Oncas' second opinion...

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Oncas
Regular Member


Date Joined Jan 2009
Total Posts : 390
   Posted 2/21/2009 3:48 PM (GMT -6)   
Sought 2nd opinion from what turned out to be a much more savvy and informative urologist this week. Suggested that my numbers were of deep concern and when prodded offered that my odds of cure were less than 50%.(not a surprise). Suggested that my cancer was uncommonly aggressive and would start with open, wide on both sides, non nerve sparing surgery as soon as possible probably followed by some sort of radiation protocol after some continence returned if indicated by detectable PSA. After checking in to set up an appt for surgery the following day I found that the earliest date available was 5 weeks from now.
I have two issues where I'm sorely needing advice.

!. Given my profile and this guy's initial advice should I wait this long or continue my search and listen to my gut feeling that time is critical and even perhaps seek input from an oncological direction. It's just so hard to trust the vendor with an issue this critical.

2. Anyone experiencing blood in semen 4 weeks after biopsy or am I perhaps looking at evidence of more extracapsular advancement.

Thanks for any advice ...

Oncas

PSA 11/11/08 8.04 (previous PSA was 2.5 11/11/05 )
Biopsy 01/23/09
DX 1/28/09 12 cores positive 9 cores 4+3=7 2 cores 3+4=7 1 core 4+4=8
9 cores suggest perineural invasion
Scans 1/26/09
Bone/Pelvic/Abdominal All clear
 
Post edited to add a subject line ~ TC-LasVegas

Post Edited By Moderator (TC-LasVegas) : 2/28/2009 1:42:24 PM (GMT-7)


gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/21/2009 3:53 PM (GMT -6)   
Oncas,

I know the wait is nerve wracking. I do know that you need some healing between the biopsy and the surgery and I am pretty certain that Drs. like to wait more than a month, in my case we waited 3 months.

I would talk to my Dr. and express my concern about the wait and see what he said.

Is the blood still bright red or is it a dull brownish color, it seems like I am remembering it took a couple of months for me but the bright red stuff didn't last for more than a couple of weeks.

Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07 robotic
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


mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 2/21/2009 4:22 PM (GMT -6)   
Oncas:
 
It is also my understanding that certain recovery time from trauma of biopsy is required before surgery.
 
Also same as Scott, blood in semen for a couple of weeks - then dark brown- about two months before normal color again.
 
Stay strong and I wish you all the best.
 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
 
  "There may come a day when the courage of men will fail, but it will not be this day."


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 2/21/2009 4:23 PM (GMT -6)   
Oncas,
My PC was also aggressive but my doctor wanted to wait 6 weeks before he will do the surgery. As far as the blood, mine was more like brown than red. That is normal for a while.
Age: 67
5ft 10 inches 182 lbs
Retired in 2001 and living in Austin TX.
Dx 12/30/08
Robotic surgery performed on Feb 9th
Surgeon: Dr. Randy Fagin, Austin TX.
Negative CT scan and bone scan done on 1/16
PSA 3.5
Post op Pathology report:
Prostate weighed 57 grams
size:5.2 x 5.0 x 4.9 cm
10-20% involved
Bilateral
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
Lymph nodes: not dissected
seminal vesicles clean


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 2/21/2009 5:21 PM (GMT -6)   
Greetings, Oncas. My doc said wait 6 weeks after biopsy before surgery.  Had biopsy on Dec 17 and surgery on Feb 4.  My semen was bloody right up until surgery.  Since then no semen - bloody or otherwise!  David

Age 55
Diagnosed Dec 2007 during annual routine physical
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 positive with 2 marginal
Gleason 3 + 3 = 6
RRP 4 Feb 08
Both nerves spared
Good pathology - no margins - all encapsulated - Gleason 4 + 3 = 7
Catheter out Feb 13 - wore pad for couple of days - pad free Feb 16
Great wife and family who take very good care of me


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/21/2009 5:36 PM (GMT -6)   
Due to agressive nature of my PC, my dr. wanted to do a surgery 6 weeks after 3rd biopsy, but due to logistics of hospital schedule, ended up being 8 weeks. Worked for me.
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
 
 


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 2/21/2009 6:11 PM (GMT -6)   

Oncas:

One way to slow down the PCa and also give you a little piece of mind is to start on Casodex and get a Lupron shot ASAP.  That will do a few things, if you decide to go ahead with surgery it will begin to shrink the tumor in the prostate immediately.  It will also give you the peace of mind knowing that the probability is very high that there will be no progression in the cancer over the waiting period.  It would also buy you some time and give you the opportunity to actually look at other options if you want.

