Iím 57 years old. Today my PSA is 0.8 (seems very low to me), and its never been higher than 1.3. I had a 12-core biopsy last May, because of a small pea size hard lump was discovered on DRE. The lab report came back with 83% chance of Organ Confined, Stage T1 or T2.
The core analysis broke down as follows:
1. 4 of the 12 cores positive for cancer (Gleason 3+3 in all samples)
1.7 mm 12% of total length (left lateral Apex)
1.0 mm 8% of total length (right Base)
1.0 mm 7% of total length (left Mid)
0.1 mm 1% of total length (left lateral Base)
2. 2 cores PIN
3. 4 cores Suspicious
4. 2 cores benign with focal chronic inflammation.
By the way the lab used the following staining techniques to back the microscopic visual analysis: CK-903, P63, & P504S. From my research staining along with the visual identification seems very accurate for diagnosis.
On the one hand the cancer discovered is very small only a millimeter in two cases, and 0.1 millimeter in one case, and one at 1.7 mm
1. Does this report look typical for Gleason Scores of 6 or does is it look really bad?
2. Is any one trying ďactive surveillanceĒ with this type of diagnosis?
3. If one chooses ďactive surveillanceĒ what are the conditions to move on to more aggressive therapy?
4. What is the probability that you would be able to feel more or larger lumps with DRE before metastasis?
5. What is the probability that your PSA definitely increases before metastasis, and that you will catch that increase with 3 month screenings.
6.Is there any documented case of diet and exercise keeping the cancer in remission or even curing the cancer?
Iím scheduled for a DeVinci robotic surgery on Oct. 31, but am thinking about delaying and rescheduling. Scary though, since there are no concrete answers.
I'm trying the active surveillance. If you go to http://urology.jhu.edu and find the page for Dr. H. Ballentine Carter there is a link to his expectant mangement program. Two of the criteria they list for participation are - no more than two cores positive on the biopsy - and the cancer cannot be felt on DRE. Other factors are present but those two stand out in what you wrote. The anecdotal information you get from the internet is helpful in getting background information or learning of others experience but I'm no medical professional and I believe that's who you should work with on making a decision. You didn't mention getting a second opinion on the biopsy pathology and I think it's a good idea. Not only is it difficult to biopsy the prostate, the grading of the tissue can be quite subjective. My own local hospital pretty much botched it in my case so I have sent samples to Dr. Epstein at Johns Hopkins Pathology Dept and also Dr. Bostwick of Bostwick Laboratories with past biopsies. My approach to the expectant management is twice yearly PSA and DRE. Changes there would trigger a biopsy. With no change in PSA or DRE I'll still get a yearly biopsy since the PSA and DRE don't catch everything. I don't know about diet and exercise studies. I believe Dr. Walsh says in his book that when the cancer spreads, it doesn't come with a special announcement. As I understand it, the Gleason grades which are used to give you the score or sum, are an assesment of how well or poorly differentiated the prostate cells are. Gleason 6 could be associated with the most minute speck of cancerous cell or something involving most of the gland itself. The higher you go on the sum, the more aggressive the cells. Taken together, the aggressiveness and total involvement can give you a forecast of the likelihood of present or future spread. Good luck with your surgery. I'm sure you and your doctor have covered all this ground and are comfortable with your decision. I wouldn't make a life altering decision based on what you hear from me or someone else on the internet. I have 2 cores positive of 24, each less than 5% involvement and my PSA was 2.5. My numbers are irrelevant, it's your's that matter.
Thanks for the quick response BooMan.
Dr. Epstein from J.H. did confirm my pathology report from Dianon.
Yes, I'm two cores too many to qualify for "active survalence", but another requirement is that any one core must be less than 50% invloved. Since my core's were 1%, 7%, 8%, & 12% I was thinking that that could possiblly be less envolved than a 50% core.
I really wish we would see more posts from guys who have chosen "watching & waiting" as a method of treatment. Most of what you read on this forum are posts from guys who have opted for surgery and are posting about their issues resulting from their procedure. There are a few that post about their experience with radiation therapy, hormone therapy or chemo but for the most part the most popular choice seems to be surgery. Just for once I would like to read first hand testimony from someone who has had success with simply watching & waiting or as you call it, "active surveillance".
If this is the method you decide to choose, I would really appreciate it if you would update this forum regularly and keep us all informed about your success with "active surveillance". If more guys knew that watching & waiting is a viable and plausible method by reading your posts about your success, I think more guys would give this method much more credence and consideration.
At this point I'm committed to the surgery, because I'm too scared of the possibility of metatisis. You might think if you monitored PSA, %free PSA,
DRE, prostate size, and PSA velocity you might catch an enlargement or increase before metastisis, but as far as I can tell no Doctor or pathologist will give any probablities of this. They are more likely to say that matastsis occurs without an announcment. In fact according to my current pathology report I currently have 13% probability of capsular penetration and a 4% chance of an Advanced stage, which of course I hope is not the case.
From my reading it sounds like John Hopkins will eventually have some meaningful statistics for active surveillnce, but if some men live for 30 years with organ confined Gleason 6, then it will take 30 years to get the final results.
Thanks for the interest. I just hope a month from now on Novmember 8, I will be recovering with the news that the surgery went well. I haven't had any surgery for 52 years; the last time I was 5 when I had my tonsils removed.
H57, I know where you're coming from, regarding wanting it out, hearing the advice, and not having had surgery. I'd had no surgery at all except some very minor more or less elective stuff on extremities. I was quite apprehensive.
The good news is that the recovery is quicker than you can imagine. [Of course the bad news is at least in my case I couldn't have imagined how bad I'd feel in the immediate aftermath.] You can count the hours, and almost feel yourself returning to normal with each passing hour.
It all sounds so gruesome, but the retelling is worse than the experiencing, at least in my experience.
CRS907 hit the nail on the head... the anticipation is worse than the surgery. I had my RRP 10 weeks ago and am completely recovered except for ED. Went 'dry' last week. Never had any pain that Tylenol couldn't handle. The catheter was the biggest annoyance (keep it clean and use Neosporin Plus Pain liberally) and it wasn't all that bad. You'll be rid of the tumor and hopefully you'll get a good pathology report and followup PSA. If you've got BPH as I did, it solves that problem, too!