Welcome to our board! I'm sure your dad will be so grateful for your help. I'll insert some comments in green. I am a layman survivor now experienced and informed about prostate cancer after dealing with a challenging case for more than ten years, but please keep in mind that I have had no enrolled medical education and have no professional medical credentials.


Quote:
Originally Posted by helensummers View Post
hello,
I am only new and not sure if I am even posting this in the correct section but I am just asking for help...
my father had psa of 9 took a course of antibiotics, had a heart bypass operation in the mean time and then went on to have a prostate byopsy..

Wow, your dad has been busy, and not the way he would like to be! I hope the bypass worked well. The fact that he needed one is a clue that he may not be eating in the way that would best help with the prostate cancer.

The PSA of 9 is below the threshold of "above 10" that suggests added challenge in cases.


his results are Adenocarcinoma composit gleason score 4+3 high grade 4 carcinoma:greater than 90% location R2-5, infiltration not seen in perineural, vascular or capsular
PIN present
intraduct carcinoma not seen

That's a fairly informative report, though it's not clear how many cores were taken and how many were positive. "Location R 2-5 makes me think the cancer is only on the right side, was found in four cores, and was extensive on that side. If at least five cores were taken on the right, then it's reasonable to think that at least five were taken on the left, which is typical these days.

The Gleason grading of 4+3 for a score of 7, with a quite dominant pattern 4, identifies a fairly aggressive cancer, as you already recognize. However, do you know whether the pathology review was done by an expert or simply by an institutional pathologist who handles children and adults, men and women, for all diseases? The Gleason is very important as a navigation mark for decision making and case management, so it would be highly advisable to get a pathology second opinion if an expert did not do the review.

The negative findings mentioned are important; they suggest a lower likelihood that the cancer has escaped the prostate capsule, making it more likely that a local therapy (one dealing just with the prostate and seminal vesicles) could be successful in curing the cancer.


dad is having a bone scan and abdo ct scan, today and tomorrow.....
is there a chance that it hasnt spread with such a high grade??

There is a chance, but it's important to understand the odds. It's a good sign that his bone scan was negative with this apparently (pending Gleason confirmation) fairly aggressive cancer, but it helps to be aware that a negative bone scan does not mean "no" cancer. What it means is not enough cancer to show up as a hot spot in the scan. It typically takes about 10% of bone involvement with cancer before the scan will show it. Still, the absence of bone metastases at this point is a hopeful sign. It's quite unlikely the CT scan will show anything as it takes a fairly large tumor before the CT scan will suggest metastasis; it's arguably worth doing both of these scans, as I understand it, in a case like your dad's.

Even if the cancer is not contained within the prostate, there is still a good shot at cure, but not through local therapy. Usually the approach would be to use external beam radiation, often combined with radioactive seeds, and typically these days combined with a two year course of hormonal therapy before, during and after the radiation. Very often prostate cancer that has spread beyond the capsule will not have advanced far - typically just a few millimeters, where radiation can wipe it out.

Here are the odds of key results using "the Partin Tables", a key prognostic tool for the success of local therapy, developed by a well known Johns Hopkins research team. We'll use the PSA of 9, the Gleason of 4+3=7 (the tables consider both 3+4 and 4+3), and a stage of T2b (likely at least that advanced, perhaps a stage 3, pending the DRE).

OC: a 19% chance that the cancer is confined within the prostate capsule

CP: a 60% chance that the prostate capsule has been penetrated

SV+: a 13% chance that the cancer has spread to the seminal vesicles

LN+: an 8% chance that the cancer has spread to lymph nodes.

Could you tell us the "stage" that has been assigned? The stage is based primarily on the DRE but also includes other evidence.


i am so worried about him, could some one please help with some information, prognosis...I am trying to remain positive
thanks so much
helen
We have all known that worry. It helps to become informed. One great book for orienting you and your dad is "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen B. Strum, MD, and Donna Pogliano. It gives informative and objective information on a broad range of approaches. It also has a superb forms section for recording your dad's case information as it develops.

Lifestyle tactics - diet/nutrition/supplements, exercise, and stress reduction - appear to be quite important to helping us achieve success, and they are things we can do on our own without having to rely on our doctors, except for guidance when we need it.

Prostate cancer has the highest five year survival rate from diagnosis of any major cancer today: 99.4% for white men, and 95.9% for black men. Actually, "today's" figures would no doubt be even better as those numbers are from the period 1996-2004, and there have been major improvements in prostate cancer technology since then. A study of men treated some years ago found that 95% of men with challenging cases, like me, are alive at the ten year mark! Now achieving that kind of success is not easy - it's not a cake walk, but those numbers give us a solid basis for hope and optimism.

Try to get your spirits up!

Take care and hang in there,

Jim

 
Old 07-14-2010, 10:03 AM   #4
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Re: grade 4 prostate cancer

Hi,
It has been said by some that Gersom therapy has saved one out of two patients who have been told by their doctors to go home and die. One way to do the therapy is to go to the institute. Another way is to buy the book on it and follow the instructions.

