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  • Newly diagnosed with prostate cancer

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    Old 09-04-2020, 01:25 PM   #1
    musicmanone
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    Newly diagnosed with prostate cancer

    I've had BPH for years. Finally, last December (12/04/2019) I had a Urolift done. It was totally unsuccessful. In June (06/15/2020) I had TURP surgery. When I went for my post-op visit with the surgeon/urologist he told me that they found cancer in the tissue removed. The cancer was in about 5% of the tissue removed. It was rated at Gleason 3+4=7. Does anyone know if they usually get all of the cancer in the prostate out with TURP surgery. I have a visit with the surgeon/urologist scheduled for 10/02/2020. He told me at my last visit that my treatment options would probably be Active Surveillance, radiation, or radical prostatectomy. He wants me to get a PSA test before the October appointment, and he also said that he would probably also ask me to have a MRI.

    I'm hoping that all of the cancer was found and removed during the TURP surgery. Does anyone know if that is at all possible, and if so, is it likely that it was all removed?

    I'm 67yo and my PSA in April was 1.86, so there was no indication that cancer was present.

     
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    Old 09-05-2020, 05:30 AM   #2
    IADT3since2000
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    Re: Newly diagnosed with prostate cancer

    Hi musicmanone and welcome to the Board!

    If you haven't been paying much attention to prostate cancer before, which is par for the course, you may not be aware that it is highly survivable these days for all but a small proportion of us who have distant metastases at the time of diagnosis, and even for them the prospects are a bit better. Nearly 99% of patients at all risk levels combined will survive to the ten year point compared to their age-matched peers. Survival at 15 years is in the mid-90s, and most of those will live many years beyond that point. Our quality of life may take some hits due to treatment, but the vast majority of us will live pretty good lives after diagnosis.

    Also, it is now known that treatment can be deferred, hopefully and often for a lifetime, for mild, "low-risk" prostate cancer, provided the patient complies with an approach known as "active surveillance." Excellent treatments are available for cancer that does need to be treated.

    A TURP can remove all of the cancer. However, it reaches only a small proportion of the prostate, and there may well be some cancer that the TURP did not cover.

    A super book to help you get oriented is "The Key to Prostate Cancer", 2018, by Dr. Mark Scholz and 29 others, mostly noted experts.

    Good luck.

    .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 and stable at <0.01; apparently cured. (Current T 99 6/5/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs.

     
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    musicmanone (09-08-2020)
    Old 09-05-2020, 09:37 AM   #3
    Prostatefree
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    Re: Newly diagnosed with prostate cancer

    The TURP is not a cancer treatment. It removes some tissue so you can pee. They inspect it. They found cancer. It acted as a crude biopsy. Now you know you have BPH and prostate cancer assuming the BPH was confirmed in the TURP pathology report. Was it? You should have an actual copy of the report. Not a doctor transcribed summary of it.

    BPH complicates cancer screening and the danger is it becomes a straw man.

    The idea a TURP procedure can remove all the cancer is a dangerous one. Theoretically possible, it is a practical impossibility. If it did, it's not going to stop it from producing more. It's a warning flag to your state of mind or an incompetent doctor if they were the source of such a thought.

    Now you start your prostate cancer journey. Your low PSA can be several things. Some men have low PSA. Of them, there is a subset that will have a low PSA and highly aggressive cancer. Some prostate supplements, medications and diet supplements can suppress PSA readings. Their danger is you lose the advantage of your number one cancer screening tool.

    I recommend you find a cancer center of excellence if you haven't already. Next recommended step is a 3T MRI to be used in conjunction with a guided biopsy to gather more information about the extent and aggressiveness of your cancer

    You want to start being very clear in your use of the language or you will misguide yourself. For example, your symptoms you describe as BPH can also be cancer symptoms. And in your case, they are both unless you don't have BPH. (Check your pathology report.) Urinary symptoms can be a symptom of cancer. So your statement, there was no evidence of cancer present, can now be updated to include your urinary symptoms. Distinguishing between wishful thinking and the facts is now your next challenge.

    There's also a concern your DRE didn't reveal anything. Are you confident in your doctor? You sound somewhat uninformed. The "failed" urolift is also a concern. What was it trying to resolve?

    Please share your entire PSA history. I also suggest you prepare a signature. It helps you keep clear in the facts. Our minds play tricks on us to avoid unpleasant possibilities.

