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orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/29/2009 10:10 AM (GMT -6)   
The consultation went very well. Dr. Cass has been in this field for 33 years. They offer IMRT. He suggested a PET scan, I am awaiting the appointment date for that. It will be in Abilene, Texas.  Then I will meet with Dr. Cass again to go over the results.  Also did a ultrasonic PSA as to my wifes request. Those results I will get hopefully on Wednesday.  Hopefully the PET scan will show nothing.  Then we will discuss the radiation treatment.  Earlier that day I followed up on the request from other members regarding Proton.  I made another call to Loma Linda to the specific person I wanted to talk with.  She returned my call that evening and they do offer proton for salvage therapy, and requested my medical records to be faxed to her to let a Dr. look over them, and get back with me.  I'm taking the advice of members for a second opinion.  In the process of having those records faxed. Just waiting on follow up phone calls to make my request for faxing.  Hopefully to get the ball rolling very soon. I would also like to thank each and every one of you for your input, it has really been helpful for my wife and me, and educational as well.  I will continue to keep you updated as to my status and decision making. Thanks again.
 
Regards, Orickster (Rick F)

60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2215
   Posted 12/29/2009 10:39 AM (GMT -6)   
Thanks Rick. I see my Radiation Oncologist today at 1:30pm so hope it goes as well. If you can maybe include some of your stats in your signature it would be helpful as I am not sure if you have been thru surgery as I have been. We are heading down the same trail it looks like and I wish you the best.
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Consulting with Primary Urologist for further tx.
Great family and friends
Michael


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 12/29/2009 11:04 AM (GMT -6)   
Rick,
I would really question your doctor's recommendation of a PET scan as it has been found unreliable in identifying prostate cancer and Medicare and some Insurance companies won't pay for it. I would ask if he has a financial interest in the facility that is doing the scanning. If he does then drop him and get an ethical Dr.
http://prostatecancerinfolink.net/2009/12/24/pet-scanning-and-prostate-cancer-management-today/
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


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/29/2009 11:06 AM (GMT -6)   
I'm a 59 year old male, and live in Texas. In August, diagnosed with prostate cancer. My wife and I decided on the da Vinci procedure with Dr. Randy Fagin in Austin, Texas. Initial biopsy: LEFT PROSTATE BIOPSY SHOWED: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 5, INVOLVING APPROXIMATELY 25% OF THE SUBMITTED SPECIMEN. ALSO SEEN ARE NUMEROUS AREAS OF HIGH GRADE PIN AND A FOCUS OF PERINEURAL INVASION. RIGHT PROSTATE SHOWED: BENIGN PROSTATE TISSUE SHOWING ADENOMATOUS HYPERTROPHY. Dr. Fagin called and thought we caught it early enough and scheduled surgery for September 30th, 2009. Surgery was performed and released the following day with a followup in 8 weeks. Never had 1 day of problem with leakage and never wore a pad. Went through physical therapy to strengthen muscles. Then back to work. Post Biopsy report: DIAGNOSOS: PROSTATE AND SEMINAL VESICLES(RADICAL PROSTATECTOMY):
Histologic Type: Prostatic adenocarcinoma.
Histologic Grade: Gleason grade 3+4=7
Laterality: Bilateral, involving approximately 35% of left prostate and less than 5% of right prostate.
Margins: Focal involvement of peripheral surgical margin measuring 3mm in greatest dimension.
Extraprostatic Extension: Focally present
Seminal Vesicle Invasion: Not identified
Perineural Invasion: Present
Angiolympatic Invasion: Not identified
Lymph Nodes: Not identified
Stage (AJCC, 2002): pT3a, NX,MX
Michael hopefully this will help. I posted this on 12/23/2009