The downside to the protocol is it makes the prostate and nerves "sticky" during the surgery so it takes a little more time on the table.

I had this done and a few others have also, I felt much better about the wait.

David 


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 


kcragman
Regular Member


Date Joined May 2008
Total Posts : 240
   Posted 2/28/2009 8:54 AM (GMT -6)   
Oncas - For me, it took a while for it to sink in about the seriousness of my condition. The first doctor said don't wait more than 2 months, the second doctor was not in as big a rush, and the 3rd guy said, "If you were a family member of mine, I'd clear my schedule and do you in the next 2 or 3 weeks." We picked him, and he did, but still, by the time I hit the table it was about 55 days from the date of my biopsy.

If I had gone to the 3rd guy first, I get the distinct impression that he would not have waited any time because of the biopsy. I know your rectal wall gets penetrated during the biopsy, but they are needle sized holes, and recovery should be pretty quick. And who cares about the recovery of the prostate? If you choose surgery they are going to cut it out anyway.

I also get the impression that my guy shuffled surgeries around based on the seriousness of the case. Obviously different doctors run their practices different ways. I can only report on my experience.

Good luck,
kcragman
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.
Feb 2009: PSA at 9 months was undetectable.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/28/2009 9:43 AM (GMT -6)   
I would take the surgical opening that you have been offered, need to get that thing out of you.

The blood after the biopsy is still normal I would say.

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
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 2/28/2009 12:32 PM (GMT -6)   
Oncas,
With gleason 8 and the number of positive cores you are in the high risk catagory. I would at least get a 2nd opinion from a prostate oncologist before I did anything. Why would you want surgery if you have to follow it up with radiation anyway. This indicates that your doctor feels that surgery will most likely not result in a cure, so why incur the side affects of surgery. An oncologist will give you a much more unbiased opinion. It is extremely important to have your PC staged as accurately as possible before you decide on a treatment option. There a a number of tests availabe to determine if the PC has spread, you need to know this before you choose a surgical option that may not be effective.
JohnT
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/28/2009 1:11 PM (GMT -6)   
Your decisions are tough Oncas my stats were much worse so it made my decision to skip surgery more automatic (after I knew what level I was really at). If you wish to buy some time while you still consider everything and/or seek other opinions or testings, you can take casodex alone also, as an option to keep it at bay during such time. Casodex side effects will probably be alot easier for you to handle compared to Lupron/Zoladex and others, also costs alot less, generic in Canada has been researched by OhioState/Andrew and is under $150 now vs. USA brand name at $600 (per month or so).
Best to you on whatever path you choose to take on this.
 


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 375
   Posted 2/28/2009 10:56 PM (GMT -6)   
Look I think you should just take the date the surgeon gave you and be happy with that, UNLESS you can get an oncologist to see you before that. I had second biopsy on 08/14/08, went on pre-planned trip to Nothern California two days later to forget about possibility of prostate cancer for awhile. First biopsy on 03/15/08, results indicated "suggestive of cancer but not diagnostic", urologist said repeat biopsy in 4 months, vacation already bought and paid for before this biopsy. I went on vacation, had blood in semen a couple times during sex during vacation, not a whole lot. Came back from vacation only to find out prostate CA in 2/12 cores, 5% one core, 25% other core, gleason score of 3+3= 6. My local urologist doesn't do robotic, went to see robotic surgeon in larger town, he agreed to do robotic surgery on 09/11/08, 3 days shy of 1 month. I am only a layman but I don't think 2 more weeks would have much of a difference. I am just paranoid about cancer, my father died in his late 50's from colon cancer, my mother from breast cancer in her mid sixties. I just couldn't live with cancer diagnosis, had to get it out due to family history. Radiation therapy can cure prostate cancer, but if it ever comes back surgery is not an option for MOST urologists, maybe someday it maybe but not today. I did not want to take chemical castration drugs for the third tier treatment for this disease, just take a big breath and go with the surgeon, that's what I did.................
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/08, 2/12 cores positive for Prostate Cancer on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 3+3=6 both cores,
Clinical Stage T1C
 
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery,
No signs of spread, organ contained,
First post-op PSA=.01 on 10/15/08,
Second post-op PSA <.01 on 01/15/09,
Incontinence gone in early December '08,
ED remains, using daily Viagra and 2x/wk bimix/trimix injections for penile rehab

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