Take your Time???

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compiler
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Date Joined Nov 2009
Total Posts : 7203
   Posted 12/11/2009 8:27 PM (GMT -6)   
I keep reading that advice over and over. They even say that in the books.
 
I agree that if you have a G 3+3 in not too many cores, that makes sense.
 
But, isn't there a window of opportunity involved and might it not be on the short side if you have stats like mine that aren't that great (but far from the worst)?
 
I would almost temper those remarks and say read a lot, study a lot, consult with a experts (PLURAL). But I don't agree with this "take your time" business. I know in my situation, I think I have to think things out but yet act decisively.
 
Mel
63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/11/2009 8:45 PM (GMT -6)   
Mel,

Once I was diagnosed with a Gleason 7 (4+3), I knew there was the possibility of a more agressive cancer. The problem with waiting any longer period of time, is that you don't know when and if the cancer goes outside the prostate. Some people will make it sound like it will take years for that to happen, my own doctors told me that it can happen in months, and even weeks if the cells are real close to the edge. And one has to remember too, that the biopsy is but an estimate, it is only based on the cores sampled and the grade, quality, and quantity of cancer found there. It's always possible that the cancer is more developed, but unless one's prostate is removed by surgery and then analyzed by pathology, there is no accurate way to know the fuller extent of the cancer.

I am not advocating for anyone to race out and react on fear or lack of knowledge, not like that at all. But there are schools of thought among cancer experts, that Gleason 7 are very unpredictable creatures, its that "4" component that can make it turn ugly in a hurry.

I was not rushed into anything by anybody, doctor's included. With the span of 3 biopsies over 18 months, I researched extensively, and pretty well knew my options and odds. Once my Gleason 7 was fully discovered, I was prepared to make my choice, and I did.

Each man here has to come to his own conclusions, and there is always risk in waiting when dealing with any cancer.

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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/11/2009 8:50 PM (GMT -6)   
Hi again, Mel,
There you go. You are getting it. At least take your time to feel good about your decision. Where a window is in prostate cancer we just don't know. Unfortunately we can't take any test and know if our cancer is indolent or potentially lethal. So we don't know when the window closes if at all. You learn what your outcomes may be, weigh the information, and don't look back. There is no use for that.

You have heard a lot of different perspectives here, and you will have to decide what is best for yourself. Again, good luck with your decisions...

Tony
Prostate Cancer Forum Co-Moderator

Post Edited (TC-LasVegas) : 12/11/2009 8:27:07 PM (GMT-7)


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 12/11/2009 8:55 PM (GMT -6)   
Mel,
If it any consolation you have most likely had the PC for 15 years or longer, Given this time period two or three months longer isn't a lot of time in the scheme of things especially if you need to nail things down.
I was a G4+3 and waited 8 months from 1st DX to treatment. I went on a no meat and no dairy diet which I think helped slow my PC growth. The extra time I felt was well spent in gathering enough info to make an informed decision. You can also take Casodex for a few months if you are really worried and this will stop anything dead.
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


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7203
   Posted 12/11/2009 9:14 PM (GMT -6)   

John:

 

I disagree. With a G4+3, 3 months CAN make a huge difference. We have no idea how long I had cancer, but we do know G4+3 is an attention-getter!

 

Mel


63 years old
PSA-- 3/08--2.90;  8/09--4.01; 11/09--4.19 (Free PSA 24%), this after 45 days on cipro! DREs have always been normal.
 
History of BPH/prostatitis.
 
PCA-3 test: 75.9 (bad news, guaranteeing I have to do....):
 
Biopsy on 11/30/09
 
Biopsy Report—Prostate Cancer

5 out of 12 positive

Gleason 4+3. More specifically:

2 cores were 3+3 (one 5% and the other 30%) on one side. On the other side:

2 cores are 4+3 (5%)--

1 core 3+4 (30%)

no peri-neural invasion

prostate is 45 grams

Stage: T1C

 Latest: Have set up an appointment at Umich with surgeon, radiation guy, general medical oncologist on Monday, 12/14. Trying to also set up appointment with Dr. Menon at Ford Hospital. Looking at another reading of the slides.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/11/2009 9:35 PM (GMT -6)   
Just a note:
Casodex will not stop anything dead. It is an anti-androgen and blocks absorption of testosterone in androgen dependent cells. However, any cells that are not dependent on androgens will not respond to Casodex. PSA may be masked with Casodex, and indicate that the drug is working. And it is but only in androgen dependent cells as long as they respond to this therapy.

