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Old 01-29-2011, 01:08 PM   #1
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A New Member

Hello all,
Darn if I don’t find myself a member your club.

Ok my stats: Father diagnosed with pCA in 1994, age 72, died within 18 months.
My current history: I’m 63, healthy otherwise still very active, Martial Arts twice a week, water and snow ski, even wakeboard. After my annual physical with emphasis on looking at the prostate because of BHP had the PSA pop to 6.7 checked it twice at two labs. DRE = negative (x3)

Biopsy 20 cores 3 positive of invasive Adenocarcinoma in the left lobe, (10mm & 60% of sample, 3mm 15% of sample, and 9mm 35% of sample) respectively Gleason grades are all 3+4=7 . Also, no perineural, lympovascular, or extracapsular extension is identified.

Ultrasound during biopsy showed no visual areas of suspect.
Bone scan is neg. for metastatic disease
BHP = approx 80 grams
I’ve decided to have the robot scheduled for March 3 about six weeks post biopsy to make sure it all healed.
Reading all your post everyone and wishing you all the best outcomes possible.
Steve

Last edited by Administrator; 02-09-2011 at 01:31 PM.

 
Old 01-29-2011, 02:43 PM   #2
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Re: A New Member

Hi Steve,

I presume that your BHP=80grams, means the size of your prostate as 80g. This indicates that you may have an infection (normal 65 years old= 25 to 45g), and if that is identified, you should take care of it before the surgery.
I also take your comment of “is identified” as; not identified, otherwise radiation therapy or HT could have been a better choice for your case.
No matter which treatment you choose, you should educate yourself about the side effects that each type may cause, temporarily or permanently.

I wish you the best.
Baptista

 
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Old 01-29-2011, 04:43 PM   #3
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Re: A New Member

Hi Steve,

Welcome to the club and to the Board, despite the fact that you were reluctant to join! We'll take you anyway.

I've read Baptista's response, and I'll add some thoughts in green to an excerpt of your post with your interesting history. I'll bet you now hope you did a good job on those prototypes.


Quote:
Originally Posted by Kirkwood View Post
...

Ok my stats: Father diagnosed with pCA in 1994, age 72, died within 18 months.
My father also died of PC, many years ago, in the 1980s. It is very important for you to understand that there have been monumental changes in the technology for dealing with prostate cancer since that time. For one thing, screening with PSA tests (and DRE exams) is now widespread in the US, and that means that we usually detect prostate cancer early, allowing us to either attempt a cure at the time or use active surveillance to smoke out whether it is a cancer that is likely to ever threaten life or quality of life. That was not so when your dad was diagnosed. The PSA test had just come to be widely used at that time, and, tragically, many newly diagnosed patients were found to already have widespread, high-risk cases. That's very likely true of your dad with that very short survival of just 18 months. The point is that your situation contrasts so strongly with his. History is not destiny, especially in prostate cancer.

Quote:
My current history: I’m 63, healthy otherwise still very active, Martial Arts twice a week, water and snow ski, even wakeboard.
Accumulating evidence suggests that exercise, both aerobic and strength, is important in coping with prostate cancer. (I suspect flexibility and balance do not hurt either.) You can pretty much check off that block.

Quote:
After my annual physical with emphasis on looking at the prostate because of BHP had the PSA pop to 6.7 checked it twice at two labs. DRE = negative (x3)
Both a PSA of 10 or lower and a negative DRE are low risk characteristics.

Quote:
Biopsy 20 cores 3 positive of invasive Adenocarcinoma in the left lobe, (10mm & 60% of sample, 3mm 15% of sample, and 9mm 35% of sample) respectively Gleason grades are all 3+4=7 . Also, no perineural, lympovascular, or extracapsular extension is identified.

Ultrasound during biopsy showed no visual areas of suspect.
As you may know by now, that is a low-risk case scenario with the possible exception of the 60% of one sample (> than 50%) and the GS of 7, but on the less risky side. Do you know whether your pathology was done by an expert in prostate cancer? Many of us have general pathologists do our samples, and they read all kinds of samples from men and women, adults and kids, cancer and many other diseases (and perhaps dogs and cats . The bottom line: many of their readings are revised upward or downward when reviewed by an expert. The Gleaon is such a key part of decision making that it is important to get a second opinion, from an expert, if the first reading was not expert.

