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smc64
Regular Member


Date Joined Jan 2009
Total Posts : 40
   Posted 1/21/2009 5:48 PM (GMT -7)   

Hello,

Yesterday I had an appointment with a medical oncologist, he told me that in his opinion any form of radiation would not be a good treatment option for me based on my age.  Stated that based on my age, surgery would statistically be my best bet.  That was not a surprised, based on all the research done so far.  However, he did surprise me when he suggested that AS would be a viable option, considering the small amount of pc found and my relatively low psa.   This oncologist seemed impressive and was referred by urology at Lahey clinic.   He was willing to take me on as a patient for AS but only if I was diligent with follow up testing and appointments.  This has made my decision a lot more difficult.  So far I had one urologist and an oncologist say AS is an option.  Another urologist who I spoke with recommended I have the prostate removed.  The urologist who recommended surgery also happen to be one of the top guys in the Boston area and likely the person I would choose if I was to go ahead with surgery, so his opinion weighs heavy in my mind.

I thought a urologist would be the best person to monitor AS, didn’t realize an oncologist would do the same.  Has anyone else used an oncologist for AS?

Another question:  Has anybody gotten sore from a DRE? Or is that telling me perhaps I have a bigger problem than the biopsy has shown.

thanks


Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/21/2009 5:56 PM (GMT -7)   
Welcome,

Don't know what AS is. I agree that radation is not the route for you. I had a robotic radical with followup radiation high dose IMRT and I still have active prostate tissue. I am also told that when it comes to those of us at a younger age it is by nature a more aggressive cancer than the one which slowly enlarges a the prostate of a 60+year old man. Bottom line is no one really knows and every expert you will see will give you a different opinon.

I have never heard of lasting pain from the DRE, are you talking about one done shortly after biopsy?

Gleason 6 is serious cancer, at this point the PSA and free PSA are irrelevant as you have pathology proving cancer.

When did you have the biopsy and what is your intention?

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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/21/2009 5:57 PM (GMT -7)   
I had been getting DRE for about 7 years, and each of them hurt me considerably afterwards, and that without anything being found through the DRE, I am sure each man would react different to them.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, 40 - 90%, G 4+3 & 3+4
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, Catheter out on 12/15/8. Stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08. Emergency room put in Catheter # day 45, 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - removed blockage, put in Cath #5, 1/19/9 -out
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grams, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


smc64
Regular Member


Date Joined Jan 2009
Total Posts : 40
   Posted 1/21/2009 5:59 PM (GMT -7)   
gpg, Active surveillance
Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/21/2009 6:01 PM (GMT -7)   
smc64 said...
gpg, Active surveillance

With proven cancer, in a word suicide.
 
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


smc64
Regular Member


Date Joined Jan 2009
Total Posts : 40
   Posted 1/21/2009 6:08 PM (GMT -7)   

I had my biopsy back in December and I’m leaning toward active surveillance.  I’m not convinced this is something that is going to give me major problems anytime soon, 5% on one core which has been described to me as low grade.              Perhaps a calculated risk.   As far as the DRE it was done yesterday still feel something on the right side.


Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/21/2009 6:32 PM (GMT -7)   
Not meant to create an arguement, what is proven cancer??? You can have a gleason 6 (3+3) or less than 5% found in a biopsy and it is considered non-threatening-indolent PCa. Defined by John Hopkins Hosp.
Is John Hopkins-Brady Institute of Urology stupid or liars, they defined "indolent PCa"? So if they are stupid do we send patients to see them??? Why do many books mention watchful waiting/AS/monitoring? Why do some doctors even uro-docs in line with a possible waiting scenario??? I have seen people wait without it looking like a mistake and so have others. Leading organizations mention it as possible, like UsToo or Paact etc.

We can't say when they should be treated exactly or even if and when, sometimes.
A study done in Michigan I think at Wayne State University on autopsies of men in their late 20's to late 30's showed alot of men had prostate cancer already at that age.....slow growing and basically in the category of indolent PCa's(not aggressive levels), these men would probably never be detected until either later DRE's or Psa testings, usually when they are 40-50 yrs. or older. This also shows that slow growing PCa is more of the norm and takes along time (most of the time), these people would have had low gleasons, generally. The more things like this that you learn about the more PCa is the norm of "exceptions" disease. Once higher gleasons are seen and higher volume and psa's then waiting is not an realistic option or rationale. Although a patient can choose so say darn the torpedos or take drugs or other methods. Hey some Quakers won't even see doctors at all, it is their option. Not all patients deal with this the same, another parameter.


