Wednesday, September 24, 2014

Gleason score - A pathologist's experience and explanation

Whilst we generally understand and accept the Gleason score given with our biopsy's. It's impact is quite subjective.

Yes we do not usually have the opportunity to share a discussion with a pathologist.
I thank 1Randy for sharing his discussion with a pathologist in Us TOO Prostrate Cancer support group meeting.

I reproduce 1Randy's post below for your attention

Hi guys. At our cancer support group meeting last week we had a Patholigest from Community Hospitals if California, Dr. Honda. He has done thousands and thousands of reports for over twenty years. He basically only does Prostate and Breast Cancer biopsys. He showed us how he rates the slides and explained the Gleason scoring in detail. Many bits of information I had never heard. Things we don't hear from our Drs. I thought if share some things. These are some bits if info. 
Gleason 10: He said in all the years he had been doing biopsys he has never seen a 10 that hasn't spread to other organs. 
Gleason 9: A 9 he said is slightly better than a 10. Most have spread and have a very high rate of reoccurance. 
Gleason 8: Slightly better than 9. Sometimes it has spread and has a high rate of reoccurance. 
Gleason 7: Thats mine. Better than an 8. Once in a while it can spread outside the capsule and has a good chance of reoccurance. 
Gleason 6: This one was interesting. I told him some people say a six is not serious. He told us a 6 is the most common. It's still cancer if course. It can still spread. Not as serious if a guy had one core if twelve possitive with 5% or 10% involvement. 11/12 cores positive with 75% involvement is a totally different thing. That can break out.
Gleason 5 and under depends in many factors.
He said we all can't just go by the Gleason score. Family history is a huge factor. Tumor size also. How many samples are positive. Basically it's all serious unless you have very low numbers. As I've said before the Amarican Cancer Society had said Prostate cancer is the second biggest killer of men next to lung cancer. He was speaking only as a Patholigest. These are facts but he said some Drs sugar coat your scores so you don't worry do much. I'm sure prostate cancer isn't our biggest problem in that the biggest worry is if it had spread to other organs. I just wanted to share. Hope no takes offense. This was information we all can look at to help. He makes no determation about treatment, he said that is between a guy and his dr. All he does is look at slides. Good luck to us all! Randy.

Thank you Randy and Dr Honda.  Visit Us TOO prostrate support group here:

Take care

Allen Lai

Saturday, September 20, 2014

Rise and Fall of PSA post radiotherapy and hormone therapy

My personal PSA movements

I have interesting news to share with those who chose Radiotherapy combined with Hormone Therapy treatments.

I participate in US TOO Prostrate Cancer Support Group - Inspire. Visit the group here

During one dialog I had a reply from Mr Richard Davis who had an interesting theory to share. That is our PSA will rise after we finished out Hormone treatment, AND it will rise until a certain point when it will possible plateau out or return back to zero level. 

He showed me a sketch graph illustrating the theory or Hypothesis developed by a prominent Oncologist / Radiologist in MD Andersons Hospital.

I produced my own graph with EXCEL as shown above with explanations to the theory.

X = Time line for 4 years, the normal time for Radiation to continue to be effective is between 3 to 5 years or even more years for some.

Y = PSA levels.

RED LINE is PSA decline due to Radiation without additional treatment of ADT.

BLUE lines show PSA rise for those people after stopping ADT at 12 months, 24 months and 36 months. I stopped after 36 months. 

I started off with PSA = 27 ng/ml with my last ADT injection on 36 months. My PSA started to rise again after stopping Zoladex.

My PSA level is now 0.18 ng/ml after 18 months from stopping Zoladex injections.

My PSA will be expected to rise until it meets the RED PSA line created by Radiation treatment AND thence will start to decline ALONG the Red line.

Please note PSA bumps are experienced with mostly Brachytherapy. I did not get the bump after 12 - 24 months after my radiation.

I hope this theory will hold true as Mr Richard has assured me that he himself and others had experienced this trend of PSA leveling out and then returning back to zero.

A paper will be presented on this hypothesis hopefully soonest.

Take care all,

Allen Lai

Tracking my PSA

My PSA chart post primary treatments

I had my primary treatment for prostrate cancer in HUKM (Hospital University Kebangsaan Malaysia) in January 2010. I had a dual modality of external beam radiation and hormone treatments. My PSA at that time was 27 ng /ml with a gleason score of 3+4. I had 32 sessions of radiation and 36 months of Zoladex, injected in my stomach every quarter.

My last Zoladex injection was administered in February 2013 with my PSA suppressed to 0.02 ng/ml throughout my treatment. My Nadir point is 0.02 ng/ml.

By May 2013 my PSA had started to rise slowly and steadily to 0.03 ng/ml, 0.09 ng/ml, and 0.12 ng/ml at every quarter, reaching 0.18 ng/ml in August 2014. It recorded a steady rise of 0.01 ng/ml per month over 18 months.

The graph in blue (Series 1) above shows the reading values and the graph in red ( Series 2) shows the amount of increase over 18 months. Yes we see two doubling rise times, 4 consecutive rises, but with a fairly slower velocity.

I was advised to be on active surveillance until my PSA reaches Nadir point plus 2.0 ng/ml which is recognized as prostrate cancer biochemical failure for radiotherapy/ hormone treatments. It would also be difficult to scan for any cancer cells at this point of time.

 I have since requested my case to be referred to the IKN (Institute Kanser Negara) in Putrajaya for further surveillance/treatments.

At IKN I was also placed in active surveillance. My next appointment is scheduled on 02 December 2014.

I am still reading into the value and benefits of early aggressive salvage treatments vis-a-vis aggressive active surveillance for disease progression until we have a confirmation of a local or distant failure.

Tough choice.

Allen Lai