PSA keeps rising

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nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/6/2009 4:12 AM (GMT -6)   
Hi,
 
I am 43 yo from Tampa area. My high PSA was found during routine check up in November ' 08. PSA at 15.4. I went for biopsies at USF Health December 09 and the pathology came back with Gleason Score 3+3, 8/12 cores positive and 10%-60% involvement in cores.
 
Since then trying to read and get informed like crazy, I cant believe how much and different information there was on the subject and just two months ago I barely knew there is a prostate in my body.
 
In January I visited two urologists - MD Anderson/Orlando (not enough experience with RP, but he said due to high PSA he will probably do a non nerve sparing procedure) and Moffitt -Dr PowSang who is very experienced and he said he will spare both nerves and he thinks the high PSA is due to cancer being in the core of the prostate as such cancer produces more PSA.
 
I also visited RCOG in Georgia - they do seeds + RT and they have a remarkable record. They even calculate an individual cure rate and based on my PSA and pathology report, it came at 85% for my case. Overall that's the option that I felt the best with.
 
 
CT scan, Bone scan and chest XRays came back negative.
 
January 19 I had a second PSA test at the same lab and it came at 16.6 (doubling time of ~1.5 years). January 23 had a second opinion PSA test at a different lab and it came at 17.4. I also had a second opinion pathology report. It still came with a Gleason 3+3 and cancer in 8/12 cores but it also included perineural invasion in two of the cores on the right side.
 
The doctor from RCOG is concerned with the fast rising PSA as well as the perineural invasion and said fast rising PSA can mean the cancer has escaped to the outside and recommended to do a Prostascint scan, which I am scrambling to do next week. I am also trying to get a second opinion at Dattolli but they seem too busy.
 
I am scheduled for February 19 to do the seed implants at RCOG, but my head will explode as much as I hope to make the best choice for my situation.
 
What do you make of my situation? Am I missing any viable option? Is there anyone else here with similar data ?
 
Thanks in advance and good luck to all of us
 
 

GarthK
Regular Member


Date Joined Feb 2009
Total Posts : 74
   Posted 2/6/2009 6:56 AM (GMT -6)   
First, you came to the right place! There is a wealth of first-hand experience here that folks are ready to share. I have three stories: mine, my older brother's, and a close friend of mine that may be of interest since we all took different approaches. First, my brother went to RCOG in Decatur, GA, for their ProstRcision treatment of seeds and carefully-focused radiation treatments. The full course took abt six weeks and they stayed in GA for the entire time (at a place that was free for patients). This was abt eight or nine years ago and he remains in good shape with undetectable PSA. He was and remains pleased with the results. Very little discomfort during the procedure and very few "quality-of-life" issues after (one of his main concerns).

The second was a friend of mine that had the DaVinci method just abt five years ago. Recovery for him seemed to be very quick and when I last spoke to him, he was also at zero PSA and was convinced that he had taken the right approach. His one point is that you MUST find a surgeon that does a LOT of robotic prostatectomies so they are truly comfortable with the device console.

Now for me. :-) I had a biopsy last Dec (stats below) which resulted in RRP (open) surgery on 1/21 and I just got the tube out yesterday. I had convinced myself that the robotic method was for me but I found a really good urologist that does both but in my case recommended the open style so he could better see what was going on. All went well (again, see below) and I expect to go back to work next week. I've no complaints.

So, three different stories, three different approaches, three happy customers. How does that help you? Good question. :-) My only bit of advice is to find a urologist that you really trust and go with what they advise. Each of the approaches offers the potential for good results so get comfortable with your doctor and let them do their work. If robotic is your way, find a urologist that does them frequently and that has a good track record. Actually true for any of the approaches so it's back to finding a doc you like. That's most important, IMHO.

Not much help and I agree, too many choices.

Good luck, welcome to the group, and keep us posted.

See ya,
Garth

Good luck to
Vitae:
DOB: Q4'46, HT: 5'9", WT: 180
PC:
Biopsy: 12/08
Cores: 4 of 12+ positive
PSA: <2.5
DRE: Slight enlargement, one node
Gleason: 3+3
Surgery: RRP on 1/21/09
Catheter: 15 days
Pathology:
Adenocarcinoma occupying 5% of prostatic volume (right posterior aspect)
Gleason: 3+2
No extraprostatic extensions
Perineural invasion within prostate only
No angiolymphatic invasion
No seminal vesicle invasion
Clear margins
AJCC: pT2a


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/6/2009 8:08 AM (GMT -6)   
Hello Nasso,
Welcome here, and sorry you needed to be here, but glad you are among us.

