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Old 01-28-2012, 04:18 AM   #1
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Unhappy What am I in for?

Please, your take on my case and thanks in advance; Age 62, good health, only family hist. is one uncle (not father or brother though) died of PCa at age 75. PSAs last 5 yrs stable around 2.6; DREs normal. But this year’s physical recently had slight ridge on DRE and PSA 3.6. Should mention DRE was esp. vigorous–this doc told me his dad died from PCa so he said he does intensive patients' DREs. Read that this can cause avg. .9 PSA increase if blood is taken right after DRE–as mine was. He said let’s wait 6 mths and recheck. I sought 2nd opinion. Internist said, well, it's my call but MRIs can now be done before biopsy. I bit bullet $ wise and got one. Path. report says: Larger prostate (54 cc tot), small node, 11mm, (like a marble in an apricot my guess). All normal on: marrow/lymph/vesicles/rectoprostatic angles. Some diffusion and extravascular extracellular space. Also, “lesion does alter prostate contour and extracapsular disease possible so attention at biopsy is recommended to exclude neoplasm”. Have first apt. w. a urologist next Tues. Should I request the “free PSA” or go straight to TRUS? What am I in for and where will all this lead? I’m really worried.

 
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Old 01-28-2012, 01:46 PM   #2
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Re: What am I in for?

Bob

Both, DRE and MRI are positive for abnormalities of the prostate. The PSA is not high and the increase to 3.6 from a 5 year stable 2.6 could be a cause of manipulations before drawing the blood for test.
A point of concern is the assertion of possible extra capsular extension. If such is present, then cancer is not contained but localized. This difference in status would imply that certain treatments may be better than others in your case. However, only a biopsy could rule the presence of cancer.

The path report description makes a reference to the neoplasm so that it can be avoided in the biopsy in case one has in mind surgery as the prime treatment. But such would be recommended only if the cancer is considered contained.
This can only be define if the biopsy include samples from those suspicious areas for extra capsular extensions.

I would recommend you to discuss the matter with your doctor before committing to the biopsy.
A proper diagnosis would give you peace of mind and lead to a proper decision on a treatment, if any.

Good luck

Baptista

 
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Old 01-30-2012, 09:48 AM   #3
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Re: What am I in for?

Your psa is normal for a 54cc prostate, but the DRE and MRIS are suspicious so a biopsy is warrented. To insure the biopsy hits the suspected area you may want to consider a color doppler guided biopsy in this situation.

 
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Old 02-14-2012, 06:06 PM   #4
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Re: What am I in for?

Had biopsy Feb 2. Got results today. T1, right side, Gleason 4+3=7. Have bone scan scheduled for tomorrow, through current urologist says its just a safeguard and she does not expect it to be positive. Now is the hard part of talking to radiologist and surgeons and trying to decide which way to go. If anyone has any ideas on that or otherwise, any advice is welcome. Thanks again to all.

 
Old 02-15-2012, 04:42 AM   #5
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Re: What am I in for?

Hi Bobbiesan,

I'm sorry you now have confirmed prostate cancer, but all indications are that you caught it very early. As Baptista noted, most of the PSA is likely due to the healthy cells in your 54 cm prostate, indicating that the cancer is not producing much PSA, which in turn suggests it is small in size. Unless your uncle who died was dealing with prostate cancer recently, there have been many and huge advances since he had prostate cancer. Our prospects are far better, though it is still no cake walk for most of us.

Unless the pathology work was done by an expert who specializes in prostate cancer, it would be wise to have it reviewed by such an expert. Often general pathologists will either undergrade (more common) or overgrade the Gleason score. That score is so important in decision making that it is wise to get this right. If it turned out you had Gleason 8 cancer, surgery would look pretty dicey as an option. On the other hand, if you really have Gleason 6 cancer, active surveillance might be your best choice. One guy in our education and support group was diagnosed with a Gleason 9; after making his plans based on that over several months, a review by an expert determined he actually had Gleason 6 cancer, which opened up surgery and radiation as good options.

These days well-done radiation is as effective as surgery, nor does age matter, based on research. It is wise to find a radiation oncologist who is completely independent of the surgeons (urologists) you talk too. At times business relationships bias what radiation oncologists say about choices, and urologists, generally, do not seem to have kept up with advances in radiation.

Publications of the Prostate Cancer Research Institute (PCRI), a non-profit organization, provide good objective information about treatment choices.

This would be an excellent time to learn about lifestyle tactics - diet/nutrition, exercise and stress reduction. They can have a strong influence on how well you do long term.

Good luck with this and take care,

Jim

Last edited by IADT3since2000; 02-15-2012 at 04:45 AM. Reason: Added thought about uncle right after posting.

