Recent diagnosis G9

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Searchmode
Regular Member


Date Joined May 2011
Total Posts : 20
   Posted 5/10/2011 8:46 PM (GMT -6)   
My husband has a recent diagnosis of PCa. His psa is 14, 1st Gleason 7 and second opinion from Epstein was 9 (4+5) on most cores with one core 7.  11 out of 12 cores positive, 1 core PIN. MRSI probable sem ves invasion. PET and Bone scan negative. Robotic Surgery with Tewari is scheduled. He says T3, recommends surgery, then radiation, and HT if needed. Saw radiologist yesterday who very strongly recommmended IMRT and said that surgery is not good choice. Confused and will appreciate any advice that you can offer. Want to make best decision for doc and treatment. thanks much!

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 473
   Posted 5/10/2011 9:01 PM (GMT -6)   
Hello Search, and welcome to a fantastic forum that no one wants to join. The fellows on this forum are among the finest anywhere, and this is a great place to obtain information that provides fodder for your decision process. You have provided a lot of information which helps, but let me ask a couple of questions; How old is your husband, and, aside from the PCa, what is his general health?

I'm also a Gleason 9. I had the open RP surgery, and am now on hormone therapy. (Lupron)

k
Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg, Ves neg
tumor contained, still 4+5=9
pni ext.
9/3, 2010 PSA - 0.04
9/3/2010, I'm 99% continent
10/14/10, PSA still 0.04, and lupron #1, now 99.9% continent
Total ED, 3 caverject failed
10/20/10 OD'd .5cc trimix, after 3hrs, neo synephrine shot
tried .15 & .17 cc neg, next .2

JNF
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Date Joined Dec 2010
Total Posts : 1601
   Posted 5/10/2011 9:06 PM (GMT -6)   
My urologist would not operate as the probability of PCa escaping the capsule was high. He said why operate with risk and side effects and then radiate with additional risk and side effects? The best surgeons like Walsh and Scardino will not operate on people with stats like your husband and myself.

For advanced cases like us the combination of brachytherapy and IMRT is superior to surgery and with fewer side efffects. I used High Dose radiation brachytherapy with IMRT. I am also on ADT. Check HDR brachytherapy at www.cetmc.com.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011

142
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Date Joined Jan 2010
Total Posts : 5809
   Posted 5/10/2011 9:40 PM (GMT -6)   
Sounds like mine. I am a G 4+5, but did not have issues in lymph nodes or Seminal vesticles. Multiple surgeons felt like they had a chance of controlling the cancer for a time (no one promised a cure).
 
I got the "great results, you will be cured" pitch from multiple Radiation Oncologists, but none offered better than 70% success when pressured. 70% in my world is far worse than the most abysmal failure, and gets no acknowledgement from me.
 
There is a trade off. With surgery (as I chose) there are guaranteed issues (short or long term varies, mine are long term) with ED and incontinence. RT may have less side effects short term, but can have ED issues years down the line.
 
I chose DaVinci surgery, followed by the same radiation that was supposed to save me all by itself. The two together did not accomplish the promised results, and I am off to the oncologists yet again.
 
Get multiple opinions from doctors of the same type (surgical, radiation, whatever) before making a choice.
 
 
DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2676
   Posted 5/11/2011 1:22 AM (GMT -6)   
There are more excellent surgeons that will operate, than will not, just an educated guess. A lot of the celebrity type surgeons are very selective about who they will operate on so as to have better statistics , i.e cure, neg margins, continence etc. This is fairly common knowledge for the PCA afficianado's I can't help you on your choice. Just didn't want you to think that you are so far gone that surgery is not an option. You are no way near that point. I f I had to make the choice for you i would go with your docs plan. Just make sure he is well versed in DiVinci
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving

proscapt
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Date Joined Aug 2010
Total Posts : 523
   Posted 5/11/2011 2:05 AM (GMT -6)   
Consensus thinking used to be that if the cancer was not capsule confined then there was no point in surgery. More recent research is showing benefits (for example, lower biochemical recurrence rates) in doing surgery even in people who have extra capsular extension or positive margins, and the removal of lymph nodes adds to the effect. It is not entirely clear why that is the case but the data are there. In most cases there is adjuvant therapy so maybe taking out the bulk of the tumor gives the adjuvant therapy more of a chance to work. You can look at the free abstracts on pub med to track this for yourself. So this is an unsettled area, but it looks to me like the conventional wisdom is slowly shifting.
"If the tool in your hand is a hammer, then every problem looks like a nail."

