My consultation report

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 12/14/2009 6:27 PM (GMT -6)   
 
When it rains, it pours. Last night, in the hotel, I reached for my suitcase and WHAM... my back went out big time. I am in pretty severe pain. Not the way one wants to feel on a very important day.
 
Despite the severe pain, the important events of the day went well.
 
Best news was that neither the surgeon or radiologist felt more tests were needed. The surgeon pointed out that all a bone scan would show in a 63 year old male would be plenty of hot spots that might need to be investigated and they would all turn out to be arthritis or healed broken bones or whatever. The risk/reward isn't there as the probability of cancer being so advanced to show up is real but very small. (I know some of you disagree strongly with this).
 
Actually, I had said that earlier but figured they would want to do the tests as part of defensive medicine. I am in such bad back pain that I am VERY grateful for that reason alone not to do it. In fact, I really learned nothing new, but my own ideas were reinforced. With surgery, if PC occurs again, radiation (salvage) is often possible and curative. Radiation can cause bowel problems and rectal bleeding and other stuff. For someone like me who has had bowel problems and lots of hemmies, it can cause problems. Also, radiation side effects can kick in a year later too.
 
My choice will be surgery. Tomorrow, after I try to somehow  teach through this back pain, we will head for Detroit and I see Dr. Menon on Wednesday. He is my first choice at this juncture. The Umich surgeon, top-notch, was interesting. He is a man of few words but straight to the point, with honest answers. Ditto with the radiation guy. Oh, we ended up not seeing the urological oncologist. She indicated that if we had all our questions answered and were satisfied from the first two experts, we didn't need a third appointment. Also, I got the impression that she is the go-to person if surgery and then radiation fails (HT, etc.).
 
I didn't really learn anything new. I was well-versed in this darn disease. Oh, the surgeon did say that he does robotic and non-robotic surgeries. The tumor I have on the apex is better to handle via robotic surgery. The other stuff: 5 out of 12 cores is a concern as is the Gleeson 4+3. The 5% volume is a positive. The low PSAs are positive. The high PCA-3 is a concern but they are still finding out about the PCA-3 test, so it is more of an indicator as to whether or not to biopsy. These days, all Gleason scores are at least 6, so a positive spin is that there is also an 8, 9, 10, which I don't have. It's a mixed bag and we won't know more until after the surgery.
 
 
 
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 12/14/2009 6:42 PM (GMT -6)   
Mel, proud of you. You have done your homework, on your own and in all your time here. Not surprised about them not doing the other tests, as a general rule, the PC will not be advanced enough to show up in a scan at this point.

With your known Gleason 7 at this point, and smaller known cancer volume, and your PSA number, I think you will do well with surgery. Even with a good doctor like Dr. Menon, there will be no guarantees about results. He will do the best he can, but your body and its cancer is unique to you.

I think of our dear Brother Sonny here, lots of great research, great attitude, great surgeon, great hospital, yet he came out a Stage Three and ended up with reaccurance almost immediately, and as we all know, undergoing RT right now as we speak. Point, even with all that said, you get what you get in the end.

I wish you only the very best as you finish up on your decision and preparation that will take place for that. And just like I told my only daughter as I was walking her down the ailse on her wedding day, if you even have a single hesitation while you should halt or abort your desire for surgery, then do it. Don't worry about the dr or the hospital or the arrangements. Its your life and your body we are talking about here, and your final opinion is the only one that counts.

David in SC

Sorry about your back messing up, that sounds dreadful by itself.
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


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/14/2009 6:58 PM (GMT -6)   
Mel,

So sorry to hear about the back. Everything looks worse when the back hurts.

Glad to hear that you listened in PC class hear on HW. I think we all collectively will give you an A + in the accelerated class.

Sounds like plan. Don't look back and go for the gold. Hopefully you won't have to wait long for an appointment.

Good luck in the next few weeks my friend.

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


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 12/14/2009 7:05 PM (GMT -6)   
Mel, congratulations on a job very well done...I am very glad that your meetings today helped reinforce your own feelings. Am sorry to hear about the back though - as one who suffers from a "bad back" I can empathize with you on that one!

Again, congratulations on doing your homework beforehand and for sharing what you learned with us. Good luck with your meeting with Dr. Menon.
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!


O Buddy Boy
Regular Member


Date Joined Oct 2009
Total Posts : 106
   Posted 12/14/2009 7:47 PM (GMT -6)   
Mel,

It looks like your on your way to surgery. Hope the back gets better soon.

I've been plagued by a bad back forever -- a congenital thing that was discovered in my mid thirties. Surgery lasted six hours. Wanna talk fun diagnostics, say "myelogram".

It gets so tight back there, last year it twisted out a rib from its socket, subluxated rib they called it.

See if you can find a good rehab therapist before the surgery. Fitness before surgery can help you recover.

Good luck

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.


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 12/14/2009 8:07 PM (GMT -6)   
Glad to see you are in the mix and such. If you care to answer about the DRE, slides review and other things, it would be interesting to hear.

Maybe ask Dr. Menon what he thinks about taking casodex for a short while, while you decide upon a future date or waiting decisions (postphonement even). Getting a surgery date is likely to be longer than maybe we would guess, I don't know...he has a following that is known. Of course you may chose other avenues too. What were your nomograms showing as far as you could assess? Did you hear anything from U of M that you would consider questionable and if so maybe answer with specifics. I am I asking to many questions? LOL
Best to you in whatever travel you take.
Youth is wasted on the Young-(W.C. Fields)


zachattack
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 12/14/2009 8:12 PM (GMT -6)   
Good luck Mel,I knew you would make your decision.best of luck with your surgery and your back.

Zach
age 55dx 12-2008,psa at biopsy 8.6
biopsy 12/12 gleason 3+4=7
da vinci surgery 6-09 nerve sparing 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 1-10-10
organ confined
extracapsular seminal vesicle involvement
lymph node involvement


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 12/14/2009 8:40 PM (GMT -6)   
Actually, I'm still not out of the bone scan woods, since I have no idea what Dr. Menon will say.
 
Zufus: Not sure what you mean by nomographs. Umich uses the Sloan Kettering calculator. Is that what you meant?
 
If I have Dr. Woods do the surgery, he recommended Jan. 30 or thereabouts ( 2 months after the biopsy). Not sure about Menon.
No DREs were done. Actually one of the radiation interns asked if I minded if he did one and I said I'd rather not. Look, I've had too many DREs since August, and especially since October.
 
If Dr. Menon wants to do one, I guess I say yes sir. Right now, I probably will have a hard time assuming the position. This back pain is BAD. I have had some pretty bad episodes in that area. This time, the timing couldn't be worse!
 
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 12/14/2009 8:43 PM (GMT -6)   
Mel, my uro/surgeon wanted a min of 8 weeks after my last of two back to back biopsies, in the end, due to hospital scheduling, I believe my surgery was 9 weeks after the last biopsy, which is good.
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

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