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    Old 06-29-2010, 05:35 AM   #1
    letsgetgoing
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    A little unusual, I think?

    Hello everyone,
    Just received my biopsy results today, they were as I expected positive though worse than I was hoping. In saying that I think that I am comparatively lucky.
    The reason I am posting is that for the last 6 weeks I have been reading this site and have gained a great deal from it. So in thanks and to contribute to the groups knowledge I would like give my story so far, as I think due to my age and PSA results it is a little different from the norm?

    Me
    51
    Very fit, run and weight train
    Eat well, avoid saturated fats

    Family history
    Paternal Grandfather died of aggressive stomach cancer (is the aggresive part of concern?)
    Father diagnosed with PC at 50 (already had metastasized to bone and elsewhere), died at 55 some 25 yrs ago.
    No cancer on maternal side.

    Recent PSA results
    22 Jul 07 2.4
    7 Nov 07 2.4 Free PSA 27%
    27 Oct 09 2.8 Free PSA 14.3%
    4 May 10 2.76 Free PSA 14.5%

    Biopsy results
    Prostate volume measured 19.6cc ( is this small? and if so is that the reason for my low ish PSA levels)

    12 core biopsy (maybe 13)
    (a) Rt base 11mm, tumor length 3.8mm, G is 3+4=7, Grade 4 = 10%
    (b) Rt mid 10mm, No specific pathologic changes
    (c) Rt apex 9mm, TL 0.2mm, G is 3+3=6
    (d) Lt base 11mm, No specific pathologic changes
    (e) Lt mid 12mm, High grade dysplasia (PIN)
    (f) Lt apex 9mm, TL 2mm, G is 3+3=6
    (g) Rt medial superior x2, 9/8mm, TL 6mm, G is 3+3=6
    (h) Lt medial superior, High grade dysplasia (PIN)
    (i) Rt medial inferior 11mm, No specific pathologic changes
    (j) Lt medial inferior 12mm, TL 2mm, 3+3=6
    (k) Rt TZ 9mm, no specific pathologic changes
    (l) Lt TZ 15mm, TL 0.3mm, G is 3+4=7, Grade 4 =10%

    Adenocarcinoma identified bilaterally. Pathologic stage T2a

    I think the only reason I have been able to identify my PC before metastisis, hopefully, was by being pro active in wanting to avoid my fathers fate. The lesson I guess is believe the free % PSA warning and get a biopsy, there is in my view no reason to delay.

    Does anyone have an idea what size tumor/s I could be dealing with. Any other comments or observations on the biopsy report would be welcome.

    My plan at this stage is to have the prostate removed surgically asap. Open surgery is the current plan as I have faith in my surgeon. Is there any reason to opt for Robotic surgery(if the surgeons are of equal skill), is it any more or less effective in removing the prostate. Please do not worry about influencing me one way or another on these or any other method as I will take it all into account and take responsibility for my own decision, just want to be sure I have not overlooked anything.
    thanks, david

    Last edited by letsgetgoing; 06-30-2010 at 07:00 AM. Reason: misunderstanding

     
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    Old 07-10-2010, 09:52 AM   #2
    IADT3since2000
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    Re: A little unusual, I think?

    Hi David,

    Welcome to the board! I'll insert some comments in green with your comments in black.


    "Hello everyone,
    Just received my biopsy results today, they were as I expected positive though worse than I was hoping. In saying that I think that I am comparatively lucky."

    That's a good attitude, and attitude is important.

    "The reason I am posting is that for the last 6 weeks I have been reading this site and have gained a great deal from it. So in thanks and to contribute to the groups knowledge I would like give my story so far, as I think due to my age and PSA results it is a little different from the norm?

    Me
    51

    Yes, a little on the young side, but not that much for prostate cancer.

    Very fit, run and weight train
    Eat well, avoid saturated fats

    Congratulations! Both of these lifestyle tactic areas are important and contribute substantially to our ability to cope with prostate cancer. As you probably know, monounsaturated and polyunsaturated fats can be good. Extra virgin olive oil is the oil to choose; flaxseed and canola oil appear to increase the potency of prostate cancer.

    Family history
    Paternal Grandfather died of aggressive stomach cancer (is the aggresive part of concern?)

    As far as science knows now, that would appear to be completely unrelated to your situation, as far as I know as an informed layman.