Tony
Prostate Cancer Forum Co-Moderator


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/11/2009 9:40 PM (GMT -6)   
I think "take your time" is a relative thing for all of us. It does depend somewhat on our biopsy results.

Most doctors won't do surgery for 6 to 8 weeks after biopsy, so there is 2 months already.

I'm not sure if you have had it for 15 years, but you certainly had it before it was discovered. Maybe you had it for 6 months, 1 year, ????.

Johns point is in the overall scheme of things, making a good treatment decsion will be more important long term to you than having the prostate removed or radiated quickly.

I can only say in my own case, my PC went from HPINS (pre-cancerous cells) to a Gleason 9 in 2 years. There is a lot of conjecture on the actual progression of the cancer. Does it start as a G5 or G6 and grow into a G9, or does it start as a G9 ?

Obviously, by the end of next week, you will be have most of the data you need to make an informed decsion.

Good luck Mel !
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


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 662
   Posted 12/12/2009 9:24 AM (GMT -6)   

I’m with Mel. Got my biopsy results on a Monday and I would have had my prostate taken out on Tuesday if I could have found a surgeon to do that. The recovery period of biopsy to surgery was excruciatingly painful to me and my family. I would say that during the period of time between PSA and Biopsy I became as informed as I needed to be. I still today pick up interesting facts… but nothing that is significant in choice. “Take your time” wasn’t a consideration for me. I actually understand the need to have the healing time between biopsy and surgery. So I may have been embellishing above when I said I’d have the surgery the next day after results. I really would not want a complicating factor like a colostomy but …that time was just a killer for me!  jnm


defender3
Regular Member


Date Joined Nov 2009
Total Posts : 98
   Posted 12/12/2009 9:35 AM (GMT -6)   
Mel - time is relative. Since a doctor won't do surgery until 6-8 weeks after a biopsy, you have "time" to do research so you make a decision that's right for you. I was seen in late August, diagnosed in early Nov and will not have a procedure until mid January or February since I want to drop a few pounds and do at least 30-days of kegels/exercising. The time has allowed me to calm myself, do my research and reach conclusions as to what's right fo me and the wife.

zachattack
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 12/12/2009 11:25 AM (GMT -6)   
Mel,I don't know if this is helpful but I had 6months between biopsy and surgery.after they found out i needed radiation my Dr. said something to me that put me in a tail-spin.He told me there is never a need to rush.And I still wonder about that.Well as always take care of your self and try to relax as much as possible.

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


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 12/13/2009 6:24 AM (GMT -6)   
Tripple Ditto to the "time is relative" thought...That or we'd really need to define what "take your time" means.
 
 
PSA - July 2007/nodules found & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6
06/25/08 - Da Vinci robotic laparoscopy
 
I waited 8 months before getting my biopsy...mainly to get in a new Insurance Calendar year.
Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/13/2009 7:36 AM (GMT -6)   
Empirical type question maybe Tony-TC or John T or other(s) could put a spin on this. Why is it that many or most uro-docs do not tell a patient you could take casodex or other control drugs while you wait upon your surgery or decision processes????

Now is it that the drug may shrink the gland and I know it would make surgery more difficult, but is that the reason? Plus I know that surgery is still possible and some folks have done just this path anyway and got their surgery via various methods.

Is it that the patient may change his mind about the major treatment that is proposed to him?

Then why not offer this option straight up to patients whom are worried 'sick' about a their own PCa scenario, especially with higher gleasons or higher psa's? Seems it would be very comforting to the patient, to hear...hey...we can prescribe x,y,z while you wait and decide or prepare for whatever. My curiousity on this and to compare and contrast opinions.

Post Edited (zufus) : 12/13/2009 6:42:43 AM (GMT-7)


Steve n Dallas
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Date Joined Mar 2008
Total Posts : 4829
   Posted 12/13/2009 8:02 AM (GMT -6)   
zufus does your idea apply to everyone with a prostate or just guys with "enlarged" prostate?