 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/21/2009 6:54 PM (GMT -7)   
zufas, the fact that smc64 is only 44 and has a real dx. of PCa concerns me. At 56 at dx, my experienced doctor said I was one of his youngest patients. I agree with just one core at 5% on a Gleason 6, in theory sounds low grade, but on a 12 core biopsy, I would be wondering what else is in there? Even in a 12 core, could be missing higher grade areas by chance. I agree with his dr. that radiation wouldn't make sense at this point with this kind of dx. I think the AS is still possible, but it's either deal with it now, or deal with it later, I guess that is a call we each have to make. If I had his stats, not sure what I would have done to be honest, but having had cancer 3x previous, probably would have done the same thing I did.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, 40 - 90%, G 4+3 & 3+4
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, Catheter out on 12/15/8. Stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08. Emergency room put in Catheter # day 45, 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - removed blockage, put in Cath #5, 1/19/9 -out
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grams, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/21/2009 7:06 PM (GMT -7)   
gpg,
It might be worthwhile if you read up carefully on active surveillance (AS) before dismissing it out of hand............as zufus has correctly pointed out very low volume Gleason 5 or 6 is a serious candidate for AS and thus avoiding the price of active treatment side effects for many years. Remember much of PCa is indolent cancer and just sits there.
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)


smc64
Regular Member


Date Joined Jan 2009
Total Posts : 40
   Posted 1/21/2009 7:21 PM (GMT -7)   
Purg. If I had one core with say 20% or 3 cores with 10% it would be a no brainer, surgery. The oncologist told me it's not something that is going to explode overnight. Yes, with AS I'd likely just be putting off the inevitable but at my age there is a lot I want to do before having to deal with all the issue that come with surgery. With that small amount maybe I can put that off for a year or two, maybe more. Say the cancer doubles in a year, statistically nothing changes. I don’t see it as suicidal because I would be diligent monitoring.
Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4017
   Posted 1/21/2009 8:33 PM (GMT -7)   
Dear smc64, I have a couple of comments re the posts in this thread:
 
1.  I think Scott's comments might be a little dogmatic and maybe should be expressed as his opinion rather than fact.  For example, studies at Duke University have shown that prostate cancer in younger men is NOT more aggressive than that found in older men.  Also, according to most experts, PSA level IS relevant even after a biopsy as that is one of the criteria used by docs in determining follow up tests and treatment recommendations.  Finally, to say that AS is "suicide" is, in my opinon, an overstatement.  However, I personally do believe that the cancer is likely to progress and that you will face the need for active treatment at some stage even if you choose AS now.
 
2.  Before totally eliminating radiation in any form, you probably should consult with a radiation oncologist as well as the experts you have already seen.  That way you will have the benefit of a full range of disciplines and be able to make a well informed decision.
 
3.  The Brady Urological Institute at Johns Hopkins conducts a well respected AS program.  Here is the link to their site. http://urology.jhu.edu/prostate/advice1.php
As you will see from reading this, they would probably NOT take you into their program.  Based on your young age, they would most likely recommend active treatment.  However, it might be worth a call to Dr. Ballentine Carter at 410-955-0351 if you are seriously considering this approach as Dr. Carter probably has more extensive experience in this area than your current physicians.
 
Hope this helps,
 
Tudpock
Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/30/08.


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/21/2009 8:38 PM (GMT -7)   
smc, to answer your question about soreness. I just had my 16 months after surgery exam today, no prostate, doctor with long fingers and a searching style, and I can tell you I am sitting here sore--or sore sitting here. It usually lasts a couple days for me.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/07 Nerve sparing open Retropubic Radical Prostatectomy
9/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 12 mts.-.04, 16mts.-.04


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/21/2009 8:58 PM (GMT -7)   
smc64, your attitude strikes me as a bit strange. your biopsy doesn't mean that's all the cancer you have, it only means that on that sample of 12 cores, that is all it found. not saying you have any more, perhaps you are that fortunate just to only have the 1 core. mostly sounds like your mind is made up, and that's fine, because utimately, like every man here, you have to make your choice or choices, its your life, your body, and now, your cancer. getting lots of opinions is the right path to be taking, no one would disagree with that.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, 40 - 90%, G 4+3 & 3+4
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, Catheter out on 12/15/8. Stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08. Emergency room put in Catheter # day 45, 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - removed blockage, put in Cath #5, 1/19/9 -out
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grams, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