My take is different. Your stats are closer to what I started out with. Keep in mind, your gleason 6 from biopsy could be easily a grade higher once they are inside you if you go that route. Your high PSA number and its velocity was much like mine. They ruled that I would not be a candidate for seeds, because if it failed, salvage surgery would be hell, if anyone could be found that would do it. You are doing the right thing by checking out all your options. I would reccomend surgery with your stats, and hope that it is still all localized at the time of surgery. open or robotics, your choice there. In my case, due to unseen complications, open surgery was the best choice for me. If my cancer were to ever come back, I can still have the option of radiation to finish it off.

My very experienced urologist/surgeon, said that the risk with my fast rising and tripling PSA, was that the cancer was on the move, and he reccomended surgery no more thant 8 weeks after the last biopsy. I had 3 of them. He said that once it was outside of the prostate capsule, it would be a whle different case, with a whole different option list and outcome.

Some here might reccomend that you wait and watch with your gleason 6. The biopsy, at best, according to my dr, is just an estimate of what is going on inside. If it really is a 6, that would be one thing, but if it really is a 7/8, its a horse of a different color.

Not telling you what to do, not trying to scare you, just trying to help you think through, its hard to do when you are in shock about having cancer and overwhelmed with what to do. Ultimately, its your body, your cancer, and your life we are talking about here.

I hope we can help you here, or at least give you some comfort along the way.

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
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 2/6/2009 9:09 AM (GMT -6)   
Dear Nasso. Welcome, I can tell you our story, and it may confuse the issue more, but I believe anyone going into this needs to be aware of all side effects..Well, Pete, my husband had Brachy , and external Radiation and lupron treatment seven years ago. After four years, We were very happy and thought he was cured. with slight incontinence and feeling great again. Well, the cancer reared its ugly head again, and the PSA rose from .5 to 8 in six months. He had salvage surgery which has been devastating to Pete....The damage caused by the radiation caused many severe side effects. You can read his signature.
The point is: if you have the surgery,....and it does come back, then you can always do the salvage radiation...but once you do radiation, that is your best shot.....After that, if it comes back you probably should go on Hormone Therapy..instead of salvage surgery....Even with the best doctors it is a difficult operation after radiation, and also there is 100% incontinence and no hope for the ED treatments to work. We went in hoping for a 40% cure of the cancer., but even the salvage surgery with all of its problems did not get the cancer. It was in the lymph nodes....and is now beginning to rise again... From our point of view it makes a lot of sense to get it out first....We all want to think that it won't ever come back, but it is a gamble whichever route you take....I think it is good to leave some better options open than salvage surgery.... That being said, there are others here that have done well with radiation and brachy.. as Garth pointed out.....Im sorry if this confuses your issue, I just wanted to point out this important fact, that we glossed over in the beginning.... Good luck. 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!


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/6/2009 10:43 AM (GMT -6)   
Hi Divo. So sorry to hear about Pete's case - where did you do the seed implants procedure?

nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/6/2009 10:46 AM (GMT -6)   
For the RP procdure - I seem to see most people with lower risk going that route, no? From my understanding, the procedure at RCOG kills the entire prostate as much as taking it out. But additionally the radiation would help if there was and extracaptular leaking.

Thanks everyone helping. Dave good luck with your first post op PSA

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 2/6/2009 1:04 PM (GMT -6)   
Nasso,
From your post it seems that the doctors are just guessing about your cancer. One stated that the high PSA may be coming from the transition zone, if that is the case then surgery is not a good option, (Sardino at Slone Kettering says the failure rate of surgery for transitions zone tumors is high), also seeds are not a good option for transition zone tumors. Doctors recommended prostascint, It's not that effective and gives a lot of false positives. So the real fact is that you and your doctors do not know enough about your particular cancer to make an informed decision on treatment.
MRIS and or color doppler can accurately see the tumor and stage it as to size and location. Color doppler is better for transition zone tumors. Nomagrams can then be used to calculate the psa that the tumor is generating. If there is more psa it is likely that the cancer may have spread to the lymph nodes. The only effective test for this is a Combidex MRI.
Good luck and don't rush into your treatment blind if you want the most successful outcome.
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


GarthK
Regular Member


Date Joined Feb 2009
Total Posts : 74
   Posted 2/6/2009 1:28 PM (GMT -6)   
One more point... I agree with Divo/Diane about the issues raised with recurrence following brachy and that is why I wanted it "out, gone, nothing left". Fortunately, my urologist agreed with this desire and all went well. However, should there ever be a recurrence, knock on wood, I will still have other options available to pursue. Doesn't mean that brachy isn't a good approach. Just means that I like keeping my options open.

