Dear Dad diagnosed with PC: Couple questions

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pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 1/19/2009 5:44 PM (GMT -6)   
 
My father was diagnosed last week with Prostate Cancer.
 
Age: 74
Gleason: 7 (3 + 4)
Stage: T2a
PSA: 5.5
 
With these stats, the calculator at http://www.prostatecalculator.org/ says that he has a
"52% risk of cancer having spread outside the prostate (at the time of treatment.)"
 
Can someone please tell me what this means? Where does it typically spread & is there anyway to find out  if it already has? 
 
Also, we are considering Robotic Prostate Surgery. Is there a rush with this? Would doing it next week vs. the first week in March make a huge difference?
 
Am scared & pretty darn sad. Please help! My heart goes out to everyone on this board.
 
 

pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 1/19/2009 5:48 PM (GMT -6)   
Not sure if everyone knows this & sorry if it is a double post, but Dr. Donald F. Gleason died just a couple of weeks ago.

gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/19/2009 5:50 PM (GMT -6)   
Welcome,

It is way too soon to think about scheduling surgery. This gleason is serious but the PSA is reasonably low. Radical prostatectomy carries the risk of side effects and for even a healthy person at 74 is a very major surgery.

It is very likely that radiation, cryo, or HIFU would result in substantial remission or cure of his cancer. But before contemplating surgery you need diagnositics to ensure as much as possible that the cancer is still local. This will mean nuclear studies where a tiny bit of tracer is injected and then a bit later he will be scanned, the tracer is picked up by cancerous tissues showing if it has or not spread.

Is he symptomatic? What lead to his having the biopsy?

Best wishes. Scott
Diagnosed @ 48yo 04/07
focal low volume tumor gleason 6
RRP 07/30/07
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/19/2009 5:57 PM (GMT -6)   
Ditto and welcome Scott (you are going to be helpful to the newbies, as your walk in this PCa fight can save others hopefully from the many pitfalls and errors that exist out there).
Hey it is always possible to consider taking casodex or similar protocols to slow down PCa, while a person makes an "informed" and hopefully multi-opinioned decision. Forget the rush b.s. many docs might tell you such, did they mention that most men have PCa in them for 10-15 years priors to diagnosis???? Would they mention you could do casodex in their office while thinking about your decisions??? A good honest doc probably will. .

Z-Bob


 

Post Edited (zufus) : 1/28/2009 3:52:11 PM (GMT-7)


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 1/19/2009 6:57 PM (GMT -6)   
Welcome to HW. Sorry to hear about your dad's diagnosis. I know entirely too well what it feels like. As the other members posted, you have time to make a decision. Typically, most will want to wait at least 6-8 weeks after the biopsy is done. My father had similar statistics and unfortunately, his had spread outside the organ. However, there are still many options for treatment. Have you checked into cancer facilities yet? I would recommend either meeting with a Prostate Cancer Team, including a surgeon and a radiation oncologist. Keep in mind, surgeons recommend surgery and Radation Oncologists recommend radiation. There are MRI's and CT & Bone scans that can be done to rule out spread, however, also keep in mind they are not 100% accurate, which was also the case with my father. However, most will encourage these tests prior to treatment.
Cancer does not operate in black and white. Therefore, do the research, go with people that you and your father trust and help him to make the best decision for him. There is a very good chance your father will live a long time and die of other causes. Stay positive and know that you are not alone.
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


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 1/19/2009 9:07 PM (GMT -6)   
My prognosis and percent for confinement was similar. Those stats are based on general information taken from many cases. The point is there remains a good hope for cure, and if not cure extended containment.

It is most difficult in the early going - I would suggest spending your energy doing everything you can to educate yourself about PC, and what route you will take for treatment. You will also need to do your homework relative to doctors and make sure you get more than one opinion. A lot of the future rests on your treatment, and the doctor carrying out that treatment. There are a lot of experienced people on this forum who have had experience - be sure and do lots of reading and asking questions. Blessings.

RB
Age 61 (now 62)
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
2nd Post PSA <.1 10/30/2008


pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 1/20/2009 1:01 AM (GMT -6)   


Thank you all for your kind words of encouragement/advice. They mean a lot to me.

