Locally advanced prostate cancer T3a

This morning I had a a phone call in reply to the questions I emailed yesterday evening. David and Ian do get back very quickly which is excellent. The email asked a couple of questions that arose when I had given a bit more thought to yesterday’s conversation and a bit of research I did subsequently. The biopsies discovered additional more aggressive cancers and I had now been given a Gleason score of 7 (previously 6). The total score is made up by the addition of the individual scores for the grades of cancer. 3 is the lowest grade for slow developing cancer so the best grad to have that indicates cancer is 6. A score of 7 indicates that there is some cancer present of the next higher grade, 4, which indicates more aggressive and fast growing. The score of 7 can be a 3-4 or a 4-3 where the first score is for the most common grade. Mine turns out to be a 3-4 and, as the prognosis for this is better than for a 4-3, this constitutes good news!

However, I was also told at what stage my cancer had developed too, T3a. This is not good news as it is now deemed to be a ‘locally advanced’ prostate cancer. T3a means that the cancer has broken through the capsule of the prostate but there is no evidence of it having yet spread to the seminal vesicles, lymph nodes, bones or other adjacent organs. Ian on the phone this morning said that the tumour is ‘pressing on the surface’ which implies it hasn’t broken through yet. What this means thou is that remaining on active surveillance is no longer an option and some treatment is necessary. I am seeing the consultant on the 21st July when we get back from France and the recommendation is highly likely to be surgery, a radical prostatectomy. Whether I will need radiation treatment as well after the surgery will depend on what they find and subsequent pathology tests. Ian said they may go ‘a bit wider’ on the right side where the tumour is pressing and that this might lead to a bit more nerve damage. I assume this might have consequences for my rate of recovery form the normal side effects; incontinence and erectile dysfunction so it is something I will need to ask about..

According to this leaflet from Prostate Cancer UK surgery is not normal offered to men with advanced local cancer.

 “A small number of men with locally advanced prostate cancer may be offered surgery (radical prostatectomy). This isn’t very common and is usually only offered as part of a clinical trial”.

Locally advanced prostate cancer http://prostatecanceruk.org/media/2491080/2796-locally-advanced-prostate-cancer.pdf

I assume that this is because once the cancer is through the capsule then surgery can no longer offer a cure and other treatments would be necessary anyway. Ian was talking this morning as if surgery was going to be recommended. If this is the case I can only assume they are confident that the tumour is still contained albeit pressing on the surface and so surgery is a good option with the chance of complete cure. The fact that he said they may need to go a bit wider where the tumour is pressing suggests they are not 100% confident as is the suggestion they may still recommend radiation treatment, depending on what they find while they’re in there.

All the Prostate Cancer UK fact sheets and tool kits are available to download from here: http://prostatecanceruk.org/prostate-information/our-publications/publications/tool-kit

Prostate targeted biopsy results

Today, about four weeks after the biopsy procedure, I phoned the BRI and got the results which were discussed at yesterday’s multidisciplinary team meeting. I was told that the results were positive and two of the samples (12 in all) showed more aggressive tumours and a greater volume of cancer. My Gleason score has been put up from 6 to 7. I know that this is the addition of two separate scores for what are considered to be the primary and secondary tumours. A score of 7 can be 4+3 or 3+4 where the prognosis is significantly different in each case (the first case being less favourable) and that this will inform the discussion and recommendations of treatment. I was told one of the options would be a radical prostatectomy followed by radiation. I didn’t query this at the time but it might mean there is a risk the newly discovered tumours are either pressing against the prostate surface, the capsule, or even through it. It may still be local, i.e. not metastasis, but it would mean surgery alone might not be enough. I was going to be offered an appointment with the consultant, Mr. Singh, on Thursday 14th July but I will be on holiday in France on that date so it will be pushed back to the following week, probably Thursday 21st. I was assured at the time that a delay of a week would be insignificant but I have emailed and left a phone message this evening asking for more details on the Gleason score and a reassurance I don’t need to cancel my holiday. I will if necessary. This is bad news but I’ve been prepared for the worst ever since I was told the MRI scan showed a cause for concern and a targeted biopsy was needed. Given all the crap that is going on at the moment over the referendum result and the UK leaving the EU I have been as low today as I have ever been. No doubt I will feel better tomorrow and have a weekend in Oxford coming up with my family of 81.