Husband newly diagnosed

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ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 4/24/2009 7:08 PM (GMT -6)   
My husband is is 61 years old and in good health except for this prostate cancer diagnosis. His first PSA test was 8.  The DRE showed no enlargement or palpable tumor.  He was referred to a urologist the DRE there was the same and the ultrasound showed nothing.  His PSA was 6 and was 14 days after the first test. He said the urologist said his Gleason score was 6 and he was 99% sure it was contained. His biopsy report reads as follows:
 
Right - Diagnosis: Prostatic adenocarcinoma. Gleason score 7 (Grades 3 + 4) noted in 3 of 6 submitted prostate core segments.  Approximately 25% of submitted tissue involved.  Perineural invasion present.
 
Left - Diagnosis: Prostatic adenocarcinoma. Gleason score 6 (Grades 3 + 3) noted in 5 of 5 submitted prostate core segments.  Approximately 95% of submitted tissue involved.  Perineural invasion present.
 
End of report by Dianon Systems a Labcorp Company.
 
The urologist is a surgeon and recommends radical prostectomy.  He made no mention of the PNI and that concerns me.  Is that indicative that the cancer has spread outside the prostate?  Should it influence treatment and does it make for a poorer prognosis?
 
I tend to worry and my husband just seems to accept it and move on.  His Cat Scan is scheduled next week.  I have searched the forum and found some encouraging information but would like some feedback on his biopsy report.
 
Thanks

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/24/2009 7:23 PM (GMT -6)   
Hello ddd49,
Sorry you need to be here, but glad you found us. Altogether, based on what you posted, your husband has cancer in 8 out of the 11 cores sampled. The five of five that were 95% is pretty cancerous for sure, but at this point tested to be Gleason 6. The other 3, @ 25%, were Gleason 7. It is always important to remember that the best biopsy is but an estimate of what they think the cancer is at that point in time. Sometimes, the Gleason scores are higher after surgery, because they have the entire prostate to examine, as well as lymph nodes, etc to check. On rare occasions, the Gleason score is lessened after surgery or treatment.

The dr. is probably correct about the cancer being contained at this point, but with the Gleason 7 cores, it doesn't take much for it to move outside the prostate itself. While you have plenty of time to think over treatment decisions, I am sure the dr. wouldn't want your husband to wait too long to decide.

With his biopsy stats, and gleason, and his age, and I am assuming he has no other major medical ailments, I myself would opt for surgery, either robotic or open, with a very experienced surgeon. Surgery before radiation in this case would make much more safe, and be more logical if any cancer cells were on the loose after the fact. Salvage sugery is not a good option in most all cases.

The other advantage to surgery at this point, is that you will more likely know the full extent of his cancer after the post surgical pathology report, and know pretty well if it was or wasn't contained.

In most cases, at this point, and I am not a dr or pretending to be one, the Cat scan/Bone scan should come back clean. With a Gleason 7 in the biopsy, it is very common to run the tests just in case.

I hope only the best for you and your husband, there are many here that will be glad to help, and we are full of experience and advice. Please keep us posted of your travels.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 6 month on 5/9
 
 


ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 4/24/2009 7:41 PM (GMT -6)   
Thanks, David that is encouraging.  I appreciate the information

Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 4/24/2009 9:58 PM (GMT -6)   
I am a big advocate of second opinions. You can always have your slides read by another professional and it is really easy to do. I tend to be a worrier as well and prefer to get a couple of expert opinions. In addition, try to keep in mind that urologists typically recommend surgery, radiation oncologists typically recommend radiation. However, I think it is helpful to hear both sides present their cases.
I was really happy my father opted for surgery, even though the outcome was not what we had hoped for and he needed follow up radiation. The good news is that we had the option of radiation. The decision is such a personal one and it really helped us to get the medical opinions, and know that there were no guarantees with any decisions. We just had to make the best decision we could with the information given and pray for the best. We refuse to look back. You have come to a fantastic place for support and information and I hope you find support and comfort at HW during these times.
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


ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 4/25/2009 5:17 AM (GMT -6)   
Sounds like your Dad is doing great, Doting Daughter. I think I am more concerned because my Dad died a few years ago from prostate cancer.  Of course he had it for at least 15 years and they did watchful waiting and hormones.  It later spread to his bones and the last year or 2 was very difficult.  I know the treatment is better now and my Dad lived to be 82 but it has still heightened my anxiety.  I will pray for your Dad and all the members here.  Sounds like he has his cure.  Blessings.

