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Old 04-14-2011, 06:25 PM   #1
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New Member Status - just diagnosed PC

Age: 54

Rising PSA levels for about 4 years, wife pushed the issue this year because PSA rose from 5.8 to 6.6 (Feb 2011) in one year. Free PSA has always been on the low side ranging from 6% 4 years ago to 4% in February 2011. Chose watchful waiting until now. 12 core Biopsy last month. Results received today:

Right Apex:
Gleason Score 3+4=7 discontineously involving 40% of the specimen (2of2 cores contain cancer. Gleason pattern 4 comprises 5% of the cancer. Cancer length 1.4 cm.
Left Apex:
Atypical small acinar proliferation suspicious for but not diagnostic of malignancy.

Right and left Mid and Right and left base - were benign prostatic tissue


Doc ordered bone scan and ct scans for early next week.

Hope to get fellow boards members to pull me through this journey.

 
Old 04-14-2011, 07:20 PM   #2
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Re: New Member Status - just diagnosed PC

You may want to get a Color dopppler Ultrasound or an MRIS to better stage your Apex tumor. There are many options available to you, but if you are considering surgery, better staging is necessary. Apex tumors have a high probability of a positive surgical margin, and many professionals recommend radiation for Apex tumors that are close to the margin.
JohnT

 
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Old 04-15-2011, 02:03 AM   #3
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Re: New Member Status - just diagnosed PC

Quote:
Originally Posted by Dad2Grunty View Post
Age: 54

Rising PSA levels for about 4 years, wife pushed the issue this year because PSA rose from 5.8 to 6.6 (Feb 2011) in one year. Free PSA has always been on the low side ranging from 6% 4 years ago to 4% in February 2011. Chose watchful waiting until now. 12 core Biopsy last month. Results received today:

Right Apex:
Gleason Score 3+4=7 discontineously involving 40% of the specimen (2of2 cores contain cancer. Gleason pattern 4 comprises 5% of the cancer. Cancer length 1.4 cm.
Left Apex:
Atypical small acinar proliferation suspicious for but not diagnostic of malignancy.

Right and left Mid and Right and left base - were benign prostatic tissue


Doc ordered bone scan and ct scans for early next week.

Hope to get fellow boards members to pull me through this journey.
Hi Dad2

Your description classifies you in the Intermediate Risk for recurrence (NCCN).
Gleason pattern 4 is high in the scale 1 to 5 (3 to 5 since 2005) and indicates an aggressive type of cancer. Your Gleason score (3+4) 7 is at the low side of the intermediate for the higher percentage of pattern 3 involvement.
The apex of the prostate (where cancer was found) is the area where many cases relate to extra prostatic extension which may suggest that surgery alone would not “resolve” the problem.

I wonder what stage (1 to 4) was given to your case but most probably the pathologist wrote 2a for the negative on the left apex (atypical). Nevertheless, he comments of a “small acinar proliferation suspicious” which if found to be prostatic intraepithelial neoplasia (PIN) could well be cells suspicious of pattern 1 or 2 indicating involvement on the left lobe and therefore stage 2b.

The importance in having a reliable biopsy report in cases of Gleason score 7 is that it will alter the options for treatments, their consequences (side effects) and the need in thinking of any possibility of a future Salvage Treatment.

I would suggest you to educate yourself in the matter of treatment options and their side effects reading the many articles in the net (just type the word “Treatments for Prostate Cancer”). A good book explaining the diagnosis and treatments is the “A Primer on Prostate Cancer; The Empowered Patient’s Guide”.
A second opinion on the biopsy is also recommended if you are not satisfied with the place where they have been analysed.

Welcome to the board.
Wishing you success in this bumpy road.

Baptista

 
Old 04-15-2011, 04:26 AM   #4
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Re: New Member Status - just diagnosed PC

Welcome to the board. Baptista mentioned that you might consider getting a second opinion on the biopsy score. I would go a step further and say that if your biopsy was not analyzed by a specialist in prostate cancer, you owe it to your self to seek that second opinion. I believe that you can find a list of such experts in the book: Invasion of the Prostate Snatchers. Gleason scores are frequently modified when an expert views the specimens, sometimes up and sometimes down. But when you have Gleason 3+4, there is a chance (as in my case) that it will turn out to be higher, requiring a different treatment option.