DX age 54 12/2009
PSA 5.6, DRE-, high pre-op PSAV. Clinical stage T1c
Biopsy: Gleason 3+4 with PNI / 6 of 14 cores + / 10% of total length + / worst 45% +
DaVinci RP 2/2010
pT2cNx / Gleason 3+4 / PNI+ / SM- / SV- / EPE- / Tumor vol 3cc / vol 40cc / 63 gm
PSA in 2010: <0.01, 0.01, 0.01
PSA in 2011: 0.01

Sagittarian
Regular Member


Date Joined May 2011
Total Posts : 412
   Posted 5/11/2011 4:10 AM (GMT -6)   
 
 
DOB = DEC-1957
PSA History
2002 = 1.83
2006 = 3.18
2007 = 3.09
2008 = 3.20
2009 = 3.50
2010 = 3.50
2011 = 4.70
2011 = 4.20
Free PSA = 7%

Biopsy, 12 Cores, April 2011
4 Positive, 2(3+3), 2(3+4) All Left Side
% on Positive Cores, 2(40%) 1(70%) 1(90%)
PNI = Not observed

Da-Vinci Surgery = 23 May 2011

Sagittarian
Regular Member


Date Joined May 2011
Total Posts : 412
   Posted 5/11/2011 5:11 AM (GMT -6)   
PC is unlike any other medical condition.  Most other conditions have a straight forward approach.  I am by no means suggesting any form of treatment.  We are all baffled with the treatment choices laid at our feet, which magnifies the stress & confusion.  As alone and helpless you may feel (as we all do), you will find a degree of comfort with this forum.  It will also assist you on making your choices.  Waves of dispair and hope come and go, and will be overwelming at times.  This is normal, but there is a shinning light, that this sight will provide.  There are many success stories here, regardless of the gloomy picture painted in ones mind.  I wish you the inner strength to drive on, keep researching, and give PC all the hell that you can.
DOB = DEC-1957
PSA History
2002 = 1.83
2006 = 3.18
2007 = 3.09
2008 = 3.20
2009 = 3.50
2010 = 3.50
2011 = 4.70
2011 = 4.20
Free PSA = 7%

Biopsy, 12 Cores, April 2011
4 Positive, 2(3+3), 2(3+4) All Left Side
% on Positive Cores, 2(40%) 1(70%) 1(90%)
PNI = Not observed

Da-Vinci Surgery = 23 May 2011

Searchmode
Regular Member


Date Joined May 2011
Total Posts : 20
   Posted 5/11/2011 5:44 AM (GMT -6)   
wow... thank you all for the quick response! My husband is in very good health. He is 57 and has never been ill. He works every day and is active. Has anyone had experence with Dr. Tewari?

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 976
   Posted 5/11/2011 6:08 AM (GMT -6)   
I understand that he is one of the best. Just from reputation.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic RP March 2009
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes - tumor volume 9%, nerves spared, no negitive side effects.
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT .01, < .01

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3129
   Posted 5/11/2011 6:28 AM (GMT -6)   
Get your psa tests after LRRP in writting and maybe go to ultrasensitive .000 3 digits if you wish such good knowable info. Myself would get psa tests every month(especially with your scenario), I found a walkin for $15...I had stats similar to yours in 2002....that information helped me know plenty. To each their own anyway. Get your post op pathology report in writting and post the info here...lots of guys did surgery and decipher it all for you. Big time important details within.
 