GarthK
Regular Member


Date Joined Feb 2009
Total Posts : 74
   Posted 4/25/2009 5:47 AM (GMT -6)   
Sorry to hear about your husband's diagnosis. I am 62 and completed RRP (open surgery) three months ago. I agree with all that has been said here but I also think that too much worrying and second-guessing is not a Good Thing, as Martha would say. I wanted the cancer gone, not just dead but still inside, so I already knew I wanted surgery. I had also decided on DaVinci but more important to me was to find a surgeon I really trusted. I did that and he recommended open surgery since my cancer was palpably detected with a low PSA score and he wanted to be able to see/feel what was going on in there. The rest is history but I've never had a second thought about whether it would have been better to do this or that or the other thing. I'm done with it and now I can get on with my life. That said, some if not many here recommend extensive testing and multiple consultations with different types of physicians and I have no problem with that other than that you end up with a variety of different recommendations and it is still up to you to decide. That was just not my way of approaching the problem.

Again, my best advice is to find someone you like/trust and go with their advice. Given your husband's relatively young age, I'd opt for surgery and get it over with.

Just my $0.02 and best of luck,
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
Post-op PSA's
3/10/09 < 0.014 (undetectable by machine)


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 4/25/2009 10:00 AM (GMT -6)   
If you look around this list you will see that your husband’s test results are about in the middle range of those of us who have been treated. To me, second opinions and lots of reading were important in feeling more in control of my choices.

NOTE: the following advice may be a very personal opinion. I am not an M.D. but I do teach statistics at the graduate level.
Go to the Sloan-Kettering website and plug in your husband’s lab results.
http://www.mskcc.org/applications/nomograms/prostate/PostRadicalProstatectomy.aspx
I believe that you will find that, with treatment, his chances of having no detectable cancer after 10 years are quite good. This helped me to realize that at this stage I was facing a risk but not the “death sentence” we sometimes equate with cancer.

Good luck as you and your husband face this.
Age at diagnosis 67, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 4/25/2009 10:07 AM (GMT -6)   
I to would like to say welcome to the forum, however I wish you were here for different reasons. Based on what you have given us I would say get a second opinion and if it matches the first which it likely will I to would opt for surgery. Do not let yourself get confused with open vs robotic. Find a good experienced surgeon that you are comfortable with. I realize that this is a trying time in your lives, I, unlike others would wish you to get things moving quick so you can get this behind you and start a new chapter in life. Please understand I am not advocating that you should not wait and discern your options, I just believe that moving on is better. Please stay with us and share your journey and when emotion and uncertainty creeps into your lives let us shoulder the burden with you.

Peace and much love
dale
My PSA at diagnosis was 16.3
age 47 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 4/25/2009 12:34 PM (GMT -6)   
ddd,
I don't know how the urologist can say that he is 99% certain it is contained. The amount of positive cores, % of positive cores and gleason score indicate a risk of micro mets. If you look at the nomograms for those stats it wouldn't come close to 99%. Take Geezer's advice and plug in your stats and then determine if you are comfortable with the risk level.
You should always get 2nd opinions on decisions that will affect the rest of your life. A 2nd opinion from a prostate oncologist and a few more tests to rule out micromets would be a good next step.

The Cat scan is just a waste of time and should only be given if psa is over 20 and even then it won't pick up much. Remember prostate cancer is slow growing and there are a number of ways to treat it in any stage. Learn as much as you can because what you don't know will hurt you.
JT


JohnT, I deleted the other duplicate post for youJames C.