     
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    Old 09-06-2020, 05:26 AM   #4
    Southsider170
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    Re: Newly diagnosed with prostate cancer

    Its certainly possible for TURP to remove all of the prostate cancer, but it isn't really that probable. Prostate cancer is usually multi-focal, where instead of one large tumor there are many small tumors.

     
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    Old 09-06-2020, 07:26 AM   #5
    DjinTonic
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    Re: Newly diagnosed with prostate cancer

    Quote:
    Originally Posted by Southsider170 View Post
    Its certainly possible for TURP to remove all of the prostate cancer, but it isn't really that probable. Prostate cancer is usually multi-focal, where instead of one large tumor there are many small tumors.
    A TURP removes tissue from the inner transitional zone to remove pressure on the urethra, the cause of BPH symptoms. Most PCa lesions form in the outer part of the prostate, the cortex. So you are "lucky" you cancer was found. Unfortunately, that means a TURP can't be considered a PCa treatment (otherwise we'd all get TURPS for our cancer, keep out prostates, and pee like pros).

    A biopsy is in order after a healing period from the TURP. You may harbor lesions greater than a G7 (3+4). Even if not, if more than one (3+4) lesion were found, you would not be a good AS candidate.

    A multiparametric MRI (mpMRI) can locate suspicious areas in the prostate that can then be sampled in a fusion biopsy. It can also suggest whether the cancer has grown locally out of the prostate and whether there are any enlarged lymph nodes, which are suggestive of metastases.

    Knowing the severity and extent of your PCa can help you decide on the best treatment for you.

    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, negative 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
    Decipher 0.37 (Low Risk), uPSA: 0.010 (3 mo.)...0.020 (3 yr. 7 mo.)

     
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    Old 09-08-2020, 01:48 PM   #6
    musicmanone
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    Re: Newly diagnosed with prostate cancer

    PSA history:

    March 2020 - 1.86
    October 2019 - 1.61
    March 2019 - 1.62
    September 2018 - 1.42
    March 2018 - 4.26
    March 2016 - 1.19
    March 2015 - 1.02
    January 2014 - 0.86

     
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    Old 09-08-2020, 01:55 PM   #7
    musicmanone
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    Re: Newly diagnosed with prostate cancer

    Following the 4.27 PSA in March 2018 I had a biopsy. The results from the report are as follows:

    Clinical Information
    Preoperative diagnosis: R97.20
    Postoperative diagnosis:
    Pertinent Clinical Data: PSA Last Result: 4.27; Date: 3/27/18

    Diagnosis
    Prostate Needle Biopsies:

    Site Diagnosis Gleason %Involved
    #Cores

    1- L Base Benign prostate tissue

    2- L Mid Benign prostate tissue

    3- L Apex Benign prostate tissue

    4- L Lat Base Focal chronic inflammation

    5- L Lat Mid Benign prostate tissue

    6- L Lat Apex ASAP - See Comment

    7- R Base Benign prostate tissue

    8- R Mid Mild chronic inflammation


    9- R Apex Mild chronic inflammation

    10-R Lat Base Benign prostate tissue

    11-R Lat Mid Focal chronic inflammation

    12-R Lat Apex HGPIN
    Performed at: TMF Central Lab
    CLIA #15D0357169, 530 N Lafayette Blvd South Bend IN 46601

    Performed by: Odeta Lapkus, M.D.
    ----------------------------------------------------
    Electronically verified by: Odeta Lapkus, M.D.

    Verified: 04/30/18 15:39
    OL/OL


    Two markedly atypical glands are identified. Immunohistochemical
    stains for cytokeratin 34BE12 and p63 fail to demonstrated basal
    cells in the atypical glands. These findings are highly suspicious
    for adenocarcinoma.

    Gross Description
    Site Color # of Pieces Length (mm)

    1- L Base tan 1 12
    2- L Mid tan 1 16
    3- L Apex tan 1 16
    4- L Lat Base tan 1 11
    5- L Lat Mid tan 3 1,2,12
    6- L Lat Apex tan 1 20
    7- R Base tan 1 14
    8- R Mid tan 1 15
    9- R Apex tan 1 16
    10-R Lat Base tan 1 13
    11-R Lat Mid tan 1 10
    12-R Lat Apex tan 1 17

    GXP/

    Microscopic Description
    Sections from blocks submitted at gross exam are microscopically
    reviewed.

     
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