Quote:
Bone scan is neg. for metastatic disease
It is somewhat worrisome that the doctor prescribed a bone scan. In 2009, American Urological Association guidelines urged that bone and CT scans not be done except in exceptional circumstances, which don't seem present here from what you have posted, because they were so rarely positive or of any value. Were there special circumstances, such as your complaint of spinal or lower back pain? (Seems unlikely with your martial arts activity.) This is a small indication that your doctor may not be keeping fully up to speed.

Quote:
BHP = approx 80 grams
Did you know that healthy prostate cells also produce PSA, and that an enlarged prostate of completely healthy cells will produce more PSA than a smaller healthy prostate? There are a few different, research-based rules of thumb for assessing PSA from healthy cells. One is to multiply the grams of prostate by 0.066 ("A Primer on Prostate Cancer, p. F4, citing research). In your case, the size alone would explain 80 X 0.066 = 5.28 out of the 6.7 found in your tests, leaving only about 1.4 to be explained by prostate cancer, a rather small volume of disease. Another rule of thumb is to take the grams or cc and multiply by .1, which would yield a PSA of 8 in your case, again suggesting little PSA due to the cancer. I'm thinking that doesn't leave much room for infection, either.

Quote:
I’ve decided to have the robot scheduled for March 3 about six weeks post biopsy to make sure it all healed.
Reading all your post everyone and wishing you all the best outcomes possible.
Steve
Modern Gleason scoring is different from that in the first half of the past decade and earlier. Now, a Gleason grade 4 or 5 is recorded as the second element even if it is quite minor. For instance, your sample could be 95% Gleason 3 and 5% Gleason 4 and still appear as a 3 + 4 =7. Do you know the extent of the grade 4? If not, it would be worth trying to find out. You should get a copy of the biopsy report, which may indicate that.

The significance is that you may actually have one of those low risk cancers that is quite suitable for an active surveillance approach. If that Gleason grade 4 should really be a 3, that would really tilt the scale. That would leave just that one sample of 60% above the 50% threshold. In the total context, I'm thinking, as a now somewhat savvy layman, that experts would see the whole picture as low risk and suitable for active surveillance. There's nothing wrong with a robotic approach, especially by an expert, but it does involve risk that you would not need to hazzard with active surveillance.

Two excellent books for orientation are "Invasion of the Prostate Snatchers" and "A Primer on Prostate Cancer."

Good luck in sorting all of this out.

Take care,

Jim

 
Old 01-30-2011, 03:31 AM   #4
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Re: A New Member

I've responded in red!
Quote:
Originally Posted by IADT3since2000 View Post
Hi Steve,

Welcome to the club and to the Board, despite the fact that you were reluctant to join! We'll take you anyway. Thanks... I think

I've read Baptista's response, and I'll add some thoughts in green to an excerpt of your post with your interesting history. I'll bet you now hope you did a good job on those prototypes.
Ya , thats the truth!
My father also died of PC, many years ago, in the 1980s. It is very important for you to understand that there have been monumental changes in the technology for dealing with prostate cancer since that time. For one thing, screening with PSA tests (and DRE exams) is now widespread in the US, and that means that we usually detect prostate cancer early, allowing us to either attempt a cure at the time or use active surveillance to smoke out whether it is a cancer that is likely to ever threaten life or quality of life. That was not so when your dad was diagnosed. The PSA test had just come to be widely used at that time, and, tragically, many newly diagnosed patients were found to already have widespread, high-risk cases. That's very likely true of your dad with that very short survival of just 18 months. The point is that your situation contrasts so strongly with his. History is not destiny, especially in prostate cancer.
That is true about my dad. I recall little of the details and we are tracing down copies of his medical records


Accumulating evidence suggests that exercise, both aerobic and strength, is important in coping with prostate cancer. (I suspect flexibility and balance do not hurt either.) You can pretty much check off that block.[INDENT]I don't feel that strong right now. I just came back from a 4 hr. martial arts belt ceremony, these young bucks are killing me! heh, heh. I actually intent to ramp my workouts about 30%.


Both a PSA of 10 or lower and a negative DRE are low risk characteristics. Yes I agree, keep in mind though this is a new medical area of learning for me, but I am lucky enought be able to read and interpet most hard core reports and studies.



