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    Old 03-30-2020, 08:49 AM   #1
    TimberT
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    Recent Diagnosis

    I am 60 yrs old and was just diagnosed with prostate cancer and am looking for information. This is not a surprise, my younger brother had a RP two years ago, my PSA went up from 2.4 to 5.1 in 12 months. My biopsy showed 2 cores @6 and 2 @ 3+4. Like most men my age I have many friends who have been down this road and my wife has been a urology nurse for 15 years. My treatment planning appt was just moved back a few more days (I've been learning to be patient, it took 10 weeks to get this far) My feeling is I'm inclined towards a RP as I'd rather be done with it at once rather than draw it out. Thank you in advance for responses.

     
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    Old 03-30-2020, 09:42 AM   #2
    Terry G
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    Re: Recent Diagnosis

    PCa is a marathon and not a sprint. One of the most important things you can be doing right now is to educate yourself on the treatment options. Exploring sites like this our a great start. For a diagnosis like yours all treatments are likely to offer a cure; however, they all come with different side effects. For some guys surgery is the best option for others any one of a number of radiation options is far better. Most urologists only offer surgery and are not qualified in radiation treatments. I encourage you to investigate all the options and only then decide what’s best for your situation. Besides this site I would encourage you to take a look at prostatecancerfree.org. They have some charts to help you understand the success rates of various treatments. The more time you spend investigating the more you’ll learn. Quick choices are likely to be poor ones. In addition I always recommend seeking out the very best practitioner and their team. You want this first choice to be successful and without regret. Good luck and keep us posted.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
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    PSAs post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3

     
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    Old 03-30-2020, 09:50 AM   #3
    Prostatefree
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    Re: Recent Diagnosis

    Continue to be patient. It's too soon to choose surgery and I am a proponent for it when appropriate. Educate yourself and seek another opinion from an RO.

    Genetic testing of the biopsy and a state of the art MRI scan are still diagnostic procedures available to you.

    Share your signature information.

    You may be stalled in this as your compete with the pandemic. Others have been put on hold with scheduling postponed. You may still have your planning appointment, but be prepared for a scheduling delay. The closer you are to an urban center and the quality of healthcare you are going to want the more likely this is to occur.

    You do not want to be in or around a healthcare environment at this time unless critical care is needed. Even if you are in an area not considered hot, without testing you are flying blind.
    __________________
    Born 1953; family w/PCa-grandfather, 3 brothers;
    7-12-04 PSA 1.9; 7-10-06 PSA 2.0; 8-30-07 PSA 3.2; 12-1-11 PSA 5.7; 5-16-12 PSA 4.76; 12-11-12 PSA 5.2; 3-7-16 PSA 7.2;
    3-14-16 TRUS biopsy, PCa 1%-60% across 8 of 12 samples, G3+3;
    5-4-16 DaVinci RP, Path-65g, lymph nodes, seminal vesicles, capsule, margin all neg, G3+4, T vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months;
    12-8-19 PSA less than 0.02, zero club 3.5 yrs

     
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    Old 03-30-2020, 09:59 AM   #4
    DjinTonic
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    Re: Recent Diagnosis

    Hi and Welcome, Timber! Given the virus situation, you have plenty of time to make a decision. The next step will be imaging to get an indication of whether the PCa is prostate-confined. Since your wife is a urology nurse, I'm sure she will be a great source of knowledge regarding your treatment options.

    Ask all surgeons you interview about his/her outcomes statistics (urinary, potency, and oncological). Also ask how confident the surgeon is that, based on your known lesion locations, the nerve bundles on either side can be spared.

    If you reach a stage where you are reasonably confident that your PCa is prostate-confined and learn the pros and cons of both surgery and the various RT options, RP is a perfectly valid choice to make. The big advantage is that it may result in a cure without ever having to confront RT or ADT. Of course there are no guarantees with any treatment, surgery included, and much would depend on your post-RP path report as to your final Gleason score and any adverse findings.

    Wishing you all the best,

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
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    Old 03-30-2020, 10:33 AM   #5
    Southsider170
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    Re: Recent Diagnosis

    Since your wife is in the urology business, she knows what doctors are on-point and if you go for surgery you definitely want a surgeon who is on the top of his game. Radical prostatectomies are the most technically challenging procedure ordinarily done in the field of urology. A minimum of 300 RP's under his belt is usually what it takes for a surgeon to really master it.

