71 yo, Gleason 10

[Nicholas27]

Grandad recently had a biopsy as he was struggling to urinate, results came back suggesting a Gleason score of 10 and a psa of 5.4. Currently waiting on the next scan to determine was options are next. My question is I know a G10 is a very aggressive cancer which is more likely to spread, what are the odds of spreading, last check up about 2 years ago. I know there’s no definitive answer, but any advice will be good. Other than that just have to play the waiting game and rake it step by step. Much love !!

[GP24]

"Gleason score of 10 and a psa of 5.4" This is a rare combination. I would send the biopsy samples to Epstein for a second opinion on the Gleason score.

You granddad will live several years with this diagnosis, I would think five to ten years. However, in my opinion there is no Gleason 10 which has not spread at diagnosis. You may not see anything yet on a CT/bone scan but you have to expect micrometastases. However, there are drugs and treatments available which will help even when the cancer has spread.

[TheTopBanana in reply to GP24]

Epstein? Epstein-Barr virus? Or is it the name of a doctor? (Tried to google)

[GP24 in reply to TheTopBanana]

Dr. Epstein and his group are leading in the US for a second opinion on biopsy samples:

pathology.jhu.edu/departmen...

The first pathologist has to keep the biopsy samples so they can be send to another doctor for a second opinion. You can ask Dr. Epstein for the details of the procedure.

I have read that in 60% of the cases the results of the two pathologists will be different.

[Magnus1964]

Gleason 10 is not good. However I have a Gleason score of 9 and I have been around for 27 years. It is different for everyone. There is no telling about your Grandfather, but there are a lot of treatments out there.

[TheTopBanana in reply to Magnus1964]

Did your PC spread?

[Magnus1964 in reply to TheTopBanana]

My cancer did spread. In between all of the ADT drugs I have had salvage radiation to a bone metastases and Provenge for spots on my lungs. Both worked and are giving me additional years of quality life.

[Garbonzeaux]

This was almost exactly my situation at diagnosis almost 3 yrs ago. The last PSA measurement before diagnosis was 5.4 and one biopsy core was Gleason 10. I was just a few years younger at 68 and having no urinary problems, though. Subsequent bone and CT scans revealed a few mets. After aggressive early treatment (see my profile), I have had undetectable PSA for over 2 yrs and am doing well. I plan to be around for many years, and with proper treatment, your grandad will too.

[scarlino]

When I was diagnosed I had a Gleason score 7 at my urologist and MD Anderson. I sent for an opinion at Johns Hopkins and it came back Gleason 9. At the time I took the Gleason 7s as the two of three choice and did Proton therapy. Looking back, the Gleason 9 was probably correct. 20-20 hindsight is a wonderful thing. Not sure how different things might have been but you do what you can with the info you have. I didn’t really know about mixed pathology and no one mentioned that.

[Tall_Allen]

Considering the high Gleason score and low PSA, there are very high odds that it has metastasized, which will be picked up in a bone scan/CT. His first step will probably be docetaxel, followed by advanced hormonal therapy. This article discusses options:

pcnrv.blogspot.com/2017/06/...

If any of his metastases are in a convenient place to biopsy, it may (rarely) provide some usable information. Since it is cheap ($250) and easy, a germline DNA test is worth doing. Color Genomics offers a good test. They mail it to his home for a saliva sample.

Because he is already having urinary issues, and that might get worse as the cancer progresses, he should discuss palliative treatment of his prostate with radiation. Unless he has very few metastases it won't delay progression, but it may prevent urinary difficulties.

[Hotrod65]

High Gleason score 10 with a fairly low PSA could indicate a Neuroendocrine component to the Adenocarcinoma which doesn't express PSA....my situation exactly and biopsy evaluation with pathology and Genomic Sequencing confirmed it.

[Don_1213 in reply to Hotrod65]

It could, but not necessarily.

My biopsy samples were looked at by 3 pathologists. One local one gave it a 9, a 5/4. Epstein gave it 10, 5/5 and MSK gave it 9, a 4/5. Given those results I decided it's probably a G9.5. At the time my PSA was 1.8 (for 20 years of checking, it was typically less than 1, usually around 0.8 - I had it checked annually since my father had PSa.

All 3 biopsy reads identified adenocarcinoma - with a touch of granulomatous prostatitis scattered around just for interest. Bone scans/CTI, MRI's showed no sign that it had metastasized.

I think the point here is - there are no hard/fast rules for how your PCa may present itself. Different people have different symptoms.

[VHRguy]

There's a theory that higher Gleason Type cells make less PSA than their less distorted counterparts. It makes sense that the less like a typical prostate cell they become, they are poorer at generating PSA. So for the same tumor burden, a G10 would make less PSA than a G7 for example.

The real point is that with a G10 it merits one's full attention. Aggressive treatment will be likely. All the best to him as he deals with this situation. And there is always hope, since it seems no one can predict a person's response to hormonal therapies. Some do very well indeed, some less so. But there's no way to tell up front. We just have to do what we can!

[j-o-h-n]

Just make sure your Grandad gets to see good up to date doctors. Also if possible please tell us more info about your Grandad. Age? Location? Treatment center(s)? Doctor's name(s)? All info is voluntary but it helps us help him and helps us too. Thanks...

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 04/27/2020 4:22 PM DST

[Nicholas27 in reply to j-o-h-n]

Still early stages, due to covid his biopsy results were discussed over the phone. So he could only explain what he understood from it all, I requested that he gets the biopsy sent through, to have as a point of reference for second opinions etc. he is 71 healthy diet, occasional drinker, exercises every day. Located on the Gold Coast In Queensland Australia. I’ll fill you all in with more information as soon as I know. He is due for his PMSA-pet scan on the 5/5 and will get the results on the 7/5.. the waiting around is the hard part, especially when you know it’s a very active aggressive type. Cheers for the help

[Nicholas27 in reply to j-o-h-n]

Not sure how many of the cores are positive etc... but I guess 1 being a Gleason of 10 is enough to trigger a prompt response from doctors and treatment.

[j-o-h-n]

Well greetings to you Down Under.

First of all let me thank you for a quick response. Second you may wish to copy and paste your response in your Grandad's bio (on his home page), where you and our members can refer to it from time to time. As you know Pca is slow growing so at his age of 71 he will still be chasing women for another 20 years at least. His pet scan on May 5th with results on July 5th sound like they're using the Kangaroo express in lieu of our old horse Pony express. Tell them to speed it up for God's sake......Yeppers a Gleason of 10 is something to be concerned about but not to go crazy over.... Keep posting here and give my regards to Grandad....and tell him to laugh.....

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 04/27/2020 10:18 PM DST

[Nicholas27 in reply to j-o-h-n]

Sorry I meant may 7th he will get the results. I think we do our months and days different on the calendar.

[j-o-h-n in reply to Nicholas27]

us MM/DD you DD/MM......

youtube.com/watch?v=q7a4z7z...(Not working as expected?)

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/28/2020 12:04 PM DST

[TheTopBanana]

How is he now?

[Nicholas27 in reply to TheTopBanana]

It has spread outside the prostate into the seminal vesicles and bottom of the bladder, 4 lymph nodes were also positive in the close region. He has started chemotherapy and is up to his 3rd dose.

[TheTopBanana in reply to Nicholas27]

No bone mets? I wish all the best to him!

[Nicholas27]

Did a pmsa-pet scan, fortunately no Mets showing, or maybe to minuscule. But hopefully just not showing at all