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    Old 01-20-2008, 06:59 AM   #1
    LabMom
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    Newbie - Father diagnosed w/ PC

    Hello everyone,

    My father was diagnosed w/ PC back at the end of Oct. He will be 69 next week. It was kind of a shock as he had been getting yearly PSA and DRE tests for about the last 10-15 years. His PSA had risen slightly over the last couple of years (it was 2.0 - good for a man his age, from everything I read) when he went in early Oct, his Urologist debated whether to even send him for a biopsy, I guess during the DRE, he felt something suspicious.

    I don't know the details (how many cores were positive or that kind of thing, mainly because either the Dr. didn't tell him, he didn't ask, or he forgot), I just know that his Gleason score was a 6 (again I don't know if it was 3+3 or 4+2, or 2+4). He had a bone scan done, that came back clear, thank goodness. Not sure why he didn't have an MRI as well (I noticed many of you have had both).

    He developed a bacterial infection about a week after the biopsy, which he is still dealing with today. He's been on several different medications but none seem to be doing the trick. His doctor recommended the seed treatment, which is currently scheduled for 2/28 (if the infection has cleared up by then).

    He has lost about 10 lbs which has my Mom and sisters and I all worried, we are hoping it is just from the stress (not to minimize that) and not from the cancer - you always get nervous when someone loses weight, and they were not trying.

    There is no history of PC (that he is aware of) in his family, all though his mother started with back pain in her late 60's that went on to become pancreatic cancer, I believe. She passed away @ 71.

    I've been reading the boards since Oct, and decided it was time to post. My questions are:

    1) With a PSA of only 2.0 (68 almost 69 year old man), does the Gleason score of 6 surpise anyone?

    2) Has anyone had to deal with this lengthy (3 months now) of an infection? If so, how did you deal with it?

    3) In your opinion, is the seed therapy the way to go for him? I know I said that it had already been decided, probably should have posted right after diagnosis. I know it's an individual decision, I guess I'm looking for people that have had it done, the good, the bad, and the ugly. What can he expect? If it doesn't work, what else can be done?

    Thank you all in advance, and I wish you good luck in your journey.

     
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    Old 01-21-2008, 05:58 AM   #2
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    Re: Newbie - Father diagnosed w/ PC

    [QUOTE=LabMom;3400447]Hello everyone,

    My father was diagnosed w/ PC back at the end of Oct. He will be 69 next week. It was kind of a shock as he had been getting yearly PSA and DRE tests for about the last 10-15 years. His PSA had risen slightly over the last couple of years (it was 2.0 - good for a man his age, from everything I read) when he went in early Oct, his Urologist debated whether to even send him for a biopsy, I guess during the DRE, he felt something suspicious.

    ... His doctor recommended the seed treatment, which is currently scheduled for 2/28 (if the infection has cleared up by then).

    ...
    I've been reading the boards since Oct, and decided it was time to post. My questions are:

    1) With a PSA of only 2.0 (68 almost 69 year old man), does the Gleason score of 6 surpise anyone?

    2) Has anyone had to deal with this lengthy (3 months now) of an infection? If so, how did you deal with it?

    3) In your opinion, is the seed therapy the way to go for him? I know I said that it had already been decided, probably should have posted right after diagnosis. I know it's an individual decision, I guess I'm looking for people that have had it done, the good, the bad, and the ugly. What can he expect? If it doesn't work, what else can be done? ... QUOTE]

    Hello Labmom,

    Daff has already provided many good comments. Here are some more thoughts responding to your questions.

    You asked: 1) With a PSA of only 2.0 (68 almost 69 year old man), does the Gleason score of 6 surpise anyone?

    No, that PSA is outstanding for a man of his age - usually the PSA is several points higher because of BPH (noncancerous enlargement of the prostate associated with aging, and his unusually low PSA in itself is a clue that his cancer is low risk, but of course the PSA level by itself is not the complete picture. A Gleason of 6 is in the low-risk range, though other case characteristics can indicate a higher overall risk. I just checked the book "A Primer on Prostate Cancer -- The Empowered Patient's Guide," page 48, which states "The most common Gleason score is (3,3)." This means the total score is 6, 3 for the most common pattern in the biopsy,from 51% to 95% of the the total, and 3 for the second most common, ranging from 5% to 49% of the total. In the (3,3) case, the whole biopsy is very likely 3, though there might be a small percentage of some other grade."