     
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    Old 03-30-2020, 01:32 PM   #6
    guitarhillbilly
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    Re: Recent Diagnosis

    I'm sorry to hear you have become a member of the "club". There are many great folks on this forum who share their experiences and knowledge. Surgery or Radiation both have potential lasting side effects and the decision should not be made in haste.

    As others have said you are in a marathon and PCa has become part of your life from now on with routine follow up exams and PSA testing. Even with "successful" treatment it can still reoccur years later whether you choose surgery or RT + ADT.

    There are way too many factors to consider to cover them all on this forum but take time to educate yourself from many great sources that are available on the web and in books.

    The results of a Pelvic MRI- A Pelvic CT Scan - and a Nuclear Bone Scan are tools that your UR and You can use to provide the treatment options available for your particular situation. In my case the MRI was performed prior to my biopsy and afterwards the Pelvic CT and NBS.

    There is no "One Size Fits All" when dealing with PCa.

    Here are some website references with PCa info:
    Memorial Sloan Kettering
    Johns Hopkins
    Mayo Clinic
    Cleveland Clinic
    MD Anderson
    Duke University

    This is an excellent book that my UR gave me after my diagnosis.

    100 Questions & Answers About Prostate Cancer 5th Edition
    by Pamela Ellsworth

    I wish you the very best outcome in whatever you choose.

     
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    Old 03-30-2020, 01:54 PM   #7
    IADT3since2000
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    Re: Recent Diagnosis

    Quote:
    Originally Posted by TimberT View Post
    I am 60 yrs old and was just diagnosed with prostate cancer and am looking for information. ...
    I strongly recommend the book "The Key to Prostate Cancer", 2018 by expert medical oncologist Mark Scholz, MD, and 29 others, most of them renowned experts. You will get a good idea of what modern radiation therapy is about and its remarkable success rates, and the chapter on surgery is good too (except that it underplays the odds of some degree of incontinence as a side effect).

    I'll add my welcome to the Board, and good luck with this!

    . Jim

     
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    Old 03-30-2020, 03:38 PM   #8
    Terry G
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    Re: Recent Diagnosis

    Although I posted earlier I thought Id offer some information about my story and a friends. My friend and I are gym rats about the same age and both were diagnosed within a couple months of each other as low risk Gleason 6. We had different Dr.s and no unusual medical conditions except I have three total joint replacements. I had about six weeks of panic time between being diagnosed and my sit down to discuss treatment options. I used that time to research everything I could find about PCa. My friend on the other hand was concerned but very confident in his Urologist position that Gleason 6 is really no big concern and that AS was the best option especially since his PSA was well below 10. They would monitor his PSA quarterly and do a second biopsy in a year.

    I too would typically be a poster child for AS. However; my three joint replacements put me at a special risk regarding additional biopsies. Each biopsy carries a blood infection risk of 3-7% per biopsy. A blood infection could cause me the loss of one or more joints. I was more afraid of the loss of one or more of my joints than I was the PCa. The time between my diagnosis and sit down with my Urologist proved to be a blessing. I went into that meeting with a ton of questions from information gained from forums like this. My Urologist was read to schedule me for RP at our first meeting and was unable to answer most of my questions regarding radiation treatments. He did recommend me getting second opinions from radiation experts.

    I decided to investigate all the radiation treatments to find which one would have the best fit for me. SBRT was my winner since it offered the fewest treatments and very precise delivery and had low side effects. The only down side I could find was it was relatively new and required me to travel out of state to get it. No regrets on my choice.

    Back to my friend. His quarterly PSAs continued to slowly rise and when they approached 10 he had a second biopsy that showed only a little more Gleason 6. His next PSA was slightly over 10 and his Dr. ordered a follow up that came in under 10. They waited three more months and the next PSA came in at 13. They immediately scheduled a third biopsy which finally showed Gleason 4+4 and a little 4+5. My friend still stuck with his Urologist and after additional imagining had RP. I remember him saying Im so tired of all this I just want it out and done. The margins came back positive and he went on ADT and 42 weeks of radiation. His surgery was this past summer and he has not regained urinary control and is workouts are currently very limited. His spirits remain amazing. Ive not asked about sexual function however he inferred all was not well.