I had stats like yours and denied surgery by Dr. Menon and righteously so, I praise him. I actually recommend you do not do it, but you already scheduled....usually most patients go with whatever the 'good doc' says, thinking all are equal experts and this like treating the flu or something.  Ask about your nomograms and odds for curative surgery just for curiosity and see if your doc already did this for you???
 
Best of your journey going forward

Post Edited (zufus) : 5/11/2011 5:33:52 AM (GMT-6)


davidg
Veteran Member


Date Joined Feb 2011
Total Posts : 4021
   Posted 5/11/2011 6:32 AM (GMT -6)   
he is considered one of the best. The only thing I would verify is if he does his surgeries by himself start to finish because I've heard otherwise. If that would be important to you of course.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

kbota
Regular Member


Date Joined Aug 2010
Total Posts : 473
   Posted 5/11/2011 6:40 AM (GMT -6)   
Ms Search, your husbands stats are very similar to mine at the same stage of diagnosis, and for what it's worth, my cancer was capsule confined. So, my body has been "debulked" of cancer. Therefore, my dr did not suggest radiation. We will save that bullet for when/if it's ever needed. I am currently taking hormone therapy with the goal of it "killing off"any remaining cancer cells.

I am obviously not a dr, but at his young age, I think you are getting good guidance.

Good luck, and God bless

K
Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
Biopsy, 7 of 18+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg, Ves neg
tumor contained, still 4+5=9
pni ext.
9/3, 2010 PSA - 0.04
9/3/2010, I'm 99% continent
10/14/10, PSA still 0.04, and lupron #1, now 99.9% continent
Total ED, 3 caverject failed
10/20/10 OD'd .5cc trimix, after 3hrs, neo synephrine shot
tried .15 & .17 cc neg, next .2

Post Edited (kbota) : 5/11/2011 5:43:46 AM (GMT-6)


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 338
   Posted 5/11/2011 9:05 AM (GMT -6)   
Search:
My numbers were similar to your loved one. My urologist said he would not cut me, thankfully. My radiologist was depressingly honest and unwilling to do any more than the minimum treatment of 70 cgys with "maybe" seed boost. Sorry, brother, you're out. However, he referred me to a top regional doctor who said surgery could be the first step in a series of treatments lasting for many years. He was right and I went with him.
Surgery has the advantage of providing a better chance of local control, that is, less prostate area problems in the future since there is no prostate. Also radiation on lymph nodes or elsewhere in the region may be available in the future.
On the other hand if surgery is not the best choice for cancer control why go with a second best option in the first place? Radiation with hormone neo-adjuvant (at the same time) has been shown to be superior in results with men like y. l. o. compared to hormones alone or surgery alone.
The key point is that he should look at this decision as the first in a series of treatment options. He has a long way to go, and many years.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3181
   Posted 5/11/2011 10:40 AM (GMT -6)   
in your situation i wouldn't be talking to any doctor who wasn't recommending some sort of combination treatment.  i went with seeds, IGRT and  short-term lupron.  not all guys qualify for seeds and surgery may very well be needed.  anyhow i wouldn't be open to the piecemeal approach with your diagnosis.  good luck to you.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Piy
Regular Member


Date Joined Mar 2010
Total Posts : 135
   Posted 5/11/2011 10:48 AM (GMT -6)   
Sagittarian said...
  Waves of dispair and hope come and go, and will be overwelming at times.  This is normal, but there is a shinning light, that this sight will provide. 
Boy ain't that the truth!!
 
My husband's stats in 2007 were very similar to your husband's.  We chose DaVinci followed up by SRT, had recurrence within 1.5 years and in 2009 went through chemo, HT and anti-angiogenics.  Ended HT in Sep of 2010, still on anti-angiogenics.  PSA is creeping back up so not much of a break before next round begins.
Good luck and hang in there!

