All your questions are valid. I had a transition zone tumor which creates high PSA while still being contained. If I would have had a peripheral zone tumor with a high PSA I would have done things a lot differently and much more quickly. Because of the scans I knew it hadn't penetrated the capsule so I needed to know if the high PSA was being generated by the tumor or was in the lymphatic system, hence the Combidex MRI. The nomograms indicated a 30% chance of lymph node involvement. Combidex convinced me that my tumor is acting like a typical transition zone tumor and is contained. Without Combidex I would have had my Lymph node radiated because of the high risk.
I had my PSA checked monthly and if it had continued to rise instead of fall I would also have acted more quickly. I felt that the PC had been in me for at least 10 years and probably 15 so a couple of more months was a small risk.
The problem was that my original uro oncologist did not take into account my high PSA in his recommendation. He recommended surgery without ADT and this was a mistake on his part as the transition zone tumor was much larger than he thought and would have resulted in a failure. The color doppler and Combidex verified this.
I just started Casodex and proscar 2 weeks ago and haven't had a PSA reading yet while using them, so the PSA change was strictly due to diet.
I fully expected to get a Lupron shot last week when I saw my oncologist, but he said to see a radiologist 1st and see what he recommended. My prostate is 60mm right on the border line for radiation without ADT3. The radiologist wants me to get a Lupron shot just to be on the safe side and my onco and he will get together next week and come up with a final recommendation.
The tumor is at the apex right next to the ureatha so a surgeon would have to be exceptional to get all the cancer without damaging the ureatha resulting in permanent incontenance. This is just too risky when radiation can get it without a problem. This alone was a justification for the scans as they revealed important information that the biopsy couldn't. How many other surgeries have failed because the tumor was in an unfavorable
location or had already penetrated the capsule?
I realize that my case is unusual and because of all the previous misdiagnosis from some very good doctors I wanted to make sure that I got it right and all the data corolated and could be explained before I took the next step. I'm glad I had both the time and resources to follow this path as it increases my odds of a favorable outcome. I still feel that many people act too quickly without adequate information.
My main concern is the high reoccurance rate, especialy from surgery, and I feel that this is due to the lack of taking all the steps necessary to properly stage the PC using all of the tools available. Based on the initial information I had and my lack of knowledge I was in the process of interviewing surgeons. I have no doubt that this would have resulted in a reoccurance. It was just dumb luck that my wife had a follow up with her oncologist and he insisted that I get a 2nd opinion from Dr Sholtz.
The value of the Combidex is only for those that the nomograms show a high risk of lymphatic invasion. If confirmed, individual nodes can be targeted rather than radiate the entire lymphatic system. My oncologist was surprized and said I was his 1st patient who came back with a clear Combidex scan. He has sent about
30 patients to Holland for the scan.
I realize the emotional toll of PC and the need for a lot of people to want the cancer out of them as quickly as possible. As you may already noticed I don't make emotional decisions and know that PC contained in the prostate never killed anyone. It's the PC outside the prostate that is the problem. I have no problem living with PC as long as I know it's contained and not growing.
Hope this explains why I took this course.
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 had BPH and not PC but to keep getting biopsies every year just in case.
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 was indolant and statistically insignificant, but PSA history 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.
Combidex MRI in 2-09 showed all lymph node clear.
Changed diet and takiing supplements while I wait, PSA dropped from 40 to 29 through diet alone. The location of the tumor next to the urethea plus the high psa make surgery an unlikely option.
Currently on Casodex and Proscar. Consultation with the radiologist suggested adding Lupron for 3 months before IMRT. May use a combination of seeds and IMRT. Radiologist and Oncologist will get together and come up with a joint recommendation next week.