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dsdmike
New Member


Date Joined Jun 2009
Total Posts : 2
   Posted 6/17/2009 12:45 PM (GMT -6)   
Just starting the search for advise. Last three PSA was 10, 9.8, 12. All three months apart. Free PSA 12%. PCA3 test positive. I do not want a needle biopsy so am looking at MRI color doppler to locate any cancer and then maybe a targeted biopsy. Live in south Florida, west coast. Any suggestions as to treatment and or doctors in area would be greatly appreciated. I will be 70 in November so am considering watchful waiting, maybe not.
Appreciate any and all help.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/17/2009 1:22 PM (GMT -6)   
Hello and welcome to Healing Well, dsdmike. Sorry you need to be here, but glad you found us on the web. We have a great group of men and women here, all will be eager to help you, give you hope and encouragement, and all the advice you can stand, lol.

Why do you not want a needle biopsy? Are you fearful of anticipated pain or perhaps the fact that its a somewhat humiliating procedure? Most of us didn't experience too much discomfort having biopsie performed, I had 3 of them along the way, 2 didnt hurt, 1 did mildly, some men here have been put under to have it done.

With your stated numbers, it would be normal at this point to have the biopsy done, my last one was a targeted one, and it wasn't bad at all.

At age 70, and no disrespect to your age, watchful waiting might make sense, once you know the extent of any possible PC. You would also want to factor in your other health issues, if you have them.

I am sure others here will give you their take on the biopsies, as a rule, its really not that bad, its one of those things, that thinking about it is worse then doing it.

Good luck to you, and again ,glad you found us here.

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, 5/9 .10 doubled in 3 months, new test in six weeks, then possibly off for salvage radiation
 
 


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 6/17/2009 1:25 PM (GMT -6)   
Welcome, although we hope for everyone in your circumstance who finds us that you don’t have prostate cancer and will soon go away.

I’m glad that you are thinking about options but I wonder if you will have enough information to make an informed choice without a biopsy. Color doppler might help in deciding if your high PSA was just inflammation rather than tumor but if tumor is suspected then I think that getting a Gleason score by biopsy will be important in thinking about watchful waiting versus more aggressive treatment.

Anyway, you have time to go step by step and learn along the way. Guys here report very different amounts of discomfort from biopsy, but all agree that being curled up on a table while a nurse, a doctor, and perhaps a couple of medical students do things to your bottom teaches you a lot about dignity or the lack thereof
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.


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 6/17/2009 2:17 PM (GMT -6)   

Dear DS:

As David said, watchful waiting (aka active surveillance) may be an option for you but you won't really know until after you get some pathology results.  FYI, here are the guidelines that Johns Hopkins uses for patients in their "expectant management" program:

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 threshold.

4.  Gleason 6 or less.

5.  2 or fewer cores of cancer.

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

There are many fine options for PCa treatment in SW Florida.  Specialists in Urology in Naples http://www.specialistsinurology.com/, has a lot of experience in robotic surgery and is expanding their treatments options into radiation as well.  I believe Dr. William M. Figlesthaler is their top gun.  I will warn you, however, that they have a strong bias toward robotic surgery, so you will want to keep that in mind should you visit them.  I would also suggest going to   Dattoli Cancer Center in Sarasota to get a good perspective on radiation as an option.   http://www.dattoli.com/

Good luck and let us know how you are doing.

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 6/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1211
   Posted 6/17/2009 4:19 PM (GMT -6)   
Hi dsdmike and welcome to this great site.
I was about your age when diagnosed with prostate cancer. I did a fair amount of reading on the subject and found that the needle biopsy, although not perfect, is still the best way of determining if cancer is present and how aggressive it probably is. Without knowing this you will be hard pressed to decide what kind of action you should consider and how quickly you should proceede. At 70 years of age, you should have many enjoyable years left and the needle biopsy is really not such a big deal; at least it wasn't for me. We are all a little different and whatever decision you make, it will be the right one for you.
All the best to you in the years to come.
 
Magaboo

Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA on the 26 Jan., 09, =0.05. PSA tests now every 6 month


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 6/17/2009 5:19 PM (GMT -6)   
Sorry you have to be here. The biopsy is really not bad at all. All of us here have had one or more biopsy and most of us had very little pain if any. I personally had absolutely no pain. The biopsy will tell your doctor if you have PCa and how aggressive it is. Good luck
Age: 67
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
Dx 12/30/08
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09
Surgeon: Dr. Randy Fagin, Austin TX.
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Bilateral 10-20% involved
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx
Negative margins
seminal vesicles clean
Lymph nodes: not dissected
1st PSA test 4/7/09 result <0.1