Post Edited By Moderator (James C.) : 4/25/2009 1:10:58 PM (GMT-6)


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 4/25/2009 1:08 PM (GMT -6)   
Welcome to the group. The others have covered almost everything, except I didn't see anyone address the PIN for you. PIN is normally and usually internal of the gland itself, cancer follows the path of least resistance and will infiltrate into the nerve sheaths INSIDE the prostate. PIN is so common on path reports that most Doctors don't even mention it and several national standards groups are recommending that it not even be reported in the biopsy report. So- bottom line- PIN isn't anything to get concerned about. so put it out of your mind..There- some good news in all this---

That said, it would be helpful for those who wish to post to you or answer questions to have the concise details of your husbands Journey so far in your signature, similar to the others you see here. Just go to Control Panel, then Edit Profile, then scroll to the bottom and fill in the signature box.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
PSA's: .04 each 3 months


ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 4/25/2009 9:23 PM (GMT -6)   
Thanks to all of you for your kindness and information.  I am trying to step back and not get too far ahead.  I am going to encourage him to make a treatment option and move forward in the next month.  Thanks for the website I will do that.  The PNI info is helpful too.  I will  add his information to my profile. Thanks again

CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 4/26/2009 6:23 AM (GMT -6)   

Greetings, everyone.  Welcome to the forum ddd49.  Sorry you have to be here but you have found friends.  My only thought would be if the doctor who made the diagnosis is a surgeon then you might want to get a second opinion from an oncologist or someone who would have an "open mind" to several treatment options.  I have great trust in doctors but it is only human nature for surgeons to like surgery, radiologists to like radiation, etc.  In my case, the urologist I see is a gereralist and doesn't do surgery or radiation or seeds so I felt he was giving me good, unbiased, advise.  Then I saw a surgeon and he confirmed what my urologist said plus I came to have great confidence in him.  I already had great confidence in my original urologist so now I had the same opinion from 2 docs and I trusted both of them.  That gave me great confidence to move forward and as the results show, I made the right decision. 

Best wishes.  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


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 4/26/2009 8:24 PM (GMT -6)   
Welcome ddd: AS you can see my Gleson was 7 and we did not know if it was contained till after surgery. I had a great pathology. no margins involved- all encapsulated the Dr called me and reported the good news as soon as he got the reports from the lab.

Best Wishes.
Jeff T Age 57
9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable
 ED- 5 mg Cialis daily, pump daily,


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 4/27/2009 12:00 PM (GMT -6)   
Just to comment on what James said...however PNI (Perineural Invasion) is different from PIN (prostatic intraepithelial neoplasia).

PIN is thought to be pre-cancerous where as the PNI is exactly what James was talking about.

And as James pointed out PNI is nothing to worry with...it is used by the doctor for when surgery is being performed, the location becomes important if the PNI is near the nerve bundles. PNI on pathology after surgery is quite common.

Best wishes,
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06


Bellatoby
New Member


Date Joined Apr 2009
Total Posts : 2
   Posted 4/27/2009 12:24 PM (GMT -6)   
My husband, age 60 was recently diagnosed with Prostate Cancer, his GLeason score was a 7 (3+4) he has chosen to have the seed implants and then 5 weeks of external radiation, also 3 hormone shots, approximately 2 months apart for the shots. Drs feel it is contained in the prostate and cancer was diagnosed very early, he PSA was 2.3. Anyone out there with similar scores and has had or will have the same treatment? Thanks

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 4/27/2009 12:59 PM (GMT -6)   
Welcome here Bellatoby...sorry your husband has PCa. I was surgery, so I can't comment on the seeds and radiation, but others have traveled down that path and will chime in shortly. Just a suggestion, start a new thread so others will spot your question easily and you will more than likely get several prompt replies.

Mods...if you spot this open a new thread for bellatoby.

