Newly diagnosed PC

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Tojo
New Member


Date Joined Nov 2008
Total Posts : 9
   Posted 11/21/2008 6:01 PM (GMT -6)   
I am writing regarding my father. He is 70, in good health until now. His history is this. At his yearly check-up last April, they checked his PSA and it had raised from 2.3 to 4.3. His Dr. had him come back for a recheck in 6 months, and it had jumped to a 9.8. He was sent to a urologist who performed the biopsy. He took 12 core samples. 3 were positive. Two were 3+3=6 and one was a 3+4=7 on the Gleason scale. One of the samples says that focal perineural invasion is present. The Dr. is recommending radiation- either laser or seed for him. He went for a bone scan today to see if the cancer has spread outside the prostate. My question is, does this sound like an appropriate plan or are there other treatments not being offered to us that we are not aware of. He is supposed to see the radiation oncologist next week. Also, could anyone comment on what the initial prognosis sounds like. The Urologist says all should be well, but keeps qualifying it with IF the bone scan is good, or if the cells are not outside the capsule. I just want to make sure this is the right course of treatment for him. He is just a little difficult to deal with- He just does not like doctors or hospitals, etc... Its a challenge just to get him to the office for a physical and bloodwork every year. Any advice would be greatly appreciated. Thanks!

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 11/21/2008 6:13 PM (GMT -6)   
Hey Tojo,

Your father's story is about like mine except my PSA was 7.1. Same gleason scores though. I had open surgery and have had zero PSAs for 2 years.

Check out all the possibilities, surgery and various forms of radiation all are good treatments. Most of them are represented here on the forum.

So wecome, sorry you have to be here, please stay with us. We can all get well together...

Jim
Age 74. 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.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 7/17/08 0.00. 
Next PSA test on 1/28/09
Lung cancer dxed on 5/16/08.  Surgery on 6/25/08  T1N1M0 - Stage IIA  Finished 4 cycles of chemo on 11/7/08.
First CT scan on 12/2/08.
"Patience is essential, attitude is everything."


Tojo
New Member


Date Joined Nov 2008
Total Posts : 9
   Posted 11/21/2008 6:16 PM (GMT -6)   
Thanks for the post. the Dr. seemed to think he was not a good candidate for surgery because of his age and his comorbidities (which is only elevated cholesterol). What treatment did you choose and was it successful so far? Thanks 

Tojo
New Member


Date Joined Nov 2008
Total Posts : 9
   Posted 11/21/2008 6:18 PM (GMT -6)   
Sorry, I just read your profile and it sounds like you have had quite a time. Was the lung cancer independent of the prostate or had it metstisized? I hope you are doing well.

biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1464
   Posted 11/21/2008 7:35 PM (GMT -6)   
Lung cancer is another primary. Surgery took care of the prostate cancer so far. Zero PSAs for two years anyway.

Get lots of information from you doc and here and there are lots of books that are valuable. See the link at the top of the forum. You will have reading for a month.

Good luck...

Jim
Age 74. 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.
50 mg Viagra + 1000 mg L-Arginine + .03 cc Trimix = Excellent Results
PSAs from  1/3/07 - 7/17/08 0.00. 
Next PSA test on 1/28/09
Lung cancer dxed on 5/16/08.  Surgery on 6/25/08  T1N1M0 - Stage IIA  Finished 4 cycles of chemo on 11/7/08.
First CT scan on 12/2/08.
"Patience is essential, attitude is everything."


Tojo
New Member


Date Joined Nov 2008
Total Posts : 9
   Posted 11/21/2008 10:53 PM (GMT -6)   
Thanks so much!

kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 11/22/2008 10:38 AM (GMT -6)   
Tojo -

Sounds like your doctor is giving you about the same info that we all got. There are multiple, very successful paths to healing with this disease. I have friends of various ages who have had open & robotic surgery, beam radiation, seed radiation (and sometimes both), hormone therapy, etc.

You will go through a series of decisions. If the bone scan is clear - you go down one path. If it is not clear - you go down another path. The patient's health & history are big issues, etc. These things will help lead you to a treatment decision. As mentioned above, educate yourself as much as possible. Do NOT hesitate to see other doctors. Ask for a consultation and hear what they have to say.

Be sure to check out proton radiation. That seems to be an up & coming treatment that is a good answer for some people - but it is only available in limited areas.