My case is exactly what you want to avoid. Based on the biopsy, I had apical cancer with a Gleason 3+4. Not knowing any better, I elected surgery. The post-surgery pathology report upgraded me to Gleason 9, and, lo and behold, I ended up with positive margins. While it is possible for the best of surgeons, following the latest techniques, to mostly avoid positive margins, you would be taking a big chance unless you went to a surgeon who unequivocally is able to do so.

I wish you the best with your tests. As with almost all who get those scans, they will very likely turn out negative.

Tom

 
Old 04-15-2011, 05:50 AM   #5
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Re: New Member Status - just diagnosed PC

Hi Dad2Grunty,

I'll add my welcome to the Board! Of course we are all sorry you had reason to be here. You are just a couple of years younger than I was when I was diagnosed. I'll add some thoughts in green to the excellent responses you have already had.


Quote:
Originally Posted by Dad2Grunty View Post
Age: 54

Rising PSA levels for about 4 years, wife pushed the issue this year because PSA rose from 5.8 to 6.6 (Feb 2011) in one year. Free PSA has always been on the low side ranging from 6% 4 years ago to 4% in February 2011. Chose watchful waiting until now.
Both your PSA level and the rise in one year (very clearly not exceeding 2.0) are characteristics of a low-risk case, though the Gleason at 7, if confirmed by an expert (or originally done by an expert pathologist, not a general pathologist), indicates intermediate risk, probably toward the lower end, as others have noted.

Quote:
12 core Biopsy last month. Results received today:

Right Apex:
Gleason Score 3+4=7 discontineously involving 40% of the specimen (2of2 cores contain cancer. Gleason pattern 4 comprises 5% of the cancer. Cancer length 1.4 cm.
Left Apex:
Atypical small acinar proliferation suspicious for but not diagnostic of malignancy.

Right and left Mid and Right and left base - were benign prostatic tissue
The low proportion of positive cores, under 34%, is also a low-risk characteristic.

Quote:
Doc ordered bone scan and ct scans for early next week.
Your doctor is not following current guidelines, which discourage these scans for cases with PSAs as low as yours and a Gleason not above 7. Were there other characteristics that triggered concern, such as lower back pain, or other of the symptoms usually due to an infection or other condition but sometimes due to prostate cancer? Are you a malpractice attorney? I initiated a thread about this a few years ago "Diagnostic bone and CT scans" (started 7/6/2008) about a major change in guidance from the American Urological Association. I believe the National Comprehensive Cancer Network's guidelines also discourage such scans in cases like yours.

You might want to contact the doctor about this issue, though it would certainly raise a major relationship issue. I suggest putting off the scans and getting a second opinion from an independent doctor, perhaps a medical oncologist who has a substantial proportion of prostate cancer patients in his practice.


Hope to get fellow boards members to pull me through this journey.[/QUOTE]

You and your wife have received the news that none of us wants to here, but did you know that survival of low- and intermediate-risk prostate cancer patients is virtually 100% at the ten year point from diagnosis? Even high-risk patients, like me, make it to ten years 95% of the time. (Moreover, those statistics are based on results that are now slipping back a few years in time. A current snapshot would almost certainly be even better.) Of course, we are all hoping to make it for a lot more than ten years. I'm now at the twelfth year point and counting, doing very well.

Take care,

Jim

 
Old 04-17-2011, 11:16 AM   #6
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Re: New Member Status - just diagnosed PC

Thanks guys for your information. We appreciate any and all. My wife said the same thing about having those scans done, and she is skeptical that they will be a waste of $. At this point I am going to proceed with the ct and bone scan - 1. because I am terribly tired all the time - extremely. I have a sedentary job, but in relatively good shape and weight, but can not shake the fatigue. Even before we knew all this my wife was telling me how much it was bothering her, my sleeping all the time. So I will do them as a precaution that nothing else is going on too.

After we have those done, however, we have decided to seek treatment at the Chicago Prostate Center, for further evaluation there. We intend to call there on Monday to see what the wait time will be to get in.

Baptista: I have been following this board for awhile now - hoping that I would not officilly have to enter, I had seen the books you mentioned and purchased them-I feel I have educated myself somewhat - however, the technical stuff mentioned by you four is great and welcomed. It is alot to take in all at once.