    My heart goes out to the guys here with serious PCa issues. Im feeling blessed with my outcome and the information that I was able to gain here and allowed me to make an informed decision. I say that knowing these are just two data points and provide no statistical information. Rather I just want to point out that anyone recently diagnosed should take the time to investigate all the options. That first treatment choice can be life changing.
    __________________
    Rising PSA:
    11/13 1.95; 9/15 3.28; 10/16 5.94
    TRUS 1/17
    Bx: Three of twelve cores adenocarcinoma Gleason 6 (3+3) all on left side, no pni.
    DOB 7/21/47; good health; age 69 @ Dx
    Treated 6/17 SBRT @ Cleveland Clinic by Dr. Tendulkar
    Reduced ejaculate only side effect; everything works
    To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.

    PSAs post.SBRT 1.1, 1.1, .9, 1.8, 2.7, 1.0, 0.3

     
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    Old 03-30-2020, 05:42 PM   #9
    DjinTonic
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    Re: Recent Diagnosis

    A bone scan is not standard of care for G7 (3+4) with a PSA <10. ASCO 2020 guidelines reiterate that bone scans are indicated for high-risk cases, which Timber is not.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
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    Old 03-30-2020, 08:25 PM   #10
    guitarhillbilly
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    Re: Recent Diagnosis

    Quote:
    Originally Posted by DjinTonic View Post
    A bone scan is not standard of care for G7 (3+4) with a PSA <10. ASCO 2020 guidelines reiterate that bone scans are indicated for high-risk cases, which Timber is not.

    Djin
    Yep A Gleason score of 8 puts one into the High Risk Category.

    "Cancers with a Gleason score of 7 can either be Gleason score 3+4=7 or Gleason score 4+3=7:

    Gleason score 3+4=7 tumors still have a good prognosis (outlook), although not as good as a Gleason score 6 tumor.
    A Gleason score 4+3=7 tumor is more likely to grow and spread than a 3+4=7 tumor, yet not as likely as a Gleason score 8 tumor."


    "To account for these differences, the Grade Groups range from 1 (most favorable) to 5 (least favorable):

    Grade Group 1 = Gleason 6 (or less)
    Grade Group 2 = Gleason 3+4=7
    Grade Group 3 = Gleason 4+3=7
    Grade Group 4 = Gleason 8
    Grade Group 5 = Gleason 9-10"

     
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    Old 03-31-2020, 05:13 AM   #11
    DjinTonic
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    Re: Recent Diagnosis

    Quote:
    Originally Posted by guitarhillbilly View Post
    ...The results of a Pelvic MRI- A Pelvic CT Scan - and a Nuclear Bone Scan are tools that your UR and You can use to provide the treatment options available for your particular situation. ...
    Quote:
    Originally Posted by guitarhillbilly View Post
    Yep A Gleason score of 8 puts one into the High Risk Category. ...
    Don't confuse high-grade with high-risk PCa. All high-grade are high-risk, but not all high-risk are high-grade. Again, the original poster is not a high-risk G7 and does not meet the criteria of a bone scan you mentioned.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
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    Old 03-31-2020, 06:11 AM   #12
    TimberT
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    Re: Recent Diagnosis

    Thank you all for your input and words of support and encouragement. I have a lot of homework to do and appreciate having a place to get a good start. I've spoken with my brother about his RP as well as a couple friends who've been down this road. I talked with my wife's old boss and friend, a semi retired urologist and found his insights helpful. Now we meet with my urologist tomorrow and get the full report and his take on it and then sort out the next steps from there...between this diagnosis and the crazy world of Coronavirus it all seams a little surreal...
    __________________
    60yr old, younger brother had RP two years ago
    PSA @2.4 12/18, 4.5 12/19, 5.1 2/20
    Biopsy 3/24/20 2 3+3, 2 3+4 (full report still pending)

     
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    Old 03-31-2020, 06:22 AM   #13
    guitarhillbilly
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    Re: Recent Diagnosis

    Quote:
    Originally Posted by DjinTonic View Post
    Don't confuse high-grade with high-risk PCa. All high-grade are high-risk, but not all high-risk are high-grade. Again, the original poster is not a high-risk G7 and does not meet the criteria of a bone scan you mentioned.