Dx June 2007 - age 48

davinci RRP October 2007
75% of prostate involved
G9
Positive margin
Scans clear
No detectable mets
SRT - Feb 2008
PSA:
At Dx: 8
Mar 09: 0.4
Jun 09: 0.7
Aug 09: 1.7
Feb 10: .008
Apr 10: .007
Jul 10: .006
Sep 10: .005

Commenced Dr. Robt Leibowitz "Three Pronged Approach" protocol in August 2009

Completed chemo Dec 28 2009

John T
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Date Joined Nov 2008
Total Posts : 3620
   Posted 5/11/2011 11:19 AM (GMT -6)   
A combination treatment should be used for high risk cases. It is very unlikely that surgery will result in a cure because of SI, high gleason and high psa. Surgery can be used as a debulking procedure and you will have the side effects of surgery stacked on the side effects of radiation and HT. Another option you may look at is Brachytherapy with IMRT to both the prostate and pelvic area along with HT. This will result in overall less side effects and according to some studies cancer control much better than surgery alone.The Dattoli Center in Sarosata does a lot of work with high risk patients. You best bet at this point is to get a prostate oncologist on you team as you will definately need him. A list of prostate oncologists and their location can be found in "Invasion of the Prostate Snatchers" by Dr Mark Scholz. You are beyond the treatment capabilities of a surgeon or radiologist although they should both be on the team that recommends treatments. An experienced prostate oncologist should direct the treatment team in order to achieve the most favorable outcome. Your husband should also get a PAP test as this is the most predictive of surgical and radiological failures. You may also want to get ISPIO imaging from Sandlake Imaging in Orlando as SI is indicative of lymphnode invasion and systemic disease.
Good luck
JohnT
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Searchmode
Regular Member


Date Joined May 2011
Total Posts : 20
   Posted 5/12/2011 4:20 AM (GMT -6)   
Thank you all for your support, advise and sharing of info. We are reading everything you send! This is all so helpful! Just wondering if anyone has used Tewari? He came highly recommended and we have spoken with one person who used him but his gleason was a 6. This gentleman was very pleased. You have all been so welcoming and we are grateful!

GTOdave
Regular Member


Date Joined Oct 2010
Total Posts : 166
   Posted 5/12/2011 6:36 AM (GMT -6)   
I didn't use Tewari, but know two who did, and they are happy with their decisions.

That said, I am amazed he is recommending surgery in this case.

Please, at a minimum, postpone the operation and get to a PC oncologist - ASAP! Remember, surgeons sell surgery, radiation docs do the same. You are facing a tough situation and need an independent advocate to guide you. If surgery is recommended, you can always go back to Tewari (and be one of his 4-5 DAILY DaVinci patients) and re-schedule.

Know this, 2 different urologists told me they would not EVER operate on a patient where the cancer had metastisized, saying that there would be no point, as radiation would have to follow. Regardless of the procedure being less invasive than open surgery, it still hurts, recovery is a challenge and it takes time.

Good luck to you both!
52 yr old, PSA 3.5, Gleason 6 with 3 of 4 top nodes (0%;1%;10%;1%) cancerous. Bottom 2 floors are clean.
PSA 7/08: 2.2; 7/09: 2.9; 7/10: 4.1; 11/10: 3.5

First post-op PSA <.00! 7 weeks after

DaVinci surgery at Yale 3/4/11. Dr. John Coleberg THE BEST!!!

45 gram gland weight
Gl 3+3
PT2C
margins clear
no metastasis
5% of gland adenocarcinoma

gibson00
Regular Member


Date Joined Nov 2009
Total Posts : 189
   Posted 5/12/2011 6:54 AM (GMT -6)   
Searchmode - My father's stats were similar to your husbands, gleason 9 & 10, T3 with seminal vesicle involvement.
Dr's said no to surgery, and instead his primary treatment was IMRT and ADT (Casodex followed by Lupron), along with a small course of chemo (taxotere) all as part of a study. His IMRT treatments ended about 1 year ago, and he still has about 6 months of Lupron left I think.
At the moment, knock on wood, he is doing very well with an undetectable PSA, and just dealing with some side effects of treatment (some pain down there).
Note - disregard my signature, it is not up to date, and I can't seem to edit it!
Father 65 y/o at diagnosis November 2009
Gleason 9 & 10, stage 3 - seminal vesicle involvement
Two TURPs mid Nov. 2009
ADT Nov '09
Suprapubic Catheter March 18th, but blocked right away, back to Foley...
IMRT March 25th
Ended IMRT and Chemo (Taxotere) late May
Sept '10 - May '11 - PSA undetectable!