Hang in there,
Garth
Vitae:
DOB: Q4'46, HT: 5'9", WT: 180
PC:
Biopsy: 12/08
Cores: 4 of 12+ positive
PSA: <2.5
DRE: Slight enlargement, one node
Gleason: 3+3
Surgery: RRP on 1/21/09
Catheter: 15 days
Pathology:
Adenocarcinoma occupying 5% of prostatic volume (right posterior aspect)
Gleason: 3+2
No extraprostatic extensions
Perineural invasion within prostate only
No angiolymphatic invasion
No seminal vesicle invasion
Clear margins
AJCC: pT2a


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/6/2009 1:31 PM (GMT -6)   
Hi John,

Thanks for sharing, let us now your next results.

I dont think any of the doctors mentioned a transition tumor - in fact this is the first time I hear about such possibility. As far as I understood, he mentioned that if the tumor is more into the center of the prostate then it produces more PSA. That is why he felt he can spare both nerves with surgery.
11/98 PSA:15.6, 01/09 PSA 16.6
Biopsy 12/08
8/12 cores positive, GS 3+3,
perineural invasion in 2 cores
CT, Bone, XRay negative


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 2/8/2009 1:02 PM (GMT -6)   
Nasso,
A transition zone tumor is in the middle of the prostate and usually generates high psa, brcause this is where most of the PSA in the prostrate is made. I think this is what your doctor was referring to, but I'm only guessing.
It is very difficult to biopsy the transition zone and most doctors don't do it or do it improperly. 25% of all PC is found in the transition zone.
The good news is that because of the large amount of tissue surrounding the transition zone the tumor is most likely contained even with a high PSA. The bad news is that it is a very difficult surgical operation with a high failure rate because it is difficult to get all of the tissue. Therefore it is important to know if you have a transition zone tumor or a peripheral zone tumor.
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


Dandapani
Regular Member


Date Joined Jan 2009
Total Posts : 62
   Posted 2/8/2009 8:05 PM (GMT -6)   
My PSA was 3.7 prior to biopsy and was 7 ten weeks post biopsy prior to my daVinci procedure.
Dan

PC diagnosis @ 53 YO
PSA: 3.4 - 3.7 for preceeding 10 years, new GP advised Urologist visit

09/18/09 12 plug biopsy
09/29/09 PC diagnosis, 1 of 12 plugs, 5% cancer, Gleason 3+3 (6), left side plug w/cancer
12/17/09 da Vinci robotic radical prostatectomy, lab confirmed biopsy, 5%, PIN rest of prostrate, negative margins
12/29/09 catheter removed

current status: 3-4 pads/diapers a day, dry overnight, however; total ED


Iggy
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/8/2009 8:28 PM (GMT -6)   
The husband of my cyber-friend was recently diagnosed with prostate cancer. He had the cancer treated and apparently destroyed with non-invasive High Intensity Focused Ultrasound (HIFU) heat treatment with a Sonablate 500 machine. He had the treatment done in Puerto Vallarta.

Here's her post from another forum:
"Absolutely no side effects, in fact he says his urine stream is stronger ~ it was probably a bit restricted because of the inflamed prostate, also he says he doesn't dribble anymore. He noticed this the day after the procedure.

And, yes, everything else is back to as before...."

The treatment is not yet approved in the US but phase 3 clinical trials have begun. http://clinicaltrials.gov/ct2/show/NCT00485381?spons=%22Synteract%2C+INC%22&spons_ex=Y&rank=3

http://www.articlesbase.com/cancer-articles/revolutionary-prostate-cancer-treatment-comes-to-puerto-vallarta-425985.html

gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/8/2009 8:54 PM (GMT -6)   
Nasso,

I understand your urgency.

What you need to understand is that once you undertake radiation you have seriously limited your options. You are a young man, and radiation in all forms is an inexact science with only about a 75% probability of cure, and potential for many side effects.

