Second set of PSA

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Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/7/2009 4:34 AM (GMT -6)   
 Just had another PSA done after 3 months my latest readings were
 
PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08
 
I am going to have a MIR-S Scan done tomorrow and a 24 core Biopsy after the MIR-S scans are back does this seem to be the correct way of going about things
 
These are my only other results on 21 Jan 2009
 
PSA was showing 9.73
 
Had Biopsy carried out 12 core results were
 
Benign Prostatic Hyperplasia with Atrophic glands
Atypical Hyoerplasia
Prostatic Intraepithelial Neoplasia (PIN), Low-Grade
 
Both lobes show similar findings
 
Comment Both specimens show no adenocarcinoma To confirm the diagnosis by immunohistologic study is available on request
 
Microscopic Examination
Reveal diffused fibromuscular hyperplasia of the stroma. Small groups of hyperplastic glands, atrophic glands and glands with atypical hyperplasia are randomly seen in every cores.few glands with low grade Prostatic Intraepithelial Neoplasia (PIN), are also present
Both lobes show similar findings

Post Edited (Colin45) : 5/7/2009 3:47:39 AM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/7/2009 9:21 AM (GMT -6)   
Colin,

Your story is a complicated one, and not that uncommon. Glad you don't have PC at this point, but can see why they want to do a more involved biopsy. It took 3 for me spread over 18 months before they declared positive for PC. The one encouraging thing I see in your results is the fact that PIN is low grade at this point. My first two biopsies showed high grade PIN, which is more likely to become cancer cell. Hoping for the best for you, there could still be non-cancerous reasons you are getting the readings that you, but hopefully the next round of testing will resolve it for you. I know it's nerve wracking and probably feels like you have a sword hanging over your head, but you are doing all the right things.

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
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 5/7/2009 10:34 AM (GMT -6)   
Colin,
You are wise to have both a 24 core biopsy and and MRIS. There is one caution, both biopsies and MRIS are notorious for missing transition zone tumors which are 25% of all PC tumors. 1.5 Telsa machines are just not powerful enough to see the transition zone and when most doctors biopsy the tranzition zone their method misses large areas. MRIS is good for seeing the P zone and the prostate bed, but not good for any interior work.
If you have to do this again next year I would recommend a color doppler targeted biospy by a skilled operator such as Fred Lee or Duke Bahn. It is much less costly, less painful and more effective.
Also try a PCA3 urine test.
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/8/2009 2:31 AM (GMT -6)   

Thanks for the advice so far I have just come back from having scans I had CAT, MIRS scan and Ultrasound carried out, on first sight (he will study them more in depth later and give the results to the Urologist) the Radio-ologist could see no signs of Cancer in my prostate he said there where calcified areas the result of cured Prostatitis. The MRSI showed high levels of Citrate and low levels of Choline (or creatine cannot remember which) which I was told was very good. The ultrasound showed that the prostate was of normal size (until I told him that the Urologist said that it was enlarged then he said it was only marginally larger) he checked before and after me going to the toilet and said that I was very nearly emptying all of my bladder he then checked my Kidneys and told me that I had a cyst on one of them but it was not Cancer

So it seems the I am back to square one if I have another biopsy there is no guide lines to go by so it will be another shot in the dark also after doing some reading there seems to be a concern the biopsies can be causing tracking problems outside the Prostate at a later date I guess I will have to wait until I see the Urologist on Sunday but I am not sure that I want another Biopsy to be told that he cannot find anything again but I still might have cancer

JohnT thank you for your advice but i come from the UK but at the moment I live in Thailand


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 5/8/2009 1:02 PM (GMT -6)   
Colin45...the needle tracking issue has never been confirmed....but what I will tell you is that it can sometimes cause some adhesions to the rectal wall. While this in itself is not usually bothersome, it does complicate any surgery later on if that is the route you end up going.

I am not a big proponent of multiple biopsies and tend to agree with what JohnT says...being in Thailand I know it's not possible, but see what you can do to avoid doing too many biopsies through the rectum.

