THE GLEASON GRADING SYSTEM

Remember the numbers associated with my biopsy specimens? Let’s get back to those. During my phone conversation with the urologist before my vacation, I was told I had a “Gleason 6” staging. Or maybe I understood that in my mind. Remember this, it will be important later in the journey.

Normally the pathology report will list each specimen or “core” (named such because it’s a “core needle biopsy”) separately by a number assigned to it by the pathologist, with each core, having its own diagnosis. The cores are listed separately because If cancer is found, it’s often not in every core, so the each core has to be examined separately to accurately make a diagnosis.

Pathologists grade prostate cancers using numbers 3 or higher based on how much the cells in the specimens look like normal prostate tissue under the microscope. Grades 1 and 2 are not used. Instead, if the core sample present with cells that look normal, it is designated as “benign.” This is called the Gleason System. Most biopsy samples are grade 3 or higher.

Since prostate cancer specimens can often have areas with different grades, a grade is assigned to the two areas that make up most of the cancer. These two grades are then added together to give the Gleason Score. In this system the higher the number, the more likely the probability of spread and thus the higher stage the cancer. The highest a Gleason sum can be is 10. Recall that the numbers are designated as a sum: 3+3, 3+4 or 4+3. The first number assigned is the grade that is most common in the specimen. For example, if the Gleason score is written as 3+4=7, it means most of the tumor is grade 3 and less of it is grade 4, and they are added for a Gleason score of 7. This sum can also be designated as 4+3=7. Although this is the same Gleason score, most of the cancer is grade 4, which is obviously higher. If a tumor is all the same grade (for example, grade 3), then the Gleason score is reported as 3+3=6.

Although most often the Gleason score is based on the two areas that make up most of the specimen, when a core sample has either a lot of high-grade cancer or there are three different grades including high-grade cancer, a higher score is determined to reflect the aggressive nature of the cancer.

The other significant part of the pathology report, besides the Gleason score is the volume of each specimen. This basically refers to the percentage involvement that each specimen is affected by cancer. For instance, one of my specimens, the one graded at 3+4, had 50% volume. And one of the 3 + 3 specimens had 40% volume. These are consistent with a possible greater involvement of the prostate gland and a greater possibility of spread.

This certainly was a cause for concern. However, I already knew from the scans that there was no spread. Next stop: Treatment Plan.

As we continue to raise awareness for prostate cancer, please remember men: Although there may not be a hard rule for screening, talk to your doctor about a PSA test if you’re between 45 and 55 years old. Screening should be done at 40-45 years of age for African Americans, Latinos or if there’s a strong family history.

THE SCANS

So what’s it like to hear you have cancer right before a vacation? Well, let’s just say that it wasn’t in my bucket list.

After our vacation, came the follow up visit. As it had already been related to me, I would need some diagnostic studies to rule out any spread. Oh yeah, I guess this is a good time to say that I’m a doctor and I was very familiar with all these steps. Familiarity, however, didn’t add any level of comfort. It did however, allow me to cut out the middle man and schedule my own tests! In my sense of losing control I needed to feel like I still had some, even if it was in my own head.

As I laid motionless on the hard, cool table for the bone scans, I could see my images on the screen and immediately knew there was no spread. I guess my knowledge was helpful in this case. But I also knew that the next step involved a discussion of treatments. And I knew that I was facing radiation or surgery. However, I thought for a moment how someone in my shoes would feel if they didn’t have the medical knowledge that I did. Would they feel lost, out of control and helpless? I think they would. Because in a way, so did I.

I guess I also have to share at this point the fact that my darling bride of 23 years was with me during these visits. It was very reassuring to know that I had her support. I told her she didn’t have to go with me but in a very assertive way, with a not so nice look she said, “shut up!” That made me happy.

To be continued…

The Start Of A Journey

About two months ago we embarked on a new journey. Although, I got ticket for this ride when I was by myself, it became apparent rather quickly that this would be a trip for two. A journey or a trip usually implies something new and exciting. Although we are experiencing something new, it’s not necessarily exciting.

There’s no better place to start other than the beginning. So here it goes:

I just recently had my first physical in at least 13 years! Yeah, yeah I know. This in spite of the fact that there’s a strong history of prostate cancer in my family. Well, the same evening of my physical and blood work, I received a call from the doctor’s office advising me that I would need to call to schedule an appointment “to go over the blood work.” That’s never a good sign.

Well, I called the next day, which happened to be a Saturday, and was told I could walk in. I was told that my PSA was elevated. For those of you that don’t know, the PSA stands for “prostate- specific antigen.” which is a protein produced by both cancerous and non cancerous cells in the prostate. There is normally a small amount of this protein in the blood, so the PSA blood test is a screening tool for possible prostate cancer.

Back to my PSA. It was 16 ng/mL. To put this in perspective, a range of 0-2.5 ng/mL is considered a safe zone. This however, can vary a little by age. Anything over 4-5 ng/mL will most likely be followed by a discussion with a medical provider. So obviously there was cause for concern. Was my father’s history of prostate cancer making its fateful appointment with me? I was told that an appointment would be made for me with a urologist. After an initial visit and a repeat PSA blood test, my value was still high, 14 ng/mL. Now came the moment of truth: “We’ll have to do a biopsy.” Each stop on this ride became a little more serious and a little more surreal.

If you’re a man between the ages of 40-50, please get a physical and a simple PSA blood test.

To be continued…

Loving In The Storm

Why me? This is usually the question we ask ourselves in the midst of a trial, an obstacle or a difficult situation. What if we started asking, why not me? Would anything change? Would it make a difference? Would we be better equipped to face a life storm?