As you may know by now, that is a low-risk case scenario with the possible exception of the 60% of one sample (> than 50%) and the GS of 7, but on the less risky side. Do you know whether your pathology was done by an expert in prostate cancer? No, I feel he was not an expert in pCA, even thought he is a good Pathologist with a reputation for correct diagnoses in this area, I hand carried the slides to Stanford for the second opinion. The current consensus is it may just be pre-operatively closer to the high side of a 3+3 =6 but they still write down 3+4 =7.

Given the left lobe 60% core sample and its estimated proximity to the margin we all feel it’s time now to look closely look at the prostate i.e. pull it out and see just were this tumor or tumors are. All involved feel it’s probably more than one mm from that margin, but no doctor, no matter how good he is, is willing to that make that call while it’s still in there.
Many of us have general pathologists do our samples, and they read all kinds of samples from men and women, adults and kids, cancer and many other diseases (and perhaps dogs and cats . The bottom line: many of their readings are revised upward or downward when reviewed by an expert. The Gleaon is such a key part of decision making that it is important to get a second opinion, from an expert, if the first reading was not expert.




It is somewhat worrisome that the doctor prescribed a bone scan. In 2009, American Urological Association guidelines urged that bone and CT scans not be done except in exceptional circumstances, which don't seem present here from what you have posted, because they were so rarely positive or of any value.Both the doc and I agreed it was a waste of time but the insurance company insisted. Another case of insurance companies playing doctor. Were there special circumstances, such as your complaint of spinal or lower back pain? (Seems unlikely with your martial arts activity.) No problems, it is interesting that they were able to detect old injured and broken toes from the arts! This is a small indication that your doctor may not be keeping fully up to speed.



Did you know that healthy prostate cells also produce PSA, and that an enlarged prostate of completely healthy cells will produce more PSA than a smaller healthy prostate?Yes I did as of last week. There are a few different, research-based rules of thumb for assessing PSA from healthy cells. One is to multiply the grams of prostate by 0.066 ("A Primer on Prostate Cancer, p. F4, citing research). In your case, the size alone would explain 80 X 0.066 = 5.28 out of the 6.7 found in your tests, leaving only about 1.4 to be explained by prostate cancer, a rather small volume of disease. Another rule of thumb is to take the grams or cc and multiply by .1, which would yield a PSA of 8 in your case, again suggesting little PSA due to the cancer. I'm thinking that doesn't leave much room for infection, either.Nice numbers. I'll investigate the foundation for those rules. I did recall some inconclusive notes on the suggested fact that BHP did increase psa numbers and I do believe there is something to it.
Modern Gleason scoring is different from that in the first half of the past decade and earlier. Now, a Gleason grade 4 or 5 is recorded as the second element even if it is quite minor. For instance, your sample could be 95% Gleason 3 and 5% Gleason 4 and still appear as a 3 + 4 =7. Do you know the extent of the grade 4? its been inferred to be closer to the 3 If not, it would be worth trying to find out. You should get a copy of the biopsy report, which may indicate that. No it didn't.The significance is that you may actually have one of those low risk cancers that is quite suitable for an active surveillance approach. If that Gleason grade 4 should really be a 3, that would really tilt the scale. That would leave just that one sample of 60% above the 50% threshold. In the total context, I'm thinking, as a now somewhat savvy layman, that experts would see the whole picture as low risk and suitable for active surveillance. There's nothing wrong with a robotic approach, especially by an expert, but it does involve risk that you would not need to hazzard with active surveillance.Yes I fULLY understand the risk.

Two excellent books for orientation are "Invasion of the Prostate Snatchers" and "A Primer on Prostate Cancer."

Good luck in sorting all of this out.

Take care,

Jim
Baptista and Jim thanks for you support. Stanford is the current surgery location of choice.
Steve

Last edited by Kirkwood; 01-30-2011 at 03:51 AM.

 
Old 01-31-2011, 05:52 AM   #5
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Re: A New Member

Hi Kirkwood,

You mentioned your prostate cancer being close to the margin. You might want to ask your doctor about the chances of positive margins after surgery (where the cancer is on the periphery of the removed prostate). If you end up with positive margins, you enter a high-risk category, regardless of your Gleason score, with just a 50% chance that the cancer won't recur, absent further radiation/hormonal therapy. Again, perhaps another reason to consider a different approach.