    Father diagnosed with PC at 50 (already had metastasized to bone and elsewhere), died at 55 some 25 yrs ago.
    No cancer on maternal side.

    I'm sorry your father died so young and for your loss. As you may know, having a "first degree" relative, including a father, have prostate cancer at a fairly young age does increase your risk of having the disease. That's water over the dam for you after your own diagnosis, but maybe it contributes to the total picture.

    However, 25 years ago was 1985 (about the time my own father died from PC), and understanding of prostate cancer was primitive then compared with today's technology. Your situation is a vastly different. Just for starters, we did not have PSA then, either to help detect the disease or to monitor the effectiveness of therapy. Back in the mid 1980s it was typical for patients to be diagnosed when they already had metastatic cancer. The situation today is that that is rare in the US.

    Recent PSA results
    22 Jul 07 2.4
    7 Nov 07 2.4 Free PSA 27%
    27 Oct 09 2.8 Free PSA 14.3%
    4 May 10 2.76 Free PSA 14.5%

    It appears you had an alert doctor who helped you catch the disease when it was still acting stealthy.

    Biopsy results
    Prostate volume measured 19.6cc ( is this small? and if so is that the reason for my low ish PSA levels)

    Yes, that is on the smaller end of the normal range. There's a book you should get that adds understanding to this and a vast number of other points: "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen B. Strum, MD, and Donna Pogliano, a PC activist, educator and wife of a survivor. On page F4 in my original 2002 edition, the Primer explains that healthy prostate tissue produces about 0.066 units of PSA per cc of volume. Therefore, a prostate of 19.6 cc would produce 19.6 X 0.066 = 1.3 units of PSA.

    That leaves about 1.5 units of PSA to be accounted for. If there is infection of prostate tissue, that can have a major effect on PSA, but your PSA numbers don't suggest that in my layman's eyes, and we have already accounted for size, which also affects PSA. My layman's view is that the 1.5 units of PSA probably is due to the cancer. The good news is that this is a pretty small amount. It is true that high Gleason score cancers - where the cells are so broken down that they can no longer produce as much PSA as the less broken down cancer cell - produce less PSA, your thorough-appearing biopsy suggests this is not the case. In other words, the low PSA probably suggests a fairly low volume of cancer. The Primer also discusses this on page F4.


    12 core biopsy (maybe 13)

    That's standard these days.

    (a) Rt base 11mm, tumor length 3.8mm, G is 3+4=7, Grade 4 = 10%
    (b) Rt mid 10mm, No specific pathologic changes
    (c) Rt apex 9mm, TL 0.2mm, G is 3+3=6
    (d) Lt base 11mm, No specific pathologic changes
    (e) Lt mid 12mm, High grade dysplasia (PIN)
    (f) Lt apex 9mm, TL 2mm, G is 3+3=6
    (g) Rt medial superior x2, 9/8mm, TL 6mm, G is 3+3=6
    (h) Lt medial superior, High grade dysplasia (PIN)
    (i) Rt medial inferior 11mm, No specific pathologic changes
    (j) Lt medial inferior 12mm, TL 2mm, 3+3=6
    (k) Rt TZ 9mm, no specific pathologic changes
    (l) Lt TZ 15mm, TL 0.3mm, G is 3+4=7, Grade 4 =10%

    Adenocarcinoma identified bilaterally. Pathologic stage T2a

    It's important to have the biopsy scored by a pathologist who is expert in prostate cancer, not just a general pathologist who handles all comers with all kinds of diseases. However, this report looks thorough, and it may well have been done by an expert. It would be good to confirm that though, and, if not done by an expert, you could request that a second opinion reading be done by an expert (and even specify the expert).

    Of the twelve cores, six (half) are positive for cancer, with four showing GS 6 cancer (the typical score) and only two have GS 7 cancer, with the proportion of grade 7 cancer being small in both cases, a favorable sign.

    The stage of T2a means that the cancer does not appear to have penetrated the prostate capsule and that it appears on only one side of the prostate and in less than half of one lobe. That's puzzling. Assessment of stage T2a is not consistent with cancer that is clearly on both sides and appears to me as a layman to extend through more than half a lobe on each side. Based on the biopsy report, the stage would be T2c, assuming no metastases (a reasonable assumption), provided the DRE was normal. The stage estimate is important as it enables us to compare our case with many others, using such well-known typically used tools as the Partin Tables.

    It is very important that you resolve this discrepancy!


