Met with Urologist

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MarineMustangPA
New Member


Date Joined Jan 2009
Total Posts : 17
   Posted 1/29/2009 8:14 AM (GMT -6)   
reference my post on ADT.  Post IMRT 42 months my PSA never went below 1.0 goal.  Settled at 1.8 and since then (25 months) have gone up to 3.1 (slowly).  The question was should I start ADT?  My urologist suggest waiting and following the situation very close.  This to preserve quality of life as long as possible.  He told me the normal PSA for a 73 year old was 6.5.  He also thought there was no benefit to treating my condition rather than waiting until it goes up to around 10.  This information matches the advice of radiation oncologist. 
 
I know there are some thoughts to treating it as soon as the PSA goes up and it is determined it isn't a bounce.   I've decided to go with the advice of my urologist.  Who does prescribe ADT3.  He uses one hormone treatment and told me the other things really don't do much and are expensive. 
 
If my PSA goes up to around 10 over the next several months or year then we will do a biopsy and perhaps a bone and C-Scan and take it from there.  He also mentioned that doing the scans really would provide anything unless the cancer was high along with a high PSA.  But again he said some men had low PSA's and spreading cancer.
 
One thing for sure there is no certainty when fighting PC,
 
Chuck 

Age 73.  Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies. 

 

Four biopsies.  Two positive and two negative.  Positive reflects involvement in one area (Left Apex 3%).  Gleason 3+4=7, T1c,  negative DRE.  Received 40 doses of IMRT delivered by Fox Chase affiliate 05/05.   PSA 10.5 before IMRT - drop to 1.8 - now 3.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


MarineMustangPA
New Member


Date Joined Jan 2009
Total Posts : 17
   Posted 1/29/2009 8:17 AM (GMT -6)   

Sorry - I forgot to check my message before posting. 

 

My urolgist doesn't prescribe ADT3.  He uses onely one hormone treatment which he thinks is sufficient.  He thinks the pills are expensive and really don't add much.

 

Chuck


Age 73.  Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies. 

 

Four biopsies.  Two positive and two negative.  Positive reflects involvement in one area (Left Apex 3%).  Gleason 3+4=7, T1c,  negative DRE.  Received 40 doses of IMRT delivered by Fox Chase affiliate 05/05.   PSA 10.5 before IMRT - drop to 1.8 - now 3.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/29/2009 10:59 AM (GMT -6)   
You might start looking into a PCa oncologists or oncologist for your future treatments, uro-docs are generally very busy with many other patients and not experts on the biology and blood work analysis and such, as is the training of the oncologist. Example that we could relate to: you don't send your car to a bicycle mechanic altough he can turn wrenches and knows something, you send it to a auto mechanic or better yet a technichan (especially when you are the Mercedes, BMW, Lincoln, Caddy or Porsche).
But, hey you are in the drivers seat, but suggest you look both ways on PCa.

:.)


 

Post Edited (zufus) : 1/29/2009 5:29:11 PM (GMT-7)


Paralleli
Regular Member


Date Joined Jul 2008
Total Posts : 123
   Posted 1/29/2009 2:21 PM (GMT -6)   
MMPA:

As you can see below, I find myself in the same sitiuation you are but at a much younger age. I think I've come to the same conclusions you have (at least for now!). Keep us posted buddy....

Zufus: Good advice concerning finding a good medical oncologist with PCa experience. I plan to start my search soon.

Note to the Moderators: I changed my user name (or whatever it's called) from Merkelman. Not shooting that old german shotgun much anymore and have chaged to an Italian SxS. Thus the name change! Trust me, it makes perfect sense...
53 yrs
PSA 4.8
T1c – Gleason 3 + 3
IMRT 1/07 thru 2/07 (42 treatments)
PSA 6/07 – 0.76
PSA 12/07 – 0.36
PSA 6/08 – 0.72
PSA 12/08 - 1.02 (Uro & Rad Onc want me to give it 3-6 more months before freaking out.  O.K. say I.)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/29/2009 6:35 PM (GMT -6)   
Paraelli, they want 3-6 months more is easy for them to say, they don't have to worry about Monday morning quartering back, they don't own your disease.....you and we herein....do. See what docs say about this like Dr. Strum et al(onco-docs) whom have seen many a patient on the rising psa side post treatments. Goto www.hypertext.org and click on english language version and read about PCa, he has another site www.pcri.org
 