Some of you had questions/comments:

Scott: My father had problems with delayed urination and slow flow and decided to get it checked. DRE (felt something), then blood work (elevated PSI), then MRI (they saw a small nodule), then the biopsy (cancer). & Scott my heart goes out to you. I just read your writeup. You are a brave man. You have been through a lot...I wish you a speedy & complete recovery.

Z-bob: My father has started on some anti-androgen pills.

Doting Daughter: You had mentioned that people typically wait 6-8 weeks after the biopsy. But what if it spreads during that time??

So why wouldn't each day of surgery postponement matter?  I understand the risks of surgery, but isn't cancer going out of the prostate and into other organs just a function of time?  And if that is the case, wouldn't a surgery done sooner be always be better than one done later? Sorry if I'm being really naive in my rationalizing....perhaps its just initial panic setting in, but can someone please take a shot at the question?

Again thank you all. I wish you/your loved ones a quick & complete recovery.


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 797
   Posted 1/20/2009 1:35 AM (GMT -6)   
Hi pcBeGone,

The reason for waiting after the biopsy is that the biopsy causes some tissue damage. So the surgeons normally recommend about a 2 month period to let the tissues heal before performing surgery. During that time, in my case I had a CT scan and bone scan done. These give some indication if the cancer has spread. For me, fortunately they were both negative. Also during that time I was getting appointments with docs. They generally advised (in my case) not to wait longer than three months.

If it's your father who has the diagnosis, then you are probably too young to remember the days when, for example, women would go into general anesthesia, get biopsied, and right then and there the docs would decide whether or not to remove the breasts. The idea was to act fast before the cancer spread further. But more recently, more than 10 years ago, it was found that this offered no advantage.
Diagnosis at age 53. PSA 2007 about 2; PSA 2008 4.3
Biopsy September 2008: 6 of 12 cores positive; Gleason 4+3 = 7
CT and Bone scan negative
Da Vinci surgery at City of Hope December 8, 2008
Radical prostatectomy and lymph node dissection
Catheter out on 7th day, replaced on 8th day, out again 14th day following negative cystogram
pT2c; lymph nodes negative; microscopic margins
next PSA 1/22/08


pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 1/20/2009 10:18 AM (GMT -6)   
Thank you. That definitely makes sense.

sandstorm
Regular Member


Date Joined Dec 2008
Total Posts : 194
   Posted 1/20/2009 12:15 PM (GMT -6)   
Sorry about your father pcBeGone, but welcome to this board. As you can already see, you came to the right place for answers and support. I cannot add anymore to what you have already been told in the previous post from board members, they have given you absolute factual information. I can only wish you luck in your journey with your father.
Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa, but stable
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c / post-op 3+4  7  stage t2c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Catheter removed 1-15-09
Pathology Report says it's gone!
First Post-op PSA due 2-17-09


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4245
   Posted 1/20/2009 2:23 PM (GMT -6)   
pcbegone,
Your dad had plenty of time to make a decision. prostate cancer is very slow growing and 3 months won't make a difference, especially with a low psa. It's much more important to have the cancer staged correctly as most treatment failures are due to improper staging. Put a prostate oncologist on the list of doctors to get recommendations from. I have found that prostate oncologists spend much more time trying to stage the cancer correctly. There are a lot of tests that can be recommended for better staging; PSA3 urine test. MRIS with endorectal coil, or color doppler ultra sound. Prosta scint with CT fusion or Combidex MRI can eliminate lymph node involvement.
Spend the extra time as it will drastically affect your outcome and evaluate all options as to both cure rates and quality of life issues. Wishing your dad the best.
It will be 5 months since diagnosis before I start treatment and I'm not worried at all as the cancer has probably been there for at least 10 to 12 years.
You can also slow the progression with diet and supplements while you wait. My psa has gone down 10% since I changed my diet.
JohnT
Diagnosed 10-08 at 63 with PSA of 33
PSA was 4.4 in 1999 and has risen steadily.
Had 13 biopsies and an endorectal MRI, all negative until 10-08. Two cores out of 25 with a gleason 6
2nd opinion with an oncologist said cancer found was insignificant, but suspected larger tumor somewhere.
Doppler ultrasound with target biopsy indicate a large tumor in the transition zone, gleason 7.
Bone and CT scans negative.
PSA3= 43; (high normal is 35)
Scheduled for Combidex MRI in Feb. (Lymph node imaging MRI done in Holland).
Location of tumor makes positive surgical margin unlikely.
Looking at IMRT with hormone therapy as soon as staging is complete with Combidex MRI.
Changed diet, eliminated all meat and dairy. Taking the normal supplements recommended for PC.
 