Good luck,
kcragman
Age: 52
March 2006: PSA 2.5

Dec 2007: PSA taken for insurance application. I did not see the results until late Jan '08 - after I was rejected. Their lab said PSA 4.5. PSA again in Feb '08: 3.7.

March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were cancerous and the 6th was suspect.  

May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.

Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph nodes and associated glands all appear to be cancer free.

July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.


Tojo
New Member


Date Joined Nov 2008
Total Posts : 9
   Posted 11/22/2008 11:16 AM (GMT -6)   
Thanks for the comment. My father is being told that due to his age that he is not a good candidate for surgery. Any comments on this- he is 70. Also, I am not sure he would agree even if offered, but he might. They are recommending IMRT or the seed radiation. He fortunately is agreeable to this. Both of the options from what I gather are good, but I feel like his dr. is skimming over side effects. He basically says they are minimal. Any comments? My father is leaning towards the IMRT because it is offered in his rather small hometown. The seed radiation is offered at a local large medical center that is only an hour away and also where I live. We live in NC, does anyone know of any clinical trials or other non surgical treatments being offered in our area. I work in the medical field and am currently in school obtaining a molecular biology degree. My father does listen to my opinion, so I am trying to educate myself to better help him. The information from reading posts on this site as well as the various links and educational resources have been wonderful. I have found though, that the best source of info is from actual people who have been down this road already. Thanks.

taiping
Regular Member


Date Joined Apr 2008
Total Posts : 62
   Posted 11/22/2008 10:19 PM (GMT -6)   
Hello Tojo,
 
This site is an excellent resource for those diagnosed with PCa, their spouses and families, but please be aware that most postings are from men who have chosen surgery, radiation therapy or brachytherapy. This is probably due to urologists recommending surgery while oncologists suggest radiation/brachytherapy. It happened to me!! There are other choices, but you may need to be insistent with your health care provider.
 
For an alternative view on treatments please read the book "Surviving Prostate Cancer Without Surgery" by Bradley Hennenfent MD, and the publications at . . .
 
For alternative therapies, you might like to read the information and ebooks at . . .
 
After educating yourself as much as possible about PCa then you will be in a better decision to make an informed choice together with your father, taking into account your father's age and clinical diagnosis.
 
Wishing you all the best, whichever road you travel. You might also be interested in the personal experiences at . . .
 
taiping
 
 
 
 
 
 
 
 
 
 
Diagnosed: June 2007. Aged 61. PSA 19.6. DRE negative.
Biopsy: June 2007; 2 cores of 18 positive.
MRI and Bone Scan: Negative.
Pathology: 5% of 1 core, "Small focus" in another core +ve.
Gleason 3 + 3 = 6.
Clinical: PCa considered confined to prostate. Stage T1c.
Treatment: After considering RP and HD Brachy, decided on Intermittent Triple Androgen Blockade Therapy for 1-year, using ZOLADEX, CASODEX 150 mg/day, AVODART 0.5 mg/day. Start PSA 19.2 (July 2007).
Completed Intermittent TAB on 23 July 2008, continue with AVODART alone and monitor PSA every 3-months. Changed to PROSCAR in Sept 2008.
Current Status: PSA = 0.01 (October 2008).
PSA nadir 0.01 (October 2008).
---------------


Tojo
New Member


Date Joined Nov 2008
Total Posts : 9
   Posted 11/23/2008 9:26 AM (GMT -6)   
Thank- you, I'll look into thise resources. Could you tell me about the treatment you chose?

taiping
Regular Member


Date Joined Apr 2008
Total Posts : 62
   Posted 11/23/2008 8:12 PM (GMT -6)   
Hello Tojo,
 
I chose Intermittent Triple Androgen Blockade Therapy which, in 1-year, brought my PSA down from 19.6 to 0.02. Then I stopped taking the medications except the AVODART (later PROSCAR) as "maintenance". After another 3-months my PSA is currently 0.01.
TAB is NOT considered a cure for PCa and my PSA is likely to rise in the future. The aim is to manage PCa like it's possible to manage, not cure, diabetes or high blood pressure. I hope to be one of the 92.5% of men with prostate cancer who die of something else. Unfortunately, death and taxes are unavoidable !!
If and when my PSA starts going up again to a significant level, or PSA doubling time seems high, I may decide either to try another course of Intermittent TAB although I'm more inclined to try a more holostic approach with a herbal treatment.
I am not convinced the conventional treatments of surgery or radiation offer any long term survival benefits, as suggested by several studies. For example, see . . .
 
