Just got back from OHSU

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duckfan
Regular Member


Date Joined Dec 2008
Total Posts : 40
   Posted 2/10/2009 1:36 PM (GMT -7)   
Well, so far we've seen 7 doctors.  The last two were with the Radiation department at Oregon Health Sciences. 
 
They agreed with the other three docs that my husband is not a good candidate for surgery because of his Multiple Sclerosis.  They felt that radiation was a good option and my husband chose brachytherapy because he can't or won't be away from home for 8 weeks having the external beam radiation done.  We live in a very small town and although we do have a radiation dept. at a hospital 30 miles away, the "guru's" in the large cities don't recommend that we go there.
 
My husband has a lot of trust in these dr's and they were very patient to explain everything.  Next step is a trip to Portland again to have a work up and a volume study.  Then he will have to come back for a few weeks then go to Portland again to have the seeds put in.  (I almost said installed)  It's a lot of travel for him.  Portland is 5 hours away from here but our kids live there so we get to see them.  It makes my husband, because of his MS very, very tired but he'll keep pushing until this is done.  All the doctors said he could wait because of the early stage but he says he'll just keep thinking "I've got cancer inside" and will never rest until it's out.  I don't blame him but is is completely his call. 
 
Good news, the MRI shows no spread outside the prostate and his cancer is very small. 
 
 
62 year old with Multiple Sclerosis currently in remission
Last PSA taken in 2008 was normal
November, upon exam abnormality felt in Prostate
Biopsy taken December 10
6 samples taken
3 positive for Prostatic Adenocarcinoma
3 Negative
Gleason Score of 3+3=6
Grade T-2
Looking into DaVinci Surgery, no decision made yet.  Update, not a good candidate for surgery because of MS.
Most likely will do brachytherapy at Oregon Health Sciences in Portland
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 2/10/2009 1:44 PM (GMT -7)   
Excellent Duckfan...sounds like you and hubby have got a game plan. I know it has been an ordeal to go through up to this point...but at least maybe some of the stress will be reduced and you can move forward with some ease. The Brachy should do the trick and is a good route to go.

Good luck moving forward and keep us posted with the progress.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 2/10/2009 2:06 PM (GMT -7)   
Duckfan, sounds like you got some good consistent opinions and a game plan. If they feel your husbands cancer is small now and contained, and factoring in his MS, then the "seed" method might just be the right fit for his unique circumstances. Please keep us posted, and I hope that both you and he, do fine with what lies ahead.

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
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4021
   Posted 2/10/2009 4:13 PM (GMT -7)   

Hi Duckfan:

I'm glad you have been able to come to a decision.  I know that evaluating and discussing the alternatives is stressful and coming to a conclusion should (hopefully) take a weight off your backs.

Brachytherapy is an excellent treatment with cure rates as good as surgery, so I'm sure hubby will be just fine.  If you want some recent perspective on "what happens" with the procedure, check out "Tudpock's Brachytherapy Journey" on this forum.

One recommendation I have at this time:  The only real discomfort I have had thru the entire process was the volume study (check my post!).  I had this done with no sedative or pills...and this is the only thing I would change.  I don't think he needs to be totally sedated, 'cause it's not that bad.  But a little Valium or equivalent would make for a better experience.

Let me know if I can be of any help and good luck.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/11/2009 6:46 AM (GMT -7)   
Sounds like a good protocol and it is not just unique for your circumstances alot of men have chosen such for various reasons, as long as you have an experienced expert that is key in any treatment. Best to you. Lots of choices in treating PCa, highly suggest people learn about all possibilities and their side effects and possible complications, so atleast you have some knowledge prior to any one time decision you may make.

I am impressed by the multi opinions, reflecting back do you have any regrets in obtaining your multiple opinions????????
 


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 2/11/2009 10:00 AM (GMT -7)   
OHSU has a solid reputation and wonderful dr's. We have another member that is currently going there. Hopefully he will post soon. Good luck with the treatment and keep us posted. It is a wonderful feeling to have found the team that you are going to move forward with. All the best in this stage of the journey!
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


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/11/2009 11:14 AM (GMT -7)   
Glad you have reached a decision, I know it has been stressful on you both.

My saturation biopsy was identical to a brachy procedure they just took cores instead of implanting seeds. The pain post procedure was easily managed with oral meds and I was in the hospital at 7:am and in the car headed home by 10:am

Good luck. 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


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 2/11/2009 3:31 PM (GMT -7)   
Dear Duckfan, I know you have been through a lot in the last few months, and it is tiring. You and your husband have made great headway in deciding what course to take, and it sounds like it will be a winner... Good luck to you both....Keep us informed.....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!


duckfan
Regular Member


Date Joined Dec 2008
Total Posts : 40
   Posted 2/11/2009 4:28 PM (GMT -7)   
zufus, you asked if we regreted multiple opinions. Well, yes and no.

