Reoccurances being systemic

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John T
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Date Joined Nov 2008
Total Posts : 4188
   Posted 1/27/2009 10:37 AM (GMT -6)   
Tony,
You asked the question on where I got the idea that most PC reoccurrances are systemic and not local. It was in one or more of Dr Leibowitz's publications.
Your question really got me thinking because you are one of the most informed persons I know and you never heard of it; and I just took it for granted. That question kept me up most of the night and led to a bunch more questions.
I took it for granted when I 1st heard it because I've had experience with breast cancer because my wife was treated 5 years ago and as everyone knows it has a high reocurrance rate. Breast Ca is always treated as systemic even though the tumor is local. Surgery and radiation are adjuncts to the primary chemo treatment. So Im used to thinking of cancer as being systemic.
 
Reocurrance being systemic makes sence when you think about it.
The local treatments, surgery, radiations ect, are exactly the same for gleason 5 and 6 as they are for gleason 8 and 9. But we know that 5 and 6 reoccurances are unlikely whereas 8 and 9 are very likely. If there is no difference in the treatment then the only variable is the cancer grade. If the prostate is completely removed during surgery then it can only mean that cancer has excaped and entered the blood stream before the prostate and all the cancer cells in it were removed.
We know that millions of cancer cells are elswhere in the body of PC patients but that only a few of them will develop into tumors.
Maybe G 8 and 9 cells are the ones that eventually develop into tumors and g 5 and 6 stay indolant.
I'm way over my head going down this road because I have absolutely no training, but I have an idea of how PC cancer works. It goes through the blood stream and usually settles in the pelvic lymph nodes , the prostate bed or the pelvic bones. For some reason it doesn't like organs. Most of the PC cells don't grow but some of them do and it could take years. I suspect that the same conditions that made it grow in the prostate will make it grow again down the road. Diet could influence the future growth rates.
If you have a reoccurance you have to assume that it came from cells that are already inside your body, unless the surgery was botched and some prostate tissue was left. If your treat this locally you are not killing all the other cells that are elsewhere just waiting to grow.
The other thing that bothers me is that recurrances usually have a much faster psa doubling time than the original tumor.The original tumor usually has a 2-3 year psa doubling time and reoccourances usualy have a much faster doubling time, a year or months, Something's happening here that I don't understand. You can come to a bunch of conclusions about this, but I don't think there is any evidence to support any of them.
 
Reoccurance in high PSA patients is fairly strateforward, no matter what the gleason score is. You can easily calculate the size of the prostate gland and determine the psa it will generate. If you know the tumor size and grade, which should be known, you can calculate the psa that it is putting out. If the psa is higher, then it must be coming from somewhere else, most likely from small tumors in the lymph nodes. Transition zone tumors are different as they create lots of psa for their size, but agressive gleason 8 and 9s create low psa. I don't know why more doctors don't use this easy psa calculation on their high psa patients to better stage their PC. I know my uros never used it.
I hope I've given you some things to think about. I don't know why more research isn't done in this area. I think it's because most PC doctors are urologists and concentrate on surgery and surgical solutions even though there is a lot of evidence that PC behaves a lot like most other cancers and spreads through the bloodstream.
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


LV-TX
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Date Joined Jul 2008
Total Posts : 966
   Posted 1/27/2009 10:59 AM (GMT -6)   
Thanks John...it was me that asked the question not Tony. I will research Dr Leibowitz's publications. My understanding that most T2 & T3 disease with low initial PSA (<20) and when reoccurrence is detected would most likely be local. Also you are correct in that the PSADT is a factor on how aggressive the reoccurrence is as well as how soon after primary treatment, the failure occurs.

The reason for the question is that those of us with low grade PCa and positive margins are at higher risk of reoccurrence. But the good news is that from what I have read, if reoccurrence does happen most likely will be local and can be treated accordingly. So I was wanting to gain further reading on the subject just to make sure I am understanding the histology of PCa reoccurrence correctly.