The biopsy report I have says it is from Bostwick Laboratories - Uniondale, NY, and the doc said it was a center that prostate cancer is all they do. So I am hoping that the gleason is scored correctly at this point, however, I am concerned that the needle just didn't go to the right place on the left side.

JohnT1 - My wife was hoping the doc would have had a color doppler when the biopsy was done - his was grayscale - showed nothing suspicious to him. When she asked him about an endorectal MRI instead of the CT and Bone Scan - he basically did some quick talking about it being experimental - both reasons we will be going elsewhere. It doesn't appear he is up on the latest and greatest. He never metioned a staging to us.

Gleason9 - I am sorry to hear of your experience - and thank you so much for giving me your perspective - for it is something to digest and consider in my selection of treatment.

IADT: Not to leave you out - all of your information gives me great hope that I needn't be to rushed to make any decisions, and I intend to remain calm and attack this as rationally as possible. You are very insightful, I was a lawyer, and now a Judge, so maybe this is why the doc wanted the scans. But I know from other patients he does this standard. I have received more records from my GP doc and it appears in 2002 my PSA was 2.2, 2006 4.6, 2008 5.3 2009 5.8 and 2011 6.6 - you have other threads where you have discussed the raising numbers. Would you have any comments on these numbers? I realize they are very low compared to some on this board. The Free PSA was not given in 2002, but in 2006 was 6% to now 4% in 2011. I can not find anything much on the Free PSA as being of any significance except to tip the scales for someone to have a biopsy or not if they are in the 4 - 10 range, is that your understanding as well?

Thanks again for all of you taking the time to answer my thread - very much appreciated to be able to talk with those that actually know what we have to look forward to.

 
Old 04-18-2011, 07:51 AM   #7
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Re: New Member Status - just diagnosed PC

Dad2

Bostwick Laboratories are known to be of the highest in pathological analyses of prostate biopsies. You couldn’t expect better opinion from another laboratory.
MRI and bone scans in asymptomatic cases of low PSA (<10) are common to be negative however, there is a test (USPIO MRI) that seems to be appropriate to find “suspicious” cancer at lymph nodes (in the iliac) which would add information on your status.
Some doctors have it as a protocol to submit patients to the scans in the initial stage to have the results/films as a diagnosis tool and to serve as well as comparative tests for future readings. File and keep those films with you.
After so many things in “positive”, it gives peace-of-mind to see things in negative.

I hope you find a doctor in whom you feel confidence.
Baptista

 
Old 04-27-2011, 06:08 PM   #8
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Re: New Member Status - just diagnosed PC

Question we have seen the doc and have the results from bone and ct scans - as expected they were negative for PC. So my local urologist/surgeon actually discussed the concept of HDR brachytherapy - described as 25 visits with an external beam linear accelerator, and two visits consisting of internal radiation needles, one in the mid cycle of the external and one at the end of the external. The needles do not stay in the prostate, as the other procedure with seeds does. He also stated that brachytherapy seeds is "old school" and not as up to date as HDR brachytherapy combo. And he has heard of seed migration. I haven't read that anywhere, is that something anyone hear was cautioned about in treatment?

I have set appointments with both the Chicago PC to undergo a color doplar and volume study, and also with my docs team member who does the external radiation.

Looking forward to any comments on these two procedures. Thanking you in advance for your time and knowledge.

 
Old 04-27-2011, 07:08 PM   #9
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Re: New Member Status - just diagnosed PC

What he is talking about is a combination of HDR (high dose rate) brachy with external beam radiation. Pending the results of your color doppler, I don't think you have any reason to believe the PC has spread outside of the prostate, so you can now get HDR brachy as a monotherapy. That would only involve a day or two in hospital and has much less toxicity than external beam radiation. Even better, you might want to investigate CyberKnife (which was modeled on HDR brachy) -- five short visits and you're done, with much less toxicity.

Both CyberKnife and HDR Brachy are thought to be more effective than traditional external beam radiation because, unlike some other cancers, PC cells are more sensitive to higher doses per session. Only HDR and CyberKnife can deliver those kinds of higher doses per session without causing undo toxicity to the bladder and rectum. Erectile function has been well-preserved too.

