Solar1 posts for the first time, with PCa diagnosis- was No Subject

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Solar 1
New Member


Date Joined Jan 2010
Total Posts : 3
   Posted 1/18/2010 5:02 PM (GMT -6)   
I've been diagnosed with prostate cancer, PSA 6.6, cancer 25% in one lower lobe (adjacent to urethra) and 15% in the other lower lobe. The bone scan is clear, but CAT scan shows scarring in both seminal vesicles and an enlarged lymph node in the lower abdomen. The surgeon at Fox Chase Dr. Greenberg says that the tumors are located as far from the seminal vesicles as they could be, and that the likelihood of them being cancerous, even though they show scarring, is only about 2%. He feels there is a similar likelihood that there is a problem with the lymph node. My understanding is that I could opt for surgery, IMRT radiation, or seeds. I'd be very appreciative if anyone has any input to share. I see the Radiologist at Fox Chase on the 27nth and will choose a treatment option very soon. Thank you, Solar1




added subject for searching and archiving

Post Edited By Moderator (James C.) : 1/19/2010 10:54:21 AM (GMT-7)


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 1/18/2010 6:07 PM (GMT -6)   
Hello Soar 1,
 
You have many options to consider. Best to educate yourself before making a selection. Here is a link that summarizes the available treatments.
 
 
Good luck with your treatment.
 
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
 
 
 


Mike H
Regular Member


Date Joined Jan 2010
Total Posts : 72
   Posted 1/18/2010 9:20 PM (GMT -6)   
Solar 1,

How old are you? If you read my original post, my age (49) was a big factor in my choosing RP surgery.

www.healingwell.com/community/?f=35&m=1684312&g=1684312#m1684312


Best of luck,

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

Post Edited (Mike H) : 1/18/2010 8:28:36 PM (GMT-7)


Solar 1
New Member


Date Joined Jan 2010
Total Posts : 3
   Posted 1/19/2010 11:51 AM (GMT -6)   
Hello Mike and Don, Thanks for your input- I hope I'll be able to do that for some other guys when I'm on the other end of this.

I'm 67 with a history of longevity on both sides of the family, a good marriage with a good, if not hugely frequent sex life that I'd like to preserve if possible. Have needed Viagra for the last 7 years and it's worked very well.

Best,

Solar1

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 1/19/2010 3:22 PM (GMT -6)   
It seems that you have had a biopsy -- did you get a Gleason score? In general higher Gleason scores work against seeding.

At the same age as you, I went for surgery over radiation because with surgery the side effects are immediate and then tend to subside while with radiation the side effects may be delayed. I figured that I was ready to confront side effects now rather than later. I was also more afraid of bowel function problems (radiation) than of ED and incontinence.

In your case the real worry is that the cancer has escaped to the lymph notes. If this is true, surgery is almost pointless since it would have to be followed with radiation.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4149
   Posted 1/19/2010 7:40 PM (GMT -6)   

Dear Solar:

Shown below is a post that I have copied and pasted a few times as I have been told it was helpful.  Hopefully, you will find this helpful as well.

First of all, I’m sorry you have to be here but I will tell you that you have found a good place for both information and support.  I am one of the few brachytherapy patients that post on this forum.  You will get lots of good advice from the surgery guys…some of it balanced, some of it clearly pro-surgery.  And you will get what I hope will be balanced advice from me, but it probably will also be a little skewed with a pro-radiation bias.  So, I’ll try to be a little bit organized and provide you with some advice from my perspective.

General

First of all, with early stage cancer you have time to research the heck out of your alternatives so you can feel comfortable that you are making an informed decision.  If you haven’t bought it yet, I advise you read “Dr. Patrick Walsh’s Guide to Surviving Prostate Cancer”.  It’s not perfect, by any means, but is an excellent primer.  (Others recommend Strum’s book, which I understand is excellent).  Secondly, the options you are considering will most likely cure you.  There are multiple long term studies for surgery and brachytherapy that indicate they provide basically the same cure rate for early stage cancer patients.  Of course, each man is different and I suggest you plug your stats into some of the predictors available to see where you fall.

You should also make sure you consult at least three EXPERIENCED doctors to gather your options.  They are your uro-doc surgeon, a radiation oncologist and a prostate oncologist.  Many of the major cancer centers, e.g. Johns Hopkins, Duke, MSK, M.D. Anderson, etc., can provide those three in a multi-disciplinary team setting.  Otherwise, you can and should still do it on your own.  I highlighted “experienced” because there are definitive studies that demonstrate better outcomes if your practitioner has done 250+ procedures…let them learn on someone else. 

You also might consider getting a color doppler biopsy to assist with your baseline.  I didn’t even know such a thing existed but would have gotten one if I had known about them.  The bottom line is to make sure you are totally comfortable with the decision.  This is huge and they are messing with pretty important real estate!

Surgery

As I said, you will likely get lots of advice here from the experienced surgery guys.  The two choices I looked at were robotic and open.  Robotic is newer but there are plenty of experienced guys now who can do it.  I would have chosen robotic if I had chosen surgery.  With surgery you get the aforementioned likelihood of cure, the immediate post-procedure knowledge of the pathology of your cancer and the psychological advantage of “having it out”, that is very important to some men (it was not to me). 