    I think the only reason I have been able to identify my PC before metastisis, hopefully, was by being pro active in wanting to avoid my fathers fate. The lesson I guess is believe the free % PSA warning and get a biopsy, there is in my view no reason to delay.

    Amen to that!

    Does anyone have an idea what size tumor/s I could be dealing with. Any other comments or observations on the biopsy report would be welcome.

    Based on the amount of PSA and the Gleason score, the tumor would appear to be small. The Primer p. F4 provides advice on publications from the Prostate Cancer Research Institute (PCRI, a non-profit organization), that address estimating the size of the tumor. (You could obtain the publication without waiting to get the Primer.)

    My plan at this stage is to have the prostate removed surgically asap. Open surgery is the current plan as I have faith in my surgeon.

    I strongly suggest you get a second opinion from a radiation oncologist, perhaps also from a medical oncologist (probably would not manage the therapy, but could serve as a disinterested advisor). Based on the Partin tables and what you have told us, but with a stage of T2c instead of T2a, here are the odds of key aspects related to success of surgery:

    Input: PSA of 2.76; Gleason 7 (though arguably Gleason 6 could be used because it is the quite dominant patter); stage T2c.

    Results, using the 2001 version of the Partin Tables for a cancer falling in the categories PSA 0 - 2.5, Gleason 3+4=7, and stage T2c:

    Organ confined PC: 51% (coin flip)
    Capsular Penetration: 36%
    Seminal Vesicles Positive: 5%
    Lymph Nodes Positive: 6%

    Surgery will not be curative if the cancer is beyond the capsule, and you can see there is a substantial chance that the capsule has been penetrated (36%) or at least that the cancer has invaded into the thin capsule (100% - 51% = 49% chance).

    Running the numbers assuming Gleason 6 is the best approximation yields this:

    Organ confined PC: 73%
    Capsular Penetration: 24%
    Seminal Vesicles Positive: 1%
    Lymph Nodes Positive: 1%

    It's worth noting that the Partin tables, as good as they are, do not account for the number of cores positive or extent of cancer in the positive cores. Other "nomograms" can do this, but the fact that half the cores are positive, is grounds to be a bit more careful.

    Radiation, whether by radiocative implant seeds, external beam in some form, or both, is able to reach at least a little beyond the prostate, including the nearby few millimeters where early spread is most common. Surgery cannot do that. External beam therapy can reach well beyond the prostate of course.

    One option for you that makes sense to me is to do some more staging, such as with an endo-rectal MRI with spectroscopy at a center of excellence. That would give you a lot better look at whether surgery was likely to be successful.


    Is there any reason to opt for Robotic surgery(if the surgeons are of equal skill), is it any more or less effective in removing the prostate.

    The accumulating evidence is that it is not more effective, but does typically involve less blood loss (not a big consideration as modern open surgery by an excellent surgeon is already quite effective) and shorter hospital stays. The vast majority of men coming to our support group after robotic surgery believe they are doing better than their open surgery peers regarding side effects, but that is a small sample of about ten.

    Please do not worry about influencing me one way or another on these or any other method as I will take it all into account and take responsibility for my own decision, just want to be sure I have not overlooked anything.
    thanks, david

    That's enough for now, but please follow up, and I hope you get more responses now that we are all past the July 4th festivities.

    Take care,

    Jim

     
    Old 07-10-2010, 04:53 PM   #3
    Johnt1
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    Re: A little unusual, I think?

    Adding to Jim's excellent assessment. The Prostate Cancer Research Institute(PCRI) web site has a tumor size calculator under PC tools, that you can use to estimate your tumor size and calculate the psa that it should generate.
    If the psa is much less than the tumor volume indicates, it is an indication of a PC varient. A plody anlaysis along with a 2nd opinion on your biopsy slides would be a good thing to get.
    JohnT

     
    Old 07-10-2010, 05:53 PM   #4
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    Re: A little unusual, I think?

    Unneeded post.

    Last edited by IADT3since2000; 07-10-2010 at 06:47 PM. Reason: Unneeded.

     
    Old 07-12-2010, 08:32 AM   #5
    letsgetgoing
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    Re: A little unusual, I think?

    Thanks for your link Johnt1

    Hello Jim,
    Thanks for your reply. After first posting I found Kcon’s thread on his search for the best intervention for him. His thread answered a lot of my comparison questions.