- Allen

 
Old 04-28-2011, 04:03 AM   #10
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Re: New Member Status - just diagnosed PC

Quote:
Originally Posted by Dad2Grunty View Post
Question we have seen the doc and have the results from bone and ct scans - as expected they were negative for PC. So my local urologist/surgeon actually discussed the concept of HDR brachytherapy - described as 25 visits with an external beam linear accelerator, and two visits consisting of internal radiation needles, one in the mid cycle of the external and one at the end of the external. The needles do not stay in the prostate, as the other procedure with seeds does. He also stated that brachytherapy seeds is "old school" and not as up to date as HDR brachytherapy combo. And he has heard of seed migration. I haven't read that anywhere, is that something anyone hear was cautioned about in treatment?

I have set appointments with both the Chicago PC to undergo a color doplar and volume study, and also with my docs team member who does the external radiation.

Looking forward to any comments on these two procedures. Thanking you in advance for your time and knowledge.
Dad2Grunty

The meeting with the radiologist will give you peace of mind.
HDR brachytherapy done with IMRT is a treatment for cases that foresees possible recurrence. Bracky looks upon the cancer in the prostate and IMRT will be directional to the pelvic area including the lymph nodes.

Seeds implant is known to be a reliable treatment too with encouraging reports of success from centers of excellence. You could also consider the IMRT/IGRT alone or done in combination with hormonal treatment which is the most traditional form of treating PCa nowadays. Just type the name and you can read articles on the procedure as well as statistics on successful rates. You can also discuss about this in your next appointment with the radiologist.

HDR stands for Higher Dose Radiation. This also means that the dose given per section will kill both, cancerous and benign cells giving a lesser opportunity for the benign to recuperate.

Read about the procedures and take with you a list of questions; such as, duration of treatments, how the treatment is done, what you should abstain from, which side effects can you expect, etc.

Wishing you the best.
Baptista

 
Old 04-28-2011, 11:29 AM   #11
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Re: New Member Status - just diagnosed PC

Hi Dad2Grunty,

I'm responding to your latest post, having read through Allen's response and Baptista's post #11 of today. I'll put some thoughts in green in an exceprt from your post #9.


Quote:
Originally Posted by Dad2Grunty View Post
... So my local urologist/surgeon actually discussed the concept of HDR brachytherapy - described as 25 visits with an external beam linear accelerator, and two visits consisting of internal radiation needles, one in the mid cycle of the external and one at the end of the external. The needles do not stay in the prostate, as the other procedure with seeds does.
That's a reasonable approach from what I've read and heard, but I'm not a radiation veteran. I've been very impressed with the five year median results statistics from the CyberKnife Stereotactic Body Radiotherapy (SBRT) that Allen is suggesting, but it is not the only game in town and has a shorter track record than the more established approaches. I expect it to become the norm within a decade, but that does remain to be seen. It is important to understand the key role of five year median results for radiation; five years (average) results are an excellent (though not perfect) barometer for longer-term results for radiation (in contrast to surgery).

Quote:
He also stated that brachytherapy seeds is "old school" and not as up to date as HDR brachytherapy combo. And he has heard of seed migration. I haven't read that anywhere, is that something anyone hear was cautioned about in treatment?
Whoa there! My "sales-pitch alarm" just wen off loudly. You can translate "old school" in this case as very well proven with outstanding results at centers of excellence. Moreover, at centers-of-excellence, lower-dose (still very high actually) seeds and seeds plus external beam therapy have continued to evolve, especially in precise imaging and dose targeting; you're not talking about a hide-bound, dogma oriented approach there! Bluntly, while HDR has notched some solid results, in well-reviewed comparison studies it has not done as well as the very-long term and extremely high success studies published by centers of excellence. The pioneering experts in Seattle have long experience with both, so you might want to look into what Drs. Blasko (more or less retired now), Grimm and Sylvester have been doing up there. Their Prostate Cancer Treatment Center has also hosted results from the expert Prostate Cancer Results Study Group. Their graphs of success for various levels of prostate cancer risk as documented in studies for varying lengths of follow-up are highly informative. This group has been a leader in published research. Their sometime research-mate Dr. Michael Dattoli has also published impressive long-term results with seeds and seeds plus external beam. The Radiation Clinics of Georgia has also published results in this area; however, unfortunately, they have neglected to update their results for long-term follow-up.