Last edited by moderator2; 07-14-2010 at 11:21 AM. Reason: please do not post websites except as described in the Posting Policy

 
Old 07-14-2010, 11:08 AM   #5
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Re: grade 4 prostate cancer

Hi sjb,

I'm responding to my edited version of your post below. I've left out the site in compliance with our board's rules, as I understand them. I'll put some thoughts in green.


Quote:
Originally Posted by sjb View Post
Hi, There is a wonderful website from Doctor who had trouble with cancer. ...
It has been said by some that Gersom therapy has saved one out of two patients who have been told by their doctors to go home and die. One way to do the therapy is to go to the institute. Another way is to buy the book on it and follow the instructions.
This approach is actually known as the "Gerson" therapy, famous for its coffee enemas, among other unusual practices. Unfortunately, it relies heavily on testimonials and very little if at all on reliable medical research published in peer reviewed journals. Some of its procedures have been identified as dangerous to patients.

If you know of any sound research to back its claims, I would like to learn of it. We have a tool we can mention on this board because it is Government sponsored: PubMed, at www.pubmed.gov . The site is sponsored by the US Government's National Institutes of Health, specifically its National Library of Medicine. Essentially, the site collects all medical research published over the world in established medical journals and makes citations and usually brief high point descriptions available to all. If free links are available to complete articles, it gives us the links. Try it; I think you will be amazed. This is the same information the medical community uses in making its practice guidelines.

I did a PubMed search for " Gerson Institute " with "limits" set (only papers with abstracts involving humans) and got 32 hits. Here are excerpts from the first:

Oncology (Williston Park). 2010 Feb;24(2):201.
Gerson regimen.
Cassileth B.
Integrative Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Abstract
The Gerson regimen, developed by Max Gerson in the 1930s, is promoted as an alternative cancer treatment. It involves consuming fresh, raw fruit and vegetable juices, eliminating salt from the diet, taking supplements such as potassium, vitamin B12, thyroid hormone, pancreatic enzymes, and detoxifying liver with coffee enemas to stimulate metabolism. Gerson therapy is based on the theory that cancer is caused by .... None of these theories has been substantiated by scientific research. Despite proponents' claims of recovery rates as high as 70% to 90%, case reviews by the National Cancer Institute (NCI) and the New York County Medical Society found no evidence of usefulness for the Gerson diet. An NCI-sponsored study of Gonzalez therapy, which is similar to the Gerson diet, showed that patients with inoperable pancreatic adenocarcinoma who underwent standard chemotherapy with gemcitabine (Gemzar) survived three times longer and had better quality of life than those who chose enzyme treatment, which included pancreatic enzymes, nutritional supplements, detoxification, and an organic diet.

To me that is pretty conclusive evidence from one of the world's leading cancer treating institutions, Memorial Sloan Kettering.

I'm not going to look further, but if you find something supportive of the Gerson method, please call attention to it.

Here's another important point. You wrote: "It has been said by some that Gersom therapy has saved one out of two patients who have been told by their doctors to go home and die. " Please consider for a moment that "one out of two" is 50% - half. Well, do you know how many prostate cancer patients have been told to go home and die? Are you aware that 99.6% of white and 95.9% of black prostate cancer patients were alive at the five year point based on the period 1996-2004, with odds no doubt even better for today's era? Do you know that 95% of high risk prostate cancer patients make it to the ten year point, that too based on a period a while ago, with current results doubtless even better? Please let this information be a new light for you that will enable you to go back and question information you may have trusted in the past.

Take care and happy hunting to you in PubMed,

Jim

 
Old 07-15-2010, 08:44 AM   #6
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Re: grade 4 prostate cancer

hi Jim, thanks so much for your reply.
the abdo ct scan came back today as normal so that was a bonus!!
the Dr caring for my dad is apparantly very good in his field and the pathology lab are experienced with this testing.
there were 12 samples and only 4 came back with prostatic adenocarcinoma, in the R2 R3 R4 R5
I think that the plan is for radical surgery...
if they remove the prostate, and there is no evidence of mets anywhere is the prognosis good?
btw the scanner used is very effecient and does many slices as opposed to the usual one thats around.
thanks so much for your help

 
Old 07-15-2010, 04:41 PM   #7
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Re: grade 4 prostate cancer

Hi again Helen,

That's good news about the CT scan, though it confirms what was expected.

I'll insert some comments in green.


Quote:
Originally Posted by helensummers View Post
hi Jim, thanks so much for your reply.

You're welcome. I'm glad I could help.

the abdo ct scan came back today as normal so that was a bonus!!
the Dr caring for my dad is apparantly very good in his field and the pathology lab are experienced with this testing.

That's reasurring.
there were 12 samples and only 4 came back with prostatic adenocarcinoma, in the R2 R3 R4 R5
I think that the plan is for radical surgery...
if they remove the prostate, and there is no evidence of mets anywhere is the prognosis good?