 
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Old 02-16-2012, 06:28 PM   #6
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Re: What am I in for?

Wife and I have appt. with PCP for next Monday morning, followed by a radiation oncologist appt. at noon referred by PCP. These are in my home town - I work out of home state at a military base. Met today with urologist (in work state) to review yesterday's bone scan. Perfectly clean except touch of arthritis in lower back, which I knew. I got more details from her about my biopsy. Only one core was 4+3=7. Three other cores were gleason 6, then eight cores clean. Based on the prostate MRI I had earlier, she knew where the problem *might be*, in the 11mm nodule, and had given it a little extra coring attention, but using the remaining cores to sample to remainder of prostate. The nodule was the culprit. She did recommend I research radiation, too, but asked if I wanted to be put on the list for the Da Vinci--no commitment but she said there's a 4-6 week wait, so it's better to get on the waiting list. I said ok.

Here are some questions, if anyone can take a stab at one or more of them, many thanks. Especially, if any of these things seem "odd", I need to know. btw I am a very fit 62 yr old with excellent health (other than the cancer, of course):

(1) she is on the younger side, but does one or two RP a week; her group of ten (half older docs, half on younger side) always works in pairs; she seems sharp and has not stumbled on any of the detailed questions I've asked--seems to know what she's doing, and appropriately, but not overly, confident; does this sound ok?

(2) if her group did the RP, wife would have to come to my work state for first week (or til catheter is out); then maybe just be back here weekends for weeks 2,3,4--wife works in home state and has house and our babies (pets) to tend. This is not ideal, but I am not getting good comfort feeling about experienced Da Vinci people in home city so far. Does it sound workable for me to care for myself weekdays for weeks 2 - 4 post op? I have no family here and only work friends and have not been here that long.

(3) given my gleasons, would you lean toward radiation or RP?

(4) she likes to carve out a little tissue outside the prostate too; in my case, esp. on the right side--she's pretty sure I'm a T1 but said there's no way to tell for sure until into the R.P.; the original MRI report said possible extracapsular extension, but from her biopsy cores, she said she doesn't think so. She takes lymphs if needed, and may need to get into the r. nerve bundle, which would mean more impotence. I told her I am about gone on that score anyway and wife and I find other ways to keep her happy + toys, but the incontinence would be a bigger issue for me due to my job. She said that is sphincter-based, not nerve bundles -- she has had good results on that issue and said starting the kegels pre-op would help on that. She did say 1-2% never get there continence back and there are no guarantees. Does all this seem right?

(5) She said radiation after a failed RP is possible, but RP after radiation is tricky and few of her group will even attempt it. I didn't ask why.

(6) Between me and wife, we have lost to cancer: my dad, my uncle, her mom, her dad, her uncle, and her aunt; wife is having a tough time with my situation and is so afraid. I feel so bad to put her through this, but just cannot help it. Really demoralizing me. But I am so grateful now that I may get through all this alive for a longer time than I thought earlier this week.

 
Old 02-17-2012, 01:11 AM   #7
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Re: What am I in for?

Here's my opinion. First of all, get a second opinion on the biopsy from a lab that specializes in PC only, such as Bostwick or Epstein.
(1) It doesn't matter how much you like her or how old she is. If she hasn't done over a thousand of that kind of RP (e.g., DaVinci) give her a pass. It doesn't matter if it is laparoscopic, robotic or open -- it's the surgeon's experience in that particular operation that makes a difference. Also ask for the % clear surgical margin rate in the last year.
(2) If you have robotic RP, your catheter will be out in 10 days or less. Maybe as little as a couple of days if you're lucky.
(3) surgery or radiation will both give you lasting cures. It's just a matter of the side effects you are willing to risk. Talk to radiation oncologists who specialize in LDR brachytherapy (permanent seeds), HDR brachytherapy (temporary implants), CyberKnife, and pencil beam proton. They all have similar cure rates and side effects if performed at centers of excellence.
(4) She is way underestimating the incontinence rate of RP. Total incontinence may be 2%, but add to that those who go through several pads a day. The nerve bundles innervate the sphincter as well as the penis.
(5) She's right that RP after radiation is tricky but doable but only by specialist surgeons. However, it doesn't make sense to me to pick a therapy based on what happens if it goes wrong, especially since modern radiation therapies have permanent cure rates of 95+%
(6) No two cancers are alike, and PC is usually slower growing and gives longer longevity than most cancers. Projecting others' experiences onto you isn't helpful. You are unique and so is the experience of your disease. I hope you won't let the myths about cancer get to you.

Gleason 4+3 is intermediate risk, but you still have time to investigate and make an informed decision. Get your bearings, and don't rush into a decision. If you set up your appointments now, you will have plenty of time. Good luck!

- Allen

 
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