Having surgery

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Ed C. (Old67)
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Date Joined Jan 2009
Total Posts : 2455
   Posted 1/26/2009 10:50 AM (GMT -7)   
Hi,
I'm 67 years old and have been diagnosed with prostate cancer. My biopsy showed 2 nodules (2mm and 4mm) both in the lower left corner of the prostate. The Gleason score was 8 and 9 respectively. I had a CT scan and a bone scan both of which were negative. I'm scheduled to have robotic (Da Vinci) surgery to remove the prostate on Feb 9th. Given the aggressive type of the cancer I'm concerned that it may have spread beyond the prostate. My PSA remained below 4 and my free PSA was at 11%. I'll appreciate your comments especially from those who may have had similar experiance.

Smokie
Regular Member


Date Joined Oct 2008
Total Posts : 46
   Posted 1/26/2009 11:48 AM (GMT -7)   

old67,

I'm sorry to hear that you are having to go through this. Gleason scores of 8 and 9 are not the best news, but by no means a death sentence either. A few things to think about:

Your PSA, at 4, is good news. It is my understanding (as a patient, not a Dr) that more PSA is released into the body as the cancer eats away at the prostate walls, therefore raising the PSA in the blood. A low PSA is a good sign that the cancer, whether aggressive or not, may well be in the early stages. It also sounds as if the cancer has not yet spread throughout the prostate.

My pre-op gleason was 7. My post-op (actual) was 6. Gleason scores are not always correct, and generally a subjective measure, depending on what lab tech is looking in the microscope.

There are others on this site who have experienced a similar diagnosis to yours, and you will receive a lot of replies from people who give you better answers than mine. We all, however, care about what happens to you and wish you the best in this tough situation.

Smokie


Age: 43
Diagnosed at 41 by routine blood test
PSA at diagnosis: 5.1
Pre-op Gleason: 3+4=7
Post-op Gleason: 6 (different labs?)
No luck finding local experience with DaVinci
Scheduled RP at Vanderbilt: 8/06
Insurance trouble, rescheduled at Centennial Hospital, Nashville
Prostate removed 9/06
Robotic, nerves spared, no positive margins
PSA since RP: good (less than .05)
Currently suffer ED
 
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2455
   Posted 1/26/2009 12:03 PM (GMT -7)   
Thank you Smokie. I guess I just have to wait and see what the biopsy reveals after the surgery. I'm hoping for a good result but I guess I'm preparing myself for what might be. I have a very good support system from my family, my church and my golf friends.
Schedules for Robotic surgery
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5


Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4814
   Posted 1/26/2009 12:18 PM (GMT -7)   

Welcome to the site AND sorry you have to be here...

Prostate Cancer is farrrr from aggressive.

Many of us here had the surgery you're fixing to have. Of the many reasons to do the Da Vinci surgery - one big one is that should it have spread outside the prostate, you can then get radiation treatment.

 


Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 1/26/2009 12:22 PM (GMT -7)   
Welcome to HW, hate you have to be here. Hang around and fix up a signature telling us the stats of your Journey so far. ok?
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/26/2009 12:46 PM (GMT -7)   
Welcome to the gang here at HW. The best part of your situation is the PSA number at this point. I would think that if your doctor strongly thought that your PC was not contained at this point, he wouldn't be reccomending surgery.
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
 
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2455
   Posted 1/26/2009 1:31 PM (GMT -7)   
Thank you all for your response.I wish you all a great future without cancer.
I'm 67 years old living in Austin Texas. Early in 2008 I had my PSA tested as part of my annual checkup. My doctor noticed a spike in my PSA that increased from 2.6 to 3.9. I repeated the test 6 months later and it was 3.5. At that point he recommended I see a Urologist who repeated the PSA test and included the free PSA as well. My total PSA was 3.3 but my free PSA was 11%. The Urologist had me do a biopsy on December 30th, 2008. The result was positive. I had 2 nodule both in the same lower left side of the prostate. I also had 3 pre-cancerous sections. I has a CT and bone scans done on Jan. 11, 2009 both of which were negative. I'm schedule to have the robotic surgery here in Austin performed by Doctor Randy Fagin who performs approx. 200 such sugeries every ryear. I'm supposed to be in the hospital for one day only. So far that is my journey./
Schedules for Robotic surgery
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/26/2009 2:14 PM (GMT -7)   
It is your decision to make right now, you could even cancel and get further opinions. Did you see John T's post about advice for newbies and others???? It was well thought out and although alot of us don't have that much time maybe to look it all over, we can make time by taking casodex and/or other drugs to slow or halt PCa, while one makes an totally informed decision. This is done by alot of patients, maybe uro-doc kind of glanced that option???
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2455
   Posted 1/26/2009 2:35 PM (GMT -7)   
Zufus,
Yes I saw John's post and that is what got me thinking and asking questions. If I postpone the surgery and do all these other tests that John recommends what will these tests show that will make surgery the wrong choice? Is the down side of surgery the side effects such as incontinent and ED. I do care about incontinence but not much about ED. Beside what are the other options that will provide better long term survival?
Schedules for Robotic surgery
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/26/2009 2:49 PM (GMT -7)   
No simplistic answers in PCa, each patient can be a unique situation, you don't have to necessarily do alot more tests. There are alot of choices out there that could have the same results, with maybe less risks or variables that appeal to you directly. High Gleason scores are generally much more risky for curative surgery, something to consider. Do you want to risk taking the gland out and all that entails and maybe find out you did it for nothing and have to resort to the other treatments anyway? What is wrong with second opinions on this even from other surgeons???? Just want you to be a happy camper with yourself down the road.
 