DJBearGuy
Veteran Member


Date Joined Dec 2008
Total Posts : 688
   Posted 1/21/2009 10:08 PM (GMT -7)   
Tudpock,

Thanks for the Hopkins link. (and smc64, thanks for bringing this up). I didn't realize that Active Surveillance meant yearly biopsies, though of course that makes sense. I and many others found the biopsy to be pretty unpleasant. At some point, like around 3 or 4 biopsies, I wonder if you might have suffered as much as if you had surgery. (Of course, it's a moot point for many of us here. )

DJ
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


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4017
   Posted 1/22/2009 6:17 AM (GMT -7)   

DJ, re the unpleasantness of the biopsy, I think that may be related to the patient's decision as to whether or not to have anesthesia (or the doctor's willingness to offer it).  I only had one biopsy, under IV anesthesia.   I would not call it a pleasant experience but it was only mildly uncomfortable as compared to what some men describe as painful or very unpleasant w/o anesthsia.

Also, smc64, even though my previous post pointed indicated that active treatment is probably the most recommended path for you, I can personally understand your thinking.  In other posts I have tried to differentiate between the psychological leanings of some men vs. others.  Many men in this forum have the urge to "get it out" at almost any cost and therefore go headlong into surgery.  Others, including ones who post frequently on this forum, don't have that urge and opt for protocols like TFT (realziggy) or AS or brachytherapy (me). The point is that each situation is different as is the psychological makeup and willingness to take risk of each patient.  Personally if I had received your diagnosis at your age, it would have been a tough call for me and I can understand your thinking of wanting to get in a few more good years before getting the treatment...but you just have to understand that entails some risk.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/30/08.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/22/2009 6:34 AM (GMT -7)   
Tudpock, I think the end of your last post is right on target. There is no definitive right or wrong in these choices, there are some many factors and variables, and quality of life issues, etc. I wouldn't want to be dogmatic on any point here, and ultimately, every man facing or having PC has to make some very personal hard choices along the way. And think for the men who may have dealt with a major illness or surgery before, or like some, avoid medical tests and such, their dx of PCa is probably causing an overload of fear and panic, which thus affects the decision process. No one easy answer or solution, that's for sure. Pity the men who had to make these decisions in pre-internet days, when you either depended only on your doctor, or looking in some outdated book in the library.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, 40 - 90%, G 4+3 & 3+4
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, Catheter out on 12/15/8. Stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08. Emergency room put in Catheter # day 45, 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - removed blockage, put in Cath #5, 1/19/9 -out
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grams, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/22/2009 8:07 AM (GMT -7)   
Wow,

Let me be clear my statement was nothing more than my opinion. It seems that the AS had already been discuused with this member and the only situation in which I personally would consider that approach, which ironically is my status these days is where there is no cancer.

Typical transrectal biopsies are like a needle in a haystack you can segment the haystack and get a gross understanding about what is going on. I have read that upon dissection many cancers which had been presumed to be low volume and indolent have been reclassified up a grade or more.

While I still think the PSA is not that relevant for this member right now in view of a postitive biopsy the fact of the free PSA being lower than 25% is considered by some to be an indicator of an agressive cancer. My free PSA pre biopsy was 4%.

I am not attempting to panic anyone, just giving my opinion some of which may not be completely accurate and that is the wonder of this board that the fact and opinion get sorted out pretty quick. Really not being Drs. all which is stated here is opinon and anecdote unless it is a clearly documented citation.

Having read all of the comments and placing myself in this persons position I think I would have to have a more extensive and quantifiable biopsy before I chose any treatment path.
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 1/22/2009 8:18 AM (GMT -7)   
Good discussion on this(appreciate all points of view-not calling anyone out on this), just trying to raise the bar on awareness, controversies, choices, and the Twilight Zone effect of PCa issues. It is never black and white, clear cut as you can see. Always exceptions, "some young men" can be found with aggressive cancer...if so waiting "seems" like suicide, some younger (larger percentage if found with PCa maybe towards the indolent level)..their total choices should be laid out before them in rationale straight talk, how many men were 'never' told that waiting could be an option??????

