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    Old 08-11-2022, 07:01 AM   #1
    C Howie
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    Newly Joined

    Had a PSA moving upward for several years now but not at the alarming rate. It did go from 6 to 8 over the past year. That inspired a prostate MRI on Aug 1. Results were posted for me to read but have not made it to the Urologist follow up yet. That's scheduled for Aug 25. (was pushed back due by his office about 4 weeks ago).

    Results show 45% confidence that I have a Gleason 7+ lesion. Said that there was a slight bulging which radiologist said he provided a 3d image in case of MRI guided biopsy ordered. Also said no evidence of outside extension. All other areas on MRI not showing further involvement.

    Looks like I have officially joined the club. I've read through this forum and it certainly shows that many people have experienced the same thing and are further down the treatment line which is always good to hear from. I have had a couple 'bad days' waiting but trying to keep the mental attitude from going south. So far, my thinking is to just get to it. I've had aortic valve surgery and made it to the other side. I'll make it to the other side of this too.

     
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    Old 08-11-2022, 10:42 AM   #2
    Prostatefree
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    Re: Newly Joined

    I'll say 6, and 6 to 8 are both alarming. Protocol is for serious consideration of biopsies to start at 4.0.

    The mantra for treatable cancers is early detection, early treatment. If you miss early detection you're playing catch up ball the rest of the journey.

    By all means, use an MRI guided biopsy and include the standard prostate random array in addition to the MRI guided targeted samples.
    __________________
    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, upgraded to G3+4, Tumor vol 35%, +pT2c, No Incontinence-6mos, Erections-14 months
    7-6-22 PSA less than 0.02; zero club 6yrs

     
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    Old 08-11-2022, 12:41 PM   #3
    C Howie
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    Re: Newly Joined

    Thanks for the reply. Good to hear from those who have been through what I face. Appreciate your response and advice.

     
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    Old 08-11-2022, 04:47 PM   #4
    Southsider170
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    Re: Newly Joined

    Until you have a positive biopsy, you aren't in the club yet. That really seems to be the next step for you, and the doc will most likely recommend a biopsy. Some men have difficulty with it, but I've had 4 biopsies and never needed to do a valium or anything. Just a local anesthetic.

    Good luck on the upcoming appointment , and presumably the biopsy which will probably be recommended.

     
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    Old 08-12-2022, 05:13 AM   #5
    C Howie
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    Re: Newly Joined

    Thanks for the reminder. Its easy to jump to conclusions and then worry about what isn't necessary true. I certainly am concerned about the biopsy but I've also found that what I imagine is usually worse than the real thing. But this one comes with additional 'issues'. Best approach is to keep going and not make things up in your head.

     
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    Old 08-12-2022, 07:53 AM   #6
    Terry G
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    Re: Newly Joined

    A biopsy is the only way to be sure cancer is present. The biopsy results will also indicate the Gleason rating. They will target the lesion.

    If cancer is found; keep in mind that it can be treated very successfully. Early detection and early treatment is the key for most cancer and especially PCa. Good luck and keep us posted. Terry
    __________________
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    Old 08-12-2022, 10:49 AM   #7
    IADT3since2000
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    Re: Newly Joined

    Hi C Howie and welcome to the Board!

    In the case a biopsy finds that you have cancer that is other than the mild type where active surveillance is the go-to approach, the doctor may advise that the usual surgery option is unusually risky because of your cardiovascular history. Just be aware that modern radiation and associated technologies (imaging, ADT (Androgen Deprivation Therapy) if needed) is highly effective in wiping out prostate cancer, with low odds of recurrence, and a usually quite tolerable side effect profile. That's enough for now, but there is more to learn if and when there is a positive biopsy result.

    Good luck!

    m

    - - - - - - - - - - - - - - - - - - - - - - - --
    22 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, for some reason based on a less sensitive test on 7/20/2021 was <0.05, still apparently cured in my ninth year since radiation (PSA as of 12/2/2020 was <0.01). (T 93 as of 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. I have also had 225 undergraduate classroom hours just in statistics and experimental design, plus more in graduate school, which dwarfs what most doctors have, and that has made my “hard knocks” experience more meaningful. What I experienced is not a guarantee for all but shows what is possible.

     
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    Old 08-12-2022, 11:24 AM   #8
    C Howie
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    Re: Newly Joined

    All good information. Nothing is certain till they have the cells and confirm. Not looking forward to the process but it needs to get started to resolve the feeling of 'limbo'. Thanks for your post. I'll update as things begin to progress.

    My brother is an MD and will help me to understand how to pick a good surgeon should it go in that direction. He helped me almost 10 years ago with the cardiac surgery and I'm proof that it was a good pick.

     
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    Old 08-12-2022, 11:42 AM   #9
    C Howie
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    Re: Newly Joined

    Thanks for this. I will update as this moves from outside in look to actual cell evaluation which I would imagine is next. Unfortunately my urologist had my followup scheduled for last week at the time of MRI booking and then pushed it back to Aug 25. I'm guessing he is out of town but have no real idea. Its tough to wait around after that report.

