Did I make a mistake ?

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fatcat
Regular Member


Date Joined Jan 2008
Total Posts : 31
   Posted 2/11/2008 12:58 PM (GMT -7)   

Just got back from the Doctor, I have surgery March 4th. My dilemma, had an up dated PSA 3.5, prostrate 22 or 33, something to do with size, not sure will look at my records later. The PSA has been steadily dropping 5.2, 4.8 and now this; I am not on any kind of therapy for size. My Doctor says if anything “it’s smallish.”   59 years old, 12% of one core positive out of 13. Should I wait a bit?  What do you think?  You folks have been really, really helpful, so I trust your opinions.


Dave7
Regular Member


Date Joined Jul 2006
Total Posts : 201
   Posted 2/11/2008 1:11 PM (GMT -7)   

What was your gleason score from your biopsy?   Not that that would cause me to feel competent to suggest what you should do, but it might assist others in making suggestions.


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 2/11/2008 2:10 PM (GMT -7)   
Hey Fatcat,

It ain't gonna go away...

Jim
Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Catheter out on 12/13/06.  Dry on 12/14/06.
Pathological stage: T2C N0 MX. Gleason 3+4.
PSAs from  1/3/07 - 1/17/08 0.00. 
Next PSA test on 7/17/08
"Patience is essential, attitude is everything."
 


Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 2/11/2008 2:15 PM (GMT -7)   
i think one of the hardest things to do is second guess your decision. Remember, PSA can swing wildly around. you've been diagnosed with cancer, it is not going to go away. The size of your prostate has nothing to do with the presence of cancer. The prospect of surgery...and life changing surgery at that is very scary. It is normal to rethink every decision you have made. I rmember the feeling of being on a wild ride with someone else at the wheel and in control. I don't think you have made a mistake. you are being very normal by feeling this way. Try not to let these feelings sway your thinking about the decisiion you have made. Now, if you ask the doctor and he thinks you should wait, that is his medical advice. For me...and for me alone...part of my deciions was my wife's desire to get the stupid thing out and put it all behind us.
You sound perfectly normal in your process here!
Paul
47 at Diagnosis.
Father died of Pca 4/07 at 86.
1/06 PSA 3.15
1/07 PSA 4.6      (Biopsy 3/07 just suspicious)
10/07 PSA 5.06   (Biopsy 11/07  1 of 12 with 8% involvment) (1mm)
Da Vinci surgery Jan 5, '08 at Mt. Sinai Hosp. NYC  www.roboticoncology.com
Saved both nerve bundles.
Path Report:  Stage T2cNxMx
-Gleason (3+3)6
-totally contained to prostate,
-10% involvement in L & R Mid lobes
 
 


Tamu
Veteran Member


Date Joined Oct 2006
Total Posts : 626
   Posted 2/11/2008 3:35 PM (GMT -7)   
My biopsy indicated 1 sample in 10 with 40% carcinoma. I went for a second opinion on treatment to a univeristy based medical center. Their protocol included having the slides read again by their pathologist. The result was that it was read as atypical instead of cancer. At that point my urologist at the univeristy based clinic then sent the slide to Dr. Jon Epstein at John Hopkins. He read it as cancer. The post op path confirmed it. My point in relating this is that perhaps you should ask for your slide to be read by another pathologist just to confirm. If it is confirmed then it is not going to go away. There have been several men that have elected watchful waiting. You might want to go to www.yananow.net and go to Mentor Experiences. Find the Watchful Waiting list and read the stories of those men that have chosen watchful waiitng.

Tamu
Diagnosed 7/6/06, 1 of 10 core samples, 40%,Stage T1c, Gleason 3+3
Da Vinci on 11/01/06, Catheter out on 11/13/06
56 Years Old
Post Op Path, Gleason 3+3, Approx. 5% of prostate involved
Prostate Confined, margins clear
Undetectable PSA on 12/18/06, 6/25/07, 1/8/08
No more pads as of 1/13/07
Began injections in April '07
 


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 2/11/2008 3:45 PM (GMT -7)   

With recent more extensive screening, many men are now diagnosed as early stage gleason 6 cancers, with the resulting debate about over diagnosis and over treatment of miniscule amounts of cancer.

Dr Epstein and Johns Hopkins have several studies, and published criteria for "insignificant" cancers, which was defined as PSA density below .15*, no more than two biopsy cores with cancer, no biopsy with more than 50% cancer and no high-grade cancer.

*PSA density is PSA figure divided by the gland size. A larger gland naturally produces more PSA.

