About My Numbers

To make a decision about treatment my Doctor looks at the numbers and then makes recommendations.

More importantly I have to look at the numbers, statistics, personal family experience, feelings, beliefs, treatment options, and an overwhelming supply of information. On top of the uncertainty that comes with such a diagnosis there is a fear that I will make the wrong decision. What ever decision is made pretty much final. There is no going back on a wrong choice. It is difficult to put into words the stress that having to make such a life changing choice induces. The Doctors and others try to make you feel better about this by saying "What ever choice YOU make is RIGHT for you."

First of all I had to consider my numbers.

• The first number I was told is that 10 samples were taken in my biopsy. Two of those samples that were on one side of my prostate next to each other had cancer cells in them. 
• It is good that there were only 2 out of 10.
• It is good that they were next to each other. That might mean that all the cancer is confined to one side of the prostate.
• It is bad that the nature of the biopsy is a hit and miss test. What I mean by that is that the samples are pretty much blindly taken from random places on the prostate that can only dimly be seen by the doctor using an ultrasound probe. The following image is what they see. This is very much like my images would have been as this patient has a similar diagnosis and numbers very much like mine. 

                       

• Maybe in time better imaging methods will be used so that the biopsy can be guided better toward the suspicion spot and biopsies might be more accurate.
• The second number to be considered is the Gleason score. This is how I understand that score. 
• The pathologist looks at the samples under the microscope and determines on a scale of 1 to 5 how much of the sample looks like cancer cells. The larger area of cancer gets a grade and the second largest area gets a grade.
• These two grades are added together to set the score. 
• My larger area was scored as a 4 and the second larger area was scored as a 3. That makes 4+3=7. So I have a Gleason score of 7.
• It was good that it was a 7 because that is considered intermediate and not high risk.
• It was bad because the first number was a 4 and not a 3 and 4+3=7 sounds the same as 3+4=7 but it is slightly worse.
• This Gleason score of 7 puts me at the very top end of intermediate risk, almost high risk. 
• Another number to consider is the PSA. Now this is the test that started me on this journey and it is used because it is a relatively simple and inexpensive blood test. My PSA has risen pretty steady over the last several years. The most alarming part is that it went from about 5 to nearly 10 in a year and from 9 to 17 in six months. That indicates that something bad is happening very fast. 
• Still another number to consider is the T score. This number has to do with the size of the tumor and a lower number is better. 
• Mine is T1c which means it was found during the needle biopsy and not by the digital rectal exam. That is good because it is relatively small and a good chance it is totally contained inside the prostate. 
• Unfortunately this number can only accurately be determined after the prostate is removed and not completely definitively by the biopsy. 

Having put all these numbers together means I have a medium grade cancer that is probably confined to the prostate. It means that I have treatment options but probably cannot just wait and see what happens. Leaving it alone would give me a probable life expectancy of 10 to 15 years before it would spread and the end would be unpleasant.

Once prostate cancer leaves the prostate and begins to spread it is NOT curable. So I had to make a treatment decision or face an untimely miserable death.