sandstorm
Regular Member


Date Joined Dec 2008
Total Posts : 194
   Posted 1/26/2009 3:11 PM (GMT -7)   
Welcome old67, sorry you had to join us. I know those Gleason scores of yours are scarry, but then a low PSA of 4 and 11% free is pretty good news to me. I' m 17 days post-op from DaVinci myself so I know what you are going to go through. You have about 10 years on me so your recovery may be a little slower but you will do just fine. After knee and gall bladder surgery 37 years ago, this DaVinci was a cakewalk. It's normal to worry about PCa spreading but your surgeon will be able to really give you some up front information on that right in the recovery room. You just get to that recovery room first. Good luck and keep us posted.
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


lifeguyd
Veteran Member


Date Joined Jul 2006
Total Posts : 664
   Posted 1/26/2009 5:54 PM (GMT -7)   

Your diagnosis is similar to mine.  I had one nodule that was read at a gleason 8.  It looks like you might be confined to one side (stage t2a in my case).  My DaVinci surgery was uneventful and my recover fairly smooth.  All of that being said, None of it is any fun.

My age is similar and I had no major problems with incontinence.  I do have long term ED problems, one side nerves were spared, but I still need a shot to get an erection.  Good luck with your surgery.  I had two friends who had brachytherapy at the same time as my surgery, but they had gleason 6 dx.  Two years after treatment, they are having various ed and urinary problems, nothing major, but it seems we all must suffer some bad stuff.

Good luck with your treatment.


PSA up to 4.7 July 2006 , nodule noted during DRE
Biopsy 10/16/06 ,stageT2A
Aggressive Gleason 4+4=8  right side
DaVinci Surgery  January 2007
Post op confirms gleason 4+4=8
No extension or invasion identified
Few continence problems
PSA 90 day (-.01)  , (6 month -.01) , (9 month +.02) , (1 year +.02) ( 18 months +.02) (two years+.02)
One side nerve spared
success but some plaque with bimix 
born in 1941


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 1/26/2009 6:25 PM (GMT -7)   
Dear 67....You are not old...You are young...and if the doctors recommend surgery for you, I say. get it out. Your PSA is low..and it is very probably contained. Di
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Forging ahead to health!


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/26/2009 6:44 PM (GMT -7)   
Welcome and good luck to you.
 
Your PSA is indeed low and that bodes well as support for the validity of the whole body scans.  Your FPSA is scary low, anything below 25% is considered to be inticative of an agressive cancer.
 
You are in the age range where radiation is more often considered because of the numerous and common side effects of a radical surgical procedure.
 
It sounds like you have taken all of this into consideration, you have a surgeon with a good background with whom you are comfortable, and I and no one else should presume to lecture you.
 
If I was you and had a confidence level that the disease was confined and so curable, I would also be going for the cure.
 
Please let us know.
 
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4168
   Posted 1/26/2009 7:08 PM (GMT -7)   
Old 64,
Agressive Gleason 8s and 9s are sometimes associated with very low psa. I don't know why and maybe someone else can give us an explaniation.
So I would not use the low psa as a factor in your decision making. Getting a 2nd opinion from a prostate oncologist could help in better staging which would lead to a better treatment strategy.
Gleason 8s and 9s are agressive and the high reoccurance rate indicates that cancer cells enter the blood stream much more than they do in Gleason 6.
The only downside of surgery is the high risk of reoccurance coupled with living with the side affects of the surgery then having to go through another treatment. Surgery could work and it has for a lot of people. With a gleason 8 you should definately be looking at getting opinions from other doctors that are not surgeons.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2455
   Posted 1/26/2009 7:47 PM (GMT -7)   
Thank you all for your input and support. I have learned a lot from this forum. By the way my staging was 1a. I'm in good physical condition (5 10 182 lbs). I exercise regularly and watch what I eat. I hope to have a successful surgery and good news to share with you. We all need a little luck and a lot of prayers.
Schedules for Robotic surgery
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5


olid
New Member


Date Joined Jan 2009
Total Posts : 3
   Posted 1/27/2009 2:58 AM (GMT -7)   
Good luck to all you gents. This is my first time on - of course since I have prostate cancer.
My doc in Vegas recommended that I have a ropbotic prostatechtomy. but that I go to the Chairman of Urol at San Diego Univ.