Good thing though, it seems that your original biopsy was correct....no cancer at this time.
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


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/9/2009 3:53 AM (GMT -6)   

Got my final Imaging report and are

No loss of normal high signal intensity in peripheral zone on T2W images and no increased choline and no decrease citrate levels of peripheral zone on MRS(less likely to br Ca prostate gland)

No enlarged pelvic lymph node, seminal vesicles involvement or ascites demonstrated

Borderline sized prostate gland(measuring about 3.8x3.9x4.2 in size, 32cc) with small amount of post void residual urine (about 5cc in volume)

The urinary bladder shows no discrete mass. no bone destruction or marrow infiltrative disease noted

No solid renal mass, renal stone, hydronephrosis, or hydroureter seen

I was told this is all good. Are there any questions to ask the Urology Doctor tomorrow before I have to decide whether to have a 26 core biopsy done or not any advice would be welcomed to help to try and make the correct decision

 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/21/2009 12:47 AM (GMT -6)   

Got the results back of my 24 core biopsy today they are

Serial sections of the prostate in section A reveal prostatic adenocarcinoma demonstrating overall Gleason grade 3+2 = 5/10 in a short segment in one out of 12 cores of tissue. No perineural and no angiolymphatic invasion present

Serial sections of the prostate in section A reveal prostatic adenocarcinoma demonstrating overall Gleason grade 3+2 = 5/10 in a small areas of one out of 12 cores of tissue. No perineural and no angiolymphatic invasion present. some groups of glands show prostatic intraepithelial neoplasia of high grade

The doctor suggested that I was a good case for Seeds or radical surgery but I intend to get a second opinion next week at the moment I am not sure which will be best 

 


 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
Benign Prostatic Hyperplasia with Atrophic glands
Atypical Hyoerplasia
Prostatic Intraepithelial Neoplasia (PIN), Low-Grade
Both lobes show similar findings
Comment. Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer 
<!-- Edit -->


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 5/21/2009 3:17 AM (GMT -6)   
Colin,
Congrats on the new baby...

How many total cores were positive? If it is a small quantity, then slow down and take your time in deciding. Your G5 is a very slow moving cancer. The choices presented are good but there is a posibility that you can delay treatment briefly to assess these choices.

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 (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/21/2009 4:54 AM (GMT -6)   

Hi Tony

It says one out of 12 on either side so I guess 2


 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
Benign Prostatic Hyperplasia with Atrophic glands
Atypical Hyoerplasia
Prostatic Intraepithelial Neoplasia (PIN), Low-Grade
Both lobes show similar findings
Comment. Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer 
<!-- Edit -->


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 5/23/2009 11:21 AM (GMT -6)   
A gleason 5 with small % cores is an ideal for active survelience.
I would read up on it as it is an excellent option for your type of cancer.
Just about any local treatment will work on your cancer with very high probability, so in your case the side affects of each treatment should be the guiding issue. You have a lot of time to make a decision so study everything you can especially the side affects.
I was initially diagonosed with a g6, two cores less that 5%. both my oncologist and interventional radiologist said they would never treat this type of low grade cancer. My oncologist recommended surgery.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants

 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/23/2009 11:56 AM (GMT -6)   

Thanks John

I am going to see another doctor for a second opinion on treatment on Wednesday the last one seem to recommend seeds because he has always been worried about the PSA level getting past 10 he says that there is a lot more chance of keeping the cancer in the capsule under 10 and because I do not have a history of my PSA only 2 readings he is trying to make sure that it is contained it only increased by 0.05 over 3 months. My problem is I am not a good reader 


 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
Benign Prostatic Hyperplasia with Atrophic glands
Atypical Hyoerplasia
Prostatic Intraepithelial Neoplasia (PIN), Low-Grade
Both lobes show similar findings
Comment. Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer 
<!-- Edit -->


TeddyG
Regular Member


Date Joined Apr 2009
Total Posts : 133
   Posted 5/23/2009 12:40 PM (GMT -6)   

It sounds like you are the ideal candidate for "watchful waiting." If you are not a reader, perhaps your spouse or other close friend is. In order to make an informed decision that may affect the rest of your life, you need to understand where you are, what are the options and possible outcomes.