1. VA doctor. My husband started with the VA. He's a 100% disabled Vietnam Veteran. Anyway, he had the biopsy at the VA. The Dr. there suggested brachytherapy at the Seattle VA. Not a good option because of the distance and my husband's MS fatigue issue.

2. Private urologist. He suggested my husband have conventional surgery (forgot the medical term). On exam, he thought my husband had another spot on the other side of the prostate that was irregular. We decided to talk to another specialist and find out about other therapies.

3. Went to Oregon Urology Clinic in Eugene, OR. The first Dr. was a surgeon specializing in the DiVinci method. He suggested that my husband wouldn't be a good candidate because of his MS. He said with surgery you have to learn how to use other muscles to urinate and if my husband's are already weakened because of MS, he would end up being incontinent.
 
4. The DiVinci surgeon referred us to a Oncologist in the same clinic. He agreed with the surgeon and suggested the 8 week course of external beam radiation.

5. The Oncoligist referred us to a Dr. at the same clinic that specializes in the radiation therapy. He agreed that surgery wasn't a viable option and told us about the 8 week therapy in Eugene. This clinic is 3 hours away and my husband didn't want to "live" in Eugene for 8 weeks. His body is in a very uncomfortable state anyway because of his MS and home is the most comfortable place for him to be.
He asked about brachytherapy and the Dr. said they don't do that in Eugene.

6. The radiation Doctor (what do they call them anyway?) referred us to a doctor at Oregon Health Sciences for the brachytherapy and that's where we ended up. The doctors at Oregon Health Sciences in Portland gave us all the information and side effects. (there were two doctors.)  The worst seems to be a closing of the uretha because of swelling. The swelling will eventually go down though.

Now, back to your question. If we had gone with the first VA doctor the brachytherapy would probably be done by now so no, all these other opinions weren't needed but hindsight is always "crystal clear" isn't it.

The second Doctor, had we listened to him my husband could very well be sitting in the chair incontinent right now because of surgery. Not a good outcome for a man already battling with Multiple Sclerosis.

So yes, we're glad we went the extra mile. We really pressed on because of all I was reading on this message board and I'm so thankful I found you. Everyone here said "TAKE YOUR TIME" and explore every option. Prostate cancer is slow growing so all you guys have time. It was funny, the doctor in Portland said "you guys seem to be knowledgeable so I guess I'm not needed." The internet really gives us power.

I hope I haven't posted the book no one wants to read but if it helps anyone then it's worth it. I'll keep posting my husband's progress because who knows, some guy with MS may come along and need this info.

The doctors at the Oregon Urology Clinic were expecially helpful. In fact, the last one we saw has called us three times to follow up. Unreal. Now if my husband could just find a good neurologist. His guy now is Russian and a real arrogant jerk. Trouble is he's only one of two in our area and the other one is in the same office. The hassle of living in a small town. At least it's beautfiul here.


62 year old with Multiple Sclerosis currently in remission
Last PSA taken in 2008 was normal
November, upon exam abnormality felt in Prostate
Biopsy taken December 10
6 samples taken
3 positive for Prostatic Adenocarcinoma
3 Negative
Gleason Score of 3+3=6
Grade T-2
Looking into DaVinci Surgery, no decision made yet.  Update, not a good candidate for surgery because of MS.
Most likely will do brachytherapy at Oregon Health Sciences in Portland
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25354
   Posted 2/11/2009 4:47 PM (GMT -7)   
We are all very interested in you and your husband's case, and would love for you to continue his treatment and after treatment adjustments, etc. With the process you all went through, you are probably even more comfortable now, hassle aside, with the treatment method that you have decided upon. I for one, hope your husband does very well with the "seeding", with his MS, and general health in consideration, it sounds like a good fit for him. We will be all rooting for him, and for 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, 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
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4021
   Posted 2/11/2009 4:49 PM (GMT -7)   

Dear Duckfan:

I'm glad you took your time.  I also talked to lots of docs and I didn't even have the complications of another disease with which to deal.  However, there is power and peace of mind in knowing that you did your homework and came to an informed decision.

Also, just so you know to ask...though I'm pretty sure it's standard...your hubby should start with Flomax the day before the seeding and continue it for a couple of months.  That should take care of any early urinary issue...I know it did with me.

I'll look forward to hearing your progress.

Tudpock


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 1/31/09.


divo
Veteran Member


Date Joined Jul 2008
Total Posts : 637
   Posted 2/11/2009 5:46 PM (GMT -7)   
Good for you and your husband, Duckfan. Thank you for all of the information...Im sure that it will help countless others, and good luck with your decision and progress. Keep us informed. 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!

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