Wife needs advice

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Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 11/22/2009 3:13 PM (GMT -6)   
 
I hope some you you can offer some advice.  My husband Jerry who is a regular member and was operated in Oct of 08 is having a recurrance his PSA is 0.3 he had in PSA taken in Oct and then 4 weeks later and we got the results last week still 0.3.  We met with his uriologist on Friday and he was very honest he said that in Jerry's case (Gleason 8 no positive margins) SRT only has about a 10 to 20% chance of working he said even if he had a positive margin the odds are only about 40% (was not aware of this) that it will cure the cancer.  He said the problem is there really is no other treatment but hormones and he felt the side effects are worse than radiation.  He said they just do not know where the cancer is and the only way to be sure is to have the radiation and if the PSA does not go down then it is a distant cancer.  He suggested we wait another month to see if the PSA goes up again he said he has patients that have had their PSA stay under 1.0 for years.     Jerry asked what if he does nothing he is 70 years old and how long before the cancer would get him.  The doctor said it could be 15 to 20 years but then again it could be two.  Jerry seems to be afraid that the radiation would cause two many side effects and for the first  time he feels good.  My question after all this is do I try to talk him into radiation or do you agree with his thinking.  I know radiation is not easy but I feel it is too big a gamble not to try. The doctor said he could start hormones and take them for 3 months then go off until the PSA starts to rise again and keep doing this instead of stay on the hormones.
 
MJ   
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck that formed stones and caused burning and pressure for 9 months.  Finally relief but may now be looking at radation.
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 11/22/2009 3:31 PM (GMT -6)   
Hormones probably have more side effects than the radiation. Also, hormones have virtually no chance of "curing " the cancer.

At this point from my perspective, a 10-20 % chance is a better game of chance than a 0 %. In fact, some studies don't place the odds that high.

These are tough decsions, particularly with a Gleason 8. I have a Gleason 9, and am watching for a similar situation.

You will find men on this site who have done well on this site with HT. If your husband decides not to go the radiation route, he does have some good options for several years.

Good luck to both of you. Sorry to hear of the rapid rise in PSA.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 11/22/2009 4:39 PM (GMT -6)   
goodlife, I have a question for you if you dont' mind.

I read your numbers on your siguniture, you have all negative for margins, bladder neck, no lymph nodes involved. seems to me, all the PC is in the gland. why they say you are pT3a, not pT1? What I understand is if nothing involved other than inside of gland, it should be stage pT1.

Thanks

Jennifer

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 11/22/2009 5:37 PM (GMT -6)   
Jennifer,

I did have an extra prostatic extension. It is a little confusing, but I believe it was the skill of Dr. Kayouk in removing enough surrounding tissue as well, so that my margins were negative.

I have been very pleased with the results so far, but still a little nervous that I eventually will have further complications. Gleason 9 is a very aggressive cancer type.

But all in all, I am at peace with whatever happens. Worrying won't help me. I continue to depend on God for whatever the future brings.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 11/22/2009 5:40 PM (GMT -6)   
Jennifer, good to hear from you. I am taking the liberty of answering your question to Good Life about stage T3a as my husband is the same stage.

First of all, the T1a is the stage used after biopsy - it indicates that the cancer was found through a PSA test rather than through the doctor feeling anything during the examination. This is called the clinical stage. After surgery, the stage assigned is referred to as the pathological stage - and therefore the definitive (final) stage of the tumor. I don't know that T1 is ever assigned to a surgical specimen - someone please correct me if I am wrong in this.

T3a is a Stage III cancer which means that it is no longer confined to the prostate gland. 3a usually means that there was extraprostectic extension - the cancer has invaded the capsule surrounding the prostate and has broken through the capsule. You might see words like "single foci" or "multiple foci" indicating that the cancer has broken through in one area vs. several areas. Now, the critical thing with EPE is whether or not the surgeon achieved a clean margin in the area (the fatty tissue surrounding the prostate). In my husband's case, the surgeon already knew from the biopsy that one of the positive cores was very close to the edge of the capsule so he went in with the intent to cut a much wider margin than he needed to around the gland. So, we got clean margins all around.

Now, how is your dear Richard doing? And how are you??
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


GarthK
Regular Member


Date Joined Feb 2009
Total Posts : 74
   Posted 11/22/2009 5:48 PM (GMT -6)   
One thing that would seem to be good to know was if there were any tumor cells circulating in the blood. If not, that would seem to indicate a localized tumor (at least to me). This has been brought up previously in this forum but never seemed to "hang around" for long in the discussions. There is a company that has an FDA-approved device that counts the individual tumor cells in a small sample of blood. This test is called the "Cellsearch Circulating Tumor Cell Test" (Google for it) which apparently can be an indicator of whether or not the cancer is localized or moving around in the blood. I've read about it a bit and it sounds like an impressive diagnostic tool which has been used for prostate as well as other types of cancer. I thought about requesting one as a baseline but never did given my low numbers and risk. Should my PSA ever start to rise, however, that will be one test I push for.

Just a thought...