Thanks for all the research you have done and it will be a great help for those reading and have been recently diagnosed.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


Doting Daughter
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Date Joined Aug 2007
Total Posts : 1064
   Posted 1/27/2009 11:23 AM (GMT -6)   
Great thread and one that is close to my heart. SO, according to many thought leaders, because my father had a positive lymph node, the cancer is considered systemic and not curable. However, our oncologist, said that he only had one lymph node that had a tiny pin drop size of cancer, and that we don't know if we got it all or not. His PSA came back as .07, then .05 following surgery and he completed radiation, just in case there was any cancer left. The real frustrating thing for me is that he only had one focally positive margin, which by definition, means the cancer just touched the margin, didn't go through right?! Well...how did the cancer get out then? This disease is so frustrating and I have to get over the fact that I too, can't put it in a flow chart or connect the dots. We are just trying to do everything we can with the info and hope we have and move forward to a cancer free tomorrow.
It would be great to see more studies and hopefully we will see positive outcomes from the studies currently underway.
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


zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/27/2009 11:26 AM (GMT -6)   
This is why the leading onco-docs have more knowledge on PCa than just uro-docs, they have to analyze it biologically because that is usually how they have to treat it, but they also are knowledgable about treatment proceedures. Doctor Strum is probably one of the very best versed in PCa total parameters and understand of the disease, many people endorse reading his book. If you have not seen his book do not pass judgement on him as being totally biased, he covers various treatments in his book even with some patient history etc.

Also the perinueral invasion thing in pathology, there is your possible path to go beyond the gland, even with lower gleasons and stats....does not mean it will either, that invasion means it could. You could also read up on Dr. Barken and 'micro mets' not what us patients are wanting to hear about PCa. I doubt he is seriously misinformed. Realize with PCa there are no definitives and inconsistences and exceptions exist all the time. However, if someone shows good data otherwise, let us all see it.


 


don826
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Date Joined May 2008
Total Posts : 1010
   Posted 1/27/2009 12:51 PM (GMT -6)   

Lord knows I am no expert on this subject. Sort of like being a frequent flyer doesn't make you a pilot. But, I read a research paper some weeks back that stated quite clearly that in "over 50% of the cases of PCa reoccurrence it was at the original site". I.E. the prostate. This was said to be true for surgery and radiation. If I can find it again I will post a link.

John, your post that generated this discussion was quite good.

Don


Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/27/2009 1:06 PM (GMT -6)   
Not really sure what the terms "systemic" means in this use. Can someone explain.
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
 
 


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/27/2009 1:32 PM (GMT -6)   
John T,
Actually, that is right, but I have known it for a couple years. Anytime that prostate cancer has spread outside the prostate is is learning to grow systemically and independently of the prostate gland. I have learned that seminal vesical invasion (SVI) for example is early systemic metastatic malignancy and a sign that the disease is elsewhere in the body. Dr. Lebowitz is an oncologist and his assessment is correct, but the degree of spread may still be locally metastatic and treatable. Thus upon a rising PSA, we mop up with radiation after surgery and it is successful in returning the PSA to undetectable levels. But I too know that we are dealing with systemic disease in my case. All I need to see at this point is a rise in PSA and I know that we will not cure this, but rather manage it. I have already resolved myself in that mode. But I am one of the few here who are in between stage 4 and 3B. I am still at a loss as to why I wasn't stage 4 after surgery. My surgeon clearly stated and wrote in his report that he did not get it all and that he stopped at the rectum to prevent damage to it. I took that to mean it had spread into the rectum which is clearly stage 4. But it's here nor there. I would be doing the same treatment regimen I am currently doing anyway.