    You asked: 2) Has anyone had to deal with this lengthy (3 months now) of an infection? If so, how did you deal with it?

    I hope you get more responses, but I have not heard that a long infection like that (or any infection at all) is due to prostate cancer, though the stress of the cancer might indirectly be affecting the course of the infection. I caught a cold within weeks of being diagnosed, and I'm sure the stress of diagnosis was partly to blame.

    You asked: 3) In your opinion, is the seed therapy the way to go for him?... I guess I'm looking for people that have had it done, the good, the bad, and the ugly. What can he expect? If it doesn't work, what else can be done?

    Seed therapy is a common approach in circumstances like your dad's, especially his age and what appears to be a mild case based on the few details you know. Seed therapy now has a long track record, and success rates are very similar to other therapies when matched for level of seriousness. Daff made good comments on whether it is best. Your dad definitely has other options based on the limited detail you have. If his PSA was 2.0 at diagnosis, which I think you meant, then his PSA did not rise more than 2.0 in the year prior to diagnosis. In fact, it probably rose quite a bit less since he probably had a PSA of at least several tenths before this year. If other case characteristics are low risk - like stage 1 or 2 (from the DRE - Digital Rectal Exam, mainly), number and percent of biopsy cores positive, percent of cores that are positive, absence of perineural invasion, to name some of the main characteristics, then that low rise in PSA indicates a case that is probably even milder than otherwise indicated.

    If seed therapy does not work, a recurrence could be so mild that no further treatment would be necessary. Or, the use of diet, etc. low-key tactics might be all that would be necessary. Failing that, a few experts in radiation therapy would probably be willing to do salvage radiation, though that is not typical. Salvage cryo therapy is an established option. Hormonal blockade therapy - either a single course of it or intermittently, would almost certainly be highly successful and would probably be all he would need to control the cancer for the rest of his life.

    There are couple of approaches that are low in intrusiveness. Active surveillance, especially at age 69, is probably a viable option, though it appears that he might feel too much stress for that approach. Another viable option could be a fairly mild version of hormonal blockade, using a combination of drugs known as an antiandrogen (typically Casodex) plus either the generic Proscar known as finasteride or Avodart, or the antiandrogen could be used alone. One leading doctor in hormonal blockade comments that with that approach you get 80% of the benefit and only 20% of the side effects. Your dad could even try a very low key approach to see if the PSA indicates that's all he needs: diet, nutrition, supplements, exercise, stress reduction, and a mild drug, either finasteride or Avodart. I am just a fellow survivor with no enrolled medical education, but I have heard experienced doctors advocate this approach as a reasonable option for low risk patients. Of course, it requires continued monitoring, but that is usually done just with PSA tests every few months with occasional scans. There are a couple of books that do a good job laying out some of these options, the Primer being one of them.

    The MRI scan is not as common as the CT scan, though the latter rarely turns up anything for low-risk cases, and some doctors consider it worthless in such cases. There are other imaging tests that can be done, as well as some blood tests, that can help nail down the low-risk nature of a case, if a patient wants to do that. A simple MRI scan is usually not very helpful, but the less comfortable endo-rectal MRI, especially with spectroscopy, is quite useful, at least accoring to the Primer.

    You did not mention your dad's overall health. That is a significant consideration, especially with a man who is 69. I'm guessing he's in good health since he's been getting regular check ups. If so, that might make more aggressive options more attractive. If he is not in good health, then less intrusive options would be especially attractive. For example, your dad's PSA doubling time with a followup test in a few months, or, even better, a couple of spaced out followups, would be an important clue about when he would probably run into trouble because of the PC. If he has serious heart disease or diabetes and a PSA doubling time of a hundred years, then it would make lots of sense to do nothing about the prostate cancer. If he is in super health except for the cancer but has a PSA doubling time of six months, then it makes sense to vigorously fight the cancer. I'm guessing your dad is somewhere in between, much closer to the good end of both the health and PSA doubling time dimensions.