I don’ know. Maybe. But those times of doubt, fear and anxiety will still be present. Yes, they will. However, by focusing on God’s word and His promises in and during a storm, by focusing on what can be learned, by focusing how to stay strong and positive and by focusing on the love of a spouse and/or friends, our mindset will be more positive, which will give us strength to fight battles.

You ask how I know? Because I’m in the eye of a storm right now! And although I’ve had moments of despair, fear, anxiety and doubt, three things have helped and continue to comfort and strengthen me:

1. God’s word on which I meditate daily

2. The love, strength and support of my wife (and my kids)

3. The prayers, messages from friends and talks with friends and people who have been down this road

What follows over the next several weeks is a description of the life storm that we find ourselves in at this moment. It is my battle with prostate cancer. More correctly stated, “our battle.” Because I do not fight alone but with the Lord by my side and as “won” with my beautiful, loving wife. My hope and prayer is that this would serve as, first of all, a testimony to God’s grace. Second, an example of how the love, sacrifice and support of a spouse can give strength and courage. And finally, as a resource to men who have been diagnosed with prostate cancer.

The fact that I love my wife may be evident by anyone who reads my blog. But that our love has grown even deeper in the midst of this storm is a blessing that I never saw coming! I love how she has made me stronger, how she has encouraged me in my low times, and how her fervent prayers have reminded me that “greater is he that is in me than the one who is is in the world.”

Men between 40-50 years old, if you get nothing else from this, please understand how important it is to have yearly physicals and have blood drawn for PSA level. It could save your life. Remember, your family needs you. Therefore, show them your love by taking care of yourself.

Why I Love My Wife

She’s beautiful. The kind of beauty that radiates from the inside.

She loves life and loves speaking life to others!

She’s analytical. She’s often deep in thought about a lot of things.

She’s an introvert but she loves that even though I’m an extrovert, I respect her need to withdraw at times.

She loves family and would do anything for her family.

She’s a motivator and deeply enjoys helping others reach their personal and fitness goals one on one.

She has the loudest, cutest laugh in any room! But it’s a joy to see her enjoying herself.

She always has a sacrificial kind of love.

She always believes in me and makes me feel strong.

In short, I love her because she means everything to me!

Love Built To Last

Recently I had a situation which left me surprised, speechless and stunned. I may share particulars of this issue at a later date. My natural tendency was to stop, breathe and process what was going on.

To do this, I had to withdraw so that I could gather all my thoughts. However, in the midst of organizing my thoughts, I was slipping into reclusiveness. Unbeknownst to me, I was at the same time pushing away the one person who wanted to be with me, cheer for and support me.

But my bride of 23 years would not allow me to withdraw, be quiet or remain lost in my thoughts. Nope! She took me by the hands and told me, “we are in this together, I want to know your thoughts and feelings. You can’t shut me out!” At that moment I realized that she would not compromise or back down. I was reminded of her deep love for me. I was reminded that because we are “won” my thoughts, feelings, fears and tears are also hers.

Yes, I was reminded of the fact that our “woness” does not work in isolation. I was reminded one more time of what our love means:

Lasting

Not Ordinary

Vital

Empathetic

Thanks honey!!

Thursday Marriage Tip

Love is not a feeling, it’s a commitment. If we say that we have “fallen out of love” what it really means is that we no longer wish have a commitment to the person to whom we made a promise and to God

Understanding Differences Between Men and Women

So this past Mother’s Day, I tried to do more stuff around the house so that that my wife, and mother of our kids, could just relax. While my wife enjoyed her cards, flowers and lunch, she also had arranged her empty Clinique products on the bathroom counter for full display. “I don’t ask much, just for some observation,” she said as she swept her right hand as to uncover a prize.

At that moment, I felt like I was three days late for the prom! So I went into “fix it mode,” because that’s what men do, right? I told her that I would get new products but she told me not to bother, that she would do it.

This incident portrays a stark difference between men and women: women want men to notice things they need whereas men want to be told what women want or need.

A woman’s desire would be for her husband to be observant and proactive in both noticing and fulfilling some wants. This lets the woman know that she is being thought of. Unfortunately, most men aren’t wired this way. Most men would be happy to fill a need once they are asked.

Knowing and understanding these differences is of vital importance in a marriage. It prevents misunderstandings, unrealistic expectations and disappointments. It is also important to be able to discuss these differences with grace, patience and without setting ultimatums. This allows for healthy communication and may also help each person to be more sensitive to each other’s needs.

So how did this play out? Well, she never did go to get her Clinique products. So I assured her that I would take care of it and I did! Now she’s all set…and I’ll try to be more intentional on being observant.

Thursday Marriage Tip

Gentleness, kindness, and self-control will produce more fruit in a marriage as a post to sarcasm.

Encouraging Love

I wanted to share a story about encouragement in our marriage. But what does this word mean? What does it entail? Well the dictionary definition of encouragement is “the action of giving someone support, confidence or hope.”

Well, as an example of this I’ll share our experience over the past year or so. Recently, my wife changed her work hours to where she has Fridays off. She also has engaged in personal development, which I think is great! In addition to this, I am two years into opening a business.

Now marriage is hard enough without adding some stressors and twists. But when we decided to push forward with these changes we also made a decision to support and encourage each other. How did we do this? By giving each other space when needed, telling each other we believed in one another, picking up the slack for each other, just being attentive and by praying for each other. The more we did this for each other, the stronger became our intimacy, confidence and prayer life.

So as we found, again, a little encouragement went a long way in the long term investment of our marriage.

What are some ways you encourage your spouse?