Re: Update with stats.....Finally!

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afterglo
Regular Member


Date Joined Mar 2008
Total Posts : 72
   Posted 12/20/2009 2:30 PM (GMT -6)   
I posted about a month ago regarding my husband's recent diagnosis with prostate cancer; in fact, I think I said that we felt as if we were stumbling around in a nightmare. The great support group here tried to calm me down, but asked for more info on the findings. So, we now have more info and once again, ask for your help:
 
Age at diagnosis: 71
 
PSA: 2.8
 
Pathology: of 10 cores taken at the biopsy, 4 were malignant, one was suspicious and one was spoiled.
 
Gleason: 3+3=6
 
DRE: Normal
 
Bone scan: clear
 
CT scan: 'something questionable' in the right kidney. Ultrasound of kidney scheduled for Jan. 13, 2010
 
Stage: T1 or T2 (depending on scan of kidney?)
 
Volume: 51cc up from 38cc in May 2009
 
Mets to bone or tissue: None
 
Recommendations from urologist: Seek a second opinion from another urologist in Brampton. His secretary to call us with a date.
 
 
My hubby and I, while still stunned by the diagnosis, have been doing research on treatment options. Hubby wants to do the 'Active Surveillance' with the help of holistic approaches such as those described by Dr. Lorraine Day. I, on the other hand, question the efficacy of her suggestions, but think that they'll do no harm while we wait.
 
Any input would be most helpful.
 
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/20/2009 3:12 PM (GMT -6)   
Hello again, thanks for supplying the extra data.

The bad news: prostate cancer, no doubt

The good news: Gleason 6, and 4 of 10 cores cancerous, normal DRE, and PSA that is well within age factored range

With your husband's age of 71, and based on all the data, I would say he would have a good shot at Watchful Waiting or Active Survelience.

Most Gleason 6's aren't real agressive. Even though I was a surgery guy, I would almost think that radiation in the form of Seeds might be a viable option for him too.

How is your husbands overall medical health? I am not sure I would go for the stress and aftermath of surgery with his numbers.

A second opinion with a radiation oncologist is definitely in order in my opinion, and talking to another urologist wouldn't hurt. Don't feel rushed, should have plenty of time to think all the options through.

Thanks for the update, and we will remember you both.

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
Post SRT PSA:
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


afterglo
Regular Member


Date Joined Mar 2008
Total Posts : 72
   Posted 12/20/2009 3:51 PM (GMT -6)   
Thanks for your reply, David. My husband's overall medical health is very good with the exception of high blood pressure which has been stablized for years with prescription meds.

I welcome a second opinion from a second urologist and would also like an app't with a prostate oncologist if such a specialty exists in Toronto, ON which is the largest city reasonably close to us.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/20/2009 4:23 PM (GMT -6)   
Glad his overall health is good, love hearing that. If you can't find a prostate oncologist specific, then seek just a good radiation oncologist, most have much experience with prostate cancer cases.

The stress of surgery, along with some degree of incontinence and/or ED is something to weigh in, and if I were over 70, with low numbers (especially knowing what I have been through in the past 13 months, and still ongoing), I would definitely listen to the argument for Watchful Waiting. While there are no guarantees, and don't let any doctors mislead you there, there's a good chance with his numbers that his cancer will not progress to a level of causing his death. Just an educated opinion.

I think you will both feel better when you a couple of more opinions from the medical community.

Please keep us posted, and once you start narrowing down your options, let us know, we have people here experiencedd with almost any treatment path you choose, including Watchful Waiting.

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
Post SRT PSA:
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 12/20/2009 5:35 PM (GMT -6)   
I would agree with David on this. With the gleason 6 and the age of 71 and otherwise healthy I think watchful waiting for a few months is a good approach. I think you will find doctors agreeing on this. I to think in the event a course of treatment is chosen that seeds would be a viable option. Please keep us posted as to the second opinion. Glad you found us yet sorry you had to join our family.

peace be with you
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 12/20/2009 6:14 PM (GMT -6)   
Dale, and I am certain in advance you would agree with me on this part. AS or WW takes a different kind of self discipline. It's not an excuse to do nothing. The patient would need to work closely with their doctor, do regular scheduled PSA tests, and still have additional DRE's and biopsies on an agreed upon schedule. If a person follows that schedule closely, and assuming they have the right criteria to start with, it's definitely worth it for men to use this method.

