Post Edited (Casey59) : 3/31/2010 8:13:05 AM (GMT-6)
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.
Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.
I understand where you are coming from 150%. I am the same. A G6 with no adverse pathological features and I am still scared as crap everyday. I noticed the same thing as you on this board. People with great pathologies and then they have BCR. Obviously, they weren’t organ confined.
So, here is what I know.
These studies of G6 people from Johns Hopkins.
This study was of 2,551 men who had surgery from 1983 to 2005.
With a median follow-up of 5.0 years (range 2–22), BR occurred in 13 patients (0.5%). The 5-, 10- and 15-year actuarial probabilities of BR were 0.3%, 0.9%, and 1.3%, respectively. Five patients (0.2%) developed LR, four of whom received salvage radiotherapy with subsequently undetectable PSA. The 5-, 10-, and 15-year actuarial probabilities of LR were 0.1%, 0.5%, and 0.5%, respectively. There were no Distant Mestastasis and no Prostate Cancer Specific Mortalities.
Then Johns Hopkins comes out with this study.
The authors conclude that most prior reports of organ-confined, Gleason score 6 with progression have, in fact, been undergraded, understaged, or situations with ambiguous staging. They go on to say that, “Even for the rare true organ-confined, Gleason score 6 (no pattern 4) tumor with supposed biochemical progression, some may be false-positive progression based on low post-radical prostatectomy prostate-specific antigen levels and minute tumors that seem highly improbable to progress.”
So, even if you have BCR it is not likely to do anything. “Great, I feel cured.” NOT!
Then Sloan Kettering comes out with this study. Which showed a crappy 1.9% of people in the low risk people had metastatic progression. Notice nobody in the Johns Hopkins studies did. I don’t know what to think now.
I also have another study, I can’t find the link it is at work, that showed after 22 years only 1 person out of 3768 G6 people died of PCa. That’s a 99.97% survival rate after 22 years, although Johns Hopkins has 100% survival.
Anyway, so to further assess my situation I went to Yana-Now.net and looked at all of the G6 people on their web-site. You have to read each of the bio’s because a lot of people are classified as G6 that actually weren’t after surgery. Out of the 173 people I looked at only 5 had BCR. The furthest one out was 19 years and he has done nothing, no salvage treatment and is PSA is 4.
I also found one other story about a guy with G6 in his lung after RP. After they removed nodule his PSA was undetectable.
So, I don’t know what to think. I am only 44 and I believe I have some for of aggressive G6 because I had it so young, although everyone from my local URO to Dr. Epstein at Johns Hopkins says that age has nothing to do with it. I suppose the only solice I have is that since I went to Johns Hopkins, even if they missed things on peoples pathologies, if they say you are a G6 in their books I know what happened to each and every patient after that. Nothing......
Even with all this good data and for having cancer, we got off very, very lucky, I still loose a lot of sleep over it. Not to mention every time I have a health problem I go running to the Dr. to make sure it is not some kind of other cancer.
By the way they also told me that a PSA test once a year was "more then adaquate" for G6 people. It was like I could do it less often then that if I wanted and the ultra-sensitive is not neccessary to them and only causes unnecessary anexity. So I don't do the ulta-sensitive as long as it is <.1 I'm good.
Post Edited (ChrisR) : 3/31/2010 5:05:03 PM (GMT-6)