Update from my doctor's visit today

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 8/31/2009 8:23 PM (GMT -6)   
The good news, my uro/surgeon was well pleased with my greatly increased stream after the corrective laser surgery a couple of weeks ago.  He was amazed that I am having so little trouble with incontinence this time around.  Told him I am like 95/98% dry, just a little urge & stress issue, getting better by the day.
 
The bad news, he consulted with the 2 radiation oncologist that I have met with so far.  He said that I was in a serious situation.  He and one of the two oncologist agreed that I do not need HT nor that it would be beneficial, the other one includes it as part of his standard protocal.  But what they are agree upon, was that I definitely had reaccurance, and that even though the psa is small at this point, it has tripled since surgery.  He said it was classic case of the danger of high psa velocity at work, and how hard it is to stop the momentum once it gets rolling.
 
He said they all agreed that I need to start radiation of at least 70 grys as soon as it can be arranged.  He felt it was dangerous at this point to let weeks or months go by, thus allowing the velocity to increase.  He said at age 57, my "youth" was too much to gamble away, and that this was not the time to do any kind of waiting and watching.
 
I told him I didn't like the mannerism of the last doctor I met, and  the first one who treated me with radiation 9 years ago is now out of my immediate area.  So my doctor is consulting with the only woman radiation oncologist in my area, same practice, and will go over my case with her asap.
 
He said I should expect some more blockage issues in the future, despite two corrective surgeries, and that the radiation will no doubt cause some future problem.
 
I am disapointed, because I was hoping he would have said that it would be safe for me to put off a decision to go through radiation at least 6 to 12 months down the line.
 
We spent a good 30 minutes of quality, blunt and honest dialogue, just the way I like it when I am with a doctor.
 
He also agreed with something I posted recently about the perinneal invasion issue that many books and many surgeons dismiss, he believes what the rad. oncologist told me, that if there was escape, and obviously there has been, it undoubtedly went straight through some nerves that the tumor had pierced along the way.
 
He final thought, was that at this point, no way of knowing if it is hopefully local still in the prostate bed, where the radiation would do some good, or is long gone to who knows where, where he said,  the radiation would not do a thing to stop it.
 
Not what I wanted to hear, but it is what it is and we say here often.
 
This is the same day that my mother (82) tripped and broke her ankle in her home, and I spent the bulk of the day dealing with that and her treatment, and making sure her house was safer from falls, and shopping for her ,etc.  As soon as we got her out of the  doctors office, we had to rush to make my appointment.
 
So that's it for now, I am not expecting the 3rd radiation oncologist to have much of a different view on my siituation, but one doesn't know till its over.
 
David in SC


 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 8/31/2009 8:39 PM (GMT -6)   
Hi David, sorry to hear this. I'm glad you've got a straight talking doctor and an option to deal with a rad oncologist you'll like and trust. ( I say so as I like and trust all women, and this new doc, you say, is a woman.) Interestingly, you're following pretty much the same path as my former boss, and long time friend followed. That was near 25 years ago. We're having lunch on Wednesday.

Keep us posted.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"  


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 8/31/2009 9:03 PM (GMT -6)   
Thats encouraging to hear about your friend, Sheldon. I have never had a woman doctor in all my 57 years, have no objection, just never had one. Hope you are still doing great too.

David in SC
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 8:54 AM (GMT -6)   
My wife and I had a good long talk last night about the doctor's visit. We decided to go ahead with radiation as soon as it can be set up, and whatever negatives come along that path, we will just have to deal with along the way. Her choice: she wants me alive to make it to our 50th anniversery, still got 14 1/2 years to go to make that happen.

Gettting ready to do this next step, reminds me in my day of taking on a second tour in Nam. You barely make it through the first one without ending up in a body bag, and then you find yourself compelled to go back.

I hope this new radiation oncologist and I click real well. I am a very fussy man when it comes to the doctors that I trust my life to, lol.

David in SC
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/1/2009 9:10 AM (GMT -6)   
David,
Have you considered visiting Duke University? They are not way too far away, but they have a world class prostate cancer program. I usually recommend a visit to a major center before the first treatment, but you have endured so much. Perhaps now is time for a consensus 2nd opinion. You can stop progression almost certainly with HT and buy time to heal the surgery. It just seems that you doctor is pushing you through doors as opposed to making recommendations on where to go to get additional input.

I remember when I was diagnosed. The urologist told me how he would treat it, told me about options, and also gave me the names of three top surgeons in SoCal should I want to travel. I really appreciated this. I chose to go to the City of Hope and have the surgery. This was one of his recommendations.

I know that radiation is the next step for you, but study after study exists that show the HT DOES impact positively the results of radiation. You can have that treatment locally. But a major center will give you peace of mind...