Unfortunately, based on your dad's PSA of 9, the Gleason of 4+3=7, and the presumed stage of T2b, the Partin Tables that I reviewed in post #3 suggest rather strongly that an RP will not be curative. However, that does not mean that radiation would not be curative, especially if external beam is part of the therapy. That's because external beams can hit the cancer beyond the prostate capsule. I may have already mentioned this, but the vast majority of the time, cancer that has been caught fairly early but that has spread beyond the prostate capsule will still be within a few millimeters of the capsule. Sometimes radioactive seeds placed near the edge of the capsule can kill those nearby cancer cells, but external beams can easily cover those areas plus areas somewhat further into the pelvic area. Microscopic spread of cancer beyond the capsule will rarely show up in the scans; that's one of the reasons the Partin Tables are so important in supporting therapy decisions. An endo-rectal MRI with spectroscopy could go much further in assessing whether there was spread beyond the prostate.

Has your dad had a consultation with a radiation oncologist? To me, that seems a natural step. If an RP is being pushed as best, you or your dad should ask the urologist why he or she thinks your dad will fare much better than the Partin Tables suggest. Those tables are used virtually universally, and the doctor will be familiar with them. It's an almost certain bet that the great majority of patients in the tables also had negative bone and CT scans. In other words, though having negative scans is good, they do not improve the odds of success over those stated in the Partin Tables. Patients are often told that they can follow-up with radiation if surgery does not work. That's true, but the patient should also be told that the side effects from the follow-up radiation will likely be substantially greater than they would have been with the radiation without prior surgery, to say nothing of the fact that the patient will also have to bear the side effects resulting from the surgery.

Radiation is actually a highly effective form of therapy. My impression is that, overall, it (especially the seeds form) does a better job than surgery with low risk patients. With intermediate risk patients, like your dad due to the GS 7, radiation is clearly superior to surgery, especially when combined with a course of hormonal therapy (two years seems to be becoming customary, based on research). If you would like to see some numbers and graphs of success of various approaches, I've provided a few plus leads in the thread "Choosing a therapy - lessons from the Prostate Cancer Results Study Group," started on May 22, 2010. You can also go to www.pubmed.gov and directly review various studies of results.


btw the scanner used is very effecient and does many slices as opposed to the usual one thats around.

That's good, likely yielding better resolution than is customary. However, the reason CT scans are not that sensitive for prostate cancer is that it takes a pretty good sized tumor in the lymph nodes before it will light up the scan. I'm thinking that better resolution will not solve that problem.

thanks so much for your help
Take care and keep up your learning,

Jim

 
Old 07-19-2010, 01:45 PM   #8
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Re: grade 4 prostate cancer

Hi I am sorry about this particular post I don't see a way to cancel a post I stuck on there twice accidentally.

Last edited by sjb; 07-19-2010 at 01:53 PM.

 
Old 07-19-2010, 01:46 PM   #9
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Re: grade 4 prostate cancer

Hi Helen, I am sorry I made a mistake in the name. It is Gerson Therapy not Gersom and I know about an old guy that says he has seen and known about several cases where this therapy worked. I personally do not accept the coffee therapy enemas recommended nor am I trying to sell anybody's therapy. They claim the coffee enemas open up the ducts to the liver to help this organ function better, at least that is what my elderly acquiantance said. My mother used the approach from the doctor with chemotherapy followed by vegetable juices to strenthen her and a number of other healthful things I have mentioned in other posts I have made. She is an 8 year survivor of cancer. She had surgery. And there are other stories I could mention of other people who have survived cancer longer with similar programs. My mother almost died from what I felt the chemotherapy did to her having had a lung collapse from port insertion, a stroke later and spine collapse later. The chemicals probably made blood cells clump together or made and aneurysm and they probably helped to let the bone cells die also making the matrix in the spine collapse. One thing she had going for her is that they caught it early. I feel if I had not gone to her to help her do the juicing she might not have survived. At the end of about 1 and a half to 2 weeks of being with her and doing the juicing for her she felt so much better that she juiced for two more years. She had also had terrible headaches and I had noticed that she was always lifting her eyebrows. After reminding her several times about this and doing massages of the scalp nicely her headaches disappeared. My father was not so lucky. He had cancer of the skin he had surgery afterward to remove it and followed it with radiation. Now it has come back and he has had another surgery to remove it. He will not be doing radiation this time. I have encouraged them to do juicing but I don't know if they will. He also has not had as healthy habits as my mother has. One of my past friends failed faster after chemo and radiation but he was already going up in his PSA, so who knows. According to one doctor's opinion she would not tell you what to do but she felt that chemo and radiation make an uphill battle. I want to make it clear that I am not telling anyone what to do, and that I am not a salesperson.

Last edited by sjb; 07-19-2010 at 01:50 PM.

 
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