60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2215
   Posted 12/29/2009 11:35 AM (GMT -6)   
Thanks Rick, as it does. You can put that on your signature so everytime you sign in it will allow others to see it and it helps them to make suggestions as well. Look forward to keeping up with this part of your journey with you as we are on a parallel course. Has your PSA gone up since surgery?
Michael
Dx with PCA 12/08 2 out of 12 cores positive 4.5 psa
59 yo when diagnosed
Robotic surgery 5/09 Atlanta, Ga
Catheter out after 10 days
Gleason upgraded to 3+5, volume less than 10%
Margin slightly involved
2 pads per day, 1 depends but getting better,
8/5 1 depend at night only, now none
 started ED tx 7/17, slow go
Post op dx of neuropathy
3 months psa.01, 6 month psa.4, 6 1/2 month psa.5
Consulting with Primary Urologist for further tx.
Great family and friends
Michael


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/29/2009 11:43 AM (GMT -6)   
PET SCAN: The Dr did tell me that the PET scan was more expensive and that medicare and insurance usually frown on this type of scan. But under new laws and guidelines he pointed out, if re-occurrence is suspect, through contestment if they don't approve it, then medicare and insurance usually pay for the procedure. He did tell me that the cost of other scans, MRI, CAT, etc.,( a total of 4) would be equivalent to the cost of a single PET scan, and that the PET scan would give them a 4-deminsional image to look at to make a more concrete decision as to where the cancer exactly is. He said the PET scan could detect cancer the size of a pencil eraser, naturally we are hoping for no signs of tumor, but if it's present, they will know the exact area to treat with radiation. Just telling you what the Dr told me. Hope this helps.
Orickster (Rick)

orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/29/2009 11:48 AM (GMT -6)   
My PSA after surgery at 8 weeks was 0.15. Did a follow-up a week later and it was 0.12. So the number is real with some floater cells hanging around. As I stated earlier, had a ultrasonic PSA done yesterday and won't get those results until Wednesday at the earliest, or the first of next week because of the holidays. Will keep everyone posted.
Orickster(Rick)

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 12/29/2009 12:07 PM (GMT -6)   
Rick,
Did you read the link in my last post? It only recommends PET Scans for those engaged in Clinical Trials looking at new agents and FREE OF ANY CHARGES. There is a very good reason that Medicare and Insurance companies won't pay for it. I would definately get a 2nd opinion as you may be stuck with a expensive procedure that will add little to your DX.
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


orickster
Regular Member


Date Joined Dec 2009
Total Posts : 22
   Posted 12/29/2009 12:21 PM (GMT -6)   
John I've read your link, very interesting. Will definitely discuss with my wife. And I am seeking a second opinion from Loma Linda as soon as all the info they wanted are faxed. Thanks buddy for your input.
Rick

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 12/29/2009 3:12 PM (GMT -6)   
Hey Rick, glad you got your consultation over with. Be interesting to see what they come up with in the end for you. I agree to, that's not the best use of an expensive PET scan, but then I am not your doctor. Sounds like expensive overkill to me. Hope he comes up with a good plan for you soon.

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


Jim B
Regular Member


Date Joined Mar 2009
Total Posts : 45
   Posted 12/29/2009 8:53 PM (GMT -6)   
Rick,

I have had three PET Bone scans and they have been instrumental in detecting a small spot on the bone thru the first scan and a second spot on the second scan. The third scan was able to show no further growth of either of the first two spots on the bone. My insurance did pay for it though they did call the doctor to question why he was doing them every six months (Blue Cross/Blue Shield and TriCare Prime) Good luck with your treatment.

Jim
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
Bone scan in Nov 09 - NO CHANGE WOO HOO!


Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 12/30/2009 8:04 AM (GMT -6)   
Hey orick,

You lucky dog with no leakage from the start!

Hope all other recoveries go quickly too.

I had to wonder what the heck you mean by a Ultrasonic PSA (and that your wife requested it)!

At first I though you maybe meant a TRUS (Transurethral Ultrasound), but heck, there's nothing left to ultra!!