Best of luck,
Tom

 
Old 01-31-2011, 05:55 PM   #6
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Re: A New Member

Hi Steve,

I'ver read Gleason9's post, and I'm responding to your post #4 before that. I'll pick up some quotations in black for you and add green for me.


Quote:
...Given the left lobe 60% core sample and its estimated proximity to the margin we all feel it’s time now to look closely look at the prostate i.e. pull it out and see just were this tumor or tumors are. All involved feel it’s probably more than one mm from that margin, but no doctor, no matter how good he is, is willing to that make that call while it’s still in there.
Location of the tumor is definitely a risk factor. However, I'm not sure I follow the logic here, the advantage of pulling it out to ascertain if it really is more than 1 mm away, or touching, or penetrating into or even through the capsule. There are some staging techniques that can improve odds a lot of getting an accurate fix on the location. One is color Doppler ultrasound, which is well described in Invasion. Another is endo-rectal MRI with spectroscopy, and guess where the world-leading center is? It's UCSF. I'll move your closing comment up here as it ties in:

Quote:
...
Baptista and Jim thanks for you support. Stanford is the current surgery location of choice.
Steve
Do you know that Stanford is one of the world leading centers for research on radiation for prostate cancer? Some expert radiation doctors also practice there of course. My impression is that the Stanford researchers focus more on external beam than seeds, but I may be wrong about that.

Once again, there is nothing wrong with expertly done surgery, but are you aware that accumulating research is indicating that radiation is at least as good? While you don't know the Gleason score based on the removed prostate as you do with surgery, I'm not so impressed that that is much of an advantage. It can help clarify the odds of a recurrence, or the need for radiation follow-up, but PSA behavior after radiation also does that pretty well. Also, say it turns out you have a Gleason 8 tumor based on the surgery pathology instead of a Gleason 7; does that mean that any metastatic spread will also be an 8? No, it does not. It strikes me that the point surgeons like to make about post surgery pathology is more a selling point than a key piece of information. (I hope you or others will chime in if they see a flaw in that thinking.)


Quote:
... I'll investigate the foundation for those rules [of thumb on PSA from healthy tissue]. I did recall some inconclusive notes on the suggested fact that BHP did increase psa numbers and I do believe there is something to it.
There's no controversy about it. BHP definitely increases PSA as growth increases, but there is disagreement about how much PSA healthy cells produce. The source for the rule of thumb of 0.066 of PSA per cc of prostate gland volume is Applewhite J, Hall C: "Transrectal Ultrasound and Biopsy in the Early Diagnosis of Prostate Cancer," Cancer Control (8): 141-150. The 10% rule of thumb (volume X .1 = healthy PSA) is discussed in "Invasion of the Prostate Snatchers," pp. 82-83, and the source cited is:

J Urol. 2003 Aug;170(2 Pt 1):370-2.
Correlation of minute (0.5 MM or less) focus of prostate adenocarcinoma on needle biopsy with radical prostatectomy specimen: role of prostate specific antigen density.
Allan RW, Sanderson H, Epstein JI.
Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland 21231, USA.

Dr. Epstein, the senior author, is one of the most respected pathologists in the field of prostate cancer. I checked the abstract in PubMed, but the rule-of-thumb is not mentioned, and there is no link to a free copy of the complete paper. ( I always like freebies.)

I hope this helps.

Take care,

Jim

 
Old 01-31-2011, 06:17 PM   #7
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Thumbs up Re: A New Member

Quote:
Originally Posted by Kirkwood View Post
Hello all,
Darn if I don’t find myself a member your club. I years back worked as a Registered Respiratory Therapist years back running a department and the hospitals Lab. Got out of that in 1986 and now work as a manufacturing engineer. I ironically, helped design and build some of the first servo motors used in the prototype robotic surgery units about 14 or 15 years back. Maybe I’ll reap some of the benefits these some years later.

Ok my stats: Father diagnosed with pCA in 1994, age 72, died within 18 months.
My current history: I’m 63, healthy otherwise still very active, Martial Arts twice a week, water and snow ski, even wakeboard. After my annual physical with emphasis on looking at the prostate because of BHP had the PSA pop to 6.7 checked it twice at two labs. DRE = negative (x3)

Biopsy 20 cores 3 positive of invasive Adenocarcinoma in the left lobe, (10mm & 60% of sample, 3mm 15% of sample, and 9mm 35% of sample) respectively Gleason grades are all 3+4=7 . Also, no perineural, lympovascular, or extracapsular extension is identified.