On Staging and Gleason. My doctors feel my PSA matched the results after surgery. Pretty much a PSA of 20 will run the risks higher and that is what we found was high risk disease. As far as Gleason goes after surgery, we know that mine was Stage 3B 4+3=7. It's not the 3's or the 7 that we fear. It's that dang 4. That is aggressive cancer and if/when my disease returns it will be aggressive. Stage will not change anything in treatment from this point forward. Gleason 6 can be indolent and it can be a real pest as well. Gleason 7,8,9,10 are easier to decide what to do with than G5 or 6. With 7 and above you pretty much have to take an action when you are just 44 years old at the time. We decided on surgery to get a clear picture of the tumor and to try to not be exposed to radiation. Didn't quite work out that way.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/27/2009 1:46 PM (GMT -6)   
David,
When the cancer is still inside the prostate it is local cancer. When it has spread outside the prostate and in surrounding tissue it is systemic and if mets are found in the bladder, rectum, seminal vesicals local treatments won't likely be a cure. This is called locally advanced prostate cancer or simply advanced. SVI is advanced prostate cancer (some argue this point, but doctors don't). Local treatments can still be used but for management purposes mostly.

Local treatment options:
Surgery, radiation (all types), HIFU, cryogenics, etc.

Systemic treatment options:
Chemotherapies like Taxotere, LHRH agonists and Casodex, Zometa, Investigative or Estrogenic drugs (Estrodial or DES, etc.), castration, etc.

LHRH agonists are hormonal blockages...These drugs include Lupron, Zoladex, Eligard, Trelstar. LHRH agonists work in the Pituitary gland and block testosterone production by making the brain tell the testes to be quiet, so to speak. Casodex, works by blocking testosterone and the more potent Dihydrotestosterone (DHT) in the adrenal and other glands. ADT is a combination of an LHRH agonist and Casodex. ADT3 is adding either Proscar or Avodart. ADT4 adds estrogenic drugs. You get the drift.

Basically, PCa sucks, Systemic PCa really sucks.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 15, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (January 13, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 1/27/2009 1:05:18 PM (GMT-7)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/27/2009 3:31 PM (GMT -6)   
Tony, thanks for the clear primer there, learned something. And yes, PCa sucks even if you try to put a good spin on it.
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
 
 


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/27/2009 3:58 PM (GMT -6)   

Selmer,
I remain very hopeful.  Being diagnosed at 44 really raises the concern.  If I get 25 years I would only be 69.  Yuk...But hope is a beautiful thing.  And so many have paved the road ahead...

 

David, here is an artice my doctor edited (Vogelzang)...good explaination.  (GnRH and LHRH are interchangable)

http://www.uptodate.com/patients/content/topic.do?topicKey=cancer/4898

Tony


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/27/2009 4:30 PM (GMT -6)   
Thanks Tony
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
 
 


divo
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Date Joined Jul 2008
Total Posts : 637
   Posted 1/27/2009 4:46 PM (GMT -6)   
John, This is a very useful informative thread, and one that I am very interested in. When Pete was dx at 66 with a psa of 16 and gleason 4 +3 ...We were told that he was not a candidate for surgery....He had lupron before radiation to shrink the prostate, and then external radiation and brachy and then lupron for another year........The cancer returned four years later to the prostate.......and THEN we were told at Sloan Kettering that he COULD have had surgery before, but he could also have SALVAGE SURGERY at this point....to debulk the tumor... After that surgery, the surgeon told us that he was disappointed, that the cancer had spread to the lymph nodes, but that he had debulked the tumor....and had bought time....Well, you know the long story after that....Ugly... That is why I am so against Salvage surgery after radiation. I think information is power. Thank you John for starting this talk. You obviously spend a lot of time studying...And I admire you and your wife for the battleground that you are on....We are all warriors here.....Diane
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!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/28/2009 7:53 AM (GMT -6)   
Diane, I agree 100% with your post and your position. Give my very best to that brave husband of yours, Pete.

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
 
 


divo
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Date Joined Jul 2008
Total Posts : 637
   Posted 1/28/2009 4:20 PM (GMT -6)   
David, Thank you very much. Pete and I actually printed out this thread...sans (yours and mine) and gave it to our urologist this afternoon. He was very interested in the site, and think he will be probably lurking. I think there are many doctors that are watching this site. There are so many many opinions and new thoughts....Zufus has brought out a lot of points that are very good...as have you and Tony, and all the moderators....Thank you all.... Diane
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!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 1/28/2009 4:40 PM (GMT -6)   
Diane, your posts always lift me up, and any news of Pete via you always makes me feel good. I mentioned this site to my dr not long ago, he didnt scan he read it, but he knew all about it. I would like to think the more in-tune doctor's would at least lurk and learn, it would help all of us. My best to my man Pete.