    Please stay in touch.

    Good luck and take care,

    Jim

     
    Old 01-21-2008, 04:23 PM   #3
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    Re: Newbie - Father diagnosed w/ PC

    You've received excellant input frim the prior posts. However no one has yet mentioned the surgical option for localised low risk prostate cancer. Are their health problems that would preclude surgery or has it been considered and rejected?
    I was the same age as your father,69, when diagnosed with a higher PSA of 4.2, a Gleason 6 and 2 positive cores at around 25%. I chose surgery because it was the only aggressive treatment that could provide a cure and there was always the fall back options of radiation and hormone therapy if it failed to cure. Forunately it has cured me as I'm 61/2 years out with undetectable PSA's, and neither incontinence nor impotence. If radiation either seeds or external beam is done first and their is recurrance the only surgical option then is for salvage prostatectomy which isn't as effective as an initial prostatectomy. Your father should do well whichever course he follows if performed by outstanding experts from leading cancer centers.
    His infection may not be resolving because his medication isn't hitting it and needs to be changed. Has it been cultured to determine which antibiotic is specific for it or is he just getting a common broad spectrum antibiotic? Infections of the prostate and urinary tract can be very persistent if not hit with a very targeted antibiotic based on the results of blood cultures. Their are many strains of staph and strep which can be quite dangerous. You should consider consulting an infectious disease specialist to get him on the right meds.
    Weight loss is not associated with early stage prostate cancer and is most likely from stress and appetite loss. I lost 20 lbs after diagnosis because I was too worried to have any appetite. I also developed a bad case of sciatica from the stress.

    Last edited by shs50; 01-21-2008 at 04:25 PM.

     
    Old 01-22-2008, 07:21 AM   #4
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    Re: Newbie - Father diagnosed w/ PC

    Quote:
    Originally Posted by LabMom View Post
    .............Jim, you said the Gleason score of 6 is in the low risk range. From what I've read it is in the moderate risk/aggressiveness category. Can you or anyone else shed some light on that?

    The one thing I'm not happy with is I don't believe the Urologist (my Dad has been going to him for 10-15 years) gave my Dad options, he just recommened the seed treatment, and my Dad & Mom kind of just went along with it. Thoughts here too please?......
    I would agree with Jim that a Gleason 6 is in the low risk range. Maybe the physical exam revealed something that the doctor felt changed that??
    I provided some input on some alternatives, and didn't really get your response to that. (I had asked what part of the country he is from also.)

    There are so many choices, and the urologists often put forth their recommendations- but as many of us have found out, unless one is totally passive and trusting- it's really worth some personal due diligence before accepting the first recommendation. That's of course my opinion. My urologist recommended surgery or seeds (both of which he would have been
    involved with and received compensation for). As you've read in my prior post-- I chose neither of the two and picked proton beam radiation. That's not for everyone, but it was my treatment of choice- and I was self-referred for that.

     
    Old 01-22-2008, 07:44 AM   #5
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    Re: Newbie - Father diagnosed w/ PC

    Not surprising that his urologist recommended seeds. So did mine and really pushed it. I might have gone along had not my father-in-law been talked into seeds by his uro at age 75. His cancer returned after 10 years, entered his bones and he was gone two years later. So when my uro pushed seeds I rejected it and did a lot of research on the various options settling on surgery as mentioned in my earlier post. At first blush seeds sounds simpler, less invasive, and equally as effective as the other options. However, its not necessarily so. Many specialists recommend that external beam radiation be used in addition to seeds, presumeably to boost the effectiveness of the therapy which seems like a lot of radiation being absorbed in a sensitive area to me. Each treatment alternative has its own risks of side effects and one has to be one's own's judge but I'd urge your parents to at least consider and investigate other options rather than simply following the local urologist's recommendations.

    Last edited by shs50; 01-22-2008 at 07:47 AM.

