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OK folks – I need to “phone a friend”. If you know anything about prostate cancer, help me make up my mind.

First of all, let me say that this is all good stuff – everything I’m going to write below is entirely attributable to the wonderful achievements of mankind – the thinking monkey.

Nothing in this post is a matter of concern. Death doesn’t faze me, being an inevitable consequence of life.

This post is a reminder how far we have come as a species. It also shows that there are a marvellous range of questions that we have not yet found time to address as a species  – things to keep future generations busy!

I LOVE SCIENCE!

This is about my diagnosis of prostate cancer that I received today (after undergoing a biopsy last week – following first an ultrasound 2 years ago, then MRI recently).

First the good news: this biopsy happened entirely due to my my fanatical diligence in getting blood tests done on a range of markers. I strongly urge everyone to be as fanatic about this, as possible. Get the data!

Everything is OK except for PSA which has been higher than normal for some years.

Now for the “bad” news (actually, it is good – since the doctor expected much worse results from looking at the MRI).

The prostate cancer I have is mostly Gleason 6 but some Gleason 7. That Gleason 7 fellow is somewhat aggressive (but, of course, nothing like Gleason 8, 9 or 10). That my worst cancer cells are only at the Gleason 7 level is a relief – for I have a genuine chance (even if it is nowhere near 100 percent) to kill this cancer.

Essentially, I have localised cancer – which has (hopefully – but can’t be guaranteed) not spread outside the prostate.

Given I’m otherwise fit and have age-based life expectancy > 10 years , I’ve been advised radical surgery – i.e. to remove the prostate entirely. (Now that’s not as simple as it sounds. It has a number of undesirable side effects! Not fun, I’m told!)

From what I’ve understood so far, I have three options: (a) surgery, (b) radiotherapy and (c) active surveillance.

I’ve already ruled out the active surveillance, which has a demonstrably lower rate of longer term survival than aggressive treatment – particularly at this early stage of detection.

I’m interested in choosing between radiotherapy and surgery. I have to finalise in the next few weeks. Can’t wait too long to decide. Each day I delay, the cancer cells might decide to migrate outside the prostate.

While I’ll definitely undertake as much research as possible (I’ve been given this book to read), I believe this blog is my way to reach out to my “phone-a-friends” – crowdsourcing. I always get better results by asking others than by merely applying my own mind.

So I’m posting my results below, also in Word and PDF formats.

I’d appreciate if you can provide me with your opinion (if you know anything about this issue) or get your friend who may be an expert on this matter, to provide his/her opinion.

You can send in your opinion either via email to me at sabhlok@gmail.com or comment on this blog.

BTW – Note that any general commiserations, etc. WILL NOT BE PUBLISHED. As I said, this is not a big deal. Everyone has to get one or other the other of the many bodily infirmities. The gravitational force of death is written in stone. So I’m merely going to use all information I can get hold of to EXTEND my life (within reason). I’m not interested in commiserations from people who are guaranteed to die, themselves! (sorry folks, we are all in the same boat) Let’s all live lives to the max, and fight death (but more importantly, chronic HUMAN STUPIDITY) till our last breath.

==TEST RESULTS IN WORD | TEST RESULTS IN PDF ===

The results as HTML

BLOOD TEST RESULTS

TUMOUR MARKERS – PROSTATE SPECIFIC ANTIGEN (PSA)            SPECIMEN: SERUM

Total PSA                                            % Free PSA

Date                      Time      Lab No.                 ug/L           Ref range

04/04/11              09:20 3077091                   2.60

11/04/12              09:10 8545212                   3.35

25/05/13              10:00 7657106 *               3.65

23/08/14              09:00 8426925 *               4.10

23/05/15              08:55 4757814 *               3.95 S

25/07/15              11:10 5811765 *                4.34 S

22/04/17              09:35 4629538 *               5.66 S                  (< 3.51)            33

CLINICAL HISTORY          

PSA 5.66 PIRADS 5 right TZ.

 

MACROSCOPY

1) “Right anterior” – Multiple cores of tissue up to 16mm. All in. 1 block.

