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Old 01-03-2011, 02:00 PM   #1
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Recently Diagnosed Prostate Cancer

Age 53, PSA 2.9 in 2007, 3.2 in 2008, 3.5 in 09, 4.8 in October 2010. DRE continues to be normal. Kidney ultrasound and bladder cystoscopy unremarkable.

Biopsy 12/1/10: two of twelve cores positive adenocarcinoma, one on each side, right side 4+3=7 (5% of core), left side 3+3=6 (7% of core).

Excellent health, walk 9 miles a week, three sets of tennis twice a week...

Prescribed tamsulosin (Flomax) and Cipro upon 4.8 PSA, immediately began having some groin discomfort and tingling/numbness throughout groin and left leg, intermittent left testicle pain. Only BPH-like symptoms before (weak stream, stop and start, etc.) Never any ED, not even a system failure. No blood in urine or semen (until biopsy.)

Bone scan negative, urologist doesn't think MRI or CAT scan necessary, but the new symptoms above have me worried that it is spreading. Urologist seems unconcerned.

Anticipating robotic prostatectomy after meeting with Dr. Vip Patel in Orlando in January 19. He has done over 4000, recommended by my urologist and my primary care physician.

Anyone else have symptoms that begun with taking tamsulosin? Anyone with similar background and prognosis? What can I expect?

 
Old 01-04-2011, 06:43 AM   #2
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Re: Recently Diagnosed Prostate Cancer

Well good luck then

 
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Old 01-04-2011, 08:23 AM   #3
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Re: Recently Diagnosed Prostate Cancer

Hi Jim and welcome to the board! I see you are now online and I'm working on a reply to your post. Jim

 
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Jim Mc (01-04-2011)
Old 01-04-2011, 10:22 AM   #4
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Re: Recently Diagnosed Prostate Cancer

Hi Jim,

The diagnosis comes as a stunning shock to most of us, especially if we are on the young side, fit and in good health! That was me at age 56 back in December 1999, but, unlike you, I was getting my first ever PSA test at that age, and again unlike you, I turned out to have a challenging case. (I'm doing well, but doing well is taking a substantial effort and concerted attention.) I'll reply in green to an excerpt from your initial post.


Quote:
Originally Posted by Jim Mc View Post
Age 53, PSA 2.9 in 2007, 3.2 in 2008, 3.5 in 09, 4.8 in October 2010. DRE continues to be normal. Kidney ultrasound and bladder cystoscopy unremarkable.
You can now reap a huge benefit form having had annual PSA tests for at least several years: you have a good handle on the PSA velocity (PSAV)in the year prior to diagnosis. That increase from 3.5 in 09 to 4.8 in October 2010 suggests a maximum PSAV of 1.3. That can be tied into impressive research by teams led by Dr. Anthony D'Amico, a well-known Boston area radiation oncologist/researcher, showing that for both surgery and radiation the risk of prostate cancer is a lot lower if the PSAV is 2.0 or lower in the year prior to diagnosis, and it appears that the lower it is, the better, but with 2.0 as a key dividing line. Their research has been confirmed in other studies. (Note that it does not apply to those not diagnosed with PC as infection and other causes can also drive PSA up, sometimes dramatically upward.) This research from the middle of the last decade strongly suggests that PSAV is a major indicator of risk that is in addition to the usual three key indicators: Gleason score, PSA level, and stage.

Having a PSA of 10 or below is also a low-risk indicator, as you probably know by now (my initial PSA was 113.6). As the DRE was normal, that suggests your stage is T1 - also a low-risk indicator.

Although the kidney and bladder results were negative, prostate infections are hard to diagnose and pin down. It is possible that a small degree of infection is helping boost the PSA as well as cancer.



Quote:
Biopsy 12/1/10: two of twelve cores positive adenocarcinoma, one on each side, right side 4+3=7 (5% of core), left side 3+3=6 (7% of core).
The biopsy is giving you two indicators of low risk, and one suggesting higher risk. Having just two of twelve cores positive is a low-risk clue, and so are the very small percentages of prostate cancer found in each core. The one unfavorable clue in this whole picture is the Gleason grade 4 cancer in that one core.

However, if the core samples was interpreted by a general pathologist, there's a fair chance that the grading might be somewhat off. It would be a wise move to have it interpreted by a pathologist who specializes in prostate cancer. If that grade 4 were reduced and no other grade 4 were found, that would open up the option of active surveillance. Research in the past half dozen years has demonstrated that active surveillance is a wise choice for many patients, with the key requirement that their case circumstances are low or very-low risk. Some doctors treating prostate cancer are reluctant to put a man as young as his forties or fifties on surveillance, but that is changing as research increasingly demonstrates that age is not an important aspect.


Quote:
Excellent health, walk 9 miles a week, three sets of tennis twice a week...
Such exercise appears to help hold back the disease, to some extent. However, strength (resistance, weights) also appears to be very important.

