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keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 346
   Posted 12/11/2009 3:43 PM (GMT -6)   
I really don't what all this says. Thanks to Opa N for telling me to go get a copy of the report.
I think i put it all as my signature.
age 45
psa 3.09 at time of physical
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side base- no evidence of malignancy
Right side mid- no evidence of malignancy
Right side apex- no evidence of malignancy
Probability of seminal vesicle or lymph node involement below avg. 5.9%
Relative risk of seminal vesicle or lymph node involvement 32.7% decreased risk


zachattack
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 12/11/2009 3:56 PM (GMT -6)   
Well welcome to Hw.I am much like you I don't understand most of the stats and such so I will let the more experienced members chime in on that.But glad to have you aboard.

Zach
age 55dx 12-2008,psa at biopsy 8.6
biopsy 12/12 gleason 3+4=7
da vinci surgery 6-09 by DR. John W. Scott (my hero)
Hospital 3 days cath 7days still leaking from cough(bad lungs)
still have ed may be the hormones.
9-09 psa 2.2 hormone inj
10-09 nuclear bone scan no results yet I will have gold markers placed 12-29-09
start rad 1-10-09
organ confined
extracapsular seminal vesicle involvement
lymph node involvement


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 12/11/2009 5:17 PM (GMT -6)   
Key....the left side is pretty high in percentage...do you know what the volume or size of your prostate is? I would think that some additional testing may be needed. The 100% mid and 88% apex to me would be of concern for cancer being close to the edge or already past the edge of the prostate. Additional testing will make things a little clearer on which treatment method would be best.

But that's my take on this...others will chime in with their thoughts as well.
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 Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 346
   Posted 12/11/2009 5:58 PM (GMT -6)   
I don't see on this report anywhere about size or volume.
age 45
psa 3.09 at time of physical
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side base- no evidence of malignancy
Right side mid- no evidence of malignancy
Right side apex- no evidence of malignancy
Probability of seminal vesicle or lymph node involement below avg. 5.9%
Relative risk of seminal vesicle or lymph node involvement 32.7% decreased risk


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/11/2009 6:12 PM (GMT -6)   
Yeah, it will help to know prostate size in cc. if possible and/or tumor volume by % if known.

You are looking at 6/6 positive cores. The 2 that are 88% Gleason 7 would really concern me.

The PSA is not all that high, as far as a raw number, but then you are only 45 years old.

What is your own inclination for treatment at this point? Based on what is posted so far, I wouldn't want
to make a guess. Your age and Gleason would make you a good candidate for surgery, since
you would be expected to have more than 20 years life expectency.

Please keep us posted and stay in touch.

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
Incontinence:  1 Month     ED:  Non issue at any point post surgery
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 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 346
   Posted 12/11/2009 6:23 PM (GMT -6)   
When i last met with urologist on 12/9 he said he wanted to do the da Vinci. I go back on 12/16. He said that he was going to start getting everything set up for surgery, that's what i want to have done as soon as possible. All i see is the tumor length & core length.
age 45
psa 3.09 at time of physical
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side base- no evidence of malignancy
Right side mid- no evidence of malignancy
Right side apex- no evidence of malignancy
Probability of seminal vesicle or lymph node involement below avg. 5.9%
Relative risk of seminal vesicle or lymph node involvement 32.7% decreased risk


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted 12/11/2009 6:53 PM (GMT -6)   

Dear keysailfisher:

There is a ton of advice given to new members here.  At the top of the list from many, many of us...whatever the treatment we have chosen...is to get multiple opinions.  That is to talk with a surgeon, radiation oncologist and prostate oncologist.  Also, to read and research your situation.

By taking the approach you have indicated, i.e. "He said that he was going to start getting everything set up for surgery, that's what i want to have done as soon as possible.", it does not appear to me that you are taking the approach that many of us recommend.  Maybe you have done more research than indicated or maybe you have sought other opinions and not revealed that to us.  If so, I apologize.  If not, I don't believe you are becoming an informed patient to be able to make an informed decision about finding a cure for your cancer.