All treatments have negative side effects and quality of life issues. For TAB some of these are (a) lack of libido and ED, (b) enlarged breasts, (c) hot flashes, (d) tiredness and emotional issues, (e) loss of bone density (and others). TAB is not a cake walk and takes some determination to complete the course of treatment. It is said that all negative effects are reversible, using medication if required. I still have libido and ED issues, but personally at age 62 I'm not very bothered about that. I'm more interested in survival.
In addition, TAB (as descibed on the Compasionate Oncology web site) is definitely NOT a mainstream treatment. My primary physician is Dr Steven Tucker in Singapore, who did a study about TAB with Dr Bob Leibowitz, see . . .
 
Again, TAB may not be for everyone, but the reason for this post is to let people know their are other treatment possibilities which may not be suggested by their doctors. That's why it's necessary to read up everything you can find about PCa and come to an informed decision.
Hope this helps . . .
 
taiping 
 
 
 

loularkin
New Member


Date Joined Nov 2008
Total Posts : 11
   Posted 11/23/2008 8:54 PM (GMT -6)   
My 71 yr old husband was diagnosed last week with prostate cancer. Of course, we are both quaking inside at this announcement. He actually went to the urologist to get some info on TURP. The doc put him through lots of tests (ultrasound, cystoscope, etc) in July and he had a biopsy. His PSA was 1. The biopsy was negative with a couple of possible pre-cancerous spots. He had him come back this month and phoned last week and said the biopsy was positive. The doc put him on Casodex, which is standard from the way they spoke. We just got the "written" report from the urologist and it said that the Gleason was 6 and my husband's PC was termed "low risk". His capsule is "intact" and his seminal vessels and urethra are clear. When the doc called he told him that he had many options for treatment and that it was very treatable and "would not affect his life expectancy!" How does he know that? He is to go tomorrow for bone scan, chest x-ray and blood work. We were told by the nurse that this is standard. We will then meet with the urologist to discuss treatment. I am simply sick over this. My husband seems to be taking it all in stride. I don't think I've slept since the diagnosis. Any advice would be greatly appreciated.
Thank you!
Nanoo

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 11/23/2008 9:49 PM (GMT -6)   
Yes it is scary when a loved one is diagnosed with cancer. However it is by no means a death sentence. With a very low PSA of 1 (in July?) and now a Gleason of 6 (the lowest that gives a positive for cancer), your doc is right. It is low risk, and it's much more likely that your hubby will die of something other than PCa.

The tests are standard, and there will be many possible treatments, including a "do nothing" option. In the meantime you can study the other options, most likely some form of radiation with perhaps hormone therapy (which is what I think the Casodex is). Surgery is perhaps less of an option at age 71. but if your hubby is otherwise fit and healthy, it would be still possible.

So yes, it is a shock but at the same time, there is plenty to be optimistic about.
Age 63. Other than cancer, in good health; BMI 20
Pre-op: No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4 of 12 cores
7 March 2008, RRP, non nerve sparing
Two nights in hospital; catheter and staples out after 7 days
Continent, no pads needed from the get-go
Post Op: Stage pT2 M- N-; clear margins and lymph nodes; Gleason 4+4=8; prostate weight: 37gm
6-week and 7-month PSAs: 0
Bimix injections working well 


taiping
Regular Member


Date Joined Apr 2008
Total Posts : 62
   Posted 11/23/2008 10:01 PM (GMT -6)   

Hello Nanoo,

I completely understand your concern, but with a PSA of 1, Gleason 6, and "low risk", you have every reason not to rush in to any decision. Even "Watchful Waiting" is an option you might like to consider. When I was diognosed with PCa last year I also felt very upset and depressed, but I felt better after I decided to find out as much as I can about the disease and the available options.

taiping

 


loularkin
New Member


Date Joined Nov 2008
Total Posts : 11
   Posted 11/23/2008 10:36 PM (GMT -6)   
Thank you both so much! I didn't realize that a Gleason 6 was the lowest that gives a positive for cancer. I have read everything I can get my hands on and I thought that Gleason 2 was the lowest! I guess we will find out more tomorrow. My prayer is that it has not spread to any other site. When the urologist sent a copy of the prostate ultrasound photo he highlited a couple of small dark spots which I am assuming is the malignancies. Thank you, thank you!
Nan

JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 11/24/2008 12:23 PM (GMT -6)   

Tojo

If you want information on Brachytherapy, I am happy to share what I know as that was my husband's choice of treatment after diagnosis in 2005.  If you want to read about it, check out JustJulie's Brachytherapy Journey - Part 1 or Part 2 :)


Husband diagnosed in December 2005
PSA of 3.74
Gleason 6
Brachytherapy (91 stranded seeds) April 2006
PSA of 0.39 - November 2008 - whoo hooo!
 