If this cancer of yours can be found to be confined by any proper measure and if it was me, there is no way I would consent to a radiological proceedure.

In my studying of this issue, there is one cure. And that is to remove the prostate while the cancer is still confined within it.

Please consider this as you consider your treatment options.

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


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 2/8/2009 10:44 PM (GMT -6)   
Nasso,

I gotta agree with the post above...young age was a big reason I did the RP...high PSA (see stats below) and number of cores positive from biopsy convined me to take my doc's advice and do non-nerve sparing. Glad I did,--- big tumor volumne, cancer out to the edges...and STILL a positive margin---would have been much worse if I had nerve-sparing RP.

Remember, the main goal is to get a LASTING CURE here---eveything else can be gotten used to.--- (not total ED with some help, by the way!)

Good luck!
Sterd82
Age 48 - pre-surgery PSA 39 (at age 45)
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
PSA as of November 25, 2008 undetectable


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 2/9/2009 2:23 AM (GMT -6)   
Hi nasso,
Welcome to HealingWell. Your numbers are not too far from minel. You have a lower PSA and your Gleason is better. But if it were me, I would do what I did over again if I had your numbers. I started with surgery. Removing the prostate and examining the specimen. As it turned out I had positive margins and cancer that escaped the prostate. But by removing the prostate, I gained that knowledge and started hormone therapy soon after surgery. Then radiation. Current studies are showing an edge for this combination over any other for those with high risk and/or advanced cases. I usually anymore, applaud those who start radiation therapy for Gleason 6, but your high number of core samples being positive indicates you should start thinking about plan B, early on. And plan C if necessary. And your age is a real factor. I was 44 at Dx. I am doing well at this time.

You have reason to be positive, you have all options still available. Whatever you decide, make sure you are getting the best provider possible. The physician does matter.

Peace be with you,

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!


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/9/2009 4:27 PM (GMT -6)   
Thanks everyone, much food for tought. I am now waiting for the prostascint scan, and also have an apointment with Dr Patel who seems very recommended.

The radiation procedure that I am so far opting for is actually a combination of seeds + radiation. It is performed at RCOG in Atlanta and has the hghest reported cure rates
Age at DX: 43
11/08 PSA:15.6, 01/09 PSA 16.6
Biopsy 12/08
8/12 cores positive, GS 3+3,
perineural invasion in 2 cores
Staged T1c
CT, Bone, XRay negative


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/9/2009 4:39 PM (GMT -6)   
Nasso, I would always respect your own decision of course for treatment, but I would tend to agree with Tony above. Are you in GA? You mentioned Atlanta. I am just outside of Greenville SC

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, Right nerves saved, 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 .05
 
 


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/9/2009 6:44 PM (GMT -6)   
David, I am in Florida but ready to go wherever I can find the best treatment. RCOG in Atlanta just came with the best cure rates that I could find and least side effects, especially in cases where the radiation might be necessary even after RP treatment. They compare the seed implants to RP. as it basically kiils the entire prostate. And the later radiation is to make sure extra capsular cancer leaking is taken care of.

Thanks again everyone, I see a lot of support for the RP route and I am still investigating the options. I think once I get some more results I will be able to form a final decision.

My second PSA was taken about 6 weeks after the biopsy - do you think this could be also a reason for the accelerated rise?
Age at DX: 43
11/08 PSA:15.6, 01/09 PSA 16.6
Biopsy 12/08
8/12 cores positive, GS 3+3,
perineural invasion in 2 cores
Staged T1c
CT, Bone, XRay negative


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/9/2009 6:48 PM (GMT -6)   
transition tumor - thanks for the explanations. Since I have 8 out of 12 biopsy samples positive, can I assume it is not transitional. Do I understand correctly that transitional tumor rarely if ever shows on the biopsies?
Age at DX: 43
11/08 PSA:15.6, 01/09 PSA 16.6
Biopsy 12/08
8/12 cores positive, GS 3+3,
perineural invasion in 2 cores
Staged T1c
CT, Bone, XRay negative


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/9/2009 9:12 PM (GMT -6)   
nasso said...

My second PSA was taken about 6 weeks after the biopsy - do you think this could be also a reason for the accelerated rise?

I really think the PSA is not of much significance at this point.  The gland has been messed with and it is well understood that PSA is an erratic marker.
 
And concerning the tumor, I don't think you can assume anything.  It can be, but also is not often a simple mass.
 