My best to you and Jerry,
Garth
Vitae:
DOB: Q4'46, HT: 5'9", WT: 180
PCa:
PSA: <2.5, DRE: Slight enlargement, one node
Biopsy: 12/08
Cores: 4 of 12+ positive, Gleason: 3+3
Surgery: RRP on 1/21/09
Catheter: 15 days
Pathology:
Adenocarcinoma occupying 5% of prostatic volume (right posterior aspect)
Gleason: 3+2, No extraprostatic extensions, Perineural invasion within prostate only
No angiolymphatic invasion, No seminal vesicle invasion, Clear margins
AJCC: pT2a
Post-op PSA's
3/10/09 < 0.014 (undetectable by machine)
6/10/09 < 0.014 (undetectable by machine)
9/8/09 < 0.014 (undetectable by machine)


qjenxu
Regular Member


Date Joined Sep 2009
Total Posts : 187
   Posted 11/22/2009 6:36 PM (GMT -6)   
Thanks Goodlife and Sephie for share your knowlage with me. It is good to know that final stage very possible will little advanced than clinic stage. I won't get heart attach if I getting some bad news on pothology reports. I need cross my finger until the repots come out.

Richard is doing fine. drinking and walking. having little trouble to get bowl going. other than that, will get up really early tomorrow back to hospital doing follow up.

Thanks

Jennifer

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 11/22/2009 9:15 PM (GMT -6)   
Garth,

I have not heard of the Cellsearch test, but there are several ways for cells to escape the prostate.

It is not uncommon to see perineural invasion, which usually means it has gotten into the nerve bundle. This is an open highway in to the lymph system. In my case, with an EPE, it could escape into the abdominal cavity.

Even with the biopsy, they basically are drilling 12 holes in the prostate, and cells can escape that way as well.

I have just reached the point where I have concluded there is not much I can do if cells have escaped. If they have, they have. We'll just deal with it as it happens. There is also some chance that without testosterone, a few cells will die without their man food source.

Live each day at a time, and let tomorrow bring whatever it is going to bring.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


Rolerbe
Regular Member


Date Joined Dec 2008
Total Posts : 235
   Posted 11/22/2009 9:18 PM (GMT -6)   
MJ,
 
Sorry to hear your news.  Of course the choice is difficult.  I can't speak with any particular medical insight, but personally, if I were in the situation, I suspect I would be inclined to wait the month and retest.  If it is any higher, then the choice would be clear to me and I would start the radiation immediately.  If it remained the same at 0.3, then  I would want to continue to get monthly PSA's.
 
Again, personal choice, but if what you were hoping for from here was a mini survey of what others thought, then here's one input.
 
Always tough news to hear of new challenges for those here.  I hope for a good outcome whatever direction you take.
51 YO
PSA at Dx: 8.2
DaVinci RALP: 10/31/08 -- Great MD in New Haven, CT
Negative margins, no extra-capsular involvement
One nerve spared
PSA at 0 for just over a year now.
 
 


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 11/23/2009 8:19 AM (GMT -6)   
MJ, I know exactly where you are coming from (see my signature below). Your husband's stats look good (1 core out of 14 positive at biopsy, good PSA before surgery and path report showed the cancer was contained in capsule).

I asked my husband last night what he would do in this situation. His response was to wait for the next PSA results. If it comes back at 0.3, have another test 30 days later. I know this can be hard - the waiting seems to always be the worst. But, if my husband's PSA was holding steady at 0.3, I would wait for one more rise in PSA. However, this might be a good time to meet with a radiation oncologist and possibly a medical oncologist to discuss the pros and cons of both treatments.

It's scary - I know. Please come back and let us know how things are going.
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (single small EPE in posterior left). Perineural tumor infiltration present. Apex margin, bladder neck and SV negative. Final Gleason 3+4 SA. PSA: 0.0 til July 2009. August 2009 PSA was 0.1, in September it was 0.3 Met with radiation oncologist, CT scan and bone scan clean. Third PSA on October 16 - PSA BACK TO UNDETECTABLE! Next PSA scheduled for early December. No radiation treatment at this time!


Zen9
Regular Member


Date Joined Oct 2009
Total Posts : 314
   Posted 11/23/2009 11:00 AM (GMT -6)   

Jerry 1,

Your husband was diagnosed two days before my surgery.  I have thought a lot about what I would do in the event of biochemical recurrence - especially recently, as I am due to be retested next month.

First, I would not take hormone therapy.  Period.

Second, I would retest the PSA to see if the 0.3 reading is holding steady.    

Finally, I would not try to talk your husband into anything.  If the PSA rise continues, I personally would not take radiation treatments in his situation; however, I know that others on this board would.  It's his decision; it's an extremely tough one; and you can best help him by being supportive of whatever decision he makes.

He is very lucky to have you in his life.

Zen9

 



Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 11/23/2009 2:02 PM (GMT -6)   
 
Thank you all so much for your comments I know this is a tough decision and I will look into the Cellsearch Circulating Test thank you Garthk, for the information.  We talked this morning to the surgeon and he also feels that radiation would probably not help Jerry and that the percent that it would in his opinion would be less then 10%.  He said if Jerry was younger he would throw the book at this cancer radiation, hormones, etc.  However, even though Jerry is a very young and active 70 year old he is probably only going to live 15 to 20 years tops, without the cancer.  He feels that watching the PSA and doing Pet scan would be what he recommends and then if the doubling time picks up to do intermitten hormone that is 2 to 3 months on then off for as long as possible.  He feels that Jerry will not die of Prostate cancer and understands his need to enjoy his quality of live for the next 10 or 15 years.  I will support him in whatever he decides but am so afraid of this cancer.  It is all just a gamble.   
 
MJ
Age 69
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck that formed stones and caused burning and pressure for 9 months.  Finally relief but may now be looking at radation.
 

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