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Prostatectomy Question? Side effects outweigh benefits?
Prostate Cancer | Last Active: Aug 27, 2023 | Replies (64)Comment receiving replies
I am always skeptical of broad statements around medical procedures/advice. Each person is an individual, with the freedom to make the decision that meets his goals and life expectations.
As I always state, I believe the medical tools available today are fantastic and provide doctors with a lot of data to make their recommendations. However, they are not perfect and limited in their efficacy. For example - A quick search will show several studies around Gleason Score accuracy when compared to final radical prostatectomy pathology outcomes. Overall, correlation studies look to show that Gleason Score is approximately 55% - 60%, depending on Gleason Score. Same thing with biopsies, excellent tool/process, but not perfect. The biopsy does a great job confirming if there is cancer, but many studies show that biopsy-based Gleason Score rankings are not that accurate. Below are a few statements from the US NIH:
The most common Gleason score by needle biopsy and prostatectomy was five. 37.2% of all patients had no change in score assignment, while 12.7% were 'over-graded' and 50.1% 'under-graded' by needle biopsy.
Of 241 cases 45 (18.7%) showed a significant change in grade from Gleason score 6 or less to Gleason score 7 or greater (Gleason score 7 in 41 cases, Gleason score 8 in 4 cases). Of 45 (53.5%) cases 24 that showed progression did so within 24 months of diagnosis.
Within the first 3 years, our data suggest that in most cases tumor grade did not evolve but rather that the higher grade component was not initially sampled.
Overall lay-man's recommendation - Take all the available information into account and make the best decision that aligns with your life expectations. Try to ignore the "this is the best option" and "why would you ever do that procedure" comments.
Best of luck and have a great weekend,
Jim
Replies to "I am always skeptical of broad statements around medical procedures/advice. Each person is an individual, with..."
Jim:
To your point, biopsy results are an interpretation, a reading and impression, of the radiologist as to the nature of the cancer cells.
At Hershey Medical Center, a Urological Surgeon at this teaching institution performed the fusion guided 18 core biopsy and Pathology reported one Gleason 9 together with G 8s. Johns Hopkins University, a recognized center of excellence,
reviewed the biopsy material and reduced the one core reading of 9 to a 7. Postop Pathology at John's Hopkins found, or reconfirmed, Gleason 9 from my surgical material.
Also, the Pre-biopsy MRI identified a suspected lesion near the capsule wall, but not extending or extruding beyond it. As above, post up pathology identified EPE.
The various tests, and the science behind them, are amazing.
However, they are not a perfect predictor of what cancer will be found and how each patient will proceed.
Best to all.
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Well of course it could go from Gleason 6 to a tad higher but it is not common.
Your ability to live 20 years from diagnosis of Gleason 6 is pretty darn good (provided you don’t drop dead from a heart attack of course).
Much, much better to wait than do any life changing treatment if you have a Gleason 6.
Or at least, that is what the research leads one to believe.