So when did my cancer start?

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/13/2010 8:41 PM (GMT -6)   
Looking aT my PSA history. Could we have spotted the trend sooner?
 
I remember we had a scare in 7/06 when my PSA jumped a bit more than usual, followed by a bigger jump in 11/06. But then look at 4/07 and 3/08. It was back down. Also, I have a history of BPH.
 
So, when did this cancer start and should we have realistically spotted it sooner?
 
Data below:
 
11/09 4.19 FREE PSA 24%
08/09 4.01 
3/8 2.90 
04/07 2.72 FREE PSA: 31%
11/06 3.1 
7/06 2.67 
2-05 2.2 (after DRE)
3-04 2.15 
2-03 2.0 
11-01 2.1 
10-00 2 
10-99 1.7 
10-98 1.6 
10-97 1.5 
10-96 1.3 
6-95 1.2 

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. Result of biopsy:

5 out of 12 cores 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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


mikey1955
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Date Joined Dec 2008
Total Posts : 673
   Posted 1/13/2010 9:02 PM (GMT -6)   

In my case, I think I went a bit slower from being symptomatic to being diagnosed than I would have liked, in hindsight. Did that change anything? I don't think so.

In terms of when did my cancer start? I've thought about that more than a few times. Which pizza? Which cigarette? Which beer? Which potato chip? Which anything? Those questions go back to when I was in my 20's and 30's (and 40's) and had incredible energy. I should have paid more attention, maybe? Maybe not?

I think my cancer was there a long time before it was found.

 


-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.
-Bladder control within 48 hours of catheter removal
-ED ongoing but improving significantly with Trimix at 7 months post-op. Oral ED meds didn't do much.


MrGimpy
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Date Joined Jul 2009
Total Posts : 504
   Posted 1/13/2010 9:04 PM (GMT -6)   
Did anyone every do a biopsy all those years ? it certainly looked ominous that your PSA was steadily rising, especially after the 11/01 test, for example

11-01 2.1 - 5 % increase
10-00 2 - 15% increase
10-99 1.7 - 5% increase
10-98 1.6 - 6% increase
10-97 1.5 - 9% increase
10-96 1.3 - 7% increase
6-95 1.2

Shows an approx rise of 5-15% in your PSA every year, that is a consistent rise that should have raised a giant red flag with your DR with a 5 yr steady increase of 38%, that is a pretty good indication something was brewing
Stats:
Age: 52
PSA (2008)=1.9
Biopsy on Jan 09, 2009
One (1) out of twelve (12) cores was positive, plus external nodule found
Gleason Score = 3+3
Surgery (Da Vinci, robotic prostatectomy): 4/7/09
Removed Catheter: 04/19/09
100% bladder control - Pad free 7/09
PSA 7/09 undetectable, under .0


John T
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Date Joined Nov 2008
Total Posts : 4269
   Posted 1/13/2010 9:23 PM (GMT -6)   
Your cancer probably started 15 years ago. That's about how long it takes an abmormal cell to grow into a noticeble tumor. Just by looking at your PSA history it's up in the air as to when it would have been noticed or should have been noticed, given your age and history of BPH, most likely after it hit 4.
Strum harps on the fact that all medical stats including psa should be represented in graph form. A graph over time show a lot more than just one or two points which is what a doctor looks at. A doctor would rarely go back through all your records. Your doctor was pretty good at noticing it when he did; it could have gone on another year or two before detection as not many men have psa tests as often as you did.
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 : 7270
   Posted 1/13/2010 9:34 PM (GMT -6)   

Nobody raised any red flag until the sudden 4.01 figure. Most of the increases were attributed to normal aging and my BPH (note the consistent but small increases). Then when we had the 2 big increases it suddenly went down on the next one.

Neither my local physician, nor my local urologist, nor a very good Umich urologist indicated there was a problem (until it hot 4.01 and everyone indicated I had a problem!).

Oh, well,...

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. Result of biopsy:

5 out of 12 cores 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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Squirm
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Date Joined Sep 2008
Total Posts : 744
   Posted 1/13/2010 10:10 PM (GMT -6)   
It depends on what guidelines you use that prompts a biopsy. Some use a static cutoff of PSA 4.0 others use 2.5, some use a rising yearly psa velocity of .35 others use age specific PSA.