Good luck,

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 is helping 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,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 5/23/2009 12:53 PM (GMT -6)   
Dear Colin:
 
As John and Teddy have suggested, it makes a lot of sense for you to at least consider watchful waiting aka active surveillance aka expectant management.  Shown below are the guidelines for this program at Johns Hopkins:
 

1.  Age 60+.

2.  T1C, i.e. nothing felt on DRE.

3.  PSA density of .1 or less (this is PSA divided by size of prostate, e.g. PSA of 3 divided by prostate size of 35cc equals PSA density of .086 which is less than the .1 threshhold.

4.  Gleason 6 or less.

5.  2 or fewer cores of cancer.

6.  No core with more than 50% cancer involvment.

Another thing you should consider is the competence of the physician who will treat you.  I admitedly have NO idea about the experience or competence of the doctors in Thailand.  However, one of the most important keys to success in the treatment of PCa is this issue.  Whatever you decide, please make sure that your doc has lots of experience and is not practicing on you...

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.

Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/23/2009 2:53 PM (GMT -6)   

Thanks Tudpock And TeddyG for your comments and I will talk to the doctor about watchful waiting the problem being in Thailand is getting recommendations for specialist doctors the doctor that I am going to see as been recommended by a few people on a forum that I look at in Thailand and it is supposed to be the best hospital in Thailand, the other thing is finding one that speaks reasonable English. Also having a second opinion if they differ which one do you believe I think that if they differ I might get a third opinion and hope for two that agree

I have done a bit of reading but after a sort while my head just goes round and round I normally end up back where I started but I will plod on and hope to make the correct decision at the moment I am between watchful waiting and seeds both have an element risk to them but I will take my time to decide


 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
Benign Prostatic Hyperplasia with Atrophic glands
Atypical Hyoerplasia
Prostatic Intraepithelial Neoplasia (PIN), Low-Grade
Both lobes show similar findings
Comment. Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer 
<!-- Edit -->


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4183
   Posted 5/23/2009 3:07 PM (GMT -6)   

Colin:

Yeah, this stuff is enough to give you a BIG headache.

As others have said, you can probably take your time...your stats would indicate early stage and slow growing.  If you do decide on seeds, there is advice you can get on this forum.  I'm about 6 months out and you can see my journey from the link in my signature.  JohnT and mj have just been seeded in the past week and have REAL up-to-date info.  And, JustJulie's husband had seeds some years back with great success...she also has a journey posted on this forum.  Plus there are others, but those are off the top of my head.

Good luck, stay in touch and let us know how we can help.

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.

Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/27/2009 10:03 AM (GMT -6)   
Went for my second opinion today first impressions on the doctor was good he took all the details so far done a DRE said he felt a mass in the middle of my prostate (the first doctor has done 2 DRE and could not feel a mass 1 was only last week) he sent me for a bone scan to make sure that is clear and I go back in the morning to discuss the options I get the feeling that he is not happy to wait to see what happens and in my own mind I am going that way myself I think that I want to try and make sure as much as possible that I can see my baby grow up for as long as possible and at 64 sex is not that important to me now the only fear is the incontinence possibility but if that was to happen I would have to live with it but I keep on changing my mind so who know how I will feel tomorrow

One more question after the bone scan the radiologist mention that I had a spot showing on my big toe which is worrying me a little would the fact that I have Gout in my toe cause a spot to show on the scan
 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
findings
Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer
5/15/0924 Core biopsy results
Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side
no perineural or angiolymphatic invation identified
One side PIN High Grade 
 


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 5/27/2009 1:13 PM (GMT -6)   
Hi Colin....bone scans are great for showing any bone activity...but very poor for accuracy as to what caused the spot to show up. In my case, the bone scan showed hot spots in spine, knees, ankles and ribs. All were due to arthritis except the ribs. Those were probably due to some old injury. Gout causing the toe to show a spot...probably...anything that can cause bone inflammation will show up on a bone scan. They are useful, but not very accurate. Biggest advantage is if the bone scan shows something, followup with xrays or mri to determine the cause is needed unless it is already known what the cause was. In my case the bone scan was taken to establish a base line for any new activity should something warrant it later on.