Tony


 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!

Post Edited (TC-LasVegas) : 9/1/2009 9:22:04 AM (GMT-6)


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 9/1/2009 9:26 AM (GMT -6)   
Why would the radiation trement cause further blockage? I was under the impression blockage is rather rare when being treated with radiation. Do you know what radiation technology they are using? Perhaps IMRT?

Just curious why they believe hormone therapy isn't necessary. The nomograms on Sloan Kettering has a higher 6 year success probability 77% vs 58% without hormone therapy. Perhaps you should mention that and get their feedback.

Post Edited (Squirm) : 9/1/2009 9:32:39 AM (GMT-6)


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 9/1/2009 9:39 AM (GMT -6)   
David,

If you'd like, I can ask my Onc at Duke who their top radiation oncologist is.

Your case is similar to mine and my rad onc at MSK who is their top dog put me on HT prior to radiation. I have 20 years to my 50th wedding anniversary and I intend on being present, God willing.

I am glad you are feeling better.

Greg

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 9/1/2009 9:40 AM (GMT -6)   
David,
Good Luck with your further treatment!! I will keep you in my daily prayers!!!
Continue to fight!!!
 
Please keep us posted!
LIVESTRONG
SHU93
Age Dx 37, 7/2008, First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008, Biopsy: 6 out 12 Postive all on right side, Gleason 7 (3+4). Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008, Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008, PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
4 Post OP PSA's from 9/2008 to 6/2009: <0.1
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 9:43 AM (GMT -6)   
Tony, I just don't have the resources to do what you suggested, though its a great idea, I am not a doctor, but I don't believe talking to 10 more doctors is going to change what is needed to be done. I don't think I want to gamble away a shrinking window of opportunity for salvage radiation to even work, with my past psa veolocity and current, it would be easy to miss my best shot. Having experienced a terrible previous radiaton bout, I am gun shy enough about doing this salvage radiation gig. And if you start talking about the side effects of HT on top of that at the same time, more than this mere mortal can handle.

I will be getting a 3rd radiation oncologists take and opinion hopefully in the next week or two, then I will have spoken to 3 plus my trusted uro/surgeon.

This entire ordeal is already a mega financial ordeal to my family, despite having a layer of health insurance in place, but with me being out of work for over a year now, we are getting by, by the hair of our teeth at best.

Just trying to deal. If I were alone with no wife or family, just about be willing to say screw it, let it do what it wants and I will take my chance,. But that is not an option for me.

David in SC
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 9:47 AM (GMT -6)   
squirm - i am already in a small percentage group of men with persistent bladder neck blockages after surgery. they said the radiation would cause swelling on its on, there is precious little clearance as it is in that area. my uro/surgeon and the 2 rad. oncol. I have spoken too all feel it will be a major issue, and even talked about doing the radiation with a catheter in place, gee, that would make number 8. They said they could inject it with water and clamp it , while being zapped, then releasing it after each treatment if need be. Didn' like the sounds of that.

greg - thank you for your kind words

shu93 - thank you too, brother.

to the moderators - still have that extra space problem on my postings, did what was suggested t wice, and it didnt seem to help, any new idea? please either post a solution or email me, thanks
 Age 57, 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
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/9 .16
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, 8/14 met with Rad Oncl, 8/18 - laser scope surgery to clear blockage, now on Cath #7, 8/26 - cath removed
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/1/2009 10:16 AM (GMT -6)   
Print your Signature, go to Edit Profile and delete your signature all together. Logout, maybe reboot, login and try retyping it altogether. Whatever is causing this issue should be completely eliminated.

There is a known bug when editing your signature that adds lines. Not sure why it is still an issue. I am certain that Peter knows about...

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 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!


CPA
Veteran Member


Date Joined Feb 2008
Total Posts : 655
   Posted 9/1/2009 11:52 AM (GMT -6)   
Greetings, David.  Sounds like you have a plan - know there are lots of options but you have done the research and are talking to the right doc's and you will soon be in the midst of this next phase.  Trust you will do well.  I continue to monitor your progress because we have so many things in common. As we say where I grew up - do good!  David

Diagnosed Dec 2007 during annual routine physical at age 55
PSA doubled from previous year from 1.5 to 3.2
12 biopsies - 2 pos; 2 marginal
Gleason 3+3; upgraded to 4+3 post surgery
RRP 4 Feb 08; both nerves spared
Good pathology - no margins - all encapsulated
Catheter out Feb 13 - pad free Feb 16
PSA every 90 days - ZERO's everytime!
Great wife and family who take very good care of me


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 9/1/2009 12:06 PM (GMT -6)   
David,
Tony makes some excellect points that are worth considering. HT isn't bad if you just take Casodex, you will have a loss of libido, but will stop progression while giving you time to cure. You know we will support any decision you make.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 12:12 PM (GMT -6)   
JohnT - Tony does make some excellent points on the inclusion of HT. The one rad oncl feels the same way, but the other one, in the same practice, doesn't. This is why us poor PC guys end up so confused with info we do get. Too many contridictions.