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
05/14/09  - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/13/2009 8:30 AM (GMT -6)   
I am just posing what I think is a reaonable question to ask just as compiler and others have done ?  Looking at any inputs from any angle, we know PCa....many angles.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/13/2009 9:41 AM (GMT -6)   
I was told at the time, that if I took the drug, it would make it much more difficult to get a "clean" surgery, if I was going down that route. But on the flip side, if I was going down the seeding or RT route, it would make the radiation's job easier. Original I wanted seeding, but it was decided my situation was too agressive, and it was reccomended that I don't do anything that could diminish the effectivness of possible surgery.
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


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 12/13/2009 11:09 AM (GMT -6)   
I was on Casodex and Lupron for two months prior to my surgery, I had originally settled on HDRT and an IMRT follow up so I started the Casodex-Lupron thing.  The onco. who gave me the Casodex-Lupron assured me that the medication would not preclude surgery.  I then met with one more surgeon and decided to go that route.  The surgeon was up front saying that it may be a little more diffucult to peel the prostate away from the nerves but he would just have to see.  I got a copy of his surgery notes and he documented that it was tough peeling the prostate away.  The surgery took about 1 1/2 hours longer than usual because of it.
 
The upsdie to the meds were my peace of mind during the wait for surgery, I knew that the cancer was shrinking and my PSA was undetectable.
 
Would I follow the same path? That's a hard question and I'm not looking back or second guessing myself.  This is just information for peopletrying to make a decision.
 
David
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 12/13/2009 11:41 AM (GMT -6)   
I have heard that taking Casodex will shrink both the prostate and the tumor moving the smaller prostate away from some of the major organs and enabling better margins. It also may kill small amounts of PC cells that may have escaped into the blood stream. It definately will slow down any androgen dependent PC cells. I know that most surgeons don't agree with this and as pointed out the surgery becomes more difficult. I don't know if there is a difference in taking Casodex or Lupron in it's effects on the surgery.
Again, this is another area in which there is a lot of disagreement among professionals when it comes to treating this disease.
There is also disagreement as to whether adjuvent HT helps in radiation. It seems logical that anything that can make the prostate smaller would be a huge benefit because you are giveing the same dose to a much smaller prostate and tumor, so the targeted area is getting 100% more radiation if it is 50% smaller. It also is logical that HT would make the PC cells weaker and easier to kill.
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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 12/13/2009 11:43 AM (GMT -6)   
I have heard that taking Casodex will shrink both the prostate and the tumor moving the smaller prostate away from some of the major organs and enabling better margins. It also may kill small amounts of PC cells that may have escaped into the blood stream. It definately will slow down any androgen dependent PC cells. I know that most surgeons don't agree with this and as pointed out the surgery becomes more difficult. I don't know if there is a difference in taking Casodex or Lupron in it's effects on the surgery.
Again, this is another area in which there is a lot of disagreement among professionals when it comes to treating this disease.
There is also disagreement as to whether adjuvent HT helps in radiation. It seems logical that anything that can make the prostate smaller would be a huge benefit because you are giveing the same dose to a much smaller prostate and tumor, so the targeted area is getting 100% more radiation if it is 50% smaller. It also is logical that HT would make the PC cells weaker and easier to kill.
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 : 25380
   Posted 12/13/2009 11:47 AM (GMT -6)   
John, I do not disagree with any of the possibilities of your last post. What you said just makes it 10x harder for a "lay" patient like the average man with PC to make a decision any easier. When the experts don't even agree among themselves, what basis is the average person suppose to make a sound decision upon? It's hard not to think of our decisions as an educated guess at best. Not the best foundation to make a major possibly life changing decision upon.

Seems like there is nothing related to the treatment of PC that we can even get two doctors to agree upon exactly the same, let alone our own personal opinions and observations.

Just makes this whole PC thing all the harder.

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


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 12/13/2009 12:32 PM (GMT -6)   
Wyatt Earp's advice about gun fighting applies, "Take your time but do it quickly."
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 PSA 9/10/09 <0.1


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 12/13/2009 1:07 PM (GMT -6)   
Mel,
John brings up some good points. If you choose to do ratiation, then ask your radiologists about Neo-Adjuvant hormonal therapy. They will still target a wider area than just the prostate with EBRT, even with brachytherapy, but neo-adjuvant HT does have some positive signs in radiation. While it has been done on surgery as well, most surgeons would prefer you don't do HT prior to the procedure because they may lose visibility of the spread during surgery.