    My comment “a little unusual” was in relation to my relatively low PSA and a low-ish Free PSA % for someone with PC and not an infection. The point being, from my experience, many GP’s will dismiss a low Free PSA% as being inaccurate if the PSA is below 4 and send you on your way. This thinking, I believe, can potentially be a lethal oversight and wanted to highlight the issue. Somewhere on this site I read that the latest thinking is that the PSA now needs to be less that 2.5 before doubt is placed on the Free PSA %. Is this correct?
    My understanding of the best way to approach this issue is to first give a course of medication to eliminate infection as the cause of a low Free PSA % then retest. If the Free PSA% is still low further investigation by a Specialist should be followed up. Is this correct?
    With all due respect to my GP, who is also a PC survivor, I think he was far from alert in as you said helping me catch the disease when it was still acting stealthy. My real life example is that I was assured without any doubt that I didn’t have PC due to my low PSA regardless of my low Free PSA%. He also said that there is strong link, though not proven, that PC is inherited through the maternal line thus eliminating my fathers death and family history from the equation. I didn’t accept this rationale and went to see a Urologist. With my recent PC diagnosis I wanted to highlight this thinking (inaccurate Free PSA% with low PSA) to the community to encourage anyone in a similar situation to seek further advice.

    Thanks for the Volume to PSA calculations. I took this information from one of your earlier posts to make the calculation and went armed with it to the see the Urologist. Fortunately it was unrequired as he has been excellent.

    I will seek further clarification on the T2a stage, as you mentioned it does seem a little confusing. Since you highlighted this issue I have done some research and the following quotes may make it clearer? I understand that we cannot give links but the information came from a document named “Volume related sequence of tumor distribution in prostate carcinoma” Google it and go down to the cmj PDF version.

    Results: Three tumor distribution patterns were identified: multiple bilateral without posterior midline crossover, multiple bilateral with crossover, and single bilateral (global) tumors. Unilateral tumors were rare (2%).

    Tumor distribution patterns changed with the increasing total tumor volume. The smallest tumors were multiple, with bilateral prostate involvement. With increasing volume, the following changes in the distribution pattern were seen: From multiple bilateral without crossover to multiple bilateral with crossover, and finally to an extensive single bilateral tumor (global tumor).

    The way I read this is that as long as the tumors do not take up more than half of each lobe and do not crossover they can still be classed as T2a whether they are unilateral (in one lobe) or bilateral (in two lobes). T2c would be where they are connected by a crossover. Does all this sound correct?

    I will continue to research my options including radiation.

    Thanks again for your reply and for the contributions you and many others make to this site.
    Good luck to all, david

     
    Old 07-12-2010, 04:39 PM   #6
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    Re: A little unusual, I think?

    Hi David,

    I'll insert some thoughts in green, leaving your text in black.


    Thanks for your link Johnt1

    Hello Jim,
    Thanks for your reply. After first posting I found Kcon’s thread on his search for the best intervention for him. His thread answered a lot of my comparison questions.

    My comment “a little unusual” was in relation to my relatively low PSA and a low-ish Free PSA % for someone with PC and not an infection. The point being, from my experience, many GP’s will dismiss a low Free PSA% as being inaccurate if the PSA is below 4 and send you on your way. This thinking, I believe, can potentially be a lethal oversight and wanted to highlight the issue. Somewhere on this site I read that the latest thinking is that the PSA now needs to be less that 2.5 before doubt is placed on the Free PSA %. Is this correct?

    I had not heard or read this (free PSA being unreliable if PSA <2.5) from the doctors I follow, but I had seen it several times on this board. However, I just did a quick PubMed search for the first time on this issue, and I found this abstract that suggests that free PSA is still of value when the PSA is below 2.5. Here's the citation:

    Cancer. 2008 Nov 15;113(10):2695-703.
    Percent free prostate-specific antigen (PSA) is an accurate predictor of prostate cancer risk in men with serum PSA 2.5 ng/mL and lower.
    Walz J, Haese A, Scattoni V, Steuber T, Chun FK, Briganti A, Montorsi F, Graefen M, Huland H, Karakiewicz PI.
    Cancer Prognostics and Health Outcomes Unit, University of Montreal, Montreal, Quebec, Canada.