Paralleli
Regular Member


Date Joined Jul 2008
Total Posts : 123
   Posted 1/29/2009 9:38 PM (GMT -6)   
Zufus:

Thanks for your response and concern. You’ll need to trust me when I say that I’ve researched, and read, and read, and am still trying to learn about PCa. For a while there I felt I was back in graduate school being befuddled by more microbiology, more chemistry, and of course, more statistics! (I’ve learned that statistics mean an entirely different thing, or lack any meaning at all, when one is on the wrong end of the old bell curve). At any rate, I still haven’t reached biochemical failure by any of the two common measures used for RT (nadir+2 or three consecutive rises). And I really don’t want to jump too soon with the HT. I understand there are different opinions concerning when to start HT, but for now, I’m comfortable with my decision to wait and watch for a time. We’ll see what the next few months bring.

Best to you….
53 yrs
PSA 4.8
T1c – Gleason 3 + 3
IMRT 1/07 thru 2/07 (42 treatments)
PSA 6/07 – 0.76
PSA 12/07 – 0.36
PSA 6/08 – 0.72
PSA 12/08 - 1.02 (Uro & Rad Onc want me to give it 3-6 more months before freaking out.  O.K. say I.)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 1/30/2009 5:13 AM (GMT -6)   
Hi Cuck,

As slowly as your PSA has risen (PSADT >24 months) I wonder if it has been concluded definately post IMRT that you have distant mets, or could you still have a local occurance with options for another local treatment.
 
And I agree with the member who suggested you be seeing an urologist specializing in oncology at this point.

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 PCA3 negative
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 : 4186
   Posted 1/30/2009 1:48 PM (GMT -6)   
Marine Mustang,
I agree with Zufus, you should see a good prostate oncologist before deciding on anything. The fact that your urologist only recommends mono ADT is a concern in that it's pretty much proven that ADT3 is much more affective than Mono therapy. A prostate onclogist is a medical oncoligist that only specializes in prostate cancer. A urological oncologist is a different type of doctor and usually specializes in surgery and treats many forms of cancer.
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


MarineMustangPA
New Member


Date Joined Jan 2009
Total Posts : 17
   Posted 1/31/2009 9:56 AM (GMT -6)   
Nothing has been concluded regarding if it is local or not.  As most know bone and C-Scans do not normally detect anything until later in the game.  Mine were negative.  My urologist plans on doing them again when necessary.  We also discussed another biopsy if things continue to climb and also looking at Cryosurgery if I'm interested.  But as most know Cryo is only effective if the cancer is contained in the prostate. 
 
Chuck

Age 73.  Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies. 

 

Four biopsies.  Two positive and two negative.  Positive reflects involvement in one area (Left Apex 3%).  Gleason 3+4=7, T1c,  negative DRE.  Received 40 doses of IMRT delivered by Fox Chase affiliate 05/05.   PSA 10.5 before IMRT - drop to 1.8 - now 3.1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/1/2009 4:01 PM (GMT -6)   
MarineMustangPA said...
Nothing has been concluded regarding if it is local or not.   
Chuck

Chuck, my point exactly.
For over a year I was let to believe that I had cancer which had escaped the prostate, only to find that it most likely has not.  After a RRP I had a persistance of PSA and instead of doing further diagnostics I was immediately shuffled off to ADT and IMRT.
 
If you still have a local issue and just wait for PSA to rise signalling mets it is a self fullfilling prophecy.  You may not have cancer at all, and you may have cancer which is regrouping and will go distant at some point.  Your slow PSADT is not consistant with what I have seen reported with  incurable PCa, it is more consistant with what is reported with local recurrance.   You do have options other than Cryo, including HIFU which I believe is vastly superior to Cryo.  IMRT can leave tissue both cancerous and normal both of which capable of expressing PSA.  I think you are a candidate for PCA3 which is diagnostic for cancer.
 
I would insist that one of my Drs. determine if the PSA was being expressed locally or otherwise and if local I would want a biopsy to determine the nature of the still active prostate tissue.  The good thing is if you find cancer free prostate tissue you stop living in the shadow of the cancer issue.
 