This may sound very selfish of me, but I am one of few here, that either by surgical skill or a miracle or both, I have had zero ed, right out of the both. And in the end, the left nerve bundle was removed in surgery , and the right side was left but described as damage. My own surgeon is still amazed. No boasting, but I have the same drive and full ability and full size as pre surgery, even reached the point where I can get errect by thought alone, something I couldnt do for months. I would hate to do anything to mess up the one skill I seem to have left, lol.

David in SC

Post Edited By Moderator (TC-LasVegas) : 9/1/2009 11:49:55 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 12:13 PM (GMT -6)   
David/CPA, thanks, as they say down here in the deep south, I am doing the goodest I can.

Post Edited By Moderator (TC-LasVegas) : 9/1/2009 11:50:13 PM (GMT-6)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4083
   Posted 9/1/2009 12:26 PM (GMT -6)   

David:

I have to say that I agree with the advice you got from Tony and JT.  I also think that is the advice you would give someone.  I understand about the financial issues and know you don't want to stretch any more but you probably have one shot to really get this right...and I hope you take the best shot.  Sorry if I sound like a nag, I don't mean to...  In any case, like JT says, we will of course support whatever decision you finally choose.

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 7/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 4:42 PM (GMT -6)   
Bro. Tud, I have the highest respect for you opinion, as well as JohnT and Tony, so don't think for a moment I am discounting any of you guys advice. All of you are probably better versed on some of the purely technical aspects of our cancer.

When I meet with this 3rd radiation oncologist, I will go with an open mind and see what she has to say. You may see me change my mind about my present opinion. After all, I am not afraid of reality and the truth, just what I don't know.

The woman that runs my local credit union, known her for years, is having her own fight with breast cancer, she has done surgery, chemo, and radiation. Her radiation oncologist is this new woman doctor I am going to be seeing next. My friend said she was the best doctor she had ever had in her life, and that her level of patient care and concern was the best ever. That encouraged me a bit.

You know brother, we are all faced with tough decisions in our fights with PC, why can't things ever be cut and dry about any of it?

Best to you to.

Squire David

Post Edited By Moderator (TC-LasVegas) : 9/1/2009 11:49:43 PM (GMT-6)


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 284
   Posted 9/1/2009 5:35 PM (GMT -6)   
David, thank you for keeping us posted and the amount of information that you provide this time and in earlier posts. I've gleaned more insight from your post than all the time with my surgeon. My wife and I are sending our best thoughts to you and the rest of the gang.

JaKe
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2215
   Posted 9/1/2009 5:47 PM (GMT -6)   
David,
I will second Jake's comments and you are highly thought of by all of us. I also know you will give great deliberation to whatever you choose to do. My best and my prayers to you and your wife.
Michael
Dx with PCA 12/08 2 out of 12 cores positive
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margins not involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only
 started ED tx 7/17, slow go
Great family
Michael


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 6:57 PM (GMT -6)   
Jake, thank you for your kindness too. Do you have any plan at this time for your rising post surgery psa? I see we had surgery about the same time.

Michael, thank you as well. The deliberation is the easy part, when its time to choose and then commit with a no backing out clause, that's much harder. Right now, its all so heavy on my mind. I feel like such a burden to my wife and family, not that any of them are complaining in the least. I have already beat a lot of medical stuff in my life, but this is turning out to be a much harder fight. A year ago, was mostly thinking, no big deal, have another surgery, heal up, and that's that. What I have learned here since then has changed my entire outlook on PC and my own situation.

David in SC

Post Edited By Moderator (TC-LasVegas) : 9/1/2009 11:49:28 PM (GMT-6)


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 284
   Posted 9/1/2009 7:39 PM (GMT -6)   
Hi David,

I'm rethinking my strategy regarding further treatment which originally was to wait until my psa got closer to .5 ng/ml. If my next psa in October returns to .1 (from .2) and my bone scan is clean then I'll probably wait for another psa three month cycle before deciding. If it remains .2 and my bone scan is clean, I'll ask for an ultra-sensitive test since based on my reading of a prior post (correct me please if I'm wrong) my current level of psa test accuracy is somewhere between .20-.29. If the ultrasensitve is in the high .2 range or higher then I'm strongly leaning toward early treatment. I am concerned about ability of radiation to cure my situation since my pathology report indicated all organ contained. Some reports give my situation a greater probability (but not certainty) of spread beyond the prostate area. But.... if the bone scan is clean... then I'm pretty sure I'll go for the radiation before too long. If I do, then like you are doing, I'm going to interview several specialists even if it is on my own dime. I don't think I'm going to accept my HMO choice this time without more homework.

