PCa newbie, questions

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Charlie57
New Member


Date Joined Nov 2009
Total Posts : 1
   Posted 11/2/2009 7:48 PM (GMT -6)   
Hello group,
 
Been Dx with PCa, age 54, G7 (3+4) on biopsy, PSA 4.5.
 
Seen uro and radiation specialist. Uro recommends surgery and radiation specialist recommends radio therapy IMRT. My uro has plenty of experience but so does the radiation doctor.
 
Another question, every since I can remember (since my teens) I have had pyronnies disease, this makes penetration possible only in the missionary position. I also have always had a somewhat of a little dribble problem a minute or two after urinating. I usually use a stall at work, and shake Mr Willy pretty well after urinating.
 
I'm afraid surgery will really mess these two problems of mine up much worse. Your thoughts? For now both problems aren't that big of a deal, wife is fine with missionary only. So in one sense, I would lean towards radiation or proton, as I'm afraid surgery will complicate my "issues" further and will leave me very incontenant and impotent, on the other hand surgery provides a path report and final stats, and age is a factor too, I'm 54.
 
Here are my questions. I have a HMO (Blue Shiled), can I go out of network to be evaluated by a top urologist and perhaps be treated? I'm not certain how that works if I'm in an HMO. What if I wanted to get Proton treatment? Can I be covered?
 
Prostate cancer runs in my family...father died of it. Dad had seeds and radiation, but it had already spread by then.
 
Thanks for your help.

Post Edited (Charlie57) : 11/2/2009 5:51:12 PM (GMT-7)


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 11/2/2009 8:06 PM (GMT -6)   
Welcome.
I'm afraid surgery will really mess these two problems of mine up much worse. Your thoughts? For now both problems aren't that big of a deal, wife is fine with missionary only. So in one sense, I would lean towards radiation or proton, as I'm afraid surgery will complicate my "issues" further and will leave me very incontenant and impotent, on the other hand surgery provides a path report and final stats, and age is a factor too, I'm 54. said...
 
What I did when I was diagnosed about 14-months ago was to put first the removal/treatment of the cancer, and everything else came second, third, etc., because a longer and healthier life was/is the most important thing to me - not ED or incontenence. 
 
Here are my questions. I have a HMO (Blue Shiled), can I go out of network to be evaluated by a top urologist and perhaps be treated? I'm not certain how that works if I'm in an HMO. What if I wanted to get Proton treatment? Can I be covered? said...
 
What does your plan allow?  First read the plan and if it isn't clear give Blue Cross Blue Shield - or your company's benefits administrator (if you're still working) a call to ask the question.  I'm supposing that when you go out of network the benefit levels change and doing so will cost you a bit more money, but if doing so is possible it's probably worth it - if that's something you want to do.  What advice have you received from your primary care physician?
 
Best wishes for a successful treatment of your prostate cancer.
 
 

Age:  60 (58 at diagnosis - June, 2008)

April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior

June '08 had biopsy, 2 days later told results positive but in less than 1% of sample

Gleason's 3+3=6

Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days

Dr. recommended robotic removal using da Vinci

Surgery 9/10/08

Northwestern Memorial Hospital, Chicago, IL

Dr. Robert Nadler, Urologist/Surgeon

Post-op Gleason's:  3+3, Tertiary 4

Margins:  Free

Bladder & Urethral:  Free

Seminal vesicles:  Not involved

Lymphatic/Vascular Invasion:  Not involved

Tumor:  T2c; Location:  Bilateral; Volume:  20%

Catheter:  Removed 12-days after surgery

Incontinent:  Yes (1/2 light pads per day)

Combination of Cialis and MUSE (alprostadil) three times weekly started 9-27-08

Returned to work 9-29-08 (18-19 days post-op)

PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0

 


Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 11/2/2009 8:07 PM (GMT -6)   
Hi Charlie,
 