Mike H
Regular Member


Date Joined Jan 2010
Total Posts : 72
   Posted 1/13/2010 10:22 PM (GMT -6)   
Compiler,

I've asked myself the same question. When did my cancer start? Should I have known sooner? I think I should have but I didn't and my doctor could not find anything so we just monitored me twice a year until we did.

Partial PSA History
12/2/00 4.9
1/31/01 3.8
6/01/01 4.6
9/21/01 4.8
1/04/02 4.2
11/1/02 5.4
11/21/02 4.2
5/5/03 5.4
12/1/04 4.48
7/26/07 4.9
2/20/08 5.1
4/3/08 6.5
4/21/08 4.8
6/10/09 6.9

2003 Biopsy Negative
7/23/09 Biopsy Positive


I wonder what would have happened with a biopsy in 2007 or 2008. What I came to decide is what if I DID have a biopsy in 2007 or 2008 and it was negative again like 2003. Had that happened maybe I would have waited another 2-4 years for another biopsy and by then it might have been way way too late.

No sense in second guessing but I guess we all do it. Best of luck with your surgery.

Mike
8/12/09 Diagnosed at 49 years old. DOB. 6/11/60

10/29/09 Surgery at Memorial Sloan Kettering Cancer Center, NYC
11/25/09 Catheter Out (4 weeks)
99% continent the day the catheter came out
Wore the pads for 2 weeks to be safe but had minor drips at most.
12/16/09 First PSA (7 weeks) < .05 Undetectable

2003 Biopsy Negative
7/23/09 Biopsy Positive. 10% cancer in 1 of 12 cores. Gleason 3+3=6.

Post Surgical Pathology:
Gleason 3+3=6
Tumor confined to prostate
Seminal vesicles not involved
Bladder neck not involved
Surgical margins free of tumor
Lymph nodes not involved


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/13/2010 10:25 PM (GMT -6)   
Mike H, your string looks really similar to what mine did. The chronic prostatitis and BPH masked it for a while, I think. Like John said elsewhere, I probably had it for 15 years or more.
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 1/13/2010 11:37 PM (GMT -6)   
If it did start 16 years ago, just consider you were on inactive survelliance. If they would have diagnosed it 10 years ago, you most likely would have done the same thing, or waited for a few years.

The time is right now. The rest is history.
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 injection
No pads, 1/1/10


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 377
   Posted 1/14/2010 12:19 AM (GMT -6)   
You raise an interesting question here. Perhaps none of us should have bothered testing at all according to the AARP article last week. I know we've had this discussion over and over again here but I guess I still don't get it. According to AARP article there is big controversy about doing any PSA testing at all given that for every life saved from PSA testing 50 men get unnecessary treatments resulting in incontinence and ED. A noted researcher in his fifties stated he would not get tested at all since there was so much overtreatment. He would just not bother with the test. So that means it doesn't really matter what my gleason score was, it doesn't really matter if I did nothing, versus surgery, versus radiation versus hifu, or cryo or hormone or chemo or whatever. Since the mortality rate from prostate ca is only 3 % (article quoted this figure) we should do absoultely nothing and get on with our lives and worry about something else. So don't get psa, don't do any treatments, mortality is so low regardless of psa and staging that we should just not worry about this cancer, worry about other medical problems. That is the gist of this article and current thinking in many circles. Oh why oh why did I bother with PSA testing all these years for needless worrying? We are all going to die of something else so forget about this disease, that is the conclusion from the AARP article......
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 6 both cores,
Clinical Stage T1C
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery
No signs of spread, organ contained,
4 0's in a row now, 14 months out
Incontinence gone in early December '08,
ED remains, have given up on penile rehab, trimix injections used for sex now, that's the way it's going to be ...


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/14/2010 1:54 AM (GMT -6)   
As I always say, my cancer started when they diagnosed it. My PSA was near 20, but it could have started that year and it could have started much sooner. It really does not matter because it is what it is. When I do speaking in groups I mention that I wish I could have started screening much sooner, but I'll never know when the disease took the nasty turn it did. You are on top of it now and that may likely prove to be early enough.