Ultrasound during biopsy showed no visual areas of suspect.
Bone scan is neg. for metastatic disease
BHP = approx 80 grams
I’ve decided to have the robot scheduled for March 3 about six weeks post biopsy to make sure it all healed.
Reading all your post everyone and wishing you all the best outcomes possible.
Steve

Best wishes!

 
Old 02-05-2011, 11:32 PM   #8
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Gleason percentages and BHP effects on PSA

There's no controversy about it. BHP definitely increases PSA as growth increases, but there is disagreement about how much PSA healthy cells produce. The source for the rule of thumb of 0.066 of PSA per cc of prostate gland volume is Applewhite J, Hall C: "Transrectal Ultrasound and Biopsy in the Early Diagnosis of Prostate Cancer," Cancer Control (8): 141-150. The 10% rule of thumb (volume X .1 = healthy PSA) is discussed in "Invasion of the Prostate Snatchers," pp. 82-83, and the source cited is:

J Jim
[/QUOTE]

Hi All,
Jim, Mark L. Gonzalgo, M.D., Ph.D. at Stanford's Urology agrees with your comments on BHP effecting the PSA results and I thank you for that statistical formula.

"Modern Gleason scoring is different from that in the first half of the past decade and earlier. Now, a Gleason grade 4 or 5 is recorded as the second element even if it is quite minor. For instance, your sample could be 95% Gleason 3 and 5% Gleason 4 and still appear as a 3 + 4 =7."

I looked into this and also talked to others whose knowledge I respect along with Mark Gonzalgo regarding "Gleason percentages". All that I talked to questioned the accuracy of using percentages on biopsy samples, given their small sampling area, when compared to the whole prostate. They further went on to suggest that the use of Gleason percentages was currently statistically more applicable to the radical prostatectomy pathology analysis than a pre-surgical needle biopsy. I guess its which camp you talk to.

Wishing the best to all of you,
Steve

 
Old 02-06-2011, 08:59 AM   #9
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Re: Gleason percentages and BHP effects on PSA

Quote:
Originally Posted by Kirkwood View Post
There's no controversy about it. BHP definitely increases PSA as growth increases, but there is disagreement about how much PSA healthy cells produce. The source for the rule of thumb of 0.066 of PSA per cc of prostate gland volume is Applewhite J, Hall C: "Transrectal Ultrasound and Biopsy in the Early Diagnosis of Prostate Cancer," Cancer Control (8): 141-150. The 10% rule of thumb (volume X .1 = healthy PSA) is discussed in "Invasion of the Prostate Snatchers," pp. 82-83, and the source cited is:

J Jim
Hi All,
Jim, Mark L. Gonzalgo, M.D., Ph.D. at Stanford's Urology agrees with your comments on BHP effecting the PSA results and I thank you for that statistical formula.

"Modern Gleason scoring is different from that in the first half of the past decade and earlier. Now, a Gleason grade 4 or 5 is recorded as the second element even if it is quite minor. For instance, your sample could be 95% Gleason 3 and 5% Gleason 4 and still appear as a 3 + 4 =7."

I looked into this and also talked to others whose knowledge I respect along with Mark Gonzalgo regarding "Gleason percentages". All that I talked to questioned the accuracy of using percentages on biopsy samples, given their small sampling area, when compared to the whole prostate. They further went on to suggest that the use of Gleason percentages was currently statistically more applicable to the radical prostatectomy pathology analysis than a pre-surgical needle biopsy. I guess its which camp you talk to.

Wishing the best to all of you,
Steve[/QUOTE]

My opinion...