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/17/2009 6:08 PM (GMT -6)   
A color doppler targeted biopsy is the best, but it is still a biopsy. The benefits are that the tumor can be seen and location and volume can be measured. A good color doppler guy can also tell the agressiveness of the tumor. Also it is usually no more than 6 samples vs the 12 in a normal biopsy.
The best color doppler guys are Fred Lee in Rochester MI and Duke Bahn in Ventura CA. It is well worth the money to travel to see these guys.
In Fla Danotolli has a color doppler and will probably do biopsies, but you have to realize that he is pushing radiation and you may not get an unbiased opinion as your would with Lee or Bahn.
I have had 12 regular biopsies and one color doppler biopsy; The color doppler gave me more info than all 12 put together and was the least painful.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


OKboy
Regular Member


Date Joined Apr 2009
Total Posts : 55
   Posted 6/17/2009 6:09 PM (GMT -6)   
DS: I'm going to chime in along with a few others and assure you that my biopsy experience was not traumatic or painful at all. As stated in earlier posts, I took a Hydrocodone an hour before the procedure and a 5 mg. Valium as I walked through the door. The injections of lidocaine were painless and the twelve cores were taken in less than 5 minutes with no discomfort at all. The worst part of the procedure was the thorough DRE at the beginning. I'm not especially pain tolerant (so my wife says). Wishing you the best.
Current age 50
Married - 4 children, 2 grandchildren
General health good - meds for hypertension; mitral valve prolapse (no meds)
No known family history of PCa
PSA 10/2005 = 1.2 (free testing site)
PSA 10/2006 = 1.22 (urologist)
PSA 12/2007 = 1.68 (urologist)
PSA 08/2008 = 1.5 (family doc)
PSA 12/2008 = 1.93 (urologist)
PSA 04/2009 = 2.9 (family doc - routine physical)
PSA 04/2009 = 3.4 (family doc sent in to different lab)
PSA 05/13/09 = 3.17 (urologist)
%fPSA 04/2009 = 15% (family doc)
4 DREs over the years - all unremarkable
Biopsy 06/05/09 = all cores benign; 3 of 12 showed inflammation/infection
prescribed 3 week regimen of antibiotic/anti-inflammatory meds.


texican
Regular Member


Date Joined Jan 2009
Total Posts : 36
   Posted 6/17/2009 6:45 PM (GMT -6)   
Hi dsdmike,

Every urologist you are likely to see will want to do a biopsy since it is an easy procedure and it usually reveals PC if it is there. That was not my experience however since I did several over about a 10 year period with PSA much higher than you. It finally showed itself as fairly aggressive and I have went through the surgery.

The biopsy(ies) was uncomfortable but not intolerable. The samples feel like a rubber band that someone stretched and released against your prostate. They get your attention but just keep counting them and you will see that 12 happens before you know it and you are out of there in only a few minutes. You will see a little blood in your urine for a while which is also a little surprising but that also passes soon.

The problem with the biopsy is they sometimes miss the cancer. In my case, I probably had cancer for some time before the final biopsy but it was not detected. On the 2006 biopsy, my urologist was sure I had cancer and seemed disappointed that the pathology didn't show it but he told me that the biopsy was the only tool to confirm cancer - the PSA meant nothing without the confirmation of the biopsy.

John
Dx December 22, 2008
Age 69
PSA 1998 5.2, 2000 2.5, 2003 5.4, 2004 7.4, 2005 15.9, 2006 20.5, 2007 31.5, 2008 34 and 32.9
Biopsy 1998-no cancer, 2003 - no cancer, 2006 - 12 samples, no cancer but PIN, Dec. 2008 - 12 samples, 2 positive with Gleason 4+3 = 7 on each. PIN on 3 others.
Di Vinci surgery on 2/10/2009, Austin TX
Pathology post surgery T3a, Gleason (4+3)7 with tertiary pattern 5.
NX,MX,R1, margin involvement 1-2 mm
Catheter removed on February 23.
First PSA followup on April 6, 2009 with 0.01 (lowest they can measure)
April 20 - no more pads


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 6/17/2009 7:20 PM (GMT -6)   
Hello dsdmike,

The biopsy was a non event for me. A mild sedative and pain block similar to novacaine and I never felt a thing. I do not know if the doppler methods can determine gleason grade or not but I would personally prefer a tissue sample for pathology if it were me.

Good luck.

Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
 
 
 


Gmike
Regular Member


Date Joined Jan 2009
Total Posts : 48
   Posted 6/17/2009 9:11 PM (GMT -6)   
Hi dsdmike,

I believe the doctor John T is referring to is the Dattoli Cancer Clinic in Sarasota. They have a color flow doppler. They usually treat patients already diagnosed with PCa. I know the 2 doctors there are radiation oncologists not urologists.

I'm not sure how far south you are, but the Moffitt Cancer Center in Tampa has a excellent rep. MD Anderson in Orlando is another one.

I've had a biopsy twice and had no problems with either.


