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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 10/13/2008 3:17 PM (GMT -6)   
Was diagnosed less then 2 weeks ago it PC.
PSA 2006 4.3
PSA 2007 5.8
PSA 7/2008 12.3
PSA 9/2008 14.9
 
Had 1st biopsy 9/7 Neg
Had 2nd biopsy 8/8 PIN + plus 4 "suspicious" areas
Had 3rd biopsy 9/8  Positive, had 2 areas, 4+3=7 and 3+4 = 7
All 7 cores tested positive with 60-80% cancer
 
Last week, had Bone Scan(s) and mutiple CT, awaiting results and
final consultation with doctor.
 
His thinking is that this is pretty aggressive, suggesting conventional surgery, non-
robotic, and min. of 40 RT treatments.  Wants to operate 3 - 4 weeks from now.
 
My PSA doubling was very fast.  Any comments or similar cases to mine.
 
Oops, I am 56 years old, had first PSA done at age 50, was over 4.
 
No known PC in family history, least none diagnosed.
 
Thank you.

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 686
   Posted 10/13/2008 4:39 PM (GMT -6)   

Welcome to HealingWell

I think that this is the best on-line source for help and support for men and their families dealing with prostate cancer. I have been posting here for almost two years now.  I keep coming back every day for the reassurance that I get.

Sorry to see that you will need to proceed to the next step.  I am a little surprised that your urologist suggested that "open surgery", rather than  Robotic would be necessary.  I have never heard that open surgery would be more effective regardless of how agressive the gleason numbers.  I was diagnosed with a Gleason 8 and my surgeon used the DaVinci Robotic procedure.

Please stay with us and continue to share your concerns and progress.  You will find that everyone here will be very supportive.  


PSA up to 4.7 July 2006 , bump noted during DRE
Biopsy 10/16/06
T2A, Psa 4.7
Gleason  4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion found
No continence problems
PSA 90 day -.01  , 6 month -.01 , 9 month +.02 , 1 year +.02
Using Bi-Mix or VED 
 
 
 


Tim G
Veteran Member


Date Joined Jul 2006
Total Posts : 2361
   Posted 10/13/2008 5:20 PM (GMT -6)   
Welcome to the forum, Purgatory.  From your posted statistics, looks like your PSA doubled from 6 to 12 in one year.  PSA velocity is often considered a better indicator than absolute numbers.  Mine quadrupled in one year even though the absolute number was in normal range for my age group.
 
I don't think that there is any difference between the open vs. robotic with cancer like yours.  There are some bells and whistles with robotic--usually less invasive and shorter recovery time; able to use magnification to see the prostate better--but the open works well, too.  The important factor seems to be the surgeon's experience.  
 
Hope to hear more from you.  Take care and hang in there...Tim
 
P.S.  I hope you have another name we can call you besides Purgatory. Nothing personal, but.....   
Age 59  PSA quadrupled in 1 yr (0.6 to 2.5) 
DRE neg  1 of 12 biopsies pos (< 5%) 
Open surgery June 2006 
Organ confined pT2a  Gleason 5   
Cancer-free for 2 years  PSA's undetectable 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/13/2008 5:40 PM (GMT -6)   
Purgatory,
Sorry you're here but welcome. The advice given to all newcomers to this wonderful site is very sound and is always the same and that is, take a deep breath, sit back and learn everything you can about this disease. Decisions then made are then based on an understanding of what you are dealing with. Most professionals involved in the treatment of a 4+3=7 Gleason would not suggest it was a surveillance candidate and would advocate active treatment. Many fine surgeons prefer to do open surgery over robotic even if they do both........they prefer to have the gland in their hands as they remove it feeling for lumps and bumps as they go. Find out why the surgeon uses the method he does. The Da Vinci corporation has a very nice and effective sales promo. First course of action is get the biopsy looked at by another lab (2nd opinions are sometimes different......if it is different from the first then don't hesitate to get a third from a renowned institution). The bone scan is a precaution but a PSA lower than 20 generally indicates there would be no visible metastasis. Bear in mind that surgeons want to operate, that is their expertise. But make sure you have a consultation with a radiation oncologist in order to get a different treatment opinion. You simply cannot have too much information before pulling the trigger. Ask away and all the fellas here (and some of their wives) will detail their experiences with the differing treatments, side effects and outcomes to date.
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 Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
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
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)

Post Edited (BillyMac) : 10/13/2008 4:57:03 PM (GMT-6)


PCADVOCATE&MENTOR
New Member


Date Joined Jul 2008
Total Posts : 8
   Posted 10/13/2008 5:43 PM (GMT -6)   
Your cancer was already developing a couple years ago with your PSA higher than 4.0ng/ml. Unfortunately, very few men know to request their biopsy tissues be sent to a pathologist who has expertise in reading prostate cancer presence. And you escalating PSA since 2006 confirmed whoever was your physician was not providing sufficient concern. I would be apprehensive of a urologist who only recommended "open" surgery. Obviously that recommendation is because he is not trained in robot assisted laparoscopic radical prostatectomy - a much less invasive procedure with less blood loss and faster recovery. The 4+3/7 Gleason grades/score is of concern and prior to surgery it would be appropriate to have blood serum testing for PAP, CGA, CEA, and NSE to determine possibility of metastasis. Early development is unlikely to show up on MRI/CT scan. If these blood tests indicate possible metastases, neither surgery nor radiation will completely eradicate all cancer, although physicians might still recommend these options to "debulk" the majority of cancer. Your report is a bit confusing in identifying two tissue samples with one 3+4 and the other 4+3, but then commenting "All 7 cores tested positive with 60-80% cancer." You should identify what Gleason Score was assigned to each individual tissue sample, and what percentage of PC was present on each individual tissue sample. If the pathology report doesn't indicate these numbers, then the pathologist did not provide an appropriate report. And if that's the case, you should ask that your biopsy tissues be sent to a pathologist with PC expertise, namely Bostwick Laboratories/ Pathologist David Bostwick
Virginia - Corporate Headquarters 4355 Innslake Drive, Glen Allen, VA 23060
Phone: 1-800-214-6628
https://www.bostwicklaboratories.com/patientservices/primary.html
Fax: 804-288-6568
(and when samples are sent in, they should be accompanied by a request that ONLY Dr. Bostwick perform the review)