Few professionals will argue against holistic medicine and that many things can affect your PSA reading as well as affect many other blood readings. My experience began with my primary care doctor seeing a small elevation in my PSA level that was not normal when measured over a specific time period. He had no choice but to send me to a urologist. The urologist had no choice but to perform a biopsy. The biopsy showed cancer in the right apex only. My urologist suggested several treatments, educated me extensively on each treatment and I chose daVinci robotic prostatectomy surgery based upon family history. When all of the removed tissue was on a table in a pathology lab, the pathologist discovered that my cancer progression was far worse than what the biopsy revealed. Had my journey stopped at arguing, in length, about what is causing my PSA levels to rise, I'd probably be dead today. By no means do I suggest that you can't ask questions and discuss the validity of a PSA test or any other test. On the contrary, I encourage such robust investigation. In my case, with my family history (father died of PCa at age 68), I felt very sure about my situation and my choices. But, that's just me! I'm sure that the decisions that are comfortable for me are not necessarily comfortable for others. Ultimately, each person needs to map their own journey. Wishing you all the best!

 
Old 02-06-2011, 10:37 AM   #10
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Smile Re: Gleason percentages and BHP effects on PSA

Quote:
Originally Posted by *tony* View Post
Hi All,
My opinion...

Few professionals will argue against holistic medicine and that many things can affect your PSA reading as well as affect many other blood readings. My experience began with my primary care doctor seeing a small elevation in my PSA level that was not normal when measured over a specific time period. He had no choice but to send me to a urologist. The urologist had no choice but to perform a biopsy. The biopsy showed cancer in the right apex only. My urologist suggested several treatments, educated me extensively on each treatment and I chose daVinci robotic prostatectomy surgery based upon family history. When all of the removed tissue was on a table in a pathology lab, the pathologist discovered that my cancer progression was far worse than what the biopsy revealed. Had my journey stopped at arguing, in length, about what is causing my PSA levels to rise, I'd probably be dead today. By no means do I suggest that you can't ask questions and discuss the validity of a PSA test or any other test. On the contrary, I encourage such robust investigation. In my case, with my family history (father died of PCa at age 68), I felt very sure about my situation and my choices. But, that's just me! I'm sure that the decisions that are comfortable for me are not necessarily comfortable for others. Ultimately, each person needs to map their own journey. Wishing you all the best!
Tony,
I tend to agree with your comment and ironically we have a similar family history. I do think that as Jim has commented on when faced with making the decision to AS (and when to not) in another of the forums, these details of what effects PSA levels are important considerations along with your selected professionals recommendations.

You chose the RRP and so have I. For the most part we have finished , as best we can, our investigation into this convoluted and stressful decision making process. Now for me barring a really extreme change in information it’s time to put my faith and life in the hands of the doctor and treatment I’ve decided on.

Once you’ve looked at all the evidence, reviewed all the legitimate research, and listened to your picked medical professional you have done all that you can. If another treatment is needed after this, then another treatment is needed. You cannot, and should not, go back and say “well I should have done this or that” because you didn’t. It’s all a bit of a crap shoot. I’ve talked to doctors who have had or have PC and these decisions are just as difficult for them.

I’m having my surgery on March 3rd and come what may that is my life’s chosen path. Conversation and forum comments here by any of us are informational sounding boards and a sympathetic ear for those who are trying to sort out what paths they may consider taking. No matter where in their CA battle process they are.

Best to all of you,
Steve

 
Old 02-06-2011, 11:04 AM   #11
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Re: Gleason percentages and BHP effects on PSA

Quote:
Originally Posted by Kirkwood View Post
Tony,
I tend to agree with your comment and ironically we have a similar family history. I do think that as Jim has commented on when faced with making the decision to AS (and when to not) in another of the forums, these details of what effects PSA levels are important considerations along with your selected professionals recommendations.

You chose the RRP and so have I. For the most part we have finished , as best we can, our investigation into this convoluted and stressful decision making process. Now for me barring a really extreme change in information it’s time to put my faith and life in the hands of the doctor and treatment I’ve decided on.

Once you’ve looked at all the evidence, reviewed all the legitimate research, and listened to your picked medical professional you have done all that you can. If another treatment is needed after this, then another treatment is needed. You cannot, and should not, go back and say “well I should have done this or that” because you didn’t. It’s all a bit of a crap shoot. I’ve talked to doctors who have had or have PC and these decisions are just as difficult for them.

I’m having my surgery on March 3rd and come what may that is my life’s chosen path. Conversation and forum comments here by any of us are informational sounding boards and a sympathetic ear for those who are trying to sort out what paths they may consider taking. No matter where in their CA battle process they are.

