If you were starting over what tests?

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BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 3/18/2008 4:25 PM (GMT -7)   
I am interested in what tests and approach members would have if they were starting over with their diagnosis of PC. Lets assume you have a increased or high PSA with or without symptoms. Armed with the information you have obtained on your journey what would you ask for now. From the information I have gleaned here on this site this probably would be my approach.
Urologist: You have indications of prostate cancer and you should probably have a biopsy to confirm the diagnosis.
Me: Could we do a CT scan, MRI and colour Doplar ultrasound to get a clearer picture before we do anything invasive?
Now armed with these results we could do a biopsy if the above scans show possible PC to obtain a clearer pathology of the cancer followed up by full body bone scan and CT to see if there were any indications of metastases.
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcima-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Gleason 4+3=7 (80% grade 4)
Biopsy pathologist's comment......neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP 8/07
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 3/18/2008 4:35 PM (GMT -7)   
I can answer this for my father. He would not do the rectal MRI.  He was so upset about this test.....especially because he was told that he didn't have lymph node involvement and then of course after surgery a week later found out that he did.  To be honest, in cases where there is micrometastatic disease, none of the tests can detect it.  Please correct me if I am wrong. 

Father's Information
DX July 15, 2007
Age 62 (now 63)
PSA 5.5
Original Gleason 3+4=7 
Post Surgery Gleason- 4+3=7
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin
One positive node
Bone Scan/CT Negative (Sept. 10, 2007)
T3a N1 M0
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07
Lupron beg. Dec 03, 2007 2 yr
Radiation started March 03, 2008 7 weeks 5x a week
2 weeks of radiation down!!!
 
 


kziz
Regular Member


Date Joined Feb 2007
Total Posts : 242
   Posted 3/18/2008 4:47 PM (GMT -7)   
Bill, From my understanding, the biopsy is the only true test to reveal all types of cancer, breast, brain, prostate, etc.... None of the urologist we went to following Kurt's diagnosis recommended any futher testing. As a matter of fact, they all said it would be "useless". We went to see an onocologist who treated my dad's advanced PCa. He set up a bone and CT scan. He told us of a gentlemen that he was currently treating who was about Kurt's age, mid 40's, who had had surgery, only to find out after that it had spread to his bone. In his opinion, if the gentlemen would have known before, surgery would have not been his best option. We did both, and have since had a repeat CT scan secondary to some enlarged lodes not related to PCa, and are getting ready to schedule another. We have to be our advocates. Courtney
Kurt & Courtney
47 year old
Great Health prior to dx
Dx on 1/29/07
PSA 4.1
Gleason 3+3=6, both lobes
Stage T2c, I believe
Tumor involves 20% of cores, both lobes
Live in OK
Da Vinci scheduled 3-14-07 in Austin
Post-Op  Gleason 6, Stage t2c nx mx  YAAAAA HOOOOOO! 
1st PSA Post OP  Undetectable!!!!!!  OFF THE CHART
2nd CT scan, to recheck enlarged lymph nodes not related to PCa NO CHANGE relook in 6 months


DanmanBob
Regular Member


Date Joined Feb 2008
Total Posts : 467
   Posted 3/18/2008 5:22 PM (GMT -7)   

In my case, not sure I would do anything differently.

I had a prostate infection, cleared up the external signs of it with antibiotics, then showed a high PSA a week later during my annual physical.  Tried more antibiotics because two doctors felt that was the problem.

PSA remained at 9 after one month of antibiotics, then rose to 14 three and one half weeks later.  Did the biopsy the next day.  Although the thought of having the biopsy was a little intimidating, I did not find the actual act of having a biopsy to be a big deal....the REASON I had the biopsy was, of course, a very big deal.....

Bone scan was clear, then surgery.