Biopsy readings are subjective: what looks like cancer to one person might appear more normal to another, which is why biopsy slides should be sent for a 2nd reading.

12% in one core of 13 does not indicate a high volume of cancer. If your gleason scores are not in the high risk category, it's worth waiting for now to further consider your options if you're doubtful. Best to feel sure you've made the right choice and have selected the best doctor available.

Whether you would want to use active surveillance medium to long term is another question. Not everyone can handle that approach, and many want to have it out yesterday.

 

 


norskie
Regular Member


Date Joined Jan 2007
Total Posts : 376
   Posted 2/11/2008 3:59 PM (GMT -7)   
My situation was I had 2 samples positive out of 13 each with 10%, 3+3 for gleason of 6. I remember asking my doctor some of the very questions you are having and what options I could or should do. The bottom line he told me was it's my decision to make but the one fact that would not change was the fact I did have it, that would not change. So based on that I made up my mind of what was best for me and proceded on. I did opt for surgery in my case and what I found out was my cancer was much more agressive then the biopsy indicated and that I was lucky to have done something when I did. I was up-graded to a 4+3 gleason 7 with a couple 5 cells. This I would have not known without completing the surgery. I am not telling what to do or what treatment to follow, there are many good options, my story is just to give you another bit of information that can occur. What you do and or what treatment you decide to follow is in your control. But once you make it don't look back, move forward with a great attitude and take this desease on with great energy. I hope this helps some and best of luck to you on your journey and be sure that I will keep you in my prayers.

Norskie
norskie
Age 49, PSA 6.22 on 9-26-06
Biopsy 11-01-06, 2 of 13 cores 10% cancer, 2 other cores abnormal Up-dated 20% prostate cancerous
Gleason score 3+3=6 After Pathology report 4+3=7 a couple agressive Grade 5 cells found
Da Vinci surgery 01-09-07 UW Madison
Pathology Report- cancer 100 % capsual contained 1-18-07
Catheter removed 1-18-07 suffered bladder spasms Catheter reattached 1-18-07 Catheter removed 2nd time 1-24-07
1st & 2nd Post PSA Blood Test .1 and less - Undetectable
3nd Post PSA Blood Test 01-17-07 .3-Next action awaits me.
Next PSA Scheduled and meeting with Radiologist set for 3-27-08
Incontenence-Pad free since end of May 07 4 1/2 months post surgery 
ED back to 95% prior to surgery - no medication required.


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 2/11/2008 4:17 PM (GMT -7)   
FatCat,

Which is going to cause you more stress, getting treatment over with, or waiting it out? No one can answer this question other than you, yourself. If your prostate is indeed 22gms, this isn't necessarily a teenie, tiny cancer. It may be small but not insignificant. At a mere 59 there is one thing we know for sure...PCa will eventually spread.

Do you have time to take a splendid summer and not be stressed...most likely, yes! Do you have years to wait out a confirmed cancer diagnosis.....sorry, it'll outlive you. This is one area when being "young" is not to a man's advantage. Good luck and take some time if you need to think a while. There isn't a huge rush.

Swim
 


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 2/11/2008 5:50 PM (GMT -7)   

Hi FatCat,

No cancer diagnosis is "insignificant."  Based on what you have said thus far, it appears that you have some good time to get a second or third opinion. 

It would also be good to obtain your detailed path report from the biopsy and discuss it with another health care professional such that you can have a good discussion regarding the benefits of another opinion.  It may cost a little, but sounds like it would be worth it.

Following my biopsy, I talked to several other health care professionals, w/o doing extra tests.  These discussions confirmed my choice of surgery, but everyone's case is different.

Like Jim (Biker) said.  If you do have cancer, it will not get better by itself.  It would be better to treat when it is smaller and non-invasive outside of the prostate.

I hope this helps.

All the best,

Barry


"Idaho" ~ Barry

 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

1st PSA  9/11/2007   <0.04 (undetectable)

2nd PSA 12/10/2007  <0.04

My web site: http://pca-info.blogspot.com


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 2/11/2008 6:30 PM (GMT -7)   

Hey Fatcat, you pushed a lot of buttons with your post.  It is for sure the biggest question we all had after diagnosis.  My cancer was pretty isolated, but it was a Gleason 8 so my only question was which treatment.

