Tuesday, June 7, 2011

PCa-understanding Terence's Gleason score and Diagnosis (DX)

Like staging, 'grading' levels are also assigned to prostate cancer cases. Grading takes place after a biopsy (removal and examination of tissue cores of the prostate) is done. 
The tissue core samples are sent to a laboratory for analysis by a pathologist. 

If cancer is present, the pathologist will assign a grade 
for each of the tissue cores, (which will result in a total grade for the cancer). 

The individual tissue core grade refers to the cancer's appearance and indicates how quickly a cancer is growing.

 Pathologists grade prostate cancer according to the Gleason score, which assigns a grade (1 to 5) based on how the cancerous cells look compared to normal prostate cells.

The diagram (at left) is a Pca grading chart- 

Grade 1. The cancerous tissue looks very much like normal prostate cells.

Grades 2 to 4. Some cells do look like normal prostate cells, others do not. Patterns of cells in these grades vary.

Grade 5. The cells do not look like normal prostate cells. They appear to be scattered haphazardly throughout the prostate.

The higher the Gleason score, the more likely it is that the cancer will grow and spread rapidly.
Terence was DX'd in 2009 with a Gleason score of 9 (5+4).

  • His biopsy consisted of 12 tissue cores, all 12 were 100% cancerous.
  • 8 cores were grade 5  and 4 cores were grade 4 (= a Gleason score of 9, indicating a very aggressive cancer).

Because Terence's PSA was high (431and he has a high Gleason score, his urologist consulted with U.W. Medicine and Sloan Kettering and they determined his prognoses to be  terminal.  The DX also showed Terence had "micro- metastasis" (there were thousands and thousands of  micro-cancer cells already spread  through-out his body but not yet showing).  The bone scans did show the cancer metastasized to his lymph nodes, sternum and lymph nodes next to his spine.

 All of his information determined the direction of his medical care- which was not to have a Radical Prostatectomy (removal of the prostate glandand some of the tissue around it. It is done to remove prostate cancer) because the cancer had already advanced (spread beyond the prostate) he immediately started hormone deprivation therapy- (blocking and stopping the body's production of testosterone) which is technically medical castration.   PCa is a hormone driven cancer and needs testosterone to grow. 

Within 10 months though, the cancer began to grow even without testosterone.

After a 6 months on a clinical trial (TOK-001- it failed) the cancer started growing at a speedy rate once again. 

 So here He is now, on Ketoconazole hoping that it will slow the cancer down, (after doubling the dosage, it seems to be working somewhat).

Terence has an appointment for a new bone scan this Friday.  We are praying that it will show great results (no further spreading) and even though the cancer isn't being treated, we're hoping the tumors will do a disappearing act!!   

 Why not hope, right?

1 comment:

  1. Hoping right along with you!