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  • Husband 55 with increasing PSA

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    Old 02-02-2019, 07:40 AM   #16
    murphy496
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    Re: Husband 55 with increasing PSA

    Tony,

    No biopsy done. The DR is saying he can wait another 6 months and recheck PSA again. So my husband who doesn’t want to the biopsy anyway said he’ll just wait. So we go back in July for more blood work to check PSA. I’m concerned about waiting but I can’t get him to change his mind. He had first check was 2.6 in 2016, 3.4 in 2017 , 4.1 in 2018 and then 6 month check 4.73 on Jan 4, 2019. I’m hoping if it’s increased again in July the DR will say we need to do the biopsy it’s the only way my husband might do it.

    Thanks
    Murphy

     
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    Old 02-02-2019, 11:15 AM   #17
    *tony*
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    Re: Husband 55 with increasing PSA

    MY EXPERIENCE: I had family history working against me. My PCP was well aware that my father died of PC at 68 and so he insisted on a PSA every year after age 40. On the day that my PSA exceeded 4.3, he immediately referred me to a urologist. My urologist did the DR and found nothing. No symptoms whatsoever. Just an elevated PSA. However, he too was concerned about the family history. So, within a week of my first urologist visit, I completed the biopsy and it turned up positive. My long journey began...

     
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    Old 07-10-2019, 03:37 PM   #18
    murphy496
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    Re: Husband 55 with increasing PSA

    Just had another 6 month check up again. Last time PSA was 4.73 this time PSA 5.24. Dr didn’t have an issue waiting again for another 6 months. But I wasn’t happy and my husband finally scheduled a biopsy for August 8th as long as he doesn’t change his mind. His total Free PSA was 25% and his K4 was 8. Just wanted to update hopefully if it is cancer maybe it will be one that can be monitored.

    Thanks again for all your words of wisdom.

    Murphy

     
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    Old 07-12-2019, 04:44 AM   #19
    IADT3since2000
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    Re: Husband 55 with increasing PSA

    Hi again murphy,

    I think you are all "right", you, your husband, and the doctor. It is reasonable to wait another 6 months, but it is also to pull the trigger on the biopsy now, especially if you and your husband are getting anxious about it. Have you considered getting a multiparametric MRI scan before the biopsy? That can provide valuable clues, and even might provide a basis for canceling the biopsy.

    Good luck!

     
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    Old 07-12-2019, 07:18 AM   #20
    murphy496
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    Re: Husband 55 with increasing PSA

    I’m the one anxious about it. My husband has no issue waiting but I can’t stand not knowing. I can’t see going every 6 months if a biopsy will tell us one way or another what we might be dealing with. His numbers are continuing to go up every 6 months. We asked about an MRI and the Dr said he didn’t see a need right now to do one. That they usually do an MRI after biopsy if needed. I’m worried about the biopsy being done too. But I’m more worried not knowing if it’s cancer.

    Thanks for your response.

    Murphy

     
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    Old 08-12-2019, 08:26 PM   #21
    murphy496
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    Re: Husband 55 with increasing PSA

    My husband had his biopsy on Aug 8 we are getting the results Wednesday the 14th. The nurse told my husband nothing jumped out on the ultrasound while they did the biopsy and his prostate is 34cc and PSA last check was 5.24. I’ll post once we have an answer as to what’s causing the steady raise in PSA over the past 3 years. Thanks again for all comments.

    Murphy

     
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    Old 08-13-2019, 10:06 AM   #22
    IADT3since2000
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    Re: Husband 55 with increasing PSA

    Good luck tomorrow!

    If it turns out to be prostate cancer that is the kind that needs treatment - intermediate or high-risk, keep in mind that radiation, in 2019, is at least as good as surgery unless there are special circumstances.