Again welcome to Healingwell
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 4/27/2009 1:03 PM (GMT -6)   

Dear Bellatoby:

First of all, the moderators may re-post your comments as a new thread so that you get attention and advice for your issues specifically.  Having said that, since I recently had the seed implants, I will reply here to see if you pick it up.

Hopefully, before making a final choice on the seeds, your hubby has taken the time to research all of the options available to him.  It's hard to know exactly what his options are without more info from you, e.g. a detailed "signature" with info about prostate size, diagnosed stage of cancer, was it found via a DRE or not, number of cores with cancer, % or cores with cancer, etc  Having said that, from the info you have provided, it is likely that he has multiple options.  I hope you will encourage him to visit with a surgeon, a radiation oncologist and a prostate oncologist if he has not already done so.  I'm guessing he has already spoken with a surgeon and radiation oncologist...  He should also take the time to review some of the other less travelled options like HIFU and TFT (see realziggy's posts) just so you are comfortable with your final decision.

And, should you stick with your brachytherapy choice, you might consider reading my "journey" which is linked in my signature below.  Also, there is another brachy journey on this site, "JustJulie's Brachytherapy Journey", written by a patient's wife.  These will show him what to expect.

In my case, I did not have the external radiation or the hormone shots.  Many radiation oncologists routinely go with the EBRT for Gleason 7 cases, but I'm not sure why he would be having the hormone shots...but, again, I don't have access to his full stats.

I'm sure you will get lots of help on this forum and I would be happy to help specifically on the seed questions as you have them.

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 5/1/09.

ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 4/27/2009 5:10 PM (GMT -6)   
Thanks to you all.
Bellatoby sounds like your husband's cancer was diagnosed very early.  I pray he will make a full recovery.
My husband has scheduled his CAT scan for Thursday.  I asked him what the purpose of this scan was and he said to see if there is any lymph node involvement.  I thought that was done by biopsy too but we are just learning.  The following week he will meet with the urologist to discuss the CAT scan.  I think he is leaning towards surgery.  He talked with 2 more pathologists today by phone.  He doesn't act worried but I would think he must be a little.  I ordered the book by Walsh.  Guess I'll read it if he won't.  Hope it gets here soon.  I would like to learn more before he has the surgery.
 

Husband Age 61
PSA 8 4/1/09, 6 4/14/09
DRE Normal
Ultrasound Normal
Biopsy 4/14/09 Right Gleason (3 + 40),  3/6 pos cores, 25% involvement, PNI
Left Gleason (3 + 3), 5/5 pos cores, 95% involvement, PNI


ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 4/27/2009 5:15 PM (GMT -6)   
Oops!! That is supposed to be Gleason 3 + 4 not 40 in the signature. I changed it in the profile. I tried to edit the post but could figure out how to do that.
Husband Age 61
PSA 8 4/1/09, 6 4/14/09
DRE Normal
Ultrasound Normal
Biopsy 4/14/09 Right Gleason (3 + 40),  3/6 pos cores, 25% involvement, PNI
Left Gleason (3 + 3), 5/5 pos cores, 95% involvement, PNI


Bellatoby
New Member


Date Joined Apr 2009
Total Posts : 2
   Posted 4/28/2009 8:29 PM (GMT -6)   
Thank you so much for all the responses, he has already had the seed implants, and a hormone shot last Tuesday. He seems to doing well well so far. His PSA tripled in about a year, he had the DRE , and then biopsy, 8 of the 12 were positive, they dont think it has spread out of the prostate. We live in New York, Utica area, and he is content with local drs. Our oncologist is great, the urologist always seems to have his hand on the doorknob. I dont think I know what the PNI is, maybe a little help there from someone in this group, and I can find out what that is. Thanks

ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 4/30/2009 6:18 PM (GMT -6)   
My husband had his CAT scan today.  He said the worse part was the stuff he had to drink.  He has all the scans to take to the Urologist next week. It is terrible to have them in the house and no idea what they mean.  It is torture for a worrier like me.  But he will see the doctor next Friday.