    This earlier paper from Johns Hopkins makes essentially the same point:

    J Urol. 2002 Aug;168(2):504-8.
    Percent free prostate specific antigen in the total prostate specific antigen 2 to 4 ng./ml. range does not substantially increase the number of biopsies needed to detect clinically significant prostate cancer compared to the 4 to 10 ng./ml. range.
    Haese A, Dworschack RT, Partin AW.
    James Buchanan Brady Urological Institute, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

    I'm not sure of the source of the feeling that free PSA does not matter below 2.5. If anyone has some research to cite, I would appreciate knowing too. Just the results in these two cites makes me doubt the unreliability claim, but I did not do enough checking to be absolutely certain that the claim is incorrect. It may very well be the case of a semi-informed doctor giving his patient a false piece of information, with the patient later passing it on, naturally believing it is true.


    My understanding of the best way to approach this issue is to first give a course of medication to eliminate infection as the cause of a low Free PSA % then retest. If the Free PSA% is still low further investigation by a Specialist should be followed up. Is this correct?

    My strong impression is that it may take a number of attempts to eliminate the infection, and that, in the end, it may prove impossible. Good luck with this. I feel the odds are in your favor, but some cases are really tough from what I've read and heard.

    With all due respect to my GP, who is also a PC survivor, I think he was far from alert in as you said helping me catch the disease when it was still acting stealthy. My real life example is that I was assured without any doubt that I didn’t have PC due to my low PSA regardless of my low Free PSA%.

    That's an unfortunate misunderstanding, but probably not uncommon among GPs. They have to treat all comers for all conditions, so it is not strange that they are not up to speed on the nuances of our complicated disease. On the other hand, it would be shameful for a urologist to make that mistake. They are specialists and should know better.

    He also said that there is strong link, though not proven, that PC is inherited through the maternal line thus eliminating my fathers death and family history from the equation. I didn’t accept this rationale and went to see a Urologist.

    He is wrong. There is likely some inheritance of a tendency from the maternal side, but the father's side is more significant.
    This is well established.


    With my recent PC diagnosis I wanted to highlight this thinking (inaccurate Free PSA% with low PSA) to the community to encourage anyone in a similar situation to seek further advice.

    Thanks for the Volume to PSA calculations. I took this information from one of your earlier posts to make the calculation and went armed with it to the see the Urologist. Fortunately it was unrequired as he has been excellent.

    I will seek further clarification on the T2a stage, as you mentioned it does seem a little confusing. Since you highlighted this issue I have done some research and the following quotes may make it clearer? I understand that we cannot give links but the information came from a document named “Volume related sequence of tumor distribution in prostate carcinoma” Google it and go down to the cmj PDF version.

    Results: Three tumor distribution patterns were identified: multiple bilateral without posterior midline crossover, multiple bilateral with crossover, and single bilateral (global) tumors. Unilateral tumors were rare (2%).

    Tumor distribution patterns changed with the increasing total tumor volume. The smallest tumors were multiple, with bilateral prostate involvement. With increasing volume, the following changes in the distribution pattern were seen: From multiple bilateral without crossover to multiple bilateral with crossover, and finally to an extensive single bilateral tumor (global tumor).

    The way I read this is that as long as the tumors do not take up more than half of each lobe and do not crossover they can still be classed as T2a whether they are unilateral (in one lobe) or bilateral (in two lobes). T2c would be where they are connected by a crossover. Does all this sound correct?

    The abstract is a worthwhile piece of science, but it by no means changes the customary staging categories. Check with the urologist; he should know. If there is something new here that I need to know, please pass that on. In this particular instance, I'll be very surprised if that is the case. In any case, the Partin Tables were based on the established categories.

    I will continue to research my options including radiation.

    That is the course of wisdom at this point.

    Thanks again for your reply and for the contributions you and many others make to this site.
    Good luck to all, david

    You're welcome. I'm glad to be able to help.

    Take care,

    Jim

     
    Old 07-14-2010, 05:53 AM   #7
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    Re: A little unusual, I think?

    Hello Jim,
    Spoke to the Pathologist yesterday and he said it was a typo, it should read T2c as you suggested. Well spotted by you, thanks again.
    Good luck to all, david

     
    Old 07-16-2010, 08:17 PM   #8
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    Re: A little unusual, I think?

    Hello letsgetgoing,

    Sorry to hear you joined our club. Lots of good advice here so you came to the right place.

    I had a da Vinci minimally invasive, robotic-assisted prostatectomy in Jan2007.