    Also, keep in mind that survival for appropriately treated prostate cancer is often not shortened by the disease , or not shortened much , generally, the main exception being cases that show widespread metastases at the time of diagnosis. The latter seems unlikely in your husband's case, but even for those patients there have been advances that are improving survival odds and duration. Because of the strong likelihood of a long survival for your husband, quality of life becomes an important consideration in choosing a therapy.

    Hoping that choosing a therapy will not be necessary, Jim.

     
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    Old 08-13-2019, 03:40 PM   #23
    murphy496
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    Re: Husband 55 with increasing PSA

    Thanks Jim, I’ll post as soon I find out post what we find out.

     
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    Old 08-14-2019, 03:36 PM   #24
    murphy496
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    Re: Husband 55 diagnosed with Cancer

    We just got home from getting the results of biopsy. It’s cancer 😢. The report reads as:

    Adenocarcinoma,Gleason 3+3 =6 (Grade group 1) with perineural invasion.

    Leftbase 1 core Gleason 3+3= 6 core involvement: 80% (14 mm) discontinuous

    Left mid: 1 core Gleason 3+3=6. Core involvement 90% (15mm) discontinuous / fragmented

    Left Apex: 2 cores 3+3=6 Gleason
    Core involvement:10% ( 2mm) <5% (0.5mm)

    Right base: benign prostatic tissue

    Right mid: 1 core 3+3=6 core involvement:<5% (<0.5mm)

    Right apex: benign prostatic tissue

    Comments Gleason Score can be grouped and range from grade 1 to grade 5

    Partin table (PSA 5.24 Gleason :3+3=6
    Clinical stage OC EE ISV NM
    T1C ( non palpable) 90 9 1 O
    TC2 ( palpable <1/2 lobe 87 12 1 0

    Test - T2b, c ( palpable > 1/2 lobe , bilateral). 76 22 1 0 result

    Positive margins 25.8
    3 year recurrence - free survival 84
    5 yr recurrence- free survival. 75
    Assumes clinical stage T1,2

    Total % cancer: 15%
    Total length of cancer. 32 mm
    Total # of involved cores 5
    Total cores: 12
    Longest tumor in single core: 15 mm*
    Max core involvement 90%
    # of cores with >50 % involvement 2*
    * discontinuous Tumor measurement

    1LB:20,17 2 LM:15,15,4 3LA:16,14
    4RB:19,17. 5RM: 20,14 6RA: 15,12 12/198 (NN1) (AAC,blc)

    Any information would be helpful. Worried about the perineural invasion on the report. The Dr didn’t mention this. The Dr says surgery to remove prostate because there is so much cancer.

    Thanks for all comments

    Murphy

     
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    Old 08-25-2019, 01:28 PM   #25
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    Re: Husband 55 diagnosed with Cancer

    Hi again Murphy,

    Of course this report is not what you were hoping for, but it is a favorable report in most key respects. The really good news is that only Gleason 6 cancer was found. That type virtually never leaps to other parts of the body to become metastatic cancer, and it is generally mild. I’ll post about the report first, and later about options.

    The “perineural invasion” that you are worried about means that cancer was found around the nerve bundles that exit the prostate, and this is considered to provide an easier way for the cancer to exit the prostate. However, the increase in risk is slight that the cancer cannot be cured by local therapy. (This was a finding for me back in late 1999; it is a fairly common feature.)

    Regarding the Gleason score, it is so important that it should be assessed by an expert in interpreting prostate biopsies; both undergrading and overgrading are fairly common when done by general pathologists who don’t do a high volume of prostate biopsies. Was your husband’s done by a known expert or at a large academic center? If so, you can probably rest easy, but if not, a “second opinion” is advisable. It is common to have the specimens sent to an expert for a second opinion.

    The fact that 5 of 12 cores, 41%, have cancer by itself would indicate that active surveillance would be more risky than viewed as sound management as recently as a few years ago and still by many doctors.. The length of the total cancer, coupled with the high percentages in some cores, reinforce that riskiness. However, some doctors who are leaders in active surveillance, seem to be thinking that active surveillance could still be reasonable despite the fairly extensive cancer in the prostate. Others would advocate radiation or surgery at this point. I don’t know what to say about that disagreement.