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 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


verboten1
New Member


Date Joined Jul 2008
Total Posts : 3
   Posted 2/1/2009 4:53 PM (GMT -6)   
gpg said...
MarineMustangPA said...

Nothing has been concluded regarding if it is local or not.
Chuck



Chuck, my point exactly.
For over a year I was let to believe that I had cancer which had escaped the prostate, only to find that it most likely has not. After a RRP I had a persistance of PSA and instead of doing further diagnostics I was immediately shuffled off to ADT and IMRT.

If you still have a local issue and just wait for PSA to rise signalling mets it is a self fullfilling prophecy. You may not have cancer at all, and you may have cancer which is regrouping and will go distant at some point. Your slow PSADT is not consistant with what I have seen reported with incurable PCa, it is more consistant with what is reported with local recurrance. You do have options other than Cryo, including HIFU which I believe is vastly superior to Cryo. IMRT can leave tissue both cancerous and normal both of which capable of expressing PSA. I think you are a candidate for PCA3 which is diagnostic for cancer.

I would insist that one of my Drs. determine if the PSA was being expressed locally or otherwise and if local I would want a biopsy to determine the nature of the still active prostate tissue. The good thing is if you find cancer free prostate tissue you stop living in the shadow of the cancer issue.

Best wishes. Scott


What do you know about HIFU? It's not approved in the US and is undergoing study. So most here don't have the option of HIFU unless they go outside of the US and pay for it themselves. Insurance doesn't cover it..

Post Edited (verboten1) : 2/1/2009 5:04:20 PM (GMT-7)


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/1/2009 5:43 PM (GMT -6)   
[What do you know about HIFU? Not much apparently. For one thing it's not approved in the US and is undergoing study. So most here don't have the option of HIFU unless they go outside of the US and pay for it themselves. So you don't really have any knowledge of it unless you've gone overseas or have read european studies on it. Please only give advice you actually know about.]

For a first post, that's pretty aggressive.
Bill

Post Edited (BillyMac) : 2/1/2009 5:05:11 PM (GMT-7)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/1/2009 6:59 PM (GMT -6)   
Everyone has every option they choose to exercise.

Even though HIFU is not approved for prostate cancer treatment here in the US it is still a recognized procedure in may countries and you can avail youself of it if you decide it is the best treatment for you. And many insurance companies do cover the cost of treatment including mine Golden Rule through United Health Care.

And to put my post into context, we are talking about a man who has already had IMRT which makes him a poor prospect for surgery or Cryo, I am simply putting it out there.

Interesting that you focused negatively on HIFU which is really incidental to this discussion and made no comment to the main issue which is whether Chuck has a local recurrance or not.

Scott

And BTW, I have been examined and biopsied by a HIFU specialist and am prepared to have a HIFU proceedure should my particular condition warrant.

Other statement?
 
Sorry that your thread was hijacked Chuck smilewinkgrin
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 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney

Post Edited (gpg) : 2/1/2009 6:07:23 PM (GMT-7)


MarineMustangPA
New Member


Date Joined Jan 2009
Total Posts : 17
   Posted 2/2/2009 8:11 AM (GMT -6)   
I appreciate all the information I receive.  Whether it is good or bad I know it is from the heart and well intended.  Of course I will sort through it.  Study it and get more information.  In the end I will need to make the best decision I can make but all input is helpful.  Thanks to everyone who participates.  I try to do the same to provide information to others.  One thing I try not to do is tell them what is best over other options.  I chose IMRT over seeds or an operation.  Was it the best choice for me?  Only time will tell but after discussing it with urologist and oncologist and  reading all the information I could find on the subject I made the choice.   
 
Good luck and health to all.
 
Chuck 

Age 73.  Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies. 

 

Four biopsies.  Two positive and two negative.  Positive reflects involvement in one area (Left Apex 3%).  Gleason 3+4=7, T1c,  negative DRE.  Received 40 doses of IMRT delivered by Fox Chase affiliate 05/05.   PSA 10.5 before IMRT - drop to 1.8 - now 3.1.  On advice of urologist I'm on a careful (4-month) wait and see before next decision.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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