My name is, Samuel Whatley. I'm a 45 year old black man, residing in Atlanta, GA. On February 28th, I was diagnosed with, Gleason 4+3=7 PCa. Attached, is a copy of my pathology report, and I will send you a copy of the email sent to me, by the nurse who called with the results.
According to the report, the cancer is confined to the prostate. I'm scared frozen. I'm learning that Gleason 4+3=7 is pretty aggressive, but not as bad as say, a 9 or 10. One of my main concerns is what normally is the prognosis for a man in my situation? Would this be considered "caught early"? If not, what is the likelihood of living a long life afterwards?
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Arthro92
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Sorry to hear of your diagnosis and you will get plenty of advice here. I was diagnosed with PCa and chose RP in October 2018. You should stay calm, be prepared to take your time on researching treatment options and learning more about the disease. Seek out doctors in whom you have confidence (generally a urologist, a radiation oncologist, and and medical oncologist) and get second opinions. Treatment decisions are very personal and ultimately, it is your decision. In terms of prognosis, there is quite a bit information if you search the web. One approach is to use various calculators (nomograms). Here is an example mskcc.org/nomograms/prostate You may also want to pick up some books on PCa. I found it helpful to read authors with a variety of opinions - some who favor more aggressive approaches and others who favor more conservative approaches. You can also consider additional tests - mpMRI, and request that your biopsy be confirmed with a second opinion - Johns Hopkins offers this service. Good luck and I wish you the best of health.
Fortunately, in these early stages, prostate cancer is slow growing. That means you have plenty of time to make a rational, well-informed treatment decision. i think you will find that as time passes and you collect information, your emotional temperature will come down.
A good first step is to get a confirmation of your biopsy results by Jonathan Epstein at Johns Hopkins. It costs $250 and is a very common practice. Just tell your Urologist to send the slides. Here's more info:
- High dose rate brachytherapy (with or without external beam)
You have to talk to experts in each of those - don't expect an expert in, say, surgery, to know much at all about any of the others (although they will probably have opinions).
Options that should be discussed with the radiation options include whether temporary hormone therapy should be used with it, and whether the external beam radiation should cover the pelvic lymph nodes too.
One of the good things about treatment at 45 years of age is that your body will probably recover quickly from the side effects of treatment. BTW - if you intend to have children in the future, you should freeze your sperm.
I'm sorry. It was scary for me as well. I was diagnosed at 42. I'm 46 now. I agree with others. Don't panic. Learn more. Consult people (but don't fear everything you hear or read). It will be important to understand what stage the doctor thinks you are in. The biopsy gives your Gleason scores (i had a mix, including 4+3 and 3+4) which are important to evaluating the aggressiveness of the cancer. It is also important to know the amount of cancer observed, i.e., how many cores had cancer and what % in them. I had cancer in 9 of 12 cores, with some high %, and after my surgery it was determined that I was stage 3. The battle with cancer has made me appreciate life more. Im thankful everyday. Keep smiling. Have fun with family and friends.
My biopsy (June 2018) results matched Jp2sea's; yet he is quite a bit younger as I am now 63. I opted for robotic radical prostatectomy (Oct 2018). First post surgery PSA is <0.006. My path report downgraded the cancer stage slightly (vs biopsy results). I am pleased with my decision for surgery (excellent surgeon in Birmingham, AL); still hopeful the ED issues will resolve.
my mri showed three lesions on my prostate. i had a biopsy and here's a small bit of the pathology report.
the 1st. lesion was benign, the 2nd lesion right mid-gland was gleason 4+3=7 {grade group 3} involving 3 of 3 cores {95% discontinuous <5%<5%} gleason grade 4 component involves 60% of the tumor. perineural invasion is present and chronic inflammation. the third lesion diffuse left mid gland gleason 3+4=7 {grade group 2} involving less than 5% of the fragmented cores. gleason grade 4 component involves 5% of the tumor.
MRI indicated that there was no evidence of spread of cancer beyond the prostate to the lymph nodes or pelvic bones. there were no central gland abnormalities, no extraprostatic tumor exrtensions and my seminal vesicles were normal. urinary bladder normal, pelvic lymphadenopathy normal and no enhancing pelvic bone lesions.