Mike
PSA
2004: 2.0
2006: 4.0 (40% Free)
2007: 3.1
2008: 5.03
2009: 5.2 (21% Free)

Biopsy(s)
August 2008(age 58): 1 core of 12 was "atypical"
May 21, 2009(age 59): 1 core of 12 positive (10%), Gleason 6, Stage T1c, 1 core atypical, prostate 45 grams
June 4th Bone scan (negative)


Family history: Father and Grandfather both had PCa


Hopeful in MD
Regular Member


Date Joined Apr 2009
Total Posts : 66
   Posted 6/17/2009 10:13 PM (GMT -6)   
Hi DSMike,

I encourage you to get the biopsy and find out just where you stand. I also recommend sedation, which makes the process comfortable for the patient. See my signature for more details. The seed implants failed for me so I am on Lupron. There are much worse things that could have happened. I'm still glad to be able to write this to you. All the best, whatever you decide. This is one thing that is very personal. Gene
Hopeful in MD
Age 69.
Dx Dec 07. PSA 8.4. DRE confirmed tumor. Three of six biopsies positive. Gleason: 6 (3+3). Seed implants Iodine 125 Jan 08. PSA's 3.9, 1.7 after implants. Then rising PSA's: 2.3, 3.4, 3.9, indicating that seed therapy not working. Dr's decided to begin hormone injection therapy with Lupron 30 MG ea. 4 mos. First injection Apr. 21, 2009. So far so good. Slight fever and aches 2nd day after shot. Buttock soreness 2-3 days. Walking helped. Waiting for hot flashes etc. Hope they will be mild.  June - hot flashes vary in frequency and intensity but not a serious problem.  Feeling a lot of fatigue - not sure of cause.  Oncologist says that Lupron should not be the cause.  I wonder. 
 
Saw radiation oncologist Jun 17.  DRE negative for nodules - hooray!  He said that new guidelines  (believe contained in recent Urology journal - name unknown) call for 3 years of Lupron therapy instead of the previous protocol of 2 years  before stopping it.  Will check this out with my urologist next visit in Aug.
 
Began seeing psychologist Jun 4 for anxiety and depression (maybe from Lupron?).  Anxiety caused primarily by serious IBS (irritable bowel probs).  Doctor is using hypno-therapy for the IBS - talk therapy for anxiety on alternating weeks for each.  Also started Celexa for anti-anxiety / anti-depressant.  Think I made a smart decision to get help.  Recommend any of you who have difficulty coping with PC or other chronic conditions etc. get professional help.  For me, it is worth it.


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 6/18/2009 8:51 AM (GMT -6)   

Greetings, DSMike.  I'll agree with most of my brothers here who say a biopsy is important to know your diagnosis.  Even if it were the worst thing in the world - which it isn't - you need to find out if you have cancer and how agressive it is by getting your Gleason score.  My biopsy was more uncomfortable than really painful.  I could feel the 12 shots (the rubber band analogy used earlier is very appropriate). 

Just get used to not having much modesty or dignity.  The treatment is more important and to get the treatment you need, people - lots of them - are going to need to do things to your most private body parts.   

I did not have the blood in my urine after the biopsy but I did have a lot of blood in my semen so watch out for that as well.  The most important thing is to find out what your situation is to the best of medical knowledge and then you can make good decisions.  There should be lots of good treatment options there in South Florida.  Please keep us posted.  Trust that everything will work out just fine.  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
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 6/18/2009 3:27 PM (GMT -6)   
I suspect not wanting a needle biopsy is more emotional than logical.
Even so, write down the pros and cons and at least tell you logical side what you should do.
Cons as I see them are discomfort (pain) and embarrassment.
Get used to both. Particularly the latter. This is not a disease for the prideful.
More embarrassing would be the hand print you wear through eternity if this kills you.
You know the one from your mother's head slap when she finds out you didn't take care of business and ended up seeing her early because of it. We won't even go into that limp and hitch in your backside from your father's reaction. smilewinkgrin

The Pros have been well expressed by others.
However, no one mentioned that you'll be able to urge others to do the same after the fact.
Also blood red semen has to be seen to be believed and there is no other way to get that experience.
Sorta cool in a weird kind of way.
I feel sorry for those who have to waffle on the biopsy decision.
I wasn't even asked. It was more, "let's go in the other room and do a biopsy." Oh, okay.
Diagnosed at 54
PSA 8.7
Biopsy 1/7/09
4 of 6 cores positive, one at 90%
Gleason 3+4=7
Neg bone scan 1/15/09
One shot Lupron Depot 1/27/09
Tax Season
RP 4/29/09
Neg lymph nodes, postive seminal vesicle, 1 positive margin
Gleason 3+4=7 with tertiary 5
Catheter out at 2 weeks no nighttime incontinence
Pad free week 5
PSA 6/6/09 <0.1

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