Tony
Prostate Cancer Forum Co-Moderator


Sephie
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Date Joined Jun 2008
Total Posts : 1804
   Posted 1/14/2010 7:24 AM (GMT -6)   
Mel, my husband's "regular" doctor was graphing his PSA for years. about 6 years ago, it bumped up enough to alarm him, and off to the urologist we went. TRUS and biopsy were negative. Two years later, another alarming jump in PSA and this time, the biopsy came up with 2 out of 10 cores positive with a Gleason 3+4. I suspect that the cancer was there at the first biopsy but the needle punch didn't hit the right spot.
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. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 1/14/2010 7:56 AM (GMT -6)   
Mel,

Goodlife, I was looking at the numbers and thinking the same thing. Would I have done anything different? Nope. I would have had regular testing, like you did. Back then, the level for concern was higher than today. Hindsight is 20-20. For all we know the first cell could have occured at birth. A stray cosmic ray could have kicked off the mutation.
Like Tony said "It is what it is". You treat it now with the tools available today.

Now I am going to sound like an engineer. (I can't help it.) Mel, did you do a curve fit as a function of e with an offset? That would give you a geometric rate to track the "doubling rate" and would also give an estimate of when it crossed the x axis. -The date the cosmic ray hit your walnut. You can check you diary to see what you were doing at that instant. Most likely it was the day you painted the bathroom for your wife.
Jeff
You can check
DX Age 56. First routine PSA test on April 8th: 17.8. Start 2 weeks of Cipro to rule out protatitis.
May PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, Gleason 6=3+3. Bone scan and C/T scan negative.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next? See Uro 1/20/10
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
11/14 4 months: Still 3 pads per day. 420ml/day, 91 um leak.
12/11 5 months: Still 3 pads per day. 400-450ml/day
1/11/10 6 months: Still 3 pads but leak is now 320 ml (5 day avg.)
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04 undetectable.


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 1/14/2010 8:25 AM (GMT -6)   
mspt98
- I am so sorry to read your posting about the AARP article - I will have to look that up.

Unfortunately, the Canadian Cancer Society as well as the Prostate Cancer of Canada spinoff have the same feeling that PSA's are a waste of time and cause too much stress - including statements that men who have PSA tests are more apt to have cardiac problems and even implied on one article that the act of doing prostate biopsies can trigger prostate cancer ( or maybe they mean higher PSA levels? )

Mind you, recently wasn't it reported that mammograms and breast self examination for women was a waste of time too? Does anyone care anymore or is it just the domain of the bean counters and accontants who want to make the most bang for the buck from insurance premiums and the such but not help those in need or at risk.

With my rapid change in PSA - even within the alleged safe margin of being under 4.0 - this grade 3 tumour (which they removed in nov/09) would have definitely shortened my life if I listened to the AARP and Canadian Cancer Society. I will have to look up what CARP says about this - that is our version of AARP -

I am glad I listened to my family doctor when he said -" go to an urologist NOW !"
When I see him next month I will be giving him one of my paintings.

hugs
BRONSON
......
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis
location: Peteborough, Ontario, Canada
............


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 1/14/2010 8:46 AM (GMT -6)   
here is one of the links I found regarding AARP article - what the American Cancer Society is saying mimics (or are we just nodding in agreement) what the Canadian Cancer Society is saying too. This is from March 2009 - is there a more recent one?

http://bulletin.aarp.org/states/az/2009/11/articles/hes_fought_prostate_screening_all_along.html


............
BRONSON
.................
Age: 54 - gay - with spouse, Steve - 59
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis
location: Peteborough, Ontario, Canada
............


t-dog
Regular Member


Date Joined Dec 2009
Total Posts : 154
   Posted 1/14/2010 9:10 AM (GMT -6)   
Great question! I too have wondered about this but my IC issues earlier in life likely masked any issues. My regular doc also maps psa in very close tolerances so a small bump gets him lookin. I didnt know the 15 year figure. Interesting....
Dx at 50 in 12/09 Merry Christmas its cancer....
3 of 12 positive, right side only, psa at dx 2.6 free%14
gleason 3+3=6
routine physical, no symptoms
Da Vinci scheduled Feb. 2k10