     
    Old 01-22-2008, 05:35 PM   #6
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    Re: Newbie - Father diagnosed w/ PC

    Thank you everyone,

    Daff, the doctor didn't tell him he was in the moderate risk/agressiveness category, that was me saying that from everything that I read. There was a scale that I found that said something like (and I can't remember exactly) but 2-4 was low risk/agressiveness, 5-6 was moderate, and 7-10 was high. My father lives on the East Coast (mid Atlantic region), and I found out from my Mom that options were at least presented to him. Do nothing (Active surveillance), remove the prostate, radiation/chemo, or the Seeds. I guess the Dr. opted (give him the benefit of the doubt) for the seeds due to the fact the cancer hadn't spread, his age, and his health.

    He has been having his urine cultured (he called again yesterday because he isn't feeling that great), results haven't come back yet, the nurse he talked to keeps (i say keeps because he's talked to her before during the 3 months he's been dealing with this infection) talking about diet/nutrition. Don't eat this, don't eat that, do eat this, do eat that. Is diet really that important here?

    I'm also confused, as my mom talked about prostisis (not sure of the spelling), and was using that interchangeably with infection. Are they one and the same?

    Thanks again for everyone's help, it is greatly appreciated.

     
    Old 01-24-2008, 08:30 PM   #7
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    Re: Newbie - Father diagnosed w/ PC

    My husband had robotic surgery at Henry Ford Hospital in Detroit. Less recovery, cause he was only there over night. Less invasive. In my opinion the best way to go. At least look into it.......

     
    Old 01-25-2008, 12:26 PM   #8
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    Re: Newbie - Father diagnosed w/ PC

    I had the seed implant in August of 2007. So this experience is a recent one. My PSA had been on the rise for the last 2 years. My general practioner and I chose to observe this, and as it continued upward made the decision to take action. The PSA had risen quickly to 2.9, the digital rectal exams showed a normal sized prostate. I had no other symptoms except for the rising PSA.

    The specialists dre showed no signs of the disease either but the PSA numbers were slightly higher at his visit. We decided to perform a biopsy and the test was positive for Prostate Cancer. I was 58 years old.

    The specialist presented a number of therapies available. Of course, my loved ones were leaning towards surgery to remove the prosatate - get it out of there, it's the only way etc.

    But I wasn't so sure. As I began searching out the options available, I knew I had alot of education ahead of me. Not only for myself but for my loved ones. To shorten the story, I decided on the seed implant - thought that would be the best for my situation, diagnosis and prognosis. I educated those people around me and as we began discussing the therapy on a regular basis, those loved understood and agreed that this procedure did make sense.

    I talked to doctors about each of the therapies available and networked to find other prostate cancer survivors to discuss their procedure.

    August 23 the seed implant was performed. I must say, for me it was definitely the right choice. There was no pain, I took a week to recuperate - could have returned to work sooner, but why. I experienced very few side effects the first week, was not bedfast...nothing.

    Today I am almost 6 months out. My first check-up at 3 months showed a significant drop in my PSA.

    Sex plays a huge part in being a human and most men have questions regarding sexual concerns post op. For me there were none. I am able to achieve and maintain an erection as before. The only difference is a significant drop in semen.

    I hoped this has helped. But I also want to stress that options are out there and take some time to research those options that are best for you.

     
    Old 01-25-2008, 12:50 PM   #9
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    Re: Newbie - Father diagnosed w/ PC

    all of you are correct- my case 1st uro suggested cryo-- 2nd at mayo recommended rp because i was too young he said and there is a chance for complete cure ... my psa pre rp was 55 and biopsy was 5plus 4 total of 9 ... i went thru rp, rt, and then experimental chemo with taxotere (6 treatments).. also 2 years of hormonal blockade with casodex for one year.... now looking at jim's case i think i would have been ok with just hormonal blockade.. i did not have lymph node involvment or metastatis but had positive bladder margin and involvement of seminal vesicles

    so it is always pays to check and not go thru rp rightaway or cryo for that matter - i think hormonal blockade is the best first treatment ... it is reversible after 6 months...while patients like myself have to live with rp for a long time (which is good but would be good to be without rp)...i have low psa of .05 for last 18 months

    mayo doctors are definately pushing for surgery in young ages -- i even read a article dated 2005 in science daily about mayo researcher saying for cases with ct3 cancers with rp there is a more than 70 percent chance of 15 year survival rates (followed by rt)

    it is very confusing with different opinions

     
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