2) “Right mid” – Multiple cores of tissue up to 17mm. All in. 1 block.

3) “Right posterior” – Multiple cores of tissue up to 17mm. All in. 1 block.

4) “Right TZ target line” – Multiple cores of tissue up to 19mm. All in. 1 block.

5) “Left anterior” – Multiple cores of tissue up to 17mm. All in. 1 block.

6) “Left mid” – Multiple cores of tissue up to 16mm. All in. 1 block.

7) “Left posterior” – Multiple cores of tissue up to 16mm. All in. 1 block. sp

 

MICROSCOPY

1) “Right anterior” – Tumour: Acinar adenocarcinoma,

Involves: 3 of 4 core biopsies,

Extent: 10mm/12mm core, 4mm/12mm core and 7mm/11mm core,

Modified Gleason score: 3+4=7 (<5% pattern 4),

Percentage of sampled prostatic tissue comprising tumour: 55%,

Perineural infiltration: Not identified.

 

2) “Right mid” – Tumour: Acinar adenocarcinoma,

Involves: 1 of 4 core biopsies,

Extent: 12mm/14mm core,

Modified Gleason score: 3+3=6,

Percentage of sampled prostatic tissue comprising tumour: 30%,

Perineural infiltration: Not identified.

 

3) “Right posterior” – Tumour: Acinar adenocarcinoma,

Involves: 4 of 4 core biopsies,

Extent: 2mm/14mm core, 1.8mm/13mm, 2mm/12mm core, and 0.5mm/12mm core,

Modified Gleason score: 3+4=7 (5% pattern 4),

Percentage of sampled prostatic tissue comprising tumour: 5%,

Perineural infiltration: Not identified.

 

4) “Right TZ target line” – Tumour: Acinar adenocarcinoma, Involves: 2 of 3 core fragmented biospies,

Extent: 9mm/12mm core and lOmm/16mm core (discontinuously), Modified Gleason score: 3+3=6,

Percentage of sampled prostatic tissue comprising tumour: 50%, Perineural infiltration: Not identified.

 

5) “Left anterior” – Tumour: Acinar adenocarcinoma,

Involves: 1 of 3 fragmented core biopsies,

Extent: 0.5mm/12mm core,

Modified Gleason score: 3+3=6,

Percentage of sampled prostatic tissue comprising tumour: <5%,

Perineural infiltration: Not identified.

 

6) “Left mid” – Tumour: Acinar adenocarcinoma, Involves: 2 of 3 fragmented core biopsies, Extent: 2mm/13mm core and 1.5mm/12mm core, Modified Gleason score: 3+3.6,

Percentage of sampled prostatic tissue comprising tumour: 5%,

Perineural infiltration: Not identified. Comment: High grade PIN is also noted.

 

7) “Left posterior” – Sections confirm benign fibroglandular and fibromuscular prostatic tissue, with no evidence of high grade PIN or invasive malignancy.

 

SUMMARY DIAGNOSIS

1) RIGHT ANTERIOR:

– ACINAR ADENOCARCINOMA, GLEASON SCORE 3+4=7 (ISUP GRADE GROUP 2), INVOLVES 55% OF SAMPLE.

Comment: There is only minimal Gleason pattern 4 disease (<5%), which may represent cross-cut pattern 3 or true pattern 4.

 

2) RIGHT MID:

– ACINAR ADENOCARCINOMA, GLEASON SCORE 3+3=6 (ISUP GRADE GROUP 1), INVOLVES 30% OF SAMPLE.

 

3) RIGHT POSTERIOR:

– ACINAR ADENOCARCINOMA, GLEASON SCORE 3+4=7 (ISUP GRADE GROUP 2), INVOLVES 5% OF SAMPLE.

Comment: This site also includes only minimal Gleason pattern 4 disease.

 

4) RIGHT TZ TARGET LINE:

– ACINAR ADENOCARCINOMA, GLEASON SCORE 3+3=6 (ISUP GRADE GROUP 1), INVOLVES 50% OF SAMPLE.

 

5) LEFT ANTERIOR:

– ACINAR ADENOCARCINOMA, GLEASON SCORE 3+3=6 (ISUP GRADE GROUP 1), INVOLVES <5% OF SAMPLE.

