New Guy Here - 3 weeks till surgery

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 10/24/2008 1:48 PM (GMT -7)   
David - in western SC
DRE - always normal
2005 PSA 3.5
2006 PSA 4.3
2007 PSA 5.8
2008 PSA 12.3  (July)
2008 PSA 14.9  (Sept)
 
2007 Biopsy  Negative
2008 Biopsy (Aug)  Neg, but 4 "suspicious" areas
2008 Biopsy (Sep)  Positive, 7 cores, all 7 positive ranging from 50 - 90%, perienual invasion detected, Gleason of 7 (4+3) and 7 (3+4)
 
Bone scan and CAT, negative at this time.
 
Scheduled for conventional radical surgery on 10-14-2008.
 
Oh yes, age 56, age of diagonsis 56, no history of PC in family, but I have had 3 bouts of
porocarcinoma, 2 twice on the scalp and last time in throat, involved 4 operations and 35 rounds of RT, last episode 2000.
 
My dr. was insistent with my biopsy report, that surgery needed to be done as soon as 6 weeks after diagnosis, does this make sense to any of your survivors.  He said time was of the essence, makes me wonder what he knows that I don't know.  Kind of hard not to be paranoid with this being my 4th round of cancer since turning age 45.
 
Nice being here, sorry for being so long winded.

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 10/24/2008 2:27 PM (GMT -7)   
Hi David and welcome to HealingWell. I think that the recommendation from you doctor isn't out of line given the gleason score and percentage of cancer from the biopsy cores taken. Although if you are hesitant I would express the concerns with your doctor and let him explain his reasons why. Generally 6 to 8 weeks from biopsy is recommended to let the swelling subside some before surgery. Did he recommend an MRI to check if it has spread to the lymph nodes or is he going to wait and remove the nearby nodes during surgery?
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base)
Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1,2008
Gleason 7 (4+3) Staged pT2c NO MX
Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 08 <.05


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 10/24/2008 4:50 PM (GMT -7)   

Hello Les,

He is planning on taking out the lymph nodes and other misc. items (?) at the time of surgery.  I did the bone scan and mutiple cats, but he and I expected them to be neg at this point, and they were, but he also stated that it didn't mean there wasn't spreading already.

 

David


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 10/24/2008 5:26 PM (GMT -7)   

Hi

I read your post and the single one below.  I am always surprised when a doctor starts pushing for immediate treatment.  Your gleason score is high but not extreme.  The biopsy showing a high percentage is of some concern.  Most doctors do not predict pereneal invasion until they have a post surgery biopsy to guide them, so I am a bit surprised at that.

I would guess that he (and you) are responding to your prior cancer experience.  I have no idea what it might mean.   You should have as good a result with open surgery as you would with the DaVinci procedure.

I would consider at least a consult with another urologist or a radiation specialist.  That will give you better looka at your situation.

I assume that the 10/14/08 surgery date is a keystroke error, since that was last week.

Let us know how everything goes.


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) ( 18 months .02)
ED still a problem, minor succces with bi-mix
urinary problems at 21 months 
 
 
 


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 10/24/2008 7:48 PM (GMT -7)   
I feel that he is considering the large % of core involvement, the gleason scores which are only slightly above the average score of all cases which is 6, and the presence of perineural invasion in his urgency, all of which are considerable. You are in the drivers seat though, make a decision you are comfortable with, you have time in the 6 week window to seek additional opinions, learn, and research your particular case.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 10/24/2008 8:04 PM (GMT -7)   

Sorry, typed too fast, surgery is on 11/14/2008, just a typo.  The "invasion" issue was spelled out clearly in the pathology report from the 3rd biopsy, which indicated the cancer.  The percentage of cancer in each core still troubles me, as it seems like many here, the stats I have read so far, have much less, what does this really mean?

Thanks, David


Lungman
Regular Member


Date Joined Jan 2008
Total Posts : 276
   Posted 10/25/2008 5:09 AM (GMT -7)   
The pathologist examines each core sample individually, and determines what percentage of each is involved with cancer. This percentage in turn represents the degree of involvement of the prostate itself, the greater % involvement in the cores means a greater degree of involvement overall in the prostate. I hope that helps, in short, the more involved the cores the more involved the prostate as a whole.
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


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 10/27/2008 6:06 PM (GMT -7)   
Your situation is similar to my biopsy, and perhaps even a little more challenging.  You have a record of PSA's with a doubling time of one year.  The fact that your gleason is also 4X3 puts you at a high intermediate level, and you have been ID'd with PC in all cores.  In addition the perineural invasion may mean nothing but does seem to mean that you are at least near the edge of the capsule.  As the issue is to catch the cancer while it is a confined cancer (if that is possible), and that is the purpose of catching it early.  Although PC grows slow, it is still growing and I think your doctor may well have your best interest at heart in moving swiftly.
 
For your peace of mind, I would go ahead and schedule your surgery while you do additional investigation, see other doctors for second opinions, look at all the options, do lots of reading, etc..  You can always back out of the surgery and do something different -in the mean time you lose no time if you go ahead with the surgery. 
 
Blessings. 
 
RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 10/27/2008 9:20 PM (GMT -7)   

Thanks for the info, RB.

I am scheduled for my open RP on Friday, November 14th at 2:00 PM at St. Francis Hospital in Greenville, SC.  My surgeon has done over 300 of these operations.  I have no intention of delaying the operation, being already a 3x cancer survivor.

I fully realize on paper that my stats don't sound too good, with all the psa velocity issues and the rapid doubling time, with gleasons of 4+3 and 3+4, etc.  The proof, of course, will be in the post-surgery pathology work like everyone else that has PC surgery.

For months even before my last 2 biopsies, I have been having all this pain in my inner hips, especially at the top of my thighs, along with a lot of real low back pain  (I am not accustomed to any back pain).  The pains rate along a scale of 2 - 4, usually with me all the time, kind of like a deep burning, gnawing kind of pain.  Mentioned it to my doctor at the time of diagnosis, but he kind of blew that off.

Thanks for your words, and bless you too, brother

David in SC


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 10/28/2008 5:49 AM (GMT -7)   
From your diagnosis you would not think the pain is related, and I suspect that is what the doctor is thinking as well.  I know that "when it rains it pours" and it seems that even our minds can play tricks on us when we are facing these kinds of stressful things.  I am not suggesting the pain is just in your mind, but I suspect you are quite anxious about all of this, and rightfully so - and that adds to the difficulty.  I am hopeful that it just so happens you are having muscle pains or other problems (the kind of things we all periodically have as we get older) and there is no relation to the PC.  I have experienced some other physical problems as well during my bout with PC, and it can make your mind troubled.  Soon you will know and this too shall pass.  It sounds like you have an experienced doctor, and thankfully we live in a time when there are many resources to patch us up and keep us going.
 
God bless you on your journey.  Keep looking up. 
 
RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
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