David
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
 
 


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 1/28/2009 5:52 PM (GMT -6)   
Oh, David, thank you....Pete is the most unbelievable man you would ever know. I met him when I was a freshman in college and worked at the desk at one of the first Holiday Inns in Dayton, O....He moved out from NY to work as a chemist. He was Greek and over 30....My parents were so worried...I fell in love with a GREEK??? at 18?...who was 30?? Well, we did love each other, and because of unbelievable luck, and love, we are together over 40 years later...We have three grown children and six grandchildren....I paint....He knows History like the back of his hand...Right now he is reading: "A World Lit only by Fire" non fiction about the Dark Ages...That is how he conquers Pca...Reading about history, watching the history channel, and working with cross words or sududko...I paint , and now that he has had the very successful hip operation, we can begin traveling again! Also the AUS is beginning to work a little better...! Diane
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!


John T
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Date Joined Nov 2008
Total Posts : 4188
   Posted 1/29/2009 12:15 PM (GMT -6)   
Les,
I've done some more reading and you are correct. Low grade cancer, below g7 or psa less than 20 with a positive margins can be local. I think this more of a question of semantics as this is most likely an extension of the original cancer that surgery didn't get.
Dr Sardino, one of the best surgeons at Slone Kettering says that if the original cancer is above a gleason 7 or has a psa over 20 and has penetrated the capsule there is no local cure.
JT

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


LV-TX
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Date Joined Jul 2008
Total Posts : 966
   Posted 1/29/2009 12:37 PM (GMT -6)   
Thank you John for your followup. As you can see from most of the folks here as well as the new folks just arriving most have g7 or less and initial PSA less than 20 and I was afraid that the message you were providing originally might be misunderstood by some of the folks. Your explanation now explains it perfectly. Thanks again.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/29/2009 12:43 PM (GMT -6)   
John,
I know Scardino is a great surgeon, and he has written books with my oncologist Nick Vogelzang) on Genitourinary oncology. But i disagree with that blanket statement. I have seen it before. I asked my oncologist about it and he said he would still have the surgery. There is much information to suggest that men have been cured with these numbers. It isn't common, but with my numbers 4+3 and PSA 19.8, I certainly hope gray areas are in my favor. Regardless, I have chosen a systemic treatment approach with two local treatments and I am a small tick below those numbers he stated.

Great job on the research.

Tony

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/29/2009 6:56 PM (GMT -6)   
In case people are not aware of 'what is cure'. Would you like to elaborate, I will leave it as an open question for others to research, or if you Tony wish to expound upon that you could or anybody else? It is not as simple as the statement implies, it does depend upon how someone defines it or at what juncture, its meaning can vary among doctors etc.
 


Purgatory
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Date Joined Oct 2008
Total Posts : 25364
   Posted 1/29/2009 7:09 PM (GMT -6)   
Diane, thanks for sharing that wonderful story about Pete. He does sound like a great guy, would love to meet him and hash over history, one of my fave past times. The first time I met my wife to be, I was just out of the Navy starting college in St. Petersburg, FL, she was 16 working at Burger King. Thought she was beautiful, but too young to date at the time. Two years later, seemed we had a common friend, and we went out, and 11 weeks later got married, this was in 1974, been together ever since. She had just turned 18. We have our three grown children and just two grandchildren thus far. Got to get my married daughter busy in that dept, but she's in no hurry, and need to get my youngest son married, lol. My best to you two.

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
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/29/2009 8:04 PM (GMT -6)   
For Bob,
A return to a remission that does not recur in ones lifetime...

Post Edited (TC-LasVegas) : 1/29/2009 7:09:30 PM (GMT-7)

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