I think the post by Selmer is one of the best thoughtout,  and evenhanded on the subject of should I or shouldn't I.  Good luck with your decision,


 
Biopsy 10/16/06
T2A,  PSA 4.7
Gleason 4+4=8 right side
adrenocarcinoma of prostate
DaVinci Surgery 01/16/07
Post op report,confirms Gleason4+4=8 , no extra extension or invasion
No continence problems
PSA results 90 day (-.01) 6 months (-.01) 9 months (+.02)
PSA one year (+.02)
Using Caverject/viagra for continuing ED problems (one year)
 
 
 
 
 
 
 
 
 


fatcat
Regular Member


Date Joined Jan 2008
Total Posts : 31
   Posted 2/11/2008 6:44 PM (GMT -7)   
Thanks for all the answers and thoughts, I'm trying to make sense of all the information, so far it's on for the Surgery. I now have time for some soul searching.   Thanks

Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2249
   Posted 2/11/2008 11:51 PM (GMT -7)   
My prostate cancer was diagnosed at a very early stage. It was 4  months from the PSA rise to the biopsy and another 4 months from the biopsy to surgery.  Eight months total.  I had plenty of time to research options.  Watchful or expectant waiting seemed at first like a very good option, but the more I read the less it seemed like an good option and more like playing Russian roulette.
 
At an early stage you have time on your side, but when you do decide what to do--or not do--the cancer will still be there.  Is it aggressive? Is it slow-growing?  Will it spread outside the prostate? How soon?  
The answer to these questions is unknown. I personally chose to use the window of opportunity I had to make a decision that was right me.  It was not by any means an easy choice, but I don't regret making it. 
 
Take care and hang in there...Tim
 
  
 
 


Age 59 PSA 2.6 PSA velocity quadrupled in 1 yr 
1 of 12 biopsy cores positive (5%) 
Open surgery June 2006  Cancer confined to one small area of the prostate Gleason 5
Post-op PSA's non-detectable

Post Edited (TimG) : 2/12/2008 12:02:27 AM (GMT-7)


lawink
Veteran Member


Date Joined Oct 2006
Total Posts : 621
   Posted 2/12/2008 7:43 AM (GMT -7)   
Hi Fatcat! :-)
With us it was .. .I have cancer .. .get it outta there!  The watchful waiting would have driven both Bob and I nuts, but that's us.  As it was we had to wait 4 months from diagnosis to surgery and even that was tough.
 
Put it this way, you could regret waiting down the road, but you will never regret getting rid of cancer and on with your life.
 
Good luck!
;o) Bob & Linda
 
Bob (61) - Laproscopic Prostate Removal Sept 27, 2006.
2 of 12 malignant biopsy samples - gleason 3 + 3 = 6.
 
Pathology - cancer completely contained, even a second more aggressive, previously undetected cancer)
PSA UNDETECTABLE Nov 2006, Feb, May, Oct2007.  ONE YEAR!!!! WHOOO HOOOO! 

Bob also has two secondary conditions -- Polycythemia (elevated red & white cells & platelets) and . . Myelofibrosis) -- If anyone has experience with or information on these, please email us.


hawkfan75
Regular Member


Date Joined Jan 2007
Total Posts : 165
   Posted 2/12/2008 11:11 AM (GMT -7)   

Hey Fatcat

I echo a lot of what has been said.  I too was having lots of doubts surrounding my choices of surgery, seeds, or just waiting.  My cancer was suspected to be very small.  I decided on the surgery, and am glad I did.  As you can see, my pathology report was worse than expected, and I've had to go through additional therapy.  Many have a small amount and surgery or seeds takes care of it.  Others change their lifestyle and live with it.  It would be great if there was a sure fire test to see exactly how much cancer you have and map it out to see if it was approaching the margins, but there isn't.  The needle biopsies do a good job, but even with thirteen darts, you're not going to hit all the numbers on the dart board.

I agree to get additional opinions on your cores.  Then do a lot of soul searching and make your decision that you feel will best suit you.  Good luck.


Age 57 at diagnosis,  PSA 4.7 (up from 3.2 one year ago)
Biopsy November 8, 2006 1 of 10 cores positive 5% LEFT Side Gleason 3+3
Robotic surgery January 19, 2007
Post Surgery Pathology Stage T3a, Gleason 3+4, positive margins and capsular penetration RIGHT Side
Post Surgery PSA:  March 5:  0.01
5 month PSA, June 13, 2007:  0.08
Adjuvant therapy began June 26 with Zoladex injection
Radiation began August 23, ended October 8
First post radiation PSA, December 18, 2007:  0
 
 


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 2/12/2008 11:42 AM (GMT -7)   
Well...there is a color doppler test but the only Doc I know for sure specalizing in this test is, Fred Lee in Michigan.
He's supposedly one of the world's few PCa specialists. Many a man has made the trip here to see Fred. He's a long time PCa patient himself.

