With my patho report, I am considered a high risk patient - high risk for recurrance. I saw my doc yesterday and I asked him about some of the comments I have seen on this board.
He is Jason Engel, with the Urologic Surgeons of Washington, and the George Washington University Hospital. He is a highly regarded robotic surgeon. My wife and I call him "Top Gun." If you ever meet him, you'll understand. He says the Walsh book (from Johns Hopkins) is about the best PCa book out there, but he and his group take a very dim view of Walsh's "overly optimistic" stats. Conversely, he says that a lot of the stuff you find on the internet can be overly pessimistic.
He has a Fellowship with GWU, and his "Fellow" doctor is writing a paper about 1,000 of Engel's patients, including at least 100 high risk guys. Hopefully this paper will be out this year, but he says it will show that his high risk guys are doing much better than the partin tables indicate, and that surgery is a very viable option for high risk patients (of course, he is a surgeon). I believe somebody said that Gleason 8 and above indicates that the cancer is probably systemic - meaning it has spread. Engel says that is crap. (Top Gun is very opinionated.) He said it would be unethical for him to operate if he believed that the cancer was systemic, because at that point it would be beyond surgical resolution.
I want to reiterate that he said that according to his numbers, if you achieve a zero at the 6 month mark, even if the cancer returns you only have a 10% chance of dying from it - regardless of age.
My wife (the PhD anatomist) told me that even after the cancer cells have broken out of the prostate capsule, they have a tendency to hang around the prostate for a while before they spread. She knows a lot about cancer at the cellular level. I asked her to write up a little blurb about that for this board. We'll see what happens.
So, I know a man hears what he wants to hear and disregards the rest - but I'm taking all of this as positive news and I wanted to pass it on to other high risk guys. It is certainly better than the tables that tell me oops - I'm supposed to be dead already.
By the way - I also received my 9-month zero. Woo-hoo! The wife & I had our usual wild celebration - a quiet glass of Guiness and a plate of hot avocado & spinach dip at the "Froggy Bottom" which we walk to after each visit to see Dr. Engel.
Age: 53; 52 at DX
March 2006: PSA 2.5
Dec 2007: PSA taken for insurance application. I did not see the results until late
Jan '08 - after I was rejected. Their lab said PSA 4.5.
Feb 2008: PSA 3.7.
March 2008: Biopsy. Gleason 7 (4+3) 12 cores taken. 5 on the left side were
cancerous and the 6th was suspect.
May 5, 2008: Da Vinci robotic laparoscopy at GW Hospital, Washington DC.
Post op: Gleason 9 (4+5). 15% of prostate involved. Stage: pT3a. Negative margins. Lymph node and nerve samples taken, and appeared to be cancer free.
July 2008: PSA at 7 weeks was undetectable.
August 2008: PSA at 14 weeks (3 months) was undetectable.
Nov 2008: PSA at 6 months was undetectable.