There is alot of bias from the various docs, money is made on this too another variable in the mix.
NBC had a t.v. special about PCa and the over done surgeries as a "cottage industry" money maker in effect, not my words, the t.v. show unveiling the reality of the unreal world of PCa. Same goes for other treatments.
The one post whereby an older guy was supposedly not a good candidate for radiation (from a uro-doc), smells awful biased unless there were mitigation circumstances, older people are the exact usual candidates for radiations and is also in many books on PCa.

I hope more straight facts, truths, options are laid out totally before patients, whom "have to choose".



This stuff is not in books for the heck of it.
 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/22/2009 8:35 AM (GMT -7)   
zufus said...

There is alot of bias from the various docs, money is made on this too another variable in the mix.
NBC had a t.v. special about PCa and the over done surgeries as a "cottage industry" money maker in effect, not my words, the t.v. show unveiling the reality of the unreal world of PCa. Same goes for other treatments.
The one post whereby an older guy was supposedly not a good candidate for radiation (from a uro-doc), smells awful biased unless there were mitigation circumstances, older people are the exact usual candidates for radiations and is also in many books on PCa.

I hope more straight facts, truths, options are laid out totally before patients, whom "have to choose".



This stuff is not in books for the heck of it.

Very true words,
 
I have been seen for this now by 8 doctors, one my internist who ordered the original PSA, three urologists, two genitourinary oncologists, and two radiation oncologists and only three of them have roughly concurred concerning my persistance of PSA and how to deal with it.
The two specialists at Duke (one of whom had trained at Hopkins under Walsh and Carducci) both concurred that my cancer was incurable and they both discounted the remaining prostate as not significant.
Different Dr.s specialize in different treatments and I think it is inevetable that they view treatment through this prizm. 
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


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4017
   Posted 1/22/2009 8:36 AM (GMT -7)   

zufus, your continued points on physician bias are excellent, in my opinion.  While seeking multiple opinions for my cancer I consulted a well known urology practice in Florida.  It "happens" that they also advertise widely for their robotic surgery services.  When discussing my condition with the urologist there, he pushed me hard toward robotic surgery and practically refused to even discuss other options.  I'm convinced that this practice is trying to amortize their considerable investment in davinci equipment by encouraging robotic procedures.  Of course robotic surgery WAS one of my options, but the bias of this so-called professional was all too obvious.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/30/08.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/22/2009 8:40 AM (GMT -7)   
I see your point, Tudpock. The hospital that I had my open RP is the only one here with the robot, and now they advertise it all the time on the local tv. So I am sure the surgeons associated with that hospital are "encouraged" to go that route. According to the paper, the robot cost the hospital over $2 million.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, 40 - 90%, G 4+3 & 3+4
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, Catheter out on 12/15/8. Stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08. Emergency room put in Catheter # day 45, 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - removed blockage, put in Cath #5, 1/19/9 -out
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grams, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 


Dirtmover
Regular Member


Date Joined Apr 2008
Total Posts : 158
   Posted 1/22/2009 9:15 AM (GMT -7)   
Hello smc, i too was 5% tumor volume  however your forgetting the most important fact , you have overlooked the fact that you MAY indeed ,have g 7 and not 6 when a biopsy is done g6 is mostly a beggining marker almost all biopsy are 6 it is a clinical staging THATS IT mine was a 6 but post op it was a 7 and 34% of the time your gleason will go up  when the prostate comes out ,a 7 with 5% is much worse  than a 6 with 20% the agressiveness is what makes it spread. look at some of the signitures on here and look at the countless times a 6 end up being a 7 i had no positive margines ,but a 7 will grow ata faster rate  and if your thinking itsa 6 the whole time your asking for trouble sooner than later, im sure you will do the right thing that is for you, i know i did.. im not wondering ,any more ...................are you?.......................dirt