JohnT
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


captain bob
New Member


Date Joined Jan 2009
Total Posts : 2
   Posted 1/21/2009 5:23 PM (GMT -6)   

Hello,

     I have prostate cancer and I am currently being treated at the Dattoli Cancer Center in Sarasota Fl. I just started my treatments and the other day they showed me on Doppler radar the area of the cancer and it will certainly show if the cancer has spread outside the prostate. The cancer has fingers like a daddy long legs. If the cancer has spread outside the prostate capsule then a course of treatment other than surgery can be employed. I would not suggest surgery but I am getting radiation followed by nuclear seeds. This center has some of the highest cure rates in the world and Dr Dattoli has treated me like a king and has explained every move they taking. Best to you and your Dad and May God Bless you both........Captain Bob


pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 1/21/2009 11:01 PM (GMT -6)   
This board is a wealth of information & everyone is soo very nice & supportive. A big thanks to all of you for being so generous with your time answering my questions & giving me support.
 
I have a few more questions. If someone could please answer them:
 
Gleason score: It's currenty 3+4. Would it have been less if we had done the biopsy, say 6 months ago? Would be more in the future?
Robotic Surgery: Can someone please tell me roughly how much this costs? (ballpark)
Surgeon: Can someone please recommend one in Houston? (One who does Robotic Prostate Surgery)
 
Thank you.
 
 

Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 1/24/2009 8:42 PM (GMT -6)   
PC

Gleason: Probably not. PCa is generally a slow growing cancer. Slow as in sometimes years for significant changes. Don't kick yourself for when the discovery was made, or for taking some time to determine the right treatment for your Dad. You should explore the 3 big options: Surgery, external beam radiation, and Brachytherapy (seed implants).
50 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
6 Wk PSA - 0 
So far, so good.  Next PSA in another 6 Wks
 


Comdon
New Member


Date Joined Nov 2008
Total Posts : 16
   Posted 1/26/2009 2:22 PM (GMT -6)   
PC bGone,
Please don't dwell on what might have been. Please put your effort into the future. Treatments and options. It may have been there for a long time, but it has nothing to do with what you are going to do about it. Proper testing and staging and Dr choices will help you decide what direction to take. I am happy to have found this forum and find it great for support and information. Best wishes
DonK
Age 53 @ DX
start age 45, 8 yrs tracking PSA at .4-1.5 / DRE suspicious-lumpy left side/Biopsy @ 2001-neg, 2005-neg then in 2007- PSA 2.5/ Biopsy-4left pos, 4 right-neg/Gleason 4+4=8 /
Davinci RP June 17, 2007@ Henry Ford, Detroit./ pT3bN1Mx/ seminal vesicles-yes; 1 of 4 Nodes=pos/Margins=clear/
Recovery very good, 10 days catheter, physically excellent. Sexual dept, showed good signs, injections  for 2 mos. Cialis a couple more mos. Now 80%, no drugs and no complaints. I would trade this for 0's
PSA's. 8/07=.008;11/07=.028;2/08=.062;5/08=.162;8/08=.219
11/08,To Oncologist, Wm Beaumomt Hosp, IMRT 36 trmts. starting PSA=.2, after 30 trtmts,1/09=.1
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 1/26/2009 2:43 PM (GMT -6)   
The important thing, is that you know about it now, and its not too late. The what ifs and could have beens will drive you insane, I know, been there, done that too many times in the past 6 months.

Comdom is correct, time to hone in the treatment options that would make the best sense.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9/9
 
 


pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 1/28/2009 3:57 PM (GMT -6)   
You guys are right. No point dwelling on what's been! Thanks for the support. This board is terrific. Best of luck to all you guys!
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