Jon Epstein (Hopkins) 410-955-5043 or 410-955-2162 (Dr. Epstein does not do ploidy analysis)

David Grignon, Centennial Professor of Pathology, Vice Chair for Clinical Programs, Indiana University School of Medicine, Clarion Pathology Laboratory, 350 West Eleventh St. Room 6014, Indianapolis, IN 46202 317-491-6685

Jon Oppenheimer, Owner and Chief Pathologist, Oppenheimer Urologic Reference Lab, Nashville, Tennessee, 888-868-7522 JPathologist@gmail.com

M. Scott Lucia, Director, Prostate Diagnostic Laboratory, Co-Director, Prostate Cancer Research Laboratories, University of Colorado, Denver – School of Medicine at Fitzsimons Dept. of Pathology, 303-724-3470 E-mail: Scott.Lucia@uchsc.edu

And, in the meantime, I'd check around to find out if there are urologists in the area who provide robotic assisted LRP. And if there is and you are comfortable, I would add that you direct the physician to include the removal of lymph nodes adjacent to the prostate gland as well as seminal vesicles, since if the cancer has migrated, those are the key pathways.

Like another suggested in replying to your report, purgatory isn't the most appropriate name to use in a setting of patients fighting cancer.

califguy
Regular Member


Date Joined Sep 2008
Total Posts : 72
   Posted 10/13/2008 8:21 PM (GMT -6)   

I too will add to check out all the options. My local urologist suggested EITHER surgery or radiation. He wanted me to check out both options. Due to a hernia repair mesh not being in the right place, he decided I should go to a bigger Med Center. At UCSF Dr Carroll told me I was a candidate for either daVinci robotic surgery or radiation and he felt I should get both sides of the story.

I chose robotic and am very happy. As another poster said, Make the decision and don't look back. Keep looking forward. If you go in knowledgeablr, there is no reason to want to look back. The folks on here can help steer you the right places to make those decisions.

 


Don't get discouraged!!
CalifGuy
 
Diagnosed Feb 2008  54 years old
3+4=7 gleason
7.5 PSA
4 out of 20 biopsies were cancerous
daVinci Robotic surgery July 24, 2008
Univ of Calif San Francisco Med Center  Dr Peter Carroll
In hospital 2 nights altho I had option of leaving the next day but stayed due to distance home.
Contained in prostate, not spread
Six weeks post surgery PSA less than .01


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 10/13/2008 8:43 PM (GMT -6)   
You might also want to check out the treatment charts and case histories on the yananow site

www.yananow.net/progress_chart.html

and the treatment experiences here

www.yananow.net/Experiences.html

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 Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
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
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 10/15/2008 1:18 AM (GMT 0)   
Seems a little different that the doc is recommending surgery AND RT in the same breath.  Surgery gives you the "real" story with regard to pathology, which gives you a better idea of any need for subsequent treatment.  What if the post-surg pathology is clean, contained, and PSA stays undectable (which is what I hope for here), would you STILL do 40 RT sessions at that point?

Sterd82
Age 47 - pre-surgery PSA 39
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
Next PSA November of 2008


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 10/14/2008 8:12 PM (GMT -6)   
Welcome to HW! Sorry about your dx, but you have found an excellent resource for support and patient education. I know this is arguable, but my father's first urologist wanted to do an open procedure because he wanted to get all the pelvic lymph nodes he could and he wasn't confident in his own ability to do that with the Da Vinci. We elected to go with another surgeon who had more experience. I'm thinking that this might be his reason for encouraging you to go open. The important thing right now is to get all the information you can and know that you have options. Please stick around and stay strong!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 10/15/2008 7:26 AM (GMT -6)   
Welcome to HealingWell. Your doubling time was quite high, possibly representing a more aggresive tumor, but research your options and make a decicion you are comfortable with. You know by now, most surgeons recommend surgery, radiation onc's like to radiate, etc. I think a second lab opinion, as well as a second, third, or however additional MD opinions are in order. Look for someone with experience with whatever treatment you choose. My original path slides were sent to 2 independent labs by my urologist, one of those being that of Dr. Epstein (Johns Hopkins) so I felt good about the concurring reports. The urology group and MD I chose does open and robotic procedures, as well as radiation, so I felt with their 1000 plus robotics and untold open procedures, he was my man, and have been happy with the results. I am all about youth in Medicine, but you want the combination of experience and technology, because age and treachery always overcomes youth and skill !!!
Good Luck, learn and understand what you are up against, and move forward. Feel free to bring any question or concern, now matter how trivial you may think it is, here for us to help you with. Chances are we have had the same concern and you will get a real world answer.
Randy
46 you when diagnosed, now 47
Pre-Op PSA 9.9
1 of 12 cores positive, Gleason 3+3
DaVinci on 9/5/2007
Post-Op Gleason 3+6, Negative Nodes and Margins
Less than 1% of prostate involved with CA
3 Month PSA 0.01, 6 Month PSA 0.01, 9 Month PSA 0.01
One Year PSA 0.01
Incontinence resolved 9/15/2007, one day after cath removal
ED showing significant improvement.
Cialis 5 mg every night.
Success with BiMix

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