Diagnosed November 2007   (43 years old )
PSA 3.9 / Gleason 6 / TC1 6 cores 1 shows 25%
Sugery scheduled 5/29/08 - City of Hope - Dr. Mark Kawachi
 "First show of the day"
 and now for the new ive been waiting for
 FINAL PATH REPORT:gleason upgraded to 3+4 T2c bilateral disease,tumor involvment 5%
extra prostatic extention:absent
seminal vesical invasion :absent
pathological staging:pTNM pT2 ORGAN CONFINED
margins free of carcinoma
usable erections ;6-6-08 with little blue pill
continence; 1 pad a day, dry at night
continence a non issue at 10weeks

Post Edited (Dirtmover) : 1/22/2009 9:34:11 AM (GMT-7)


smc64
Regular Member


Date Joined Jan 2009
Total Posts : 40
   Posted 1/22/2009 9:38 AM (GMT -7)   
Hello all,
I first want to thank everybody who has responded to my post. It is impressive to see how many people care and are willing to help and offer advice. Truly appreciated!
As for me, my mind is not made up yet. My wife has been out of town this week so we haven’t had the opportunity to discuss this further. Plan to over the weekend. As my oncologist and many of you have said, I have a tough decision. My age and health (in shape, exercise regularly no family history of pc) put me at the top of the spectrum as far as recovering. Other than my age and free psa I would be a good candidate for AS. I do realize that there could be more pc than has been detecting in the biopsy but I don’t believe it’s a large amount. After my last dre the other day I was told everything was smooth and I have absolutely no symptoms. We’ll see.
I too believe some urologists are not necessarily looking out souly for your interest. Here’s a story. The Urologist that diagnosed me was very quick to try to set me up with his partner who does the Devinci surgeries. He told me his partner was having great success, “some of his patients are having erections with the catheter still in”. So I asked him how many has he done, his response was “he has already done about 40 surgeries”. Needless to say, I ran for the door there. Since then, his partner office has tried to contact me several times. They even called yesterday after I told them I wasn’t interested. I agree there is a considerable investment in Devinci equipment and perhaps some dr push you for economic reasons and not medical.
This site and the YANA site have been great! Thanks again
Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/22/2009 10:14 AM (GMT -7)   
The best advice to a patient, is get pathology reviewed by one of the handful of pathologists like prior poster mentioned, how do you know for a fact you have a Gleason 6 and not Gleason 7??? Excellent piont (another-Twilight Zone parameter). How many times have we seen post pathology or reviewed pathologists (2nd opinion by experts) that the Gleason number changed either higher and sometimes even lower. Get the most amount of information possible on your disease level, including partin tables, narayan tables, nomograms, maybe even 2nd opinons on scans (reviewed by another radiologist-I had two others look at mine, just to be verify what first rad-doc was saying). Plus I looked at it, of course I knew crap for that, but I did not see any blackened or hot spots-like seen in books...doesn't mean anything but it is neat to see your own skeleton completely.

Moody Blues (lyrics)- "face piles of trials with smiles, keep moving, on the threshold of a dream"
It is a dark day for us hearing you have cancer, then we stop and smell the roses (eventually) after that major fallout is past our minds and look forward, the past is the past now.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/22/2009 10:49 AM (GMT -7)   
smc64, i think you are thinking the right approaches this. and I understand too with your wife being gone, mine is a very qualified nurse, and we shared in the research and decision for myself. the only point i think might be misunderstood (perhaps by me), is that you might be perfectly correct in thinking how low level your pc is at this point, and that's the only place i see a real gamble. your comment on your last dre, all 7 of my previous ones including right up to my dx were smooth, and syptoms, many men here, myself included, were in good general shape/health with no other sympton ahead of time, if you look at my pre surgery stats, had a pretty serious cancer going on that i would have known about other then having psa done since age 50 just because i was told that men should. some mens gleasons go down after surgery, but a larger percentage actually go up, as my dr said, until they have the entire gland to run through pathology, anything thing done ahead a time is like a "best estimate". one reason surgery was considered the"gold standard" is because it gave the best opportunity to see the best scope and range of the cancer. my interest to you, is not pushing my solution, or any other solution, but just don't want you or any other man with any pc dx to underestimate what it can do on its on.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, 40 - 90%, G 4+3 & 3+4
Open RP surgery 11/14/8, Non-nerve sparing, 4 days hospital, staples out 11/24/8, Catheter out on 12/15/8. Stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08. Emergency room put in Catheter # day 45, 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - removed blockage, put in Cath #5, 1/19/9 -out
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grams, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery  Scheduled now for 2/9/9
 
 

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