Best to all of you,
Steve

I have a friend that has regular episodes of elevated PSA readings. His primary care doctor, like mine, does not have a choice except to refer him to a urologist. The question always comes up, "What is causing my PSA readings to elevate?" The answer is always, "A lot of things can elevate your PSA!" He's in his 50s and he has had at least 7 biopsies that have all been negative. I feel so sorry for him. It's like torture. If it were me having this condition, I'd have my prostate removed just to stop the repeated biopsies. But again, that's my opinion. I would never suggest that to my friend. I just hate seeing this guy being tortured every year or so.

Best wishes!

 
Old 03-14-2011, 04:03 PM   #12
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After surgery...

Hello All,
Well, its eleven days post surgery and I’m finally starting to feel comfortable again. I had a bit of a reaction to the anesthetics and the first four days post were just a very painful blur that I would not wish to go thru again.

Most of us will have very little post surgical problems. I was one of the few in which my bowels shut down completely and would not start back up for twenty-four medication cycles. For those who don’t know, a medication cycle is every four hours… or six cycles per day.
Along with the bowel shut down my sense of smell and taste has turned to full on. It’s not good when the smell of a plain cup of black coffee brought to the person you share the room with makes you vomit, or you have to ask for anti-nausea meds when the meals trays are delivered and lay there in a cold sweat!

The fourth day I’m suddenly starting to feel better and I’m alternately crying and laughing at my wonderful prim and proper lady as she compliments me on how good I’m now passing gas!
So the hospital I think had enough of me and they send me home.

The catheter was removed today and I’m so far able to control urine flow most of the time…if I pay attention… a lot of attention.

The doctor said everything when very well and he was able to remove the 65 g. prostate, all nearby lymph nodes, and detached seminal vesicles while leaving both nerve bundles alone. There were no surprises to the bad side only on the good. That was that everything looked normal on the outside other than the prostates large size.
Stanford’s Pathology report:
“demonstrated bilateral involvement by prostatic adenocarcinoma, Gleason score 3+4=7, without extracapsular extension. The specimen designated “additional margin” shows no involvement by carcinoma. The separately submitted right and left lymph nodes show no involvement by carcinoma.
PROSTATE CARCINOMA SUMMARY
Site (Left Lobe, Right Lobe Bitateral) Bilateral specimen Type Prostatectomy Size (cm in 2 Greatest Dimensions) 2.6 x 2.5 Gleason Score 3+4=7 Gleason Pattern 4/5 (combined %) 10.

Margin Status… Uninvolved
Seminal Vesicle Involvement…Absent

Extraprostatic Extension… Absent

Lymphovascular Invasion …Absent

Large Venous Invasion…Absent

Lymph Node Status… Left and right… Uninvolved

DIAGNOIS
Prostate, robotic prostatectomy
--PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3+4=7
ONE lymph node with no carcinoma seen (0/1)
Lymph node, right pelvic, dissection
--TWO lymph nodes with no carcinoma seen(0/2)
Lymph node, left pelvic, dissection
--FOUR lymph nodes with no carcinoma seen(0/4)
Prostate, additional margin
--no carcinoma seen.”

Thanks for all your support. We will see what the ultra sensitive PSA test shows in six weeks.

Steve

 
Old 03-15-2011, 08:06 AM   #13
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Re: A New Member

Congratulations on the great results! With no positive margins or extension beyond the prostate, your prospects look fantastic!

Take care with your recovery and enjoy the blooming spring and balmy summer.

Cheers,
Tom

 
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Kirkwood (03-15-2011)
Old 03-16-2011, 04:34 AM   #14
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Re: A New Member

Steve
Wonderfull news from your pathologic report. I wish you a continuous recovery.

Baptista

 
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Kirkwood (03-16-2011)
Old 04-19-2011, 09:27 PM   #15
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Thumbs up Re: A New Member

Its post about six weeks my RRP and I had my blood drawn last Friday for the first ultra sensitive PSA then saw the urologist today. I’m still in a state of happy cautious shock as my PSA is 0.01!

Sooo…I’m cautiously (there’s that word again “cautious”) hoping I may have this pCA …if not cured… at least under control.

In three months we will do another ultra sensitive PSA and see how I’m doing. Thank you all for your support up to this point.

I continue to read all of your postings...

Steve

Last edited by Kirkwood; 04-19-2011 at 09:28 PM.

 
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