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Cancer: Prostate Message Board

  • Curious what you think.

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    Old 04-28-2021, 06:48 AM   #1
    Pdubs4444
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    Curious what you think.

    One month from today I have RALP surgery to remove the prostate. Nerve sparing. I am PSA 7.2, Gleeson 4+3, small nodule felt on DRE, t2b. CT and bone scan clean.

    My surgeon is excellent and I really need to just trust him. He told me I could wait until end of summer for surgery if I want. That I am curable and cancer is contained. I'm not waiting, that's for sure. End of summer would be 6 months after diagnosis.

    But makes me wonder how he can be so confident enough to even say I could wait. My biggest fear now is it has broken through the capsule. Can he tell that much from a CT? I don't know, just a bit nervous about what I will hear when I wake up from surgery.

     
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    Old 04-28-2021, 07:15 AM   #2
    DjinTonic
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    Re: Curious what you think.

    I personally would not wait that long and would go ahead with the surgery as planned. I believe his point is that there is nothing on imaging that points to your tumor pressing on the capsule or invading any adjacent structures, and, in his opinion, nothing is likely to change in the near future.

    However, as you know, a biopsy can miss lesions of a higher Gleason score. Let's look at it from another angle: nothing (other than time) is to be gained by postponing surgery. You still haven't created a signature, so I don't know how many cores were taken in your biopsy and the Gleason scores of each that was positive, nor your PSA history, nor whether you had a genomic test like OncotypDx or Decipher done to estimate your risk of metastasis.

    If you doc thinks you have a winning hand, I think you should play it now. Only a post-op path exam sampling the entire prostate can rule in or out the various adverse findings.

    Djin
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    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 04-28-2021, 12:11 PM   #3
    Terry G
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    Re: Curious what you think.

    Dubs...I agree with Djin and don’t see any advantage to waiting. You’re comfortable with your decision and surgeon and appear ready to go. The cancer and your condition may not get worse but for sure it won’t get better. Terry
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    Old 04-29-2021, 05:38 AM   #4
    IADT3since2000
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    Re: Curious what you think.

    Quote:
    Originally Posted by Pdubs4444 View Post
    ...Can he tell that much from a CT? I don't know, just a bit nervous about what I will hear when I wake up from surgery.
    My understanding is that the CT helps the doctor understand your anatomy and also that the negative CT and bone scans rule out fairly large tumors elsewhere in the lymph nodes and bones, the likely sites where prostate cancer usually spreads first.

    If your doctor is talented and with a lot of experience, then he is assessing your odds based on that experience and believes you have a very good shot at a cure.

    I too feel that, once you have made your decision, you don't gain anything by waiting.

    Good luck!

    Ö.Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    21 years as a survivor. Doing well. 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 PSA as of 12/2/2020). (Current T 93 12/2/2020.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 04-29-2021, 06:31 AM   #5
    Prostatefree
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    Re: Curious what you think.

    Cure is misleading. I've had about as good a result as I can ask for from my treatment, but I do not feel cured.

    I will be monitored for at least 10 years before being "released." I've lost my prostate, two sphincter muscles, and endured a serious surgery with all it's consequences.

    I am surviving my cancer. It is not a condition that "ends." I am left in a different place than if I had not had cancer or it's treatment.
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    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;
    1-15-21 PSA less than 0.02; zero club 4.5 yrs

     
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    Old 04-29-2021, 10:08 AM   #6
    Gary I
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    Re: Curious what you think.

    PDubs.....Superb advise from all!

    With you mind made up, there is no advantage in waiting. When things happen with existing Prostate Cancer it usually isn't for the better.

    Your urologist may be an excellent surgeon, but he's a typical 'feel good' prognosticator. The same is true when he says he can 'cure' you. Nice to have confident surgeon, but the best any of us can realistically hope for is to have an extended remission, while we continue to monitor.

    Get it done ASAP, and best of luck.
    __________________
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    Second 3T MRI 1/17
    RALP 7/17, G3+4, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over next 4 months
    DCFPyl PET & ercMRI @NCI - 11/17
    One inch tumor still in prostate bed
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    Old 04-29-2021, 04:24 PM   #7
    Insanus
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    Re: Curious what you think.

    The is no way your Surgeon can determine you donít have a micro metastasis somewhere in you body to day.

     
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    Old 05-03-2021, 09:15 PM   #8
    HighlanderCFH
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    Re: Curious what you think.

    The others are giving you very good advice & commentary. Have the surgery on time, as scheduled.

    While it appears your surgeon is VERY certain that it is all contained in the prostate (and I agree that it probably is), that does not mean there is not a higher Gleason grade tumor in there that was not detected by the biopsy.

    In this light, it is best to have the surgery sooner, rather than later, to get rid of all potential health threats. It does sound very much like you can expect to hear the word "cure" after your surgery -- and the best way to facilitate this is to pluck the culprit ASAP.

    Good luck!
    Chuck

    Last edited by HighlanderCFH; 05-03-2021 at 09:17 PM.

     
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