Tough making the call in your case whether to wait or do something. Best of luck in whatever direction you decide.
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


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 5/27/2009 3:21 PM (GMT -6)   
Colin -- You have a tough call here between watchful waiting and action. One of the questions is "Suppose that you put off treatment for five years? How much would that change your chances of successful treatment?

If you are thinking of seeds, be sure to ask about contact with children. At least some hospitals recommend limiting contact, some say don't let them sit in your lap for 2-4 months while others say keep them 3 (or even 6) feet away. I suspect that the latter shows an excess of caution. With a new baby, avoiding seeds for a while might fit better with fathering.

The radioactive iodine used in the seeds has a half life of about 4 months which is to say that in four months it is 1/2 as radioactive and at eight months 1/4 as radioactive. It is also the case that radiation weakens rapidly with distance (an inverse square law) so the radiation at two feet away is 1/4 that at one foot.

Sorry if this adds complications to your decision but it is important that you find out.
Age at diagnosis 66, 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
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/27/2009 7:24 PM (GMT -6)   
Sawatdi krap Colin,
Yours is a tough decision to make. You are a poster child for watchful management. Only 2 of 24 positive with low Gleason (5) and volume together with a somewhat elevated PSA that could well be attributed to other causes (inflammation etc). It is a fact that huge numbers of men with your statistics never have their health affected by the cancer advancing and are blissfully unaware that there is anything there. Watchful management entails careful monitoring of the PSA, perhaps yearly biopsies and there are dietary steps that can taken which seem to affect the PSA. But you you have to be comfortable with taking this course and many would find it too stressful. I would really take my time giving a lot of thought about all the options before committing to treatment. As the other members have stated each treatment has its price. It somewhat surprises me that your docs did not suggest watchful management as a viable option in your case so I'd be trying to find a doc who was supportive of this (not to encourage you down this path but simply to get a different perspective)
Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01

Post Edited (BillyMac) : 5/27/2009 6:54:34 PM (GMT-6)


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/28/2009 1:39 AM (GMT -6)   

I saw the doctor again this morning the bone scan came back clear he said that as far as he is concerned that there are three treatments available Surgery, Brachytherapy and externale radiation the latter one he dismissed without comment the nearest he got to Watchful management was to ask how old my parents were when they died. He only deals with open surgery and quoted me his a 90% success rate for no return in 10 years a 95% rate of still being contingent and a 50-50 on the ED side which for what I what seem quite favourable

One question I need to ask is Watchful management just putting of the treatment to a later date or is it a good possibility that I might never need treatment (I think I know the answer already same as all the prostate question no one really knows) because biopsies every year do not appeal to me at all

I go to see two more doctors on Sunday (recommended by the doctor I see today) then I suppose in the next week or two I will have to make my decision thanks for all the comments so far I am taking note of them all but with what is going on in my brain at the moment I am thinking "the soonest done the soonest mended"


 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
findings
Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer
5/15/0924 Core biopsy results
Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side
no perineural or angiolymphatic invation identified
One side PIN High Grade 
 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 5/28/2009 6:02 AM (GMT -6)   
An answer to your question as to whether watchful waiting is a treatment or just putting things off is that it is a medically respectable alternative. We are much more used to medical conditions of the "this needs to be seen to" kind where any good doctor would say; "Do it now." But PC can be so slow in its development that it is never going to need treatment in your lifetime. Two extensive studies published this spring both suggest that too many patients may be treated when waiting would be better.

My younger brother was 52 when he was diagnosed, waited for three years with annual biopsies, and when the results showed progression, opted for seeds. Now at 60 his PSA is undetectable. But what is the lesson here? Take your pick: 1) Waiting was good because it didn't hurt his chances of successful treatment. 2)Since he ended up being treated anyway he needn't have put it off.