Quote:
Prescribed tamsulosin (Flomax) and Cipro upon 4.8 PSA, immediately began having some groin discomfort and tingling/numbness throughout groin and left leg, intermittent left testicle pain. Only BPH-like symptoms before (weak stream, stop and start, etc.) Never any ED, not even a system failure. No blood in urine or semen (until biopsy.)
I've never heard of that before. Perhaps someone else can comment.

Quote:
Bone scan negative, urologist doesn't think MRI or CAT scan necessary, but the new symptoms above have me worried that it is spreading. Urologist seems unconcerned.
Guidelines published by major cancer organizations now discourage bone, MRI and CT scanning unless circumstances are unusual. That's because a useful payoff is extremely rare. The urologist is right in line with current thinking that the MRI and CT are unnecessary. At some point an "endo-rectal MRI," probably with spectroscopy, might be appropriate to aid in choice of treatment. Prostate cancer is usually a slow-growing, slow-spreading disease, and your results are consistent with a high probability of that pattern.

Quote:
Anticipating robotic prostatectomy after meeting with Dr. Vip Patel in Orlando in January 19. He has done over 4000, recommended by my urologist and my primary care physician.
He has an excellent reputation, and having him do a robotic surgery seems a good option. You might want to consider other options also, including active surveillance depending on a rereading of the biopsy by an expert, if not initially done by an expert.

Quote:
Anyone else have symptoms that begun with taking tamsulosin? Anyone with similar background and prognosis? What can I expect?
Based on your case characteristics, you have a very high likelihood of being cured. Even if cure is not achieved, you have an extremely high likelihood of surviving prostate cancer.

Take care,

Jim

 
Old 01-05-2011, 08:57 AM   #5
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Re: Recently Diagnosed Prostate Cancer

Glad you are doing OK. Thanks very much for taking the time to address my concerns, very generous of you. That must have been a shocking initial PSA...

My urologist agrees AS might have been an option if 3+3, but everyone seems to concur that robotic prostatectomy is my most viable option.

Met yesterday with radiation oncologist, who said come back after RP (didn't even suggest radiation at my age).

Chief of RP at Cleveland Clinic yesterday as well, no doubt must come out. I know I should be more worried about mortality, but I'm obsessing over potency. 25 score on SHIM, but I think he thinks the 4+3 side could result in nerve loss. He seemed to think the cells in the photomicrograph included with the biopsy results were sufficient confirming evidence of high risk 4, but I will ask again about having slides confirmed.

He doesn't like to offer odds, but it sounds like I need to come to terms with the distinct possibility of non-existent/unsatisfactory sex life (or worse).

I suppose I'll try to focus on my good fortune in having a high possibility of being cured, but the thought of weak or non-existent erections keeps depressing me.

Thanks again so much for your time...

Jim

 
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Old 01-05-2011, 11:42 AM   #6
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Re: Recently Diagnosed Prostate Cancer

Just a suggestion for one more person to talk to. Dr. David Spellberg at Naples Urology Associates was one of the pioneers of using CyberKnife for prostate cancer. Prospects for retaining complete sexual potency in a man your age are pretty good with this treatment. There are now five years of data, which show cure rates similar to RP.
- Allen

Quote:
Originally Posted by Jim Mc View Post
Met yesterday with radiation oncologist, who said come back after RP (didn't even suggest radiation at my age).
...
He doesn't like to offer odds, but it sounds like I need to come to terms with the distinct possibility of non-existent/unsatisfactory sex life (or worse).

I suppose I'll try to focus on my good fortune in having a high possibility of being cured, but the thought of weak or non-existent erections keeps depressing me.


Jim

 
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Jim Mc (01-05-2011)
Old 01-14-2011, 08:57 AM   #7
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Re: Recently Diagnosed Prostate Cancer

Hi,

I'm currently waiting for the results of my biopsy, I get them on Monday (17th).

Age 59 (next Tuesday!)

Reasonably fit, not over weight, some exercise.

PSA:-

March 2005 - 0.67
August 2010 - 3.26
December 2010 - 4.77

DRE normal

Consultant put me on Tamsulosin (for BPH symptoms) in September, no real improvement, still frequent trips to 'dribble'. Not too much of an issue overnight (just 2-3 trips).

I had an anti-biotic right at the beginning (can't remeber what type), but urine came up negative for infection.

Just finished a Cipro course following the biopsy (+ injection and suppository!). Not happy on Cipro - runs and headache!

Consultant doesn't want me to try Finasteride or even saw palmetto as he wants to monitor PSA.

All will be revealed on Monday!

If positive biopsy is passing the test, I've never wanted to FAIL something so much in my life!!

Finger nails down to the quick!!!!

Good luck all,

Mick

 
Old 03-13-2011, 02:15 PM   #8
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Re: Recently Diagnosed Prostate Cancer

Jim Mc
I'm new to this board and I was reviewing recent postings and I was wondering how things are going for you. I had Proton Therapy at Loma Linda after a failed RP and a year on I am confident of a cure without side effects such as impotence or incontinence. Check out Proton Therapy if you haven't had surgery yet or you need further treatment in the future.
Best of luck.

 
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