But surgery is invasive, even the robotic kind.  You have the inherent risks of major surgery, a catheter for some period of time (a week to months) and some time needed to recover from the operation.  You also almost certainly will experience incontinence – typically improving over a period of months.  You will most likely experience ED.  That improves over time for most men, especially with the help of Viagra, Levitra or Cialis.  There is some clear evidence that ED is psychological as well as physical.  In other words, once you lose the ability to have erections, it’s tough to get them back because you are trying so hard to make it happen.

The things that some surgery docs don’t tell you are that you lose your ejaculate, your penis may get shorter and many men ejaculate urine.

One advantage of surgery that many surgery patients cite is the fact that, if the cancer recurs, you have salvage radiation as an option for further treatment.  I personally find this a rather specious argument, since the cure rate from this salvage radiation treatment is low and further treatment is likely to be required anyway.

Brachytherapy

This was my choice and1 year out, I’m glad I made it.  I’ll let you know in 20 years if I’m still glad!  You can read my “story” if you click the link at the bottom of my signature.

A typical poster-boy candidate for brachytherapy will have Gleason 6 or less, a prostate size of 50cc or smaller, Stage T1-T2, and PSA less than 10.  With G-7, brachytherapy alone may also be used if all of the other criteria are met plus cancer found in only a few cores and with a small %.  Otherwise, the doc will typically use HT to lower the prostate size and/or supplement the brachytherapy with a 4-5 week course of additional radiation therapy.

Brachytherapy as a procedure is pretty non-invasive and is typically done on an outpatient basis.  There is very little pain involved and the patient pretty much returns to normal activities within 48 hours.  Besides the aforementioned curative power of seeds, the urinary effects are much different than surgery.  There is rarely any incontinence, but a patient may experience some frequency and/or urgency during the first couple of months.  Most docs put men on Flomax for 3 months to assure normal urinary activity.  Pre-procedure, most patients take a written test about their urinary activities.  If things are pretty normal pre-procedure, they are more likely to be normal post. 

The same can be said for ED in brachytherapy patients.  A patient performing well before seeding is more likely to perform well afterward.  In any case, most of the “performing” patients return to sexual activity within a couple of weeks of the procedure.  However, if and when ED occurs in brachytherapy patients, it is likely to be a couple of years down the road.  If that happens, the same little blue pills that help surgery guys will likely do the trick for seed guys.  In general, brachytherapy patients show somewhat less ED than do surgery patients when normalized for age, diagnosis, etc.

While “radiation after surgery” is generally available (but not highly successful) if the cancer returns for surgery patients, “surgery after radiation” is not usually an option for brachy patients.  There are only a few docs who will do salvage surgery after radiation and personally, I would not recommend it.  So, if cancer returns to a brachytherapy patient, the options are likely to be hormone therapy, cryosurgery, HDR radiation, re-seeding or maybe even HIFU…there ARE options…unlike what some surgeons will imply.

This got a little long, but I hope it helps.  Best of luck to you; please let us know how you progress.

Tudpock

 


Age 62, Gleason 4 +3 = 7, T1C, PSA 4.2, 2 of 16 cores cancerous, 27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/09.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

zachattack
Regular Member


Date Joined Dec 2009
Total Posts : 97
   Posted 1/20/2010 4:12 AM (GMT -6)   
Solar1,Welcome to the best place to be in our situation These guys and gals have helped me beyond all my expectations.Take care brother.

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


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 1/20/2010 6:25 AM (GMT -6)   
Welcome to the club Solar 1. To answer your question as best I can I would have to look at my own situation. I went in for surgery which was aborted and then went on to IMRT and hormone therapy. If given the choice under different circumstances I believe I would still have opted for radiation. Yes I had side effects but I did not have incontinence. My impotence was attributed to the hormone and libido loss as much as it was the radiation. 32 months later I feel great and living life large.
Obviously there are varying opinions about how to handle this and honestly all of them have merit. Find the solution that best fits you and go for it. You will get it right.
Stay in touch please

peace and love
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
PSA Jan 15th 2010 is .13

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%


Solar 1
New Member


Date Joined Jan 2010
Total Posts : 3
   Posted 1/20/2010 9:50 AM (GMT -6)   
Hello, and thank you all - geezer, don, mike, especially tup doc, zackattack, and livininadream

Best,

Solar1

Burlcodad
Regular Member


Date Joined Nov 2009
Total Posts : 254
   Posted 1/20/2010 10:53 AM (GMT -6)   
Hi
 
I also saw Dr Greenberg at Fox Chase .  Have you gotten any second opinions from other places in the Philly area?  I went to Thomas Jefferson and you can see a surgeon and radiologist the same appoiintment.  I also saw Dr Lee at UP/Penn Presby and decided on him because he had the most experience of all with robotic surgery.  I'd be glad to answer any questions regarding my opinions on the three places - feel free to email - best of luck
 
Ray
diag 9/09
 
age at diag 54
 
PSA 6/09 1.3
 
stage 2b (biopsy done because of firmness felt on right side)
 
3 positive cores out of 12 (all less than 25%)
 
Gleason 6
 
Surgery  1/13/10 at UP- Penn Presby with Dr David Lee. Home 1/14/10 Nerves spared on both sides -Catheter removed 1/19/10  Path report scheduled for 2/11/10
 
 

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