mspt98
Regular Member


Date Joined Dec 2008
Total Posts : 377
   Posted 1/15/2010 12:52 AM (GMT -6)   
Dear tatt2man:
   I read your post and heard what you said. But if what I have read in the AARP article recently and other curent articles is  correct , it DOESN'T MATTER WHAT YOUR GLEASON SCORE IS, NOR WHETHER OR NOT YOU HAVE EXTRA-PROSTATIC EXTENSION NOR SEMINAL VESICAL INVOLVEMENT NOR BONE METS! Your chance of dying from prostate cancer is very low regardless of your stage, its stlll too low to treat at all. So they say you are wrong when you think youv've extended your life by having treatment. They say I am wrong for having done the same thing. I really don't understand how improved mortality rates wouldn't be reflected by some kind of response by us guys to this disease but this is what the article is saying. Do absolutely nothing about your prostate cancer and still have normal continence and sexuality without risk of dying. This is what the article says. If anybody else has a better interpertation of the current data on this issue of PSA testing I'd love to hear why I went through surgery........
my age=52 when all this happened,
DRE=negative
PSA went from 1.9 to 2.85 in one year, urologist ordered biopsy,
First biopsy on 03/08, "suspicious for cancer but not diagnostic"
Second biopsy on 08/14/08, 2/12 cores positive on R side, 1 core=5% Ca, other core = 25% Ca, Gleason Score= 6 both cores,
Clinical Stage T1C
Bilateral nerve sparing Robotic Surgery on 09/11/08, pathological stage T2A at surgery
No signs of spread, organ contained,
4 0's in a row now, 14 months out
Incontinence gone in early December '08,
ED remains, have given up on penile rehab, trimix injections used for sex now, that's the way it's going to be ...


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/15/2010 11:44 AM (GMT -6)   
MSPT98,
I believe what all the data is saying is that if you have a confirmed G6 tumor, low psa, low tumor volume. and no nodule felt your chance of ever dieing of PC is about 2%; and this is regardless of any treatment chosen including non treatment. In the area of psa testing the majority of men DXed, about 60%, will have these low risk stats. This is because this type of pc is very slow growing and you will outlive it.
If you have intermediate or high risk stats you must get treated because this type of PC is more agressive and your chances of dieing are far greater.
Some wrongly propose that psa testing is causing the majority of men to be treated for something that would never hurt them and we are wasting billions of dollars.
It's not the psa testing that is at fault, but the education of patients and doctors in understanding that not all detectd PC must be treated immediately.
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


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/15/2010 11:59 AM (GMT -6)   
I guess after rethinking the question, for most, you likely got prostate cancer at conception. This disease is largely hereditary.

Tony
Prostate Cancer Forum Co-Moderator


mjluke
Regular Member


Date Joined Jan 2009
Total Posts : 189
   Posted 1/15/2010 1:56 PM (GMT -6)   
MSPT 98:
You are making a lot of sense but don't expect to get much support for your position, as most members of this forum have had their surgery or some other procedure and really aren't  interested in considering that it may have been a mistake, notwithstanding overwhelming evidence that you are probably correct. And don't expect that many surgeons or radiotherapists want to hear it either.


 
63 years old-tumor discovered on digital exam- biopsy December 2008-
4 of 12 samples positive-all on right side
Gleason 3+3=6
PSA-3
Otherwise excellent health.
Brachytherapy- May 19, 2009 -so far, so good.
 
  "There may come a day when the courage of men will fail, but it will not be this day."

Post Edited (mjluke) : 1/15/2010 12:12:18 PM (GMT-7)


goodlife
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Date Joined May 2009
Total Posts : 2692
   Posted 1/15/2010 2:10 PM (GMT -6)   

MSPT 98

Maybe I am misreading the article, but consider the following :

1. These are studies.  Most likely we can find studies to back up opposing points of view.

2. The European study found a 20 % advantage with PSA screening

3. The U.S. study only looked at 7 to 10 years.  I am hoping to look beyond that.

4.  With statisic that 1 in 36 men will die from prostate cancer, apparently it does make some difference.

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 injection
No pads, 1/1/10


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7270
   Posted 1/15/2010 2:13 PM (GMT -6)   
Where is the so-called overwhelming evidence that mspt is correct?
 
Do we have a bunch of Gleason 7,8,9, 10 people who have gone untreated so we can compare them to those who have been treated?
 