FYI. Definition of Neo-Adjuvant therapy is the use of a secondary therapy ahead, or prior, to a primary therapy.

Tony
Prostate Cancer Forum Co-Moderator


cocrgolfer
Regular Member


Date Joined Oct 2009
Total Posts : 171
   Posted 12/13/2009 6:57 PM (GMT -6)   
Herophilus said:
"Got my biopsy results on a Monday and I would have had my prostate taken out on Tuesday if I could have found a surgeon to do that."

I felt exactly the same way. I went to Moffitt Canceer Center in Tampa on a Thurs. to meed with Dr. Pow-Sang. He told me they were scheduling surgeries out six weeks. Well, OK, but if you could take it out tomorrow I'd do it. So he immediately went to his scheduling nurse and came back to tell me they had an opening the next Tues. I got in all the golf I could over the weekend, which keeps me from thinking about anything else (Boy did it help last year during the stock market collapse!), went up Mon. for the pre-surgery tests and Tues. afternoon my (&%4@ betraying prostate was gone. I did research on the seeds and radiation but the decision was pretty easy for me. Since then I found HW and thanks to the intelligent people here I have learned more about Pca than I ever knew before. Nothing I have learned here however has made me second guess myself.

Mel, this is just my experience and in no way a recommendation for your case.
Best of luck, You have gotten so much good advice here am sure you will do what is right for you.

Steve

goodlife
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Date Joined May 2009
Total Posts : 2691
   Posted 12/13/2009 9:19 PM (GMT -6)   
I would only say this about HT. Knowing I was facing permanent elimination of "wet" sex, possible permanent ED, and all the rest of the bad stuff. I made sure I used my equipment every time I had the chance. ( no it didn't help later, there are some things you can't store up )

But, if I had to choose between not worrying, and not wanting to have sex becasue of the Hormone Deprivation, I think I would rather worry. Sounds stupid, I know, but at the current time, the sex is the worst part of PC recovery for me.

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


STW
Regular Member


Date Joined Jun 2009
Total Posts : 292
   Posted 12/14/2009 5:30 PM (GMT -6)   
I was diagnosed with PCa in January, a not unexpected result given family history. I decided on surgery after a bit of research, consulting with a radiation oncologist, and a prayer or twenty. I could have had surgery as early as mid-February. However, I'm an accountant with my own practice and February surgery would have made me miss a major portion of the tax season and, quite possibly, put me out of business. I laid that out for my urologist and he told me he had no problems giving me a shot of Lupron to slow things down and get me safely to the end of April. I was afraid any meaningful delay could be enough to get past the possible cure/palliative care tipping point. Even if the Lupron had no PCa effects, which I don't believe, it did give me peace of mind to stay in business. It also meant I was doing something.

35 years ago my father had to decide surgery or not for PCa. He chose surgery and enjoyed life with my mother until the week before my surgery. A friend of theirs chose the chance of sex over surgery at about the same time (this was pre-nerve sparing days) and ended up dead in not so many years. That sex thing didn't work out real well for him as a long term strategy. My parents both think he was an idiot.
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 PSA 9/10/09 <0.1


O Buddy Boy
Regular Member


Date Joined Oct 2009
Total Posts : 106
   Posted 12/14/2009 9:07 PM (GMT -6)   
Anybody go any faster than 10 days from dx to surgery?

Needless to say I'm on the fast-track side of this issue. I look at my path report with perinueral and capsular invasion, a 3+4 pre- and post-op Gleason and I'm absolutely convinced I made the right choice.

I wonder how many 3+4s go to 4+3s just getting a Ph.D. in doctor shopping? We know the Gleason's usually bump up, but does waiting 'til the cows come home contribute? We don't know, do we?

Mind you, I was well aware of my surgeon's CV even before he started at this clinic.

OBB
55 yo
Dx:9/29/09
DRE: Susp
PSA: 3.5
Gleason: 3+4/7
6/12 Cores Positive; Sextants were 1%, 3%, 8%, 15%, 12%, 0%
RALP: 10/09/09
PATH:
Margins: Clear
Lymph Nodes: Clear
Seminal Vesicles: Clear
Gleason: No increase from biopsy 3+4/7
Some perineural and capsule invasion.
T2c,NO,MX
Incontinence: Minor. 1 light pad a day. Some days don't need it.
ED: Natural with encouragement. 20mg Cialis and pump just makes things more fun.

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