Ralph Alfalfa
Regular Member


Date Joined Nov 2008
Total Posts : 469
   Posted 11/24/2008 9:52 PM (GMT -6)   
Hi Nan,
This is a great site for advice and opinions of treatment options. It is the only one a lot of us go to. Research...research...research. Do not jump to a treatment without learning all you can about the different treatments. There are several different ones and you and your husbands choice is strictly yours. Get a second opinion if you'd like. Any Dr. worth his salt won't mind at all.
Find a local support group, besides this one. There is one in my area that I didn't know about untiln yesterday.They won't offer you medical advice, but they will show you the paths to take when seeking that advice. I'm 57 and my doctor says I'm one of the young guys. At 70, things don't progress quite as quickly as in younger folks, so you have time to really stop and think about it. I was diagnosed Oct.27th (day after my birthday...Happy birthday,Bob) and have opted to have DaVinci surgery in January. My Gleason is 7, (4+3), Psa 14.5. Biopsy: 4 positive, on the left side, pre-cancerous on the right. Bone scan and CT scan negative. No invasion of the lymph nodes or seminal vesicles.

Keep in touch and read all you can about this bad hand you've been dealt. But...Get some sleep.

Good luck.
Bob

lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 681
   Posted 11/24/2008 10:21 PM (GMT -6)   
Tojo said...
Thanks for the post. the Dr. seemed to think he was not a good candidate for surgery because of his age and his comorbidities (which is only elevated cholesterol). What treatment did you choose and was it successful so far? Thanks 

  I have never quite understood the reasoning that is used when a doctor claims older age as a reason for certain treatments.  I don't know your fathers physical condition, but I was a very young 66 when I was diagnosed.  I say very young, in that I was in excellent physical condition, despite having controlled hypertension and high cholesterol ( who doesn't?). I was told that surgery was the first and best response, because of my aggressive gleason scores. Many men are more youthful than they were a generation ago.  Three close friends who are slightly older than me were treated with brachy or radiation, but could have had surgery if they chose.

Not to cast any doubts on your father's urologist, but if he is in a small town, he probably does not have the breadth of experience that you might find in say a large University Hospital system.  Particularly if you want to have surgery, I would recommend that you seek out some of those better known doctors, at least for a second opinion.

Good luck with your search..


PSA up to 4.7 July 2006 , bump noted during DRE
Biopsy 10/16/06
stage 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
plaque buildup due to injections 
 
 
 


loularkin
New Member


Date Joined Nov 2008
Total Posts : 11
   Posted 11/24/2008 11:49 PM (GMT -6)   
We got excellent news today! It is our 40th wedding anniversary and what a great day it has been! Bone scan, blood work and chest x-ray were all fine! WHEW! We spent 90 minutes discussing the various options with my husband's doctor and have opted for surgery in January! My husband's cancer is on only one side of his prostate and is in 3% of the gland. His Gleason 6 (3+3) and he has been on hormone therapy since diagnosis. His doctor told him surgery was considered a "cure" and radiation was considered a "control". I feel a great sense of relief that he has decided on surgery. His doc said he is a "young" 71 and should have no problems. Thank you everyone for your information and your support..it means a great deal to me!
Thanks again..off to a good night's sleep!
Nan

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 11/25/2008 11:16 AM (GMT -6)   
loularkin, that's good news- a decision is made. Don't second guess, and begin preparing for the surgery and after care. Take time this holiday season to concentrate on the holidays and let the surgery take its own holiday for now... You could also create a personalized signature with details of the journey thus far, if you want.
James C.
Co-Moderator- Prostate Cancer Forum
Age 61
4/19/07 PSA 7.6, referred to Urologist, recheck 6.7
7/11/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/17/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/24/07 (open) Retropubic Radical Prostatectomy performed
9/26/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
Present- 1 year: ED- Viagra, pump continues, no response- Trimix .10ml x 2 weekly continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4243
   Posted 11/25/2008 11:45 AM (GMT -6)   

Dear Nan:

Not to interfere with your sound sleep and I know everyone is different in their decision making processes but...from the way I understand your posts and your timeline, your husband is only a week post-diagnosis and has talked with only one doctor and you have made a decision?