    I can help you interpret the Partin Table findings. The tables use PSA, the Gleason score and the “stage” to relate the patient’s results with a very large database to see the likelihood of the cancer being “organ confined” (OC), the chance of extension of cancer beyond the capsule (EE, extracapsular extension), the odds that the cancer has already invaded the seminal vesicles (ISV), and the odds that one or more lymph nodes are positive for cancer (NM per this report, which I think means Nodes Malignant). For your husband, the PSA is 5.24, moderately elevated, and the Gleason is 6, leaving the stage; his stage is T2b or T2c based on some ambiguity in the findings due to very little cancer on the right side of the gland, per my layman’s view. Normally, cancer on both sides per the biopsy would warrant a stage of T2c. I’m thinking the TC2 (palpable, though the rest of the report seems to be about the biopsy rather than the DRE, which relates to “palpable”) probably is your typo for T2C and the numbers at the end for T1C, TC2 and Test – T2b,c indicate the percentage likelihood for OC, EE, ISV, and N. For example, the Test – T2b,c line would be 76% chance that the cancer is confined to the prostate, a 22% chance that there is an extension already beyond the prostate, a 1% chance that it has spread to the seminal vesicles, and a 0% chance that it has spread to the lymph nodes. The report gives several Partin scenarios of risk, but they are all quite good though not ideal. You can see that the odds of being free from cancer for five years after surgery look pretty good at 75%, which assumes stage T1 or T2, with T2 looking very likely to me.

    Your husband has a number of options, decidedly not just surgery. The possibilities include at least radiation, surgery, a course of androgen deprivation therapy (rather common in some countries such as Japan but uncommon in the US as a first therapy for milder cases like your husband’s appears to be), and active surveillance. It really helps to get an opinion in cases like this from a radiation oncologist who is not connected with the surgeon (to avoid the possibility of business favors that affect care of patients) or from a “medical oncologist” who sees a lot of prostate cancer patients. It is well known – proven by research – that surgeons (urologists) strongly prefer surgical treatment while radiation oncologists strongly prefer radiation treatment. The patient and his supporters need to take an active role to overcome biases and get the best care for himself.

    Does that cover everything?

     
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    Old 08-26-2019, 04:21 PM   #26
    murphy496
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    Re: Husband 55 diagnosed with Cancer

    Quote:
    Originally Posted by IADT3since2000 View Post
    Hi again Murphy,

    Of course this report is not what you were hoping for, but it is a favorable report in most key respects. The really good news is that only Gleason 6 cancer was found. That type virtually never leaps to other parts of the body to become metastatic cancer, and it is generally mild. I’ll post about the report first, and later about options.

    The “perineural invasion” that you are worried about means that cancer was found around the nerve bundles that exit the prostate, and this is considered to provide an easier way for the cancer to exit the prostate. However, the increase in risk is slight that the cancer cannot be cured by local therapy. (This was a finding for me back in late 1999; it is a fairly common feature.)

    Regarding the Gleason score, it is so important that it should be assessed by an expert in interpreting prostate biopsies; both undergrading and overgrading are fairly common when done by general pathologists who don’t do a high volume of prostate biopsies. Was your husband’s done by a known expert or at a large academic center? If so, you can probably rest easy, but if not, a “second opinion” is advisable. It is common to have the specimens sent to an expert for a second opinion.

    The fact that 5 of 12 cores, 41%, have cancer by itself would indicate that active surveillance would be more risky than viewed as sound management as recently as a few years ago and still by many doctors.. The length of the total cancer, coupled with the high percentages in some cores, reinforce that riskiness. However, some doctors who are leaders in active surveillance, seem to be thinking that active surveillance could still be reasonable despite the fairly extensive cancer in the prostate. Others would advocate radiation or surgery at this point. I don’t know what to say about that disagreement.