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
Post SRT PSA:
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 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 in place


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 12/20/2009 6:55 PM (GMT -6)   
Afterglo, I must say David is a smart man. I agree with him completely. Get other opinions for sure. We are not Drs. with the low grade AS is a real choice. RT and seeds are a great option as well. My 70 y/o uncle chose seeds due to his age and the complications or lack of. He is very pleased with his treatment. I was diagnosed at 57 and chose open surgery as recomended. The 2 of you must discuss the options and make a decision. Best wishes with you quest.

Jeff T
Cajun Country
Jeff T Age 57

9/08 PSA 5.4, referred to Urologist
9/08 Biopsy: GS 3/4=7
10/08 Nerve sparing open RRP- Path Report: GS 3+3=7 Stg. pT2c, margins clear
3 mts: PSA .05 undetectable

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 12/20/2009 7:03 PM (GMT -6)   
Pretty easy choice for a 71 year old. Wait to see if it progresses, by taking psa tests quarterly and getting another biopsy in a year. You will know a lot more about what the PC is doing and how agressive it is. You can easily get treated in a year or two if you have to, but the odds are that he will go for quite a few years without any treatment or any danger.
JY

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


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 12/20/2009 8:44 PM (GMT -6)   

If you are near Toronto, and if you are considering Active Surveillance...

Dr Laurence Klotz at the University of Toronto is one of the top experts in the world in AS, and has been running the benchmark program there since mid-90's with many hundreds of men.  Patient selection is a key tactic for major AS programs, but Klotz runs a 2-tiered program:  They want patients to be "low risk" if they are up to 70 years old, but they are comfortable with intermediate risk patients if they are older than 70.

Here's a link to an intelligent, informative discussion:  http://www.healthboards.com/boards/showpost.php?p=3466896&postcount=29


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 12/20/2009 8:52 PM (GMT -6)   
I think the obvious fly in the ointment here is the kidney. That may require removal if it proves to be cancerous. They use the DaVinci for that as well.

I agree that the PC can be watched for a while.

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


mikey1955
Veteran Member


Date Joined Dec 2008
Total Posts : 673
   Posted 12/20/2009 9:01 PM (GMT -6)   

Do you know the % core content of each of the 4 positives?

 

Mike


-Nov/Dec 07, March 08 and Dec 08: Severe perineum pain . Septra/Bactrim for 8 months for diagnosed prostatitis.
-PSA start of 2008: 5.3..... PSA June of 2008: 7.3
-14 DRE all benign or nothing felt
-TRUS Biopsy Nov 08: 5 of 8 cores positive GS 3+3 or 6. 30-65%. Perineural invasion.
-General Health: pretty good, 5' 10", 180 lbs, slim.
-Open RP surgery: May 09 both nerve bundles spared. Bilateral lymph node dissection performed. Discharged 48 hours after surgery.
-Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.


afterglo
Regular Member


Date Joined Mar 2008
Total Posts : 72
   Posted 12/21/2009 6:55 PM (GMT -6)   
I'd like to thank each and every one of those who responded to my request for input after I had posted as much info as I currently have regarding my husband's prostate cancer diagnosis.
 
As far as the percentage of malignancy in the four cancerous cores, I don't know, but will find out that as well as  the percentage of free PSA.
 
As of this morning, we have an appointment for the second opinion on January 6th. I questioned the fact that the ultrasound would be done after that, but was told that it is not an issue at this point. I would have thought differently, but I'm very new to this anyway.
 
Yes, the 'suspicious finding' in the right kidney is a wild card here for sure.
 
I am hopeful that in the not too distant future Hubby might be able to consult with Dr. Klotz as Toronto is only an hour's drive from us.
 
To everyone on this forum: I wish you the best of Christmases and a healthy, happy and prosperous New Year!yeah
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