My dad has stage four PC with bone and spinal mets. He’s on Casodex and Lupron. Seeing his urologist again next week. Does he need an oncologist too? Can we get a Gleason if the Doctor doesn’t want to do a biopsy of prostate. It has been classified as adenocarcinoma. So many questions.... what else should we be doing?
Gleason score without prostate biopsy - Advanced Prostate...
Gleason score without prostate biopsy
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Teacha
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Teacha....95% of the cancer in prostate is ADENOCARCINOMA. There is no other way to know Gleason grade other than biopsy of prostate tissue. They take the tiny chunks of
prostate tissue ,put under microscope and see the shape,size, arrangement ,deformity etc.
and based on this data , Gleason Grade is given Gleason grade is a combination of two numbers, e.g 4+4=9. Now, 3+3=6 is considered pre-cancer...3+4=7 is considered low grade cancer and 5+5=10 is considered most aggressive cancer.
He has mets..that means he should be on Anti Androgen Therapy (ADT) and good that he is already taken the first step..that is being on ADT (casodex+Lupron)...This combo is going to attack cancer cells depriving them of testosterone and starving them of food. As cancer cells starts dying, his PSA will start plunging.
As ADT can weaken bones, he needs Calcium and Vit D plus physical activity to keep bones strong. There are medicines to keep bones strong.
People can live anywhere from 5 years to 15 years these days even if they have metastatic prostate cancer with proper treatment. Last but not the least, he should eat anti inflammatory foods such as veggies, fruits, turmeric, ginger, garlic .....and avoid sugar, meats and processed food.
So, Teacha..its seems scary and dreadful but it can be managed.....Remember..we all have
expiry date..whether we have cancer or not. Support your father and I think its better to get an oncologist who monitor his PSA and other parameters of improvement.
With best wishes and prayers for your father and your family.
Thank you. It is so good to hear positive stories. I really appreciate the information. Such good people here.
"As ADT can weaken bones, he needs Calcium and Vit D plus physical activity to keep bones strong. There are medicines to keep bones strong."
There is no credible evidence the supplementing improves bone mineral density. In fact, the best evidence we have proves that adding Vitamin D does not "keep bones strong."
pcnrv.blogspot.com/2018/07/...
Calcium supplementation has been associated with increased risk of fatal prostate cancer:
cebp.aacrjournals.org/conte...
ncbi.nlm.nih.gov/pmc/articl...
ncbi.nlm.nih.gov/pmc/articl...
The only reason to supplement either of these is if blood tests show low levels.
I agree about the importance of weight-bearing exercise to improve bone strength.
Tall Allen u r so informative thank u for all that u do and ur responses
How does 4+4=9. My Gleason on one biopsy was 3+3=9.
seems like the lab person calculated wrongly. First digit indicates overall differentiation in entire gland whereas the second digit indicates pockets of scattered differentiation of cells. Total of the two has to be correct.
e.g 3+4=7 means cells are at level 3 in most of the gland BUT there are some cells here and there in the gland which are at level 4 .
I think you meant 4+4=8 and 3+3=6, right?
VA said 3+3=9. When it should have been 6.
Someone there can't add.
Yes, you should be talking to a medical oncologist.
After he has been diagnosed with metastases, it no longer matters what the Gleason score inside the prostate is. He can spare himself a biopsy.
Here are the current options for newly diagnosed metastatic PC:
pcnrv.blogspot.com/2017/06/...
Thank you very much. There is so much to learn and process..
Tall Allen...are you saying 3+4=7 and 5+5=10 gleason grades are same once there are bone mets ? Do you mean the prognosis does not depend on gleason grade ?
Neither the prognosis nor any treatment decision depend on the Gleason score after metastases have been detected. That is true for both pelvic lymph node metastases (stage N1) and distant metastases (stage M1). A prostate biopsy at that point is a waste of time, money, and is completely unnecessary. Moreover, it is hazardous because it subjects the patient to a (small) risk of infection and an unknown risk of spreading the cancer.
TA makes a good point. The only thing Gleason score tells us is that a score of 8-10 is at higher risk of progression than a score of 7 . But once it has progressed or metastasized it doesn’t make much of a difference except that low volume of mets is better than high volume.