Husband Age 61
PSA 8 4/1/09, 6 4/14/09
DRE Normal
Ultrasound Normal
Biopsy 4/14/09 Right Gleason (3 + 4),  3/6 pos cores, 25% involvement, PNI
Left Gleason (3 + 3), 5/5 pos cores, 95% involvement, PNI


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/30/2009 6:32 PM (GMT -6)   
Hi ddd,
I know it's tough to do, but be patient. I have seen so many come through here, and I believe that your hubby can do quite well. Your hubby seems to be handling things well and you are taking the right steps. This is a great group and you can count on us at each point to reassure you and for support.

Peace.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 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!


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 4/30/2009 7:20 PM (GMT -6)   

ddd,

From my experience, the Walsh book will provide an excellent baseline source for your decision making. My wife and I both read it and came to the same conclusion regarding my stats and treatment selection. The next question was "where to get the treatment?" This is probably the hardest time in the journey as the world goes upside down with the diagnosis and then your head spins around with everything you hear and alot of what you read. You are on the right track by asking and researching.

If you decide on surgery, keep in mind that Walsh is a strong advocate for open surgery because he is the father of the procedure but there are many, many well qualified surgeons that do robotic and laproscopic minimally invasive RP's with excellent results.

best wishes to your family,

TeddyG


Background:
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who ishelping me through every stage of this war.
Stats:
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare but review of literature says ~1.3 %; family says "miracle."
Now working w/ post-surgery issues....
 


ddd49
New Member


Date Joined Apr 2009
Total Posts : 16
   Posted 5/8/2009 8:06 AM (GMT -6)   
My husband got the results of the CAT scan today and it reads as follows:
CT Pelvis with Contrast
 
Techhnique: Multiple 5-mm contiguous axial images are obtained through pelvis after the administration of oral and 100 mL of Optiray-320 intravenous contrast.
 
Findings: There is no evidence of pelvic adenopathy.  There is no evidence of a soft tissue mass within the pelvis.  The prostate gland is mildly enlaged measuring 4.1 cm in diameter.
 
Evaluation of the bony structures demonstrates no evidence of a sclerotic bony lesions to indicate the presence of sclerotic prostate metastasis. Several lytic lesions, however, are scattered throughout the lower lumbar vertebrae and iliac bones. There is a 7 mm lytic lesion of the left L4 vertebral body as well as a 3 mm lytic lesion within the right aspect of the L4 vertebral body. At least 5 lytic lesions are noted within the medial iliac bones measuring between 5 mm and 1.2 cm in diameter. Several small lytic lesions are noted within the posterier acetabulum measuring a maximum of 3 mm in diameter.  There is a 4 mm lytic lesion of the left superior pubic ramus.
 
Impression:
No evidence of pelvic adenopathy in this patient with a history of prostate carcinoma.
Small lytic lesions are noted within the bony structures of the pelvis, specifically most prominately involving the medial iliac bones and L4 vertebra. A neoplastic disorder such as multiple myeloma is not excluded.
 
End of report
 
 The doctor said there is no evidence  of spread and statistically a  97-99% cure rate.  He will do a nerve sparing surgery on June 11.  He gave us the report as we left so I did not know about these lytic lesions and now it has me very concerned.  Anyone have experience with these lytic lesions being noted on CT scan and what it means? Thanks


Husband Age 61
PSA 8 4/1/09, 6 4/14/09
DRE Normal
Ultrasound Normal
Biopsy 4/14/09 Right Gleason (3 + 4),  3/6 pos cores, 25% involvement, PNI
Left Gleason (3 + 3), 5/5 pos cores, 95% involvement, PNI
CAT Scan 4/29/2009 Negative

Post Edited (ddd49) : 6/16/2009 6:46:06 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/8/2009 8:48 AM (GMT -6)   
Sounds like a pretty good report. about a month till surgery, that will give the two of you plenty of time to get ready and to enjoy each other before then. My best luck to the both of you.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 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, 6 month on 5/9
 
 

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