Danman Bob
Age 57
Prostate removal November 2007
Gleason score 9, PSA 14
Biopsy result - 9 of 12 sticks showed cancer
Despite high Gleason score, cancer was confined to the prostate
Unrelated surgery January 2008 delayed incontinence recovery, which is now showing good signs of improvement (1 to 2 pads a day)
Began using Osbon Erec-Aid Esteem manual pump for therapy mid-February 2008
Begain using Viagra 3 times a week December 2007 to stimulate blood flow


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 3/18/2008 5:31 PM (GMT -7)   
Doting daughter,
You are of course correct. As an abnormality is made up of millions of cells before it becomes visible then micrometastases would not be visible.

kriz,
My thinking is that generally the biopsy is quite a random, blind sampling. From what I have read the colour enhanced dopler ultrasound is far superior to traditional ultrasound, especially when combined with MRI and the two together will allow greater targetting when it comes to the biopsy. Although I can no longer find the article, I have read it will not only show more clearly and accurately the extent of the tumour within the prostate but will also show if there is spread to lymph nodes and the vesicles
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07----4 of 10 cores positive for Adenocarcima-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Gleason 4+3=7 (80% grade 4)
Biopsy pathologist's comment......neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP 8/07
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable


smilingoldcoot
Regular Member


Date Joined Jan 2008
Total Posts : 338
   Posted 3/19/2008 11:22 AM (GMT -7)   

BillyMac

If a bone scan or CT indicated anything it would seem to me a little late to be doing the biopsy as cancer would already be out of the prostate.

I have asked myself these questions many times already since finding out I had PCa. 

THings I would do now that I did not do.
 
1.  Insist that a minimum of 12 samples be taken with the biopsy. 1997 and 2000.  If I remember right there were only 6 samples on each.   Both negative but the one in 2000 indicated PIN.  The only thing I noted was beneign.
 
2.  In 2004 when my new urologist said he would order a biopsy if I had not already had a negative one in 2000, I would have made him order one and again, at the minimum, 12 samples.  This even though my PSA was welll within normal range after taking antibiotics for an infection in the prostate.
 
To me the DRE and biopsy is a small price to pay for early detection.
 
Keep   yeah   

Richard

Retired USAF Richard & Debbie on The Shores of Toledo Bend Lake Louisiana
Neg Bios 1997 & 2000 PSA within considered normal range
11/06 PSA 1.9 PSA 11/07 was 4.9 PSA 12/07 was 7.7 MDA 2/12/08 3.3 On Proscar so shud double
Biospy 1/10/08 Gleason score (4+5)9, Stage T1C  8 of 12 samples positive 
Bone scan 1/17/08 hot spot on ribs, CT shows rib enjury CT CHest 1/30/08 Clear
M.D. Anderson appt 2/12/08 CT Abdomin & Pelvis Clear Recommended Hormone&Radiation
2/19/08 Dr Fagin, Austin, TX did not recommend surgery based on medical history
2/22/08 Contacted U of Florida Proton Therapy Institute - Appt 3/13/08 awaiting acceptance
Turn Stumbling Blocks into Steping Stones and Keep Smiling


Dutch
Regular Member


Date Joined Feb 2007
Total Posts : 400
   Posted 3/19/2008 7:08 PM (GMT -7)   
With hindsight being great, the first thing I would have done (because I had 2 brothers who had Pca) would have been to be more aware of my PSA readings.  My PSA had begun to climb two years before it reached the 4.0 range.
 
The only other test I would have had would have been the color doppler.
 
Dutch
Diagnosed Feb 2001  (Age 65)  Currently 72
PSA 4.8      Gleason 3+3=6      Stage   T2b
Completed Proton Therapy @ Loma Linda - Aug 2001 - No side effects.
7yr PSA - 0.2
Our responsibility now is to educate men about Pca, PSA and the importance of early detection. 
 
 
 


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 3/20/2008 6:14 AM (GMT -7)   

Urologist: You have indications of prostate cancer and yoou should probably have a biopsy to confirm the diagnosis.

Me: PSA trend is more important than one individual reading. Scans and MRIs do not give the black and white results often published, and are not likely to reveal metastases now.

An enlarged prostate produces more PSA so prostate size needs to be factored in for a PSA reading to be meaningful, or a "free PSA" test done.

Let's repeat the PSA test to confirm any trend, and include a "free PSA" test which will indicate the % of PSA resulting from benign causes.

If there's an established trend , and the "free PSA" test indicates a high probability of PC, a biopsy can be done.

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