    My pre-surgery biopsy came back showing Gleason 6 (3+3); T2a (less than one-half of one lobe involvement).

    My post-surgery pathology showed a little worse condition of Gleason 6 (3+3); T2c (bilateral involvement).

    There are many options to treat prostate cancer. My advice, take your time. Research as much as you can about each treatment. Talk to those who have had treatment. Most of all, find a doctor who has a lot of experience in the treatment that you choose. I had a surgeon that had done over 900 da Vinci robotic-assisted prostatectomies before he got to me. I felt very confident with this guy. Make sure the doctor you pick has a long and successful history in prostate cancer treatment.

    Best wishes!

     
    Old 07-20-2010, 08:29 PM   #9
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    Re: A little unusual, I think?

    hello Tony,
    I am pleased to hear you seem to be recovering very well.
    The experience factor you mentioned seems to be the most important factor. As someone mentioned elsewhere, find the most experienced doctor and let him choose his tools, particularly in respect to open or robotic surgery.
    In reference to your recovery, how long was it until you could do vigorous activities.
    Thanks for your advice.
    Good luck to all, david

     
    Old 07-20-2010, 08:53 PM   #10
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    Re: A little unusual, I think?

    I'm retired now (Sep2009) but at that time I was a lineman for the phone company. Lot's of outside work. Lots of pole climbing and manhole work. Lots of bucket truck work and driving line trucks, etc. Heavy lifting and such. My urologist told me I could return to work (unrestricted) in 6 weeks. Men who do less vigorous work, say office work or maybe warehouse work could return in 4 to 5 weeks. I had absolutely no problem returning to my full schedule.

     
    Old 09-07-2010, 09:21 PM   #11
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    Re: A little unusual, I think?

    Hello everyone,
    I don’t have the knowledge or detailed thought patterns to give advice in payback for all the knowledge I gained on this site. Therefore my thanks is an update of my situation.

    Since I last posted on Jun 20 a lot has happened. Being a big picture person I have trouble with the massive amount of detail involved in researching treatment options. My process in dealing with this issue was to read/skim-read as many reputable articles and comment as possible, get the gist of each article and move to the next.
    This method suits me but makes it very difficult to explain with authority/detail why I chose a particular route. Also my personality is such that I cannot wait around, I need to act decisively and usually quickly. I am also not suggesting this method or of acting quickly to anyone else, but right or wrong its what I did.

    So in the end I chose the open surgery route. The big picture reasons for this were that I think there is a good chance I have Hereditary PC. My relatively young age of 51. My need to act decisively and hopefully only once. It was an easy choice as my surgeon is young (mid to late 40’s) and has well over 2000 operations. There was a further wait time for robotics which I didn’t consider superior to open in any case. A better option for radiation treatment afterwards if required as I felt the volume of my PC was larger than I had expected due to my biopsy and there could be local extensions (wrong assumption). Could not do the longer treatments when there was a chance of putting the cancer in the bucket. Nothing I read seemed to say surgery was a bad option for long term survival which is a major consideration for me with youngish children. Other lesser reasons which don’t currently spring to mind.

    The operation went very smoothly and my confidence in my surgeon was well founded. His comments that I can remember were that all went well, the left SV felt grainy as did the bladder neck. The lymph nodes were beautiful. We left hospital on op day plus 3. 3 or 4 days later our surgeon phoned us with an overview of the pathology report which was “very encouraging and specimen confined”. This made the following 2 weeks more bearable with the catheter.

    My PSA was 2.76 and my Free PSA % was 14.5
    Biopsy, 6 positive cores, 2 PIN, Gleason score 3+4=7, Gleason grade 4 only 10%

    Excerpts from the pathology report are as follows.
    Microscopy
    Sections of the prostatic apex confirm bilateral involvement by adenocarcinoma. The apical resection margins are negative for malignancy.

    Step sections through the gland confirm the presence of bilateral transition and peripheral zone carcinomas.
    The index tumor is a peripheral zone carcinoma located in the Rt posterior aspect of the prostate gland which exhibits architecture consistent with Gleason Grade 3+4=7, Grade 4 =10%. Lesser volume peripheral carcinomas are identified on the Lt hand side with morphology ranging from Gleason Grade 3+3=6 to Gleason Grade 3+4=7, Grade 4 =10%. High-grade dysplasia (PIN) is identified bilaterally.
    The transition zone carcinomas are located in the anterior of the gland and exhibit architecture consistent with Gleason Grade 3+3=6.