Swim
 


CaPCa
Regular Member


Date Joined Aug 2007
Total Posts : 118
   Posted 2/12/2008 2:17 PM (GMT -7)   

The lumpectomy approach sounds intriguing, however I would be concerned with leaving the prostate intact. PCa is multi-focal, and a focus of cancer cells too small to be mapped could be missed. Even if all of the cancer were removed, the genetic and/or envronmental factors, which caused the cancer in the first place, could strike again somewhere else in the remaining prostate. Obviously, age and concern of side effects from other treatments must be weighed, and I am biased due to my personal choice of surgery.


Age:44
Father diagnosed and cured at age 52.
08/21/07: Diagnosed with T1c cancer
1 of 12 biopsy cores positive; 10% tissue
Gleason score: 3+3=6
PSA level prior to biopsy: 4.3 (velocity < 0.4ng/ml)
10/19/07: da Vinci prostatectomy by Dr. Vipul Patel at OSUMC.
              Difficult surgery due to prostate inflammation.
              Both nerve bundles spared.
              Spongy erections began within 24hrs of surgery!
10/24/07: Catheter out; down to 1 Serenity pad/day next day.
              Final pathology: neg margins, no capsular penetration,
              Gleason 3+3=6, 5% tumor involvement, multi-focal.
11/04/07  First usable erection with Cialis
11/22/07  Thanksgiving - Bye-bye, pads
01/17/08  First post-surgery PSA result: < 0.008 ng/ml
 


wd40
Regular Member


Date Joined Jan 2008
Total Posts : 218
   Posted 2/12/2008 2:26 PM (GMT -7)   
My doctor put it this way, he said " It is there but I can not tell you if it will cross over the prostate boundaries today, tomorrow or next month, all that I can tell you is it will."
12/06/07 DaVinci and open prostate surgery after difficulties in breathing stopped the davinci.
Walked a lot
90% control the day the catherter removed.
pad only for a sneeze before the week was out
No pads most of the second week.


mozart250
Regular Member


Date Joined Jan 2007
Total Posts : 102
   Posted 2/13/2008 6:11 AM (GMT -7)   
Hey fatcat:

From what I have read, watchful waiting is really recommended only for older folks who will probably die of something else anyway. As biker90 said, "It ain't gonna go away...".

Also be aware that many of us (self included) have had post op pathology reports worse than the initial biopsy (both in Gleason and in amount of cancer).
52 Year Old DBA by profession; amateur pianist by passion.
 
June 2006:  PSA 4.6.  DRE prostate enlarged.  
Aug  2006:  Second opinion confirms first.  Biopsy suggested.
Sep  2006:  Biopsy results positive one lobe.  Gleason 3+3.
Nov  2006:  RPA performed at Fletcher Allen in Burlington VT.
Nov  2006:  Pathology report: Stage T3a and Gleason 3+4.
Dec  2006:  PSA 0.1
Feb, May  2007:  PSA 0.0 (under 0.1)
Aug, Nov  2007:  PSA 0.1
 
Trying my hand at blogging.


Bootheel
Regular Member


Date Joined Oct 2007
Total Posts : 300
   Posted 2/13/2008 7:59 AM (GMT -7)   

Dear Fatcat,

My first biopsy indicated "atypical cells". It was not sent out for a second opinion. I wish it had been.  My Uro recommended another biopsy in six months. It indicated "atypical cells" once more.  This time he sent it to Mayo clinic.  Pca was diagnosed Gleason 3+3 Low volume, <5% 2 cores out of 18, both sides, some pereneural invasion.  I opted surgery.  Wish I had done it after the first biopsy.  My post op path was gleason 7 (3+4) one positive margin. A lot more serious than I thought.  The guys who respond to you have good advice. It won't go away. I'm glad I did'nt choose watchful waiting. In my case it would have been like playing russian roulette.You have some hard decisions to make.  Do the research.  Learn all you can about your disease.  I did.  It helped me make a calculated decision on what was best for me. My Post op pathology hit me hard but I know now where I stand and what options are available if it recurrs.  Just a thought.


Age 65
Diagnosed 10/12/07
PSA 6.3
Biopsy 18 core samples, 2 positive <5%
Stage T1a Gleason 6 (3+3)
LRP  1/29/08
Post-op
Gleason 7 (3+4)
1 positive margin 1mm 

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