Post Edited (gibson00) : 5/12/2011 7:40:25 AM (GMT-6)


Bluepoint oysters
New Member


Date Joined Apr 2011
Total Posts : 8
   Posted 5/12/2011 8:38 AM (GMT -6)   
I underwent robotic surgery with dr tewari on April 5th of 2011. He is excellent.his staff and wiell Cornell staff are also total pros.He probally does fifty surgeries a month so he has probally seen almost everything that's connected with Pca.Everyone is different I'm 50 years old and in good shape. I'm down to 1 pad per day and getting better every day.Ed still a problem but I'm sure in a little time that will improve. If surgery is the route you choose I'm positive you are in great hands.He does about 80 percent of the surgery his team starts the prep and closes.

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 959
   Posted 5/12/2011 12:42 PM (GMT -6)   
If you decide on surgery, Dr. Tewari would probably be a fine choice. I don't know him personally, but has a good reputation and considerable experience. The much harder question is whether surgery is -- or is not -- the best choice. On that question, you may have a "bias problem" -- surgeons get paid for doing surgery, and are most familiar with surgery, so on the whole -- albeit with exceptions -- they are more likely to recommend surgery. Same is true with radiation oncologists, for radiation. That does not mean that these doctors are unethical or that they put profits before their patients' health. It is just that their perspective on difficult questions, which have no clear "right answer," is colored to some extent by their experiences, their familiarity and expertise, and by their own interests. We all have biases, so nothing surprising about this. Given this, I think JohnT has the best advice for you. Go see a medical oncologist. First, with some advanced statistics, you might need a medical oncologist now or at some point. But, more immediately, a medical oncologist (at least if you see the right one) will be (1) knowledgeable about prostate cancer, but (2) not as likely to have a strong pro surgery or pro radiation bias as a surgeon or an RO -- since the medical oncologist does not do any of these procedures. In your situation, there is absolutely no way I would decide on surgery or radiation without meeting with a medical oncologist who has expertise in prostate cancer. I would not say the same thing for low risk disease, but for higher risk disease I think it is very important. If you tell us where you are located, someone on this board will be able to suggest the name of a medical oncologist with whom you should consult. Best wishes, Medved

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 2269
   Posted 5/12/2011 1:51 PM (GMT -6)   
I must agree with JNF 100%.. I had similar stats to your husbands..I have had all 3 treatments. The surgery was a waste of time in my case and the complications almost killed me..(Staph infection).

They SAY having surgery and reducing tumor volume helps but I think it helps surgeons bank accounts more than anything else..Just My Opinion...

Gleason 8-9-10 is a whole different ball game...The seeds plus IGRT for a total dose of around 150Gy seems to deliver the best overall results..And yes, a little ADT along with the radiation seems to enhance the effectiveness of the radiation..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Searchmode
Regular Member


Date Joined May 2011
Total Posts : 20
   Posted 5/15/2011 9:45 PM (GMT -6)   
Looking for your recommendations for a top notch med oncologist? We are in Delaware but can travel. Anyone have experience with Snuffy Myers?

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4450
   Posted 5/16/2011 2:43 PM (GMT -6)   
Hey, guys, let's not let this one slip off the front page
James C, 64, Kingsport, E. TN
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% inv, lf. lobe, GS6
9/07: Nerve Spar. open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 4/10-.06, 9/10-.09, 12/10-.09, 2/11-.08, 5/11-.08
Bimix .30
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