Where is this overwhelming evidence?
 
The only thing we know is that in most cases PC is a slow growing cancer. That is NOT sufficient to make that leap of faith that no treatment should be necessary.
 
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. Result of biopsy:

5 out of 12 cores 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

REVISED BIOPSY REPORT: The previous was read by Umich. Slides were then sent to Dr. Menon at Ford Hospital. Here is their report (much better) -- changes in bold print below:

5 out of 12 cores positive. Gleason 3+4. More specifically: 2 cores were 3+3 (one 5% and the other 20%) on one side. On the other side, 3 cores were 3+4 (5%, 5%, 20%)

 Latest: Surgery with Dr. Menon at Ford Hospital, set for 1/25/10

 


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 1/15/2010 3:04 PM (GMT -6)   
MJ, take a look at some of the stats for those members who have had surgery...you'll see a fair number of stage IIIs among us. While over treatment may be a problem for some, it is not the case with many on this board including my husband. One of the options presented to my husband was AS - two years ago we were told that all three options were open to him: AS, radiation and surgery. If we had watched his situation, the single minute focus of EPE found on the surgical path report might have become larger, multiple foci, and his negative seminal vesicle involvement might have been positive.

You can argue til the cows come home but screening and treatment save lives. I suspect that much of the over-treatment is the result of the patient's desire to get the nasty thing out rather than any one particular medical specialty pushing their product. What's needed is better education for men - before and after diagnosis - and a better decision-making process for those who are told they have prostate cancer.

While a worthy organization, I wouldn't make a treatment decision based on what AARP says though the article brings up some valid points. Again, as has been said before, there is no one size fits all for any cancer. Though valid and worthy of consideration, generalities should not weight heavily in the decision to treat or not.
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. PSA: 0.0 til July 2009. August 2009- 0.1, September 0.3, October back to 0.0, December 0.0. Thank you God!


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 1/15/2010 4:16 PM (GMT -6)   
I grow weary of this entire subject. One group trying to outdo the other group, should we test - not test, treat - not treat, agressive - non agressive, etc. etc. PSA testing has saved thousands of lives just here in the US alone. It is just a test ,a marker. Still takes a biopsy to get a diagnosis, or several biopsies. All these academic discussions from the ACS and the AARP do nothing to save lives, or to improve the quality of life issues with Prostate cancer patients and survivors. Where's the advocate for the still nearly 30,000 that die just in the US every year, with some of them dying a lingering and painful death? We don't need less testing, we need better testing, we need some accurate tool or test or both, that can help isolate agressive cancers from the truly indolent ones that don't need immediate attention.

Arguing that over testing and/or over treatment wastes "billions of dollars" and saves few, is a cold hearted remark, and an easy one to spout, if it's not effecting you, your immediate loved ones, or someone you are close to.

To me its not about who appears more brilliant or smarter on this subject, its who is helping those in need, making sure that men get tested, and continuing to educate treatment choices that are appropriate for the stats of the person. The rest of it can be talked about and argued to death, and perhaps puff up a few egos here and there among the experts and the alledged experts, but none of that will help a single victim of PC or their families that suffer along with them.

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: 1/10 .12
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


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 1/15/2010 4:32 PM (GMT -6)   
I am interested in this issue of "when the cancer first arose" since I have a family history of prostate cancer and, for my age (45), above-normal psa results. Although I have done a very substantial amount of reading about prostate cancer while my father had the disease (going well beyond the books that are typically recommended for newly diagnosed), I still have no idea at what point (other than a positive DRE) I should get a biopsy. Two well-regarded urologists have told me that they do not recommend a biopsy based on my present psa results. One of them said he would not suggest a biopsy unless my psa got above 2.5 or went up .4 more a year for a few years. A third (who I contacted by email) said "I estimate, based on your family history, psa results over 5 years, and estimated gland size, there's about a 20% chance you presently have p ca -- so if that makes you want to know the answer, get a biopsy." And I have had some other variations of these suggestions from knowledgeable people. So -- some of you who have had treatments might say "when I first got the disease is not relevant - it is just unknowable history." But for me, on the front-end, I still can't get solid, consistent advice on at what point to biopsy. So there's just uncertainty.....
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5
 

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