    Sections through the bladder neck, ejaculatory ducts and seminal vesicles are unremarkable. There is no evidence of tumor involvement.

    Conclusion
    Prostate-Adenocarcinoma.

    Bilateral peripheral zone tumors – Gleason Grade 3+4=7, Grade 4 =10%. The index tumor is located in the Rt. Posterior region. The tumors are prostate and specimen confined.
    Tumor Volume – 1.61cc
    Bilateral transition zone tumors – Gleason Grade 3+3=6. The tumors are prostate and specimen confined.
    Tumor Volume – 0.94cc

    I hope the above pathology was of some use to people, and not just because my typing skills are so poor.

    I have not had a chance yet to properly interrogate my Urologist. Some of my questions, and I welcome any comment, are
    Is there anything in this report or my case that appears unusual or may indicate further issues?
    Using Jims calculation (taken from a book) on PSA leakage I came up with a Tumor size of 0.665cc for my PSA of 2.76. This is considerably smaller than the actual tumor size of 2.55cc and therefore I would have expected a PSA of around 10. Does this indicate anything?
    In relation to the lymph nodes being visually in good condition. Is there any history of lymph nodes being cancerous when the Seminal Vesicles and ejaculatory ducts are clear of cancer?

    Jim I was interested to read in one of your posts that your son is in Afghanistan. I also have done 2 tours of Afghanistan though in the early days. I was also involved in the invasion of Iraq from the earliest stage. I have spent all my time at the pointy end thus understand the experience, give him my best.

    Before signing off the last point that I would like to make is the one I made in my first post. That is get and believe your “free PSA %”. Even if you have a low normal PSA but your “free PSA %” is lower than 25 get a Biopsy.

    Special thanks to Jim, Johnt1 and Tony

    Best of luck to all,
    david

     
    Old 09-09-2010, 09:13 PM   #12
    letsgetgoing
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    Re: A little unusual, I think?

    Hi Got,
    Thanks for your advice and I am very glad to hear that the HIFU treatment has gone so well for you guys.
    I can relate to your comments on incontinence as I have only had the catheter out for 3 days.
    The whole catheter episode was very unpleasant for me. Unlike some other gentlemen on this website who were able to walk some miles for exercise with it in, I was completely different. From day one I had severe pain in the end of the penis which was relentless, apparently this is one of the side effects for some people but not usually until after an extended period. The only way to minimize the pain was to sit still, I counted the minutes till it was removed.
    Thats even now becoming a distant memory and I am on to the next stage of dealing with the incontinence and ED, hopefully it will be resolved positively sooner rather than later.
    best of luck,
    david

     
    Old 09-10-2010, 07:27 AM   #13
    kcon
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    Re: A little unusual, I think?

    Quote:
    Originally Posted by letsgetgoing View Post
    ...My relatively young age of 51. My need to act decisively and hopefully only once....


    Hello David,

    First of all, congratulation on your excellent pathology report. Your strong desire to "act decisively and hopefully only once" has a very high probability of coming true! Your thoughts put into words here, and your case as a whole, sounded very familiar to me (I was 49 at diagnosis). After I realized that I was just outside of the low risk category for AS, I, too, recognized that I had a chance and a likelihood to put PC completely behind me and this helped in my decision making process, which also included considerations for my family situation. At this point, I consider my recovery to be complete...and I wish (and anticipate) the same for you.

    With pride, I wear my t-shirt (given as a Father's day present by my kids) which reads the score:
    Cancer: 0
    Me: 1

    Recognizing that you are now in the urinary control recovery phase, and recognizing the similarities of our cases, I thought I would provide links to a couple of past postings I have made to others about my lessons learned during this period. I off these in hopes that they help with insight of the road ahead for you:
        • Feedback to another patient about pads: http://www.healthboards.com/boards/showpost.php?p=4059515&postcount=12

        take care...

         
        Old 09-10-2010, 08:58 AM   #14
        letsgetgoing
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        Re: A little unusual, I think?

        Hi Kcon,
        Thanks for your kind words and encouragement, hopefully my recovery will follow a similar path to yours.

        The links that you have provided are excellent. Not just the content, which is just what I need at this early stage, but also the detailed way you went about it. The exercise picture you describe is very motivating.