    Djin
    If you read my posting closely I stated that the tests are TOOLS that the UR and individual CAN USE to determine treatment. Never stated that they all are required or must be used. Never stated that ALL THE TOOLS in the toolbox must be used or required.

    His UR may elect to use the Biopsy Lab results only for treatment recommendations.

    This posting acknowledges that I know he in NOT in the high risk category.

    "Gleason score 3+4=7 tumors still have a good prognosis (outlook), although not as good as a Gleason score 6 tumor."

    "Grade Group 2 = Gleason 3+4=7" is BETTER than 4+3=7 which puts one in Group 3.

     
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    Old 03-31-2020, 06:46 AM   #14
    DjinTonic
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    Re: Recent Diagnosis

    Quote:
    Originally Posted by guitarhillbilly View Post
    If you read my posting closely I stated that the tests are TOOLS that the UR and individual CAN USE to determine treatment. Never stated that they all are required or must be used. Never stated that ALL THE TOOLS in the toolbox must be used or required....
    Actually, a careful reading was why I posted. You did not say "an individual," but rather "...your UR and you can use." I only wanted to clarify.

    Djin
    __________________
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. Bx, PCA3-
    7-05-13 TURP for BPH (90→30 g) path neg. for PCa, then 6-mo. checks
    6-06-17 Nodule on R + PSA rise on finasteride: 3.6→4.3
    6-28-17 Bx #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 3% RLM
    Nodule negative for PCa. Bone scan, CTs, X-rays: neg.
    8-7-17 Open RP, neg. frozen sections, Duke Regional Hosp.
    SM EPE BNI LVI SVI LNI(5L, 11R): negative, PNI+, nerves spared
    pT2c pN0 pMX, G9 (4+5) 5% of prostate (4.5x5x4 cm, 64 g)
    Dry; ED OK with sildenafil
    11-10-17 Decipher 0.37 Low Risk; 5-yr met risk 2.4%, 10-yr PCa mortality 3.3%
    LabCorp uPSA: 0.010 (3 mo.)0.015 (1 yr. 6 mo.)0.015 (2 yr. 4 mo.)

     
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    Old 03-31-2020, 08:48 AM   #15
    IADT3since2000
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    Re: Recent Diagnosis

    Quote:
    Originally Posted by TimberT View Post
    ... My feeling is I'm inclined towards a RP as I'd rather be done with it at once rather than draw it out. Thank you in advance for responses.
    Hi again,

    You need to be aware that for most patients the immediate aftermath of an RP is an ordeal lasting at least weeks (just check other threads on this Board about that), and for many continence and sexual recovery takes months to perhaps a year and a half or so, often with at least some lasting decrease in capability. An RP is not a "one and done" kind of thing! If you are okay with that, and with a fairly substantial risk of needing salvage radiation and ADT later, then you are more likely to be able to "own" that RP treatment choice and to experience less regret if things go south. Another tactic for minimizing later treatment regret is to consult with both urologists and radiation oncologists before making a decision.

    Modern radiation has multiple delivery options, and some are one day (low-dose permanent seeds), two day (high dose rate temporary radiation seeds), or 5 treatments spread every other day (SBRT - Stereotactic Body Radio Therapy, an inelegant name, sometimes called Cyberknife for one of its popular delivery methods), as well as traditional longer courses of radiation. My impression is that most doctors would also want an "intermediate-risk" patient to be on a short course (3 - 6 months) of Androgen Deprivation Therapy (ADT), in support of radiation. Full recovery from a short course of ADT is usually pretty fast, such as several months after stopping the ADT.

    If you look at results for radiation, both for cure and side effects, keep in mind that many centers are doing much better after around 2007. That's when excellent imaging and targeting became more common, with dose improvement happening about a half decade earlier. Modern radiation has notched excellent results for both cure and minimizing the risk of side effects for intermediate-risk (and even high-risk) patients.

    Deciding what to do is often difficult. Good luck with this.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low at <0.01; apparently cured.. Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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