This is the strange thing about PC -- we end up much more responsible for making our own decisions. If only you had broken your leg we wouldn't be having this discussion.
Age at diagnosis 66, 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
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 5/28/2009 5:08 PM (GMT -6)   
Colin,
It might be worthwhile reading some of the treatment stories (there are a great number) posted on the YANANOW site. They are broken down by different criteria (age at diagnosis,PSA,Gleason, treatment, etc) and there are many who have chosen "watchful waiting" so you may get a good idea of why they chose that path and the outcomes to date.

www.yananow.net/Experiences.html#as

Bill
1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 5/31/2009 9:39 AM (GMT -6)   
Just seen 2 more doctors today asked both about "active surveillance" neither thought that it was a good idea so I have talked to a surgeon that does da Vinci/Laparoscopic he quoted me doing more than 200 Laparoscopic and over 100 da Vinci prostectomies I do not know if these numbers have been stretched I can get no recommendations about any surgery doctors so I will have to go with my gut feelings and go for open surgery although I would of liked to go for the da Vinci but I am a bit concerned about the experience of the doctor. I decided against "active surveillance" because I am the type of person that needs to know what is happening I also am concerned about the possibility of to many biopsies complicating surgery later and that if the cancer is contained now it may escape while waiting so I intend to go for surgery of one type or the other here I go again changing my mind again about what type of surgery
 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
findings
Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer
5/15/0924 Core biopsy results
Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side
no perineural or angiolymphatic invation identified
One side PIN High Grade 
 


Colin45
Regular Member


Date Joined Feb 2009
Total Posts : 216
   Posted 6/2/2009 11:25 AM (GMT -6)   
Hi again to all still struggling to make a decision about which surgery to have I would like to ask a couple of more questions. when I had my last operation many years ago I was told that I bleed alot although I had lots of blood test at the time they could not find out why, this is leading me more to the da Vinci operation because the blood loss seems to be less does that seem to be a correct assessment. The next question although the surgeon as done only about 100 da Vinci operations he as done about 200 Laparoscopic operations would this surgeon seem to have enought experience in a da Vinci machine I am wondering if doing Laparoscopic surgery is a good grounding for the use of a da Vinci machine 
 
 
Age 64 From UK now in Thailand 
Baby boy born 2/14/2009
 
First PSA was showing 9.73 on 1/21/09.   on 5/7/09 PSA 9.78  Free PSA 0.83   Free:Total  PSA 0.08 
1/28/09 Biopsy carried out 12 core results were
findings
Both specimens show no adenocarcinoma
 
MRSI done on 5/8/09 No signs of any cancer
5/15/0924 Core biopsy results
Gleason'S Grade 3+2=5
Involving approx 30% of one out of 12 cores on each side
no perineural or angiolymphatic invation identified
One side PIN High Grade 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 6/2/2009 12:23 PM (GMT -6)   
My local urologists had 100 DaVinci surgeries under his belt. The Cleveland Clinic Doc had 750. I am sure the guy with 100 was capable, and I would have been fine, but I decided quickly that more is better.

The Cleveland Clinic guy talked about separating the layers of the prostate, until he found a good one, useing pieces of paper on his desk as an example. It was clear to me that here was a guy who is so comfortable with what he is doing, that I signed up right there. In my case with a G9, most doctors don't even try to spare the nerves. My Doc spared them both, partly because of his skill with the DaVinci.

I don't know if you have seen some of the videos some of the guys have posted web addresses for, but it is totally amazing, not only what they need to do, but what they can do.

I can't image doing sutures with that thing, but they do. I would tend to advise you to find a guy with a lot of DaVinci surgeries. It just make sense that practice makes a guy better.
Age 58
PSA 4.47
Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09
Nerves spared
0/23 lymph nodes involved
pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.
Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Thankful for early diagnosis, and U.S. healthcare
Living the Good Life, cancer free
6 week PSA undetectable. 

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