        I agree our cases have some similarities. Very soon after my first post I found your first thread. The information contributed by yourself and many others was a great starting point for me and I am sure many others. Again its not just the information in the posts but also the inspiration the posters engender.
        Thanks and best of luck,
        david

         
        Old 12-02-2010, 10:11 PM   #15
        letsgetgoing
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        Re: A little unusual, I think?

        Hello All,
        At nearly 3 months since having the catheter removed I seem to have my incontinence somewhat under control and heading in the right direction.
        Currently and for the last two weeks I have been on one Depends per 24 Hrs. The urine weight is coming in now at just over 1oz or 30gms.
        I feel in control of the situation now but it was not the case earlier on.
        To begin with I was unaware that I needed to be doing Kegel exercises prior to the RP. Too focussed on the PC outcome I guess and I also moved fairly quickly from diagnosis. This oversight probably delayed my recovery in the early phase. I also have not used any professional help other than a little advice from my Urologist. The majority of my information has come from contributors on this website with special thanks to Kcon and his links on this thread.

        The early days were very frustrating. For at least the first two weeks it seemed I had no control other than when sitting or sleeping. I was diligent with my kegel exercises, initially doing four very strenuous sessions per day. Because of the RP and incontinence I was not exercising at all.

        The only time I was able to judge my ability to stop my urine flow was first thing in the morning or if I went overnight which I rarely needed to do. On most occasions by the time I got to the toilet the urine stream had already started but I was able to stop it mid flow with some effort. This was important for me as it showed me that the muscles were there and it isolated the muscles that I needed to direct my kegel exercises at. My take on the kegel exercises based on my Urologists advice is that you need to exercise the forward muscles of the pelvic floor. These are the ones that you use to stop the urine flow or if you wanted to raise your penis.

        My major planning issue at this early stage was how do I move forward from here. I could stop my urine flow but could not maintain the pressure continuously especially while moving. How can someone do one never ending pelvic floor contraction. What I decided to try was to do was what I called "a half hold", that is hold a contraction at an easily maintainable level and only use the full contraction when standing up, coughing etc. This of course was not perfect as I would often forget to half hold but it was a step forward from just doing kegel exercises and seemed to give me direction and a little more control.

        Overall though after 4 weeks I seemed to make very little progress which tempered my enthusiasm. As a result my kegel exercises almost ceased and I only did the half hold sporadically though I did continue to do a full contraction when standing etc. Funnily enough a week or so after this my control suddenly began to improve, though I was still on about four depends per day. I put this improvement down to time allowed to heal and more moderate kegel type exercises. I then seemed to have a steady increase in control with very lttle proactive effort to where I plateaued at about 8 or 9 weeks. I was still on 3 to 4 pads per day but they were lighter and I had more control unless I was active in the garden.

        At this stage I decided to start training again. This was a decision made more to maintain my usually good fitness levels rather than to help my incontinence. But the effect on my incontinence was amazing, within 2 weeks, on days that I was not running, I was down to one pad in 24 Hrs weighing about 2.3 oz or 65 gms. My traning consisted of running, dumbells and bag work. As I said above I am now down to just one light pad per day, 1 oz.

        The key points from me on my incontinence journey so far are:
        Accept that the initial period will be frustrating with very little return on effort, you need to heal.
        Do not over do kegel exercises especially if you have not done them pre op as the muscles simply become too tired to do their job.
        Practice the half hold when moving around.
        Always practice fully holding when standing, sitting, coughing etc to try to make it semi automatic.
        Dont forget to visit the toilet to get back into the habit and to stop the bladder pressure from over riding your muscle control.
        Exercise from the start, at least walk even short distances.
        When you plateau it sometimes helps to make some changes to your training to restart the improvement.
        Its just takes time but once the foundation is there it creates its own momentum and seems to improve with less effort.
        Thats all that I can think of for the moment.

        Overall I think my incontinence is progressing at the average or maybe just a little slower than average for my age, 51.
        On the other hand I am very happy with my erection situation. From 2 weeks post op I have been able to achieve an erection (up to 80%) and orgasm both with and without drugs. I think I am very lucky in this respect so much so that my urologist's words were "thats bizarre". He did mention though post op that my nerve bundles came away from the prostate very easily and that they commented on it during the process.
        Finally I had my first post op PSA test and its all good so far, <0.03.
        I consider myself very lucky so far and am very thankful.
        Good luck to all,
        david

         
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