For me, I found it appropriate to take the time to do a lot of research - hard copy and web - and consult with multiple doctors in different disciplines before making a decision.  With early stage PCa you usually have time and options.  I'm not suggesting that your decision is incorrect and, if this works for you guys, God bless.  But I needed to ask multiple questions of multiple people before I could sleep well about such a huge decision.


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
27cc
Brachytheraply volume study done on 11/14/08
Brachytherapy scheduled in early December


JustJulie
Regular Member


Date Joined Mar 2006
Total Posts : 355
   Posted 11/25/2008 11:48 AM (GMT -6)   
Tudpock18 makes a good point - we too investigated every option available to us at the time.
 
Tudpock18 I see your Brachy is coming up - good luck and if you have any questions let me know.
 
Husband diagnosed in December 2005
PSA of 3.74
Gleason 6
Brachytherapy (91 stranded seeds) April 2006
PSA of 0.39 - November 2008 - whoo hooo!
 


loularkin
New Member


Date Joined Nov 2008
Total Posts : 11
   Posted 11/25/2008 3:10 PM (GMT -6)   
Hello All..I appreciate so much everyone's input! We have been researching everything we can find on all procedures at reputable sites, Mayo's, John Hopkins, etc. My husband also has several friends who have undergone various treatments and so he has their input. He simply isn't comfortable with leaving the cancerous prostate in place. He wants it out and wants to get on with life. He is very active and wants to keep up on his daily routine without interruptions for EBRT, etc. Our urologist told us that once you have radiation that if you would choose to have your prostate removed at a later date, recurrance, etc that it is very, very difficult to have done. Also there is some bowel problems associated with brachytherapy or so we were told. So, those were considerations for him as well. I think that I would choose surgery, if I were in his shoes. I would want it out and gone! But, I think that is up to everyone's judgement along with their doctor's. I think my hubby is very confortable with his decision as he seems anxious to get the surgery behind him (14 Jan 2009) and continue onward! So here are my best wishes for a wonderful Turkey Day! Don't eat too much and will talk again soon!
Thanks again!
Nan

41diagnosed
Regular Member


Date Joined Jun 2007
Total Posts : 176
   Posted 11/25/2008 3:49 PM (GMT -6)   

As many treatment options are available, the hardest thing is making the decision and feeling confident.  Cheers to you and your husband for reaching resolution quickly.  If you have a good surgeon with whom you feel comfortable and he is experienced, he should be on a road to recovery soon with good results.  All paths have their risks, and no guarantees with any of them.  But all have good statistical outcomes overall.  So there is more chance than not that everything will be ok. 

Wishing you a luck with your course of treatment.  With the decision behind you, the holiday season won't be gloomy but should be full of hope.


 
43 yo. now
 
5/07 PSA 4.65 at routine physical
6/07 biopsy Gleason 7 (3+4)...diagnosed at 41 y.o.
6/07-9/07 manic research and interviews with physicians across the country in search of the "right" decision.  I went to Mass General in Boston, Loma Linda, University of Chicago and Northwestern.
9/17/07 - RRP at Northwestern Memorial by Dr. William Catalona.  Thankful the father of the PSA test was right here in Chicago.
Post op path report confirmed Gleason 7 (3+4). negative margins, no seminal vesicale involvement, no lymphatic or vascular invasion, bladder and urethral free and tumor volume was 5% of 27.3g.  
9/27/07 - catheter removal...let the games begin...
12/31/07 - threw out the pads (I only had used 1 pad per day for protection against minor drips)
 
I started Trimix 8 weeks after surgery with success.  I hope someday I won't need injections, but I hope more that my PSA stays at 0 forever.
 
9/17/08 One year past surgery and doing well.  PSA less than .1 and ED continues to get better and showing reasonably good results using Levitra which for a long time did nothing. 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4243
   Posted 11/25/2008 3:59 PM (GMT -6)   

Hello Nan:

I will just share one more thought and then shut up.  I am not trying to talk you out of surgery or trying to get you to second guess yourself.  I was encouraged to talk with more than one doctor and that gave me more peace of mind as different disciplines have far different perspectives on this disease.  If you're satisfied with your choice of doctor and treatment that's great and I wish you both the best.  And, given surgery is your choice, I hope you discussed open vs. robotic and asked the very important question re the number of procedures your doc has performed...check out another thread called "Experiece Counts" to see the latest studies on that point.


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
27cc
Brachytheraply volume study done on 11/14/08
Brachytherapy scheduled in early December

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