     
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    Old 08-12-2022, 04:02 PM   #10
    Southsider170
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    Re: Newly Joined

    Quote:
    Originally Posted by C Howie View Post
    Thanks for this. I will update as this moves from outside in look to actual cell evaluation which I would imagine is next. Unfortunately my urologist had my followup scheduled for last week at the time of MRI booking and then pushed it back to Aug 25. I'm guessing he is out of town but have no real idea. Its tough to wait around after that report.

    Prostate cancer requires patience, its really isn't a one and done kind of thing. After your biopsy, you'll have to wait for the pathology report which take a week or two to come back from the lab. After that, if the tests are positive, you may need to have bone scans or other staging tests. If you are ok'ed for surgery, the general rule is they don't do it until 6 weeks or more after biopsy, give the area time to heal before they cut it out.

     
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    Old 08-12-2022, 04:29 PM   #11
    C Howie
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    Re: Newly Joined

    More very useful information for someone newly in the process. Could never have known what this forum has informed me in just a day or two. Expectations, including timing are all important to keep anxiety under control. Made the decision to utilize the U of Michigan Prostate Cancer Center for care if I can. I'll contact them Monday.

    The six week expectation makes sense. No kind of serious quality medical care comes at the snap of a finger. Wish it did but realism is a better approach.

    Thanks

     
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    Old 08-13-2022, 05:15 AM   #12
    Prostatefree
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    Re: Newly Joined

    Quote:
    Originally Posted by C Howie View Post
    My brother is an MD and will help me to understand how to pick a good surgeon should it go in that direction. He helped me almost 10 years ago with the cardiac surgery and I'm proof that it was a good pick.
    Prostate cancer is different than many other medical issues. Men have a blind spot for this issue as evidenced by your slow response to your dangerously rising PSA. Even male urologists are susceptible to the myth PC is not a risk to be taken seriously. If your brother is guiding you, the first mistake was not having a biopsy at 4.0 or shortly thereafter.

    This is your issue and you are your own best advocate. I'm glad you found your way here. Follow the protocols. You've missed the first and most important. Don't do it again and don't put this on you're brother.

    I suggest you find a cancer center of excellence with extensive experience with prostate cancer. You will have an experienced team of several disciplines necessary to deal with prostate cancer. In addition to the guided biopsy including the standard array of samples, be prepared to request a second opinion on the Gleason score and a Decipher test.

    What was the result of your DRE?

     
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    Old 08-13-2022, 06:48 AM   #13
    C Howie
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    Re: Newly Joined

    Couple things here. First is the DRE which had a non-remarkable result. Nothing to note of concern. Had that done twice by two different doctors with the same message. Nothing noted of concern and to stay on a pattern of close monitoring.

    I do consider this a penalty free zone with very helpful and caring people. This is fairly personal stuff and I am grateful to all those who share their view. At the risk of sharing personal information, I was probably less than full disclosure about my brother. He is a family practice physician and does not engage with medical advice among our family. He will help locate experts but does not advise. We all agree after serious illnesses with both parents that its unfair for him to be both a family member and a medical advisor. He does not advise me on any course of action medically. He is a retired Air Force Lt. Col. after spending his adult life providing medical service to Air Force families.

    Each of us has a story as to how we got where we are. For me, this started with a PSA of note but happened during the pandemic when I also relocated from Georgia to Michigan. As we moved through the process of life changing geographic locations, it was difficult to engage in a medical system at the new location. The pandemic activity made it tough as a new patient. At the time, everything was in a monitor situation but started moving along shortly after.

    Thanks much for you comments. Any and all advice and feedback is very much appreciated and this is a great forum.......helpful to me

     
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    Old 08-15-2022, 06:52 AM   #14
    ASAdvocate
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    Re: Newly Joined

    To put things in perspective, the American Cancer Society’s statistics show that, of men diagnosed today, over 98 percent will NOT die from prostate cancer within five years (or even ten years).

    There are some aggressive cases, but those are included in the overall statistics. I was diagnosed in 2009, and no specialist, anywhere, has ever suggested treating my low risk prostate cancer. Instead, it is regularly monitored.

    Today, men are choosing active surveillance, surgery, and radiation in equal numbers, so there is much to learn about what is appropriate and the most confident option for you. Take the time to inform yourself.

    https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/survival-rates.html

     
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    Old 08-15-2022, 08:48 AM   #15
    C Howie
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    Re: Newly Joined

    That is a healthy reminder. I think the biopsy is a good idea now but not looking forward to the process. I want to understand what I have and what my options are from a top medical team. Your post makes sense. I have read that many choose to not treat aggressively. I am going to talk to the Doctor who has been treating me for a little over a year and also get the opinion of the U. of Michigan prostate cancer team. I will read as much as possible in the meantime but stick to the information sources from major medical, research and recognized cancer expertise.

    Thanks

     
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