Since you are close, Duke has a program where, with one appointment, they will review your biopsy slides and MRI (if you had one) and have you meet with a surgeon, radiation oncologist and medical oncologist during the same visit. Other teaching colleges probably have similar programs but this is where I went. I found making the treatment decision for my high risk cancer more stressful than receiving the original diagnosis. Take your time. Let the emotional shock die down a little. Do a lot of research on your own and take whatever advice you find online, even here, with a grain of salt. Trust your instincts when it comes to doctors and specialists and find one you are comfortable with. This is FAR from a death sentence.
Hello Samuel Whatley. I am sure you had rather not be in this club, but you are. So, welcome. The first (second, third, fourth, fifth) rule is: do not panic. This is not an emergency where your decision must be reached in an instant. You have weeks to inform yourself and Rule Six is get yourself informed. Buy a book and read it. The clearest to answer your questions I think is Scholz's Key to Prostate Cancer. Rule Seven (you know I am making these up, right?) is _beware_ of "experts" whether they are in this forum or wearing white coats. Your doctors will know a lot about treatment and little to nothing about Whatley. Rule 8 second opinions. Your G(leason) 7 is medium aggressive. Insist that your biopsy is read at a second lab that specializes in urologic cancers. Another pathologist may read as G6, even less aggressive. You have majir medical resources in Atlanta. Use them.
Rule 8 -- every CaP is unique. My story is not yours. CaP in a young Black male is more aggressive than G8 in this 75 year old white male. (back to rule 7).
Rule 9. Take care of yourself emotionally, mentally, spiritually, nutritionally and physically. That is how the healing happens.
This is the club no man wants to join. Responses may seem scattered as to results and type of treatment because they are. I was diagnosed with Gleason 8- also confined to the prostate. I chose cryosurgery- still have my prostate and my PSA is still less than 0.07 17 years later. At your age preserving the nerve bundles should have a high priority. Location of the cancer will be important- if there are cells near the base it will make nerve sparing
more difficult if you choose surgery. I don't know about other therapies so I won't waste your time about them. Good luck. I didn't have my treatment until 13 months after diagnosis- my surgeon wanted to shrink the prostate as much as possible before treatment- my urologist at my yearly appt, has been saying the same thing for 16 years. "If I didn't know better I'd swear they removed your prostate".
thank you, guys, for your encouraging words and advice. i am still new to this and so i didn't think to include the pathology report. especially since it comes in PDF format, it's hard to copy and paste it, so i had to write everything. that was a lot. but here is somewhat of the mri and pathology report. maybe you can help determine better where i stand with all of this.
my mri showed three lesions on my prostate. i had a biopsy and here's a small bit of the pathology report.
the 1st. lesion was benign, the 2nd lesion right mid-gland was gleason 4+3=7 {grade group 3} involving 3 of 3 cores {95% discontinuous <5%<5%} gleason grade 4 component involves 60% of the tumor. perineural invasion is present and chronic inflammation. the third lesion diffuse left mid gland gleason 3+4=7 {grade group 2} involving less than 5% of the fragmented cores. gleason grade 4 component involves 5% of the tumor.
MRI indicated that there was no evidence of spread of cancer beyond the prostate to the lymph nodes or pelvic bones. there were no central gland abnormalities, no extraprostatic tumor exrtensions and my seminal vesicles were normal. urinary bladder normal, pelvic lymphadenopathy normal and no enhancing pelvic bone lesions.
You are quoting exactly the numbers my husband had 18 years ago. We made some mistakes in treatment choices but he is still above ground and enjoying life.
In addition to what TA advises I would look into HIFU with Dr Steven Scionti. DrScionti in FL emphasizes that you need the proper MRI and scans to lay the groundwork to see if you are a HIFU candidate but you may avoid all the side effects my husband has experienced. He was diagnosed at 57 so u are a young man.
My husband was a T2a as well. But like I said, you are much younger at diagnosis so choose wisely.
To be honest, my husband lost sexual function after surgery. He mostly quickly regained his urinary incontinence. Now after 18 years worth of treatments he again has some urinary incontinence.
Arthro - like you I'm new to this business. Tall Allen's advice is excellent. I too had my slides sent to Dr. Epstein at Johns Hopkins, and though he confirmed my diagnosis (Gleason 6) I was glad to spend the money and feel you will be too. It's $275 now btw, but money very well spent. Good luck and keep us posted.
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