So sorry about your news. I think a good oncologist on your team is a good idea and can be helpful. My husband thought his biopsy was not a big deal. (He has prostate cancer.. my dad also had prostate cancer.. .I do not remember if he had a biopsy) I think a healthy diet can really help. If your dad is not interested in making drastic changes.. cutting out processed foods and eating more fruits and vegetables can really help.(Think flood the body with nutrients) . My husband changed his diet to a plant based diet. No meat, fish, dairy and no eggs.(Except for special occasions. .like in a birthday cake). We juice a lot of vegetables for him on a regular basis.. he drinks 64 ounces of fresh vegetable juice a day.(I tried to get my dad to juice but he hated it)
I like nutritionfacts dot org for free information on diet.. his videos are short and to the point. (most are about 5 minutes long)
If you want to add supplements and such there is a lot of information here and you might want to see an integrative doctor. They will help you sort out which supplements and life style changes might be helpful.
If you think your dad will consider it.. meditation is wonderful. Recently I have gotten hooked on an app called headspace. The first 10 meditations are FREE. I must have done these for over a month before I subscribed.(I just kept repeating them) They have great meditations on dealing with stress too.
Sending you tons of hugs, prayers and love!
Softwaremom.
Thank you so much. There are such good people here and it really helps.
You and others may also be interested in looking at Dietary Recommendations while living with Prostate Cancer from the folks at the University of California San Francisco (UCSF).
urology.ucsf.edu/sites/urol...
Charles
Teacha: On this site you will find helpful and documented information and also well-intentioned opinions. I trust that you can apply critical thinking and good judgment to determine what's best for your dad. In that regard, be sure to consider your dad's quality of life at this stage. For example, if enjoying certain foods is a source of joy for him, then be sure you have a very good basis before telling him he can never again eat those foods because they exacerbate his cancer.
Sorry to hear about the monster, I have not seen my urologist since I was diagnosed, your in better hands with the oncologist. I started just like dad is casedex and lupron, then taxotere Chemo with lupron and Xgeva. Going on 35 months now. Good luck
Most definitely your Dad should see a Medical Oncologist. Sure an Urologist will say that they can treat, but consider that most Urologists are surgeons at heart. No need to subject him to a biopsy as this is a risk of infection. I had an infection and ended up 8n the hospital fir six days hooked to an IV with alternating antibiotics.
GD
Greetings Teacha, Tell us more about Dad... In fact if you tell us your location someone here may be able to recommend a good Pca Oncologist for your Dad. How old is your Dad?
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 06/18/2019 2:34 PM DST
My dad is 76. Initial PSA 300 and two weeks later 358. He has two bone mets in pubic and iliac bone as well as tumor on spine. We live in New York in Mid-Hudson Valley near Poughkeepsie. We are having a second opinion w Onco- Dr Min Teo at Memorial Sloane Kettering next week. Dad is healthy and has relatively no pain except spine. But he has had other spine issues for years and surgery for spinal stenosis so we thought it was that. He golfs two or three times a week and he and my mother have an active happy social life. He is optimistic. The Lupron depot and/or Casodex is making him tired and fatigued during activity and a little forgetful. Otherwise he feels fine. Thank you all for your thoughtful responses.
Thank you for your response...I too am a patient at MSKcc. Well you're Dad is being treated at one of the best Cancer Centers in the U.S., that's good. I guess he's seeing his doctor at the Kimmel Center on 68th Street in Manhattan.
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 06/19/2019 9:05 AM DST
The Gleason score is probably irrelevant, and the test is painful and dangerous. Unless the cancer is slow growing (unlikely with Stage 4 with pain and in the bones), the score will not change the treatment one bit. Read the literature on natural things that help a lot - like raw food diet and vitamins, zero sugar. The immune system has to do the killing of 99% of the cancer cells. I know of no conventional medical treatment that actually kills PC cells - they just slow things down. Hormone (see how this works - it can keep the cancer under control for a couple of years) then add Enzalutamide - it is the only treatment that I know of that helps over a period of time (18 months in my case), and is comparatively side-effect free if taken in much smaller doses than suggested (at full dose one can become allergic and there are side effects). Avoid the heavy stuff!
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