    I can help you interpret the Partin Table findings. The tables use PSA, the Gleason score and the “stage” to relate the patient’s results with a very large database to see the likelihood of the cancer being “organ confined” (OC), the chance of extension of cancer beyond the capsule (EE, extracapsular extension), the odds that the cancer has already invaded the seminal vesicles (ISV), and the odds that one or more lymph nodes are positive for cancer (NM per this report, which I think means Nodes Malignant). For your husband, the PSA is 5.24, moderately elevated, and the Gleason is 6, leaving the stage; his stage is T2b or T2c based on some ambiguity in the findings due to very little cancer on the right side of the gland, per my layman’s view. Normally, cancer on both sides per the biopsy would warrant a stage of T2c. I’m thinking the TC2 (palpable, though the rest of the report seems to be about the biopsy rather than the DRE, which relates to “palpable”) probably is your typo for T2C and the numbers at the end for T1C, TC2 and Test – T2b,c indicate the percentage likelihood for OC, EE, ISV, and N. For example, the Test – T2b,c line would be 76% chance that the cancer is confined to the prostate, a 22% chance that there is an extension already beyond the prostate, a 1% chance that it has spread to the seminal vesicles, and a 0% chance that it has spread to the lymph nodes. The report gives several Partin scenarios of risk, but they are all quite good though not ideal. You can see that the odds of being free from cancer for five years after surgery look pretty good at 75%, which assumes stage T1 or T2, with T2 looking very likely to me.

    Your husband has a number of options, decidedly not just surgery. The possibilities include at least radiation, surgery, a course of androgen deprivation therapy (rather common in some countries such as Japan but uncommon in the US as a first therapy for milder cases like your husband’s appears to be), and active surveillance. It really helps to get an opinion in cases like this from a radiation oncologist who is not connected with the surgeon (to avoid the possibility of business favors that affect care of patients) or from a “medical oncologist” who sees a lot of prostate cancer patients. It is well known – proven by research – that surgeons (urologists) strongly prefer surgical treatment while radiation oncologists strongly prefer radiation treatment. The patient and his supporters need to take an active role to overcome biases and get the best care for himself.

    Does that cover everything?
    Jim,

    Thanks for all the information it was a huge help in understanding the path report. We are going to Vanderbilt for our second opinion Sept 12 they are reviewing the biopsy slides in their pathology department. I’m in the process of making a list of questions to ask while there. Once we see the DR and see what they recommend. I’ll post again.

    Thanks again for all your help.

    Murphy

     
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    Old 08-28-2019, 04:42 AM   #27
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    Re: Husband 55 diagnosed with Cancer

    Going to a major center known for its research in cancer research has helped many patients find their best course. Sometimes we patients can get good care or monitoring locally but with the aid of the experience and facilities for key actions and strategic thinking that major centers or experts can provide. That's basically what I did, though my caregiving team is now closely related to and located very near an emerging major center.

    Good luck!

     
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    Old 09-12-2019, 06:08 PM   #28
    murphy496
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    Re: Husband 55 diagnosed with Cancer

    Jim,

    Vanderbilt confirmed Gleason 6 on biopsy second opinion pathology for all 5 slides that were positive. The Dr we saw said my husband has the option of surgery or active monitoring. He said he was recommending monitoring.The Dr is doing other testing. A genetics test and scheduled a MRI on February 3 with an Artemis Fusion biopsy on February 24. The DR said if the genetics come back that this could change into something aggressive then we would move up the MRI and the biopsy to sooner. The Dr said we needed to see the whole picture to make a decision.My husband doesn’t want to do surgery if he can monitor a Gleason 6 cancer. I really just want him to have surgery to have it removed. What are some opinions on just monitoring with MRI’s and Biopsies?

    Thanks
    Murphy

     
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