If it can be determined to be local, I think surgery is your best option.
 
Regards.  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


Dirtmover
Regular Member


Date Joined Apr 2008
Total Posts : 158
   Posted 2/10/2009 11:53 AM (GMT -6)   
good morning nasso,patel is an excellent doc ,i am ,,,,or was 43 at dx as well given your age it just makes sence to do the robotic,,,i would do it all over again ,, you know where you stand ,you have a path rport not a big ???????   be around for your kids and wife my brother, remember your young, and MOST of the young guys recover from rrp very well ed included i have  hell i pee like im 12 again NO LEAKS  even when drinking now and then othe eqipment works pretty well also iKNOW this is a concern your gonna be fine remember you get 1 shot ,,,do it right  give patel some serious consideration this was my first surgery ever i was scrared to death and it was no where near what i thought it was, went to hollywood blvd 2 days after sergery. scool your gonna be fine tongue
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


nasso
Regular Member


Date Joined Feb 2009
Total Posts : 27
   Posted 2/10/2009 1:13 PM (GMT -6)   
thanks again for the support. You are right, the biggest concern is to be around for my kids and wife. But the side effects are a big concern.

Is there a way to determine if the tumor is local before the procedure ?

I looked at the Partin tables and it gives me a 38% non-local if I keep my GS 6, or 50% non-local if my GS is an actual 7 that would be upgraded after the surgery.
Age at DX: 43
11/08 PSA:15.6, 01/09 PSA 16.6
Biopsy 12/08
8/12 cores positive, GS 3+3,
perineural invasion in 2 cores
Staged T1c
CT, Bone, XRay negative


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 2/10/2009 4:49 PM (GMT -6)   
nasso,
Let me add to what everyone else has said. I started not knowing anything and found with my biopsy being 8 of 10 cores and bilateral (both sides) that the urologist originally told me seeds would do it. Then it seemed sort of like a used car dealer he added harmone theraphy, and finally suggest after that I should have external beam radiation followed by seeds - shoot all the guns. You will note from my signature below that I changed my mind after getting a second opinion and doing research and went with DiVinci surgery. Now, your situation is similar in biopsy so I am wondering why they think that seeds alone may work for you.

I too would suggest you contact a second opinion and I know where you are you are looking at one of the finest DiVinci guys with Dr. Patel. I hope all of this doesn't cause you trouble of mind, but this is the toughest time for the right decisions must be made up front. God bless.

RB
Age 61 (now 62)
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA <.04
2nd Post PSA <.01 10/30/2008


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 2/12/2009 11:55 AM (GMT -6)   
Nasso,
You have been given a lot of advice on this forum based on what others did and their results. These have little bearing on your individual situation as your PC is individual and has to be looked at as your individual PC.
There are things you can do to determine if it is local or not and this will definately affect your treatment options. Your high PSA, number of cores, and % of cores put you in an intermediate or high risk catagory as you already saw from the partin tables. This makes the treatment option highly important. In the low risk catagory the option you pick really doesn't mattter much.
1. MRIS with endorectal coil does a good job at spotting extra capsular penetration. This would be an important thing to know in choosing a treatment. This is offered at Hopkins and UCSF and maybe a couple of more places.
2. A good PC oncologist can use data from the biopsy, gland size and psa history and calculate how much psa is being generated by the tumor and the gland. If there is more PSA then it is likely coming from some where else. Other doctors can do this as the software tools are available, but few do. The good oncos always use these tools. He can calculate the probability of it being local or systemic, like the partin tables but with more information fed into the software.
3. If the probilility of it being systemic is high (your call, but my cut off would be 25%) a Combidex MRI to pin point lymph node involvement is very useful in tailering treatments.
The process is simple: Why more people don't do it is mystifying.
1. Determine the biology of your individual cancer with as many tests and software tools as possible.
2. Match the correct treatment to your particular biology (not someone else's) to give you the best possible probability of cure.
3. Pick the very best doctor in that treatment area.
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


Budalaska
New Member


Date Joined Feb 2009
Total Posts : 4
   Posted 2/13/2009 2:15 PM (GMT -6)   
I am a new member, first post today, please read my post from today, many simularities.  Just wanted to point out that I had lupron injection one month ago and psa dropped from 9.8 to 2.2 in that time.  You might ask your dr about that for you.  The side effects arn't as bad as the alternative risk.  Bud
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