As we say, glad you found us, sorry your here, and most of all Welcome.  You will find a tremendous amount of help here, from guys whom have alot of experience, and hopefully will be able to answer most of your questions.  I am a similar age to yourself  with a Gleason 7.  I decided that surgery was the way to go for me, and I am extremely happy with the results so far.  Just thought I would mention that I had a dribble problem myself before surgery.  No matter how much shaking I did, still had that little dribble after urination.  Well it must of been some sort of obstruction with the Pca, becasue now the water works is working great, no dribble any more and I am back to being a fire hose. 
Should you decide on surgery hopefully you will get the same result.  Good luck with your decision, but I am certainly happy with mine........Cheers Kev.
Age 51yrs
6 out of 8 cores positive 3 X 60% / 3 X 10%
PSA 4
Gleason Score 3+4=7
Stage T1c
Robotic Surgery 24/12/08
Upgrade Gleason Score 4+3=7 Gleason Differential 60%/40%
Stage T2c
Three small foci total volume <10%
Neg Margins and Nodes
Nil - Extraprostatic Extentions
Dry less than 1 week.
ED- taking Meds- Its been 9 mnths now getting some action ! yay !
PSA 1/09  .03
PSA 2/09  .03
PSA 5/09  .03
PSA 9/09  .03
"Everyday in Everyway I get better"


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/2/2009 8:09 PM (GMT -6)   
Hi Charlie,
Welcome to HealingWell. This is a great site as you can see, for patient to patient communications. I'll start with your questions and the answer is, you need to ask the doctors you are interested in if they have taken Blue Shield before. If they have then chances are good for you that you will get approvals. I am sorry to hear about your father. It is a sad testimony about how this disease can spread through heredity. I don't know that treatment by radiation, Proton or IMRT, will have any better results than surgery in regards to Peyronies Disease. That is a question for the doctors as well. I know that Proton is based on the premise of less side effects, but IMRT has an excellent record as well. And side effects are not like they used to be with external beam radiation. They have come a long way in that regards. I have been treated with both surgery and IMRT and function pretty well in term of incontinence. I don't have much of a sex life after hormonal therapy, but that's a different discussion.

Again, welcome and all the best to you...

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)
Hormone Therapy May '07 to September '09 ~ Currently off.
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (October 7, 2009): <0.1

My journey is at: www.caringbridge.org/visit/tonycrispino

My InfoLink page is at Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 11/2/2009 8:21 PM (GMT -6)   
I think the best approach before making a decision is to get the best possible staging of your tumour. Usually, most decisions regarding the treatment of prostate cancer are based on fairly limited information regarding staging........at worse a PSA reading, DRE and maybe 6 or 8 core samples. CT and bone scan usually show very little if the tumour is not reasonably extensive. Take on board what other members have to say about various other scans and get them if possible. I think the best bet is to approach surgery with the thought that you will have some problems after.....both on the ED and incontinence front. This is not being a pessimist but rather realistic.......slow recovery of these functions is the norm and you will not be in a state of shock at what may well be somewhat temporary following the surgery. Keep your own copies of every report and test result. Most importantly, educate and educate yourself about the disease before committing to a decision and there is no better place to learn from than the great fellas (and some wives) on this forum. Good luck with whatever you ultimately decide and stay with us,
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
PSA August 09 (2 year mark), <0.01


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 11/2/2009 8:45 PM (GMT -6)   
Welcome, Charlie.

Glad you found us. I am hoping your first and most important concern is the erradication of the cancer. Any primary treatment you decide upon will have its share of side effects, how bad and how much depends on so many variables.

At your age, and since your dad died of PC, I would be looking at the most agressive approach, with side effects being secondary. WIth a gleason 7, you already have a moderately agressive cancer in you.

Please keep us well posted of your journey

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sessions/72 gys.


coxjajb
Regular Member


Date Joined Nov 2008
Total Posts : 184
   Posted 11/2/2009 10:26 PM (GMT -6)   
Charlie57, HMO plans usually have a PCP that acts as a "gate keeper". Th that case, all care must be coordinated through your PCP. Some HMO plans work similar to a PPO plan and do not have a "gate keeper" but do have a limited provider network. Best advise is to contact the customer service department for your plan and ask. If your plan PCP does act as a gate keeper, he / she can authorize you to go to an in-network urologist for treatment.
Age 51
Pre - Op PSA, 4.3
Gleason 3+4=7
Stage T1C
da Vinci Prostatectomy 8/1/08
No issues with incontinence since day 1 after catheter removal
Mild ED. Levitra works well for me
PSA 0.00 at one year post op

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