Then it dawned on marblehead that you mean Ultrasensitive PSA of course!!!

Glad to have gotten that out of the way.

Take care ... we will now return to our show already-in-progress, eh?
Age 58, 195lbs, 6'4", 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
Biopsy Nov2008 1 of 12 cores 5%, Gleason 3+3 - Sona showed size 140+ cc (110 grams post op).
02/03/09 open RRP surgery , Nerve sparing both sides, 1 day in hospital, Day 4 first BM,
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
02/18/09 Cath out, passed a 1cm oblong STONE within hours.
03/06/09 Started Levitra@20mg / Viagra@100mg / (04/01) Cialis@20mg -- no real effect (thru 11/2009).
04/01/09, 07/07/09, 10/01/09 PSA <0.1 - Stone Was Oxalate stone -- X-ray no stones.
08/09 - started MUSE@1000mcg ... pump&plump - success(80-90%) (alpro ache).
09/09 @500mcg +pump&plump + 2 advil - success(80-90%) - (less Alpro ache).
10/09 TrimixGel (500/300/100mcg): 1st:60%, 2nd:(pump&plump) 60%, 3rd(added 500mcg muse):70-80% -- (no Alpro aches!) but none @ useful hardness!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 12/30/2009 9:23 AM (GMT -6)   
Take this as a question, not an opinion or advice. Your PSA is 0.12 and falling. The recurrence is generally defined as 0.2. Why The hurry to treat? Maybe watch it another month or two?

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 12/30/2009 10:39 AM (GMT -6)   
According to both my Uro/Surgeon and my Radiation Oncologist, recurrance after surgery is three consecutive PSA rises above .10. .20 is a threshold that some radiationists draw a line in the sand, while others use .50 or in a few cases, 1.0.

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


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4188
   Posted 1/2/2010 6:18 PM (GMT -6)   
http://prostatecancerinfolink.net/2010/01/02/more-on-pet-scans-and-their-role-in-prostate-cancer-detection/

Another study to show your doctor about PET scans. This one had a 100% failure rate in detecting PC in the nodes.
If you want to spend money get a Combidex scan as it is 96% effective.
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


chinito
Regular Member


Date Joined Dec 2008
Total Posts : 28
   Posted 1/2/2010 7:37 PM (GMT -6)   
thanks everyone, i have learned so much from this website. my 3rd post surgery rose to .050 and i didnt know anything from the intern that spoke to me about the need to wait and the 'doubling factor' . i have gone on a non dairy mostly vegetarian and very little sugar for the next few months as i have heard this helps. has anyone heard of apricot kernels for rising psa's
Age 56
DOB 9/02/52
DX Prostate Cancer 12/2/08
Double Bypass Heart Surgery 8/08
Gleeson Score 3+4=7
9 out of 12 cores were postive
PSA was 7.71 rose to 12.2 week of surgery
DaVinci surgery 2/06/09
Cath out 2/17/09
Path staging PT2c Bilateral disease, stage 11
PERINEURAL INVASION, present and extensive
vENOUS (large vessel) absent
LYMPHATIC (SMALL VESSEL) invasion SUSPICIOUS FOR LYMPHOVASCULAR INCASION (C5, C10, C20) (16) no evidence of malignancy
ADDITIONAL PATHOLOGIC FINDS High grade prostatic intraepithelial neoplasia, which is extensive
3 month post op PSA undetectable
6 month post op PSA undetectable
10 month post op PSA rose to .050 need to return for more testing


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 1/3/2010 7:39 AM (GMT -6)   
Hello Chinito,

You may want to start a new topic with your question on apricot kernels. The drug was called laetrile and has been widely discredited. Here is a link with a bit of information on the subject.

http://www.cancer.gov/cancertopics/pdq/cam/laetrile/patient/27.cdr#Section_27

Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Lupron injection on May 15 and every four months for next two years
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
 
 
 

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