Respectfully,

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 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 12/11/2009 8:59 PM (GMT -6)   
I agree with Tudpock (and others). But if you are not going to read some books, study your options, evaluate open versus laproscopic versus robotic surgery, and talk with a radiation oncologist and a medical oncologist in addition to your current urologist to compare treatment alternatives and the risks and benefits of each, then *at an absolute minimum* you should ask your urologist how many "da vinci" procedures he has done, and how many in the past year. In my opinion, if he has done fewer than a couple of hundred of them, or fewer than one a week in the past year, then I would not allow him to operate on me. You should know that, with prostate surgery, there is a demonstrated correlation between experience and skill of the surgeon and outcomes. In other words, your continence, ability to achieve an erection, and potentially your life could depend on the skill of your surgeon. I wish you the best.


Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 12/11/2009 9:06 PM (GMT -6)   
Key,
The indication is that you have a very large tumor on one side. What you don't know is if the tumor has extra capsular extension or if the tumor is located in a spot that would make surgery difficult. A color doppler ultrasound or an MRIS could give you more information. There are a lot of cases in which surgery may not be the best option and you will wind up getting radiation. It's much better to know before they start cutting than after.
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 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


keysailfisher
Regular Member


Date Joined Dec 2009
Total Posts : 346
   Posted 12/11/2009 9:13 PM (GMT -6)   
I've done alot of research and surgery seems to be the best option for my age. My surgeon is very skilled with the da Vinci.
Frank L.. Tortora, MD

      
Frank L.. Tortora, MD
 
 

Dr. Tortora graduated Cum Laude from Yale University and from medical school at Emory University. His internship and residency were served at UNC Hospital in Chapel Hill NC. He is still affiliated with the UNC School of Medicine as a Clinical Associate Professor in the departments of Surgery and Family Practice. Dr. Tortora is a Diplomate of Urology. Dr. Tortora is sought after nationally by developers of new urological techniques and treatments and is considered an expert for panel discussion in his field. He has helped develop medical and surgical techniques to aid the treatment of male sexual dysfunction. His past appointments include President of the Medical Staff of Western Wake Hospital where he still maintains a close administrative association.


age 45
psa 3.09 at time of physical
Biopsy results 12/9
Left side base 3+3=6 21% 2/2 cores positive
Left side mid  3+3=6 100% 2/2 cores positive
Left side apex 3+4=7 88% 2/2 cores positive
Right side base- no evidence of malignancy
Right side mid- no evidence of malignancy
Right side apex- no evidence of malignancy
Probability of seminal vesicle or lymph node involement below avg. 5.9%
Relative risk of seminal vesicle or lymph node involvement 32.7% decreased risk


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/11/2009 9:26 PM (GMT -6)   

I agree with John.  This would be a good place for a color doppler.

These aren't available everywhere, so you may have to travel a little to get one.

Second opinions are a good idea for cases like this that show a high core percentage, and particulary from a radiation oncologist or a prostate cancer oncologist.  You will find many men on here who say the surgeon recommends surgey and the radiation guy recommends radiation.  Hopefully a prostate oncologist is a more neutral person.

Just be sure you take the time to understand your cancer, your treatment options, potential side effects, and 5 and 10 year prognosis rates.

Good luck.  Oh, and take a deep breath.  This is not a death sentence.  Statistically you have a high percentage chance of a long life.

Goodlife

 

 


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


Jim B
Regular Member


Date Joined Mar 2009
Total Posts : 45
   Posted 12/11/2009 11:03 PM (GMT -6)   
Key - It sounds like you do really have a well qualified surgeon and for that reason I think you are very fortunate. I'm sure he is so well secure in his abilities that he would welcome the opportunity to help refer you to other prostate specialists for additional opinions. I know it is important to "get this taken care of" but it is equally important to "get this taken care of" when fully informed of other options. Please accept my apologies if I have overstepped protocol here but I agree with most of the guys on this thread who are urging you to get more info.
Dx age 48 PSA 11.58
Biopsy Nov 04
4 of 6 specimens positive
gleason 4+5=9
Perineural invasion at two locations
40 radiation treatments Jan-Mar 05
PSA May 05 0.07
Aug 05 0.15
Feb 06 0.92
Oct 06 0.55
Sep 07 0.42
Mar 08 1.13
Aug 08 2.26
Nov 08 3.98
Jan 09 5.81
Mar 09 9.02
Bone scan in Nov 08- one spot in pelvic region 1.9cm with SUV of 11
Bone scan in Mar 09-two spots. Original now 2.5cm with SUV of 22 and 2nd spot less than 1cm with SUV of 7.8

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