 

6) LEFT MID:

– CINAR ADENOCARCINOMA, GLEASON SCORE 3+3=6 (ISUP GRADE GROUP 1), INVOLVES 5% OF SAMPLE.

 

7) LEFT POSTERIOR:

– BENIGN PROSTATIC TISSUE.

Sanjeev Sabhlok

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5 thoughts on “OK folks – I need to “phone a friend”. If you know anything about prostate cancer, help me make up my mind.
  1. Raj

    The surgery sounds good to me. Importantly, whatever that’s needed to keep ya alive. The party’s just gettin started! ;)

     
  2. A V Raju

    Hi Sanjeev ,

    Let me say this : ” You are a brave man!” and truly a wonderful quality for a great leader. I was very unhappy and disturbed by the revelations in your write up and spent a lot of time reading about the tests and I have learnt that there is nearly no reason to worry for a Gleason 6 and even for Gleason 7. Have read the story of a person who posted the Gleason Readings from 2003 till now with the highest being 9 and average being 8 while the right drugs he has been using bringing it to 3 or 4 when in use . The worry he had was that a surgery would bring in a probable inconsistence and weakening of the muscle controlling the bladder. So Sir, my sincere view is- please do a metered , measured “wait and watch ” and be not hasty.
    We all love you, care for you , your health and of the family and let not the thinking monkey lose its balance , because there is a limit to the thinking capability itself and time should guide us into taking a right step. Regards – A V Raju

     
  3. Sanjeev Sabhlok

    Thanks, Raju. I’ve started reading up a bit more carefully now. That fact that you’ve read something about this is a very positive outcome. The greatest possible spread of scientific knowledge is a vital goal for me. I keep telling my mother to stop wasting time with spiritualism and focus on learning science – and about her own body.

    You are right, the situation here is not drastically alarming. But it is not great, either. The worst Gleason readings is 3+4. Grade 4 cancer is restricted to 5 per cent or so of the right anterior biopsy. (That is different from 4+3 which would have reflected a more aggressive result.) But the problem is that only 45 per cent of the right anterior is normal. This means grade 4 cancer occupies 2.5 per cent of the right anterior. The right posterior, as well, has some coverage of grade 4 cancer (around 5 per cent), but only 5 per cent of the biopsy from that region is cancerous (for around 0.25 per cent of that portion being grade 4 cancer).

    Active surveillance is an option, but given the observed continuous increase in PSA over the years, I suspect it is certain that cancer will keep growing. And the more it grows, the greater the chance of its spread, which will need aggressive treatment in the end. My doctor said there are no drugs available for the cancer, so in the end one has to go under the knife or radiation anyway.

    Let me study a bit more over the weekend. I’m currently becoming inclined to surgery, which will leave me with the option of radiation if any residual cancer is found after the surgery.

     
  4. Bindu

    Hi Sanjeev

    I have very limited knowledge about prostate cancer and I don’t have any training in medical field.But when a close relative was diagnosed with cancer I have gained a lot of insight about treatment options alternative to mainstream treatment from this website.
    They were not helpful for me as I have not been able to implement them as recommended.
    But they seem extremely sensible and useful especially for preventing spreading to other parts.

    I trust reading these two pages from the website will be well worth your time.
    https://www.cancertutor.com/faq_make_up_mind/
    https://www.cancertutor.com/prostate-cancer/

     
  5. David Van Slyck

    I found your blog by accident. I was going to discuss your political interests, but when I discovered that you had prostate cancer, I thought I might help in my own humble way.

    In my area of Southern California, there is a facility that treats prostate cancer with “proton” therapy. Loma Linda east of Los Angeles shoots protons at the cancer, rather than surgically removing it. Google “Loma Libda proton therapy and prostate cancer”.

    I am not a doctor or familiar with the treatment. But it sounds plausible for certain tyoes of cancer. My 90 year old mother underwent proton therapy for her lung cancer. It ” burned” some small spots on her chest, but eliminated the cancer.

    Good luck to you. We need more people like you in the world.

    Contact me if you like.

     

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