Right now until I'm still nursing my broken ankle and a bladder infection... hopefully soon we'll be lucky enough to deal with just one problem at a time!

Thanks for asking, typing it out helps me sort things out.

Best regards,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09


Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2457
   Posted 9/1/2009 8:02 PM (GMT -6)   
Hi David,
I'm sorry about the recurrence news and the immediate need for RT. It seems that the hits just keep coming at you. I hope that you find a good radiation onco and catch the PC still in the prostate bed. I'll be praying for you and wishing you a healthy future full of zeroes.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
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 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 4 months
8 weeks PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/1/2009 9:10 PM (GMT -6)   
EdC - thanks for the encouragement. See you are still holding your own. I remember when I committed to surgery with my uro/surgeon, he said (and I know now this is standard), the priorities are get rid of cancer first, second - eliminate any incontinence, and thirdly - deal with ED. I have noticed quite a few members that have the cancer under control, but some still dealing with incontinence and many dealing with ED. With me, just a short period of incontinence (a month or less), total freedom from ED, but still dealing with cancer now that they are confirming a reaccurance. Something screwed up on the priority list with me. It's nice to have normal sex (minus ejaculation), but the whole point of this project was to eliminate the cancer. Not sure who to complain to, lol.

Michael - sorry about your broken ankle, didn't know that. My 82 year old mom just broke her's Sunday night. Never had a bladder infection in my life, my uro said that was more than amazing. Least you got a plan going. This next part is simply my observation, I am not a doctor, but looking at your stats, you are a Stage 3, Gleason 8, and your post surgery PSA doubled in 3 months. That's pretty heavy compared to my stats. The big difference I see between our cases, was that my pre-surgery PSA was much higher than yours and took bigger and faster jumps. Don't wait too long brother, the oncologists I have spoken too recently both used .5 as the max. for effectivness of salvage radiation. Other doctors use other lines in the sand. I will be watching in on you too in the weeks/months ahead, so keep posting.

David in SC

Post Edited By Moderator (TC-LasVegas) : 9/1/2009 11:49:07 PM (GMT-6)


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 9/2/2009 4:40 AM (GMT -6)   
Good morning David, I suppose as I always do I will take the Dale approach here. I believe you to be a positive person and now more than ever I am praying that you remain positive and continue to seek knowledge. Give yourself permission to believe that your cancer can and will be stopped in its tracks and the blockage of which you speak will not happen. Some say I put to much focus on attitude and faith and I guess I do, but gosh darn I am not a doctor and if all I can do is remain positive and hopeful then that is what I am going to do.
Sounds like you have laid out a good plan and sounds like you have some good advice from friends here at HW.
I am confident of one thing, we will still be here chatting on this forum ten years from now.
love you brother

dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

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
PSA July 28th 2009 is .01

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%


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 9/2/2009 7:12 AM (GMT -6)   
Brother Dale, I appreciate your posts and your always positive attitude, and more importantly, if it works for you, then its definitely the right thing to do. I don't consider myself to be negative or positive, very pragmatic most of the time, very much a realist, never a denialist, but prone to have extremely sensitive emotional side and a capacity for empathathy whether I want it or not.

I know I can't will or wish my cancer away, but I know its possible it will not win. The jury is still out at this point. My own doctors are telling me that I will probably face a lifetime of urinary block stricture problems, just happens to be the bonus prize I won by choosing surgery.

Faith, I use to wear that on my sleeve, all bubbly about it, willing to disusss and engage on the drop of a pin, as I aged, I keep it inside, all my core values are set in stone. My persona ethics, how I treat people, how I conduct business, are all extensions of my faith.

I have spent my entire working life working with facts, figures, percentages, graphs, trends, etc, so its of my mind set to put everything into black and white (no racial slur intended).

This is why I pick straight talking blunt doctors when I can, I let them know I am an educated patient, and not to blow the proverbial smoke up my, hmm, lower orifices.

Ten years isnt good enough for me brother, my wife and I have 14 1/2 years ago to make it to our 50th anniversery, and I intend to be there to take the lady out. That is my motivation.

At the human level, this is what I want, at the higher level, its all out of my hands anyway, and I accept that.

May the Lord continue to bless you and keep you, my brother of faith.

David in SC
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