My impression is that the seeds migration issue is minor, but that would be worth checking with an unbiased source other than the doctor who is pitching the HDR solution.



Quote:
I have set appointments with both the Chicago PC to undergo a color doplar and volume study, and also with my docs team member who does the external radiation.Looking forward to any comments on these two procedures. Thanking you in advance for your time and knowledge.
Color Doppler ultrasound takes special, expensive color Doppler equipment and a lot of experience-based expertise to get the best from the scan (and many important clues can be gained from a well done color Doppler scan), though any such scan should be more than adequte for the volume determination. My impression is that there are only a handful of such experts practicing in the whole country, and Chicago did not have one of the sites as of last year. Dr. Fred Lee in Minnesota or Illinois is the closest expert I know of who is near to you. That said, it may be that there is a new and expert facility now in Chicago. The leading prostate cancer education and support organization, Us Too International, is located in Illinois, and the staff might be able to give you some local insight into the Chicago operation, as might a nearby chapter of Us Too. The non-profit organization known as PCRI (the Prostate Cancer Research Institute) has published at least one excellent article on this technology in its free PCRI Insights newsletter. The article included some excellent illustrations.
Ordinary color Doppler equipment lacks the resolution to do the job well. If you do learn that this is a new and expert facility, please share what you learn.

Take care,

Jim

 
Old 05-04-2011, 05:40 AM   #12
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Re: New Member Status - just diagnosed PC

Thank you all for your kind replies. My wife and I just returned from our visit in Chicago (five hour trip for us) - investigating the implant seeds brachytherapy. After my discussions with my local urologist, and further rethinking the twenty-five visits for IMRT (a one hour drive each way) and two hospitalizations for HDR brachy we decided to keep the appointment in Chicago. I am glad I did, IADT - you were right about the alarms bells going off, my wife had the same feeling.

When we arrived in Chicago - my doc explained the entire procedure very well to us and he also explained the HDR/RT procedure that my local doc wanted to start. He basically said I do what is best for the patient and he would not recommend HDR/RT for my case, this I did not need that, if he thought I did, he would send me back to my doc to pursue that procedure. He examined me and they took a very thorough medical history and went over all my tests.

It took about one minute to decide for us that this was the best solution for me. I underwent a volume study on the same day, and had no enlargement to deal with before the procedure, so when I go back the seeds will be implanted and I should be good to go within hours. The time factor is huge to me to achieve the same result. At this point I am very comfortable with this decision and appreciate everyone's sound advice on this board.

I will keep posting as my treatment gets underway.

 
Old 05-05-2011, 06:47 AM   #13
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Re: New Member Status - just diagnosed PC

I'm glad you have found a doctor in whom you have confidence and an approach that feels right for you. At this point we can all use a bit of luck, so I'll wish you that.

Take care,

Jim

 
Old 07-02-2011, 07:31 AM   #14
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Re: New Member Status - just diagnosed PC

Post Brachy now three weeks. I can report the procedure went very well. We were prompt and the staff was too. We arrived at 10:30 for my procedure scheduled at 11. I was made very comfortable, and the procedure went as expected. We were back at the hotel by 3:30 (with food as I was starving). During the five hour trip home, I can describe only minor discomfort sitting or hitting bumps.

I am experiencing a lot of fatigue, and getting up twice in the night. No real pain or discomfort to speak of. I understand this could change as the seeds do their work to destory the prostate, but I remain hopeful that they will be minor considering the alternative to surgery or doing nothing. At this point I am extremely happy with this treatment and will post my three months PSA level when it is taken.

Thanks to all who helped me with my questions and the wealth of information you provide to newcomers.

Dad2Grunty

 
Old 07-11-2011, 10:10 AM   #15
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Re: New Member Status - just diagnosed PC

Hi Dad2Grunty,

I'm delighted to hear that your procedure went so well and that you are doing well now!

I'm curious wether you ever had a color Doppler ultrasound exam, which you mentioned at one point. I'm wondering if Chicago now has expertise in that.

Take care,

Jim

 
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