Waiting now for a consultation date. I am very concerned about incontinence and ED. Think I am getting stressed out now as well. The waiting gets me nuts.

Fred M

BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 1/27/2009 3:40 AM (GMT -7)   
old67
Welcome to the best PCa patient to patient site on the web. It is unfortunate you had to come but you will find all are anxious and happy to help.

olid
Welcome to you as well. You might want to start your own post as you might get missed here. Include your stats if you can, add your concerns and be you'll be deluged with help and reassurance.
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)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/27/2009 6:55 AM (GMT -7)   
olid, welcome to the group. the things you describe feeling are all very normal and expected with a new dx., it can be very scary. good place to be, lots of good people and loads of good info and support.

i agree with billy above, start a new thread about yourself, that way you wont get buried in this thread, and more people will get to know you

david in sc
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
 
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2455
   Posted 1/27/2009 11:24 AM (GMT -7)   
Olid,
I share your fear and anxiety. I'm in the same boat as you. I'm having robotic surgery on Feb 9th. This is a great website for support and information. Please tell us a little bit about yourself and your diagnosis.
Schedules for Robotic surgery
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 1/27/2009 1:22 PM (GMT -7)   
Old67 -

Review my profile below. With a Gleason 7 I was told by 3 doctors (all surgeons), "Don't wait, step on the gas." I did, and afterwards I was elevated to a Gleason 9 with a pT3a tumor. My doctor told me it had bulged out, but not broken out. All samples of everything around the prostate were negative. So, personally I am glad I had the surgery because I think I was really on the verge of a carcenomic jailbreak.

BUT - we are all different. Choose what is right for you. There are a lot of successful treatment paths out there.

After knee surgery and shoulder surgery, I'll agree with Sandstorm, the actual robotic RP is a piece of cake. Of course the first 12 - 24 hours after any surgery usually, um, what's the word? - oh yeah, sucks. But beyond that, the catheter is more of an inconvenience than anything else. If you go with the surgery, take stool softeners when you get home (discussed before in other strings) and be sure to ask your doctor about bladder spasms (also discussed before).

Good luck with whatever path you take,
kcragman
Age: 53; 52 at DX
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.
Feb 2008: PSA 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 node and nerve samples taken, and appeared 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.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25353
   Posted 1/27/2009 1:25 PM (GMT -7)   
old67 - i was the king of bladder spasms - ask your dr about ditropan right from the start, was either a 4 or 8 dollar drug at walmart in the generic, works very well
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
 
 


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2455
   Posted 1/27/2009 6:35 PM (GMT -7)   
kcragman,
I'm glad everything worked for you and hope you will continue yo have undetectable PSA. I'm actually following the same path as you. My biopsy was done on December 30th and the only reason for Feb 9th date is because the Dr. wanted to wait 6 weeks from the biopsy date. I hope to have good results from the post op biopsy.
Schedules for Robotic surgery
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5


hb2006
Regular Member


Date Joined Nov 2008
Total Posts : 299
   Posted 1/28/2009 1:24 PM (GMT -7)   
old67
 
My gleason scores were the same as yours and my psa jumped from a 4 to 10 in one year. The scans were all clear. But the urologist recommended surgery and I agreed as I have a PC history on my father's side. I had the surgery on May 21, 2008. Incontinence ended exactly at 8 weeks and I have been working on the ED. Had the nerves spared on the right side. Post surgery PSA'a have all been at zero. It had not spread but the left side of the prostate was completely cancerous.
 
Viagra and Cialis haven't been doing much so I switched to Levitra and had a huge difference in response. I'm also on the Injection Therapy and the Trimix is great.  

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2455
   Posted 1/29/2009 7:45 AM (GMT -7)   
hb2006,
Great news about the success of your surgery. The last time I had a PSA was in November 2008 and it was 3.3. I had my biopsy in December. My doctor will also spare the nerves on the right side since my cancer is on the left side. I've been doing the Kegel exercises to improve my post op incontinence. I hope your ED will improve soon. Wish me luck and say a prayer for me. Thanks
Schedules for Robotic surgery
Gleason score (4+4) in one nodule
(4+5) in another nodule
Negative CT scan and bone scan
PSA 3.5

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