Depression-- the more one reads-adjuvant or not

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compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/6/2010 3:08 PM (GMT -6)   
When I first got dx. with PC I read a LOT. What an emotional roller coaster that was! I'd read the Walsh book and Strum book. I'd read something that sounded optimistic. That's good news. Then something else would make my situation look bad. What a shock. And so it goes...on and on.
 
This is now happening again. My pathology results are again right in that controversial area. I have a G 4+3 and one focal positive margin. So, what to do? Do I do adjuvant therapy? My doctors at Ford hospital do NOT recommend it. They point out that it is very controversial. Their argument is that many/most folks do NOT develop a rising PSA, so why subject them to something they do not need? Of course, the other side is to be aggressive, get the buggers now, and increase your chances. Well, since I would prefer NOT to do the radiation, I am glad to accept their recommendation. But then I read something that definitely advocates radiation.
 
Once again, another emotional upheaval! I hate this crap. I'm still going to go along with the Ford doctors, but clearly this is all so controversial!
 
I am indeed getting depressed with all of this (no, I am not at all suicidal ala that other thread). My wife and I are going walking soon at the mall after a nice dinner and then we will be going to a movie. Got to get away from this as best I can!
 
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%)

 Surgery with Dr. Menon at Ford Hospital,  1/26/10. He says all looked good. Spared nerves. Awaiting pathology report, set for 2/2/10.

Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland.

Lymph Nodes: Clear

Perineural Invasion: yes. Seminal Vessical Involvement: No

Extraprostatic Extension: yes

Positive Margin: Yes-- focal-- 1 spot .5mm

Final Weight is 52.7 gms

Incontinence: just joined that club-- definite leaks-- my guess is 1 pad during the day -- at night??? First night tonight!

 

 

 


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 2/6/2010 3:21 PM (GMT -6)   
Mel, Enjoy the dinner and movie. We understand!
Jeff T
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.
15 months out injections Caveject (success)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/6/2010 3:33 PM (GMT -6)   
Most of the drs that I have spoken with do not reccomend adjuvant radiation. Got this from 3 radiation oncologist, a medical oncologist, and my own uro/surgeon.

You haven't even had your first post op PSA yet. The doctor's I spoke with on this subject all want to wait till they see see post surgery rises in a row above .10 before calling it recurrance, and before disucssing SRT. Reasoning, salvage radiation is a serious step, and the last curative thing a surgery guy has going for him. They feel its better used with a verified recurrance.

I agree with this thinking, and it was only when I was totally convinced I had recurance, could my mind start to work in the direction of having accepting the need for SRT.

I agree with Bro. Jeff above, enjoy the movie and dinner. Enjoy your weekend and further out too. There is nothing going on with your PC right now that requires immediate attention or any kind of decision. You are still a man healing from a major surgery, and working through some degree of incontinence. I wouldn't worry about anything other than that right now.

If your PSA does comes back on the high side, and hopefully it won't, you can start thinking about your next, if any, course of action.

For now enjoy yourself, and your wife.

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 43 days, 1/10 - Corrective Surgery #4, and Caths #11 and #12 in at the same time


turner
Regular Member


Date Joined Jan 2010
Total Posts : 119
   Posted 2/6/2010 4:17 PM (GMT -6)   
Mel
 Jeff and David are right on. I can appreciate your concern. Some of us experience psa anxiety while others like yourself from your path report. Either way we have to try our best and not let it disrupt our living today. Easier said than done I know. I keep telling myself it is what it is and keep up the healing and treatments...whatever they might be. I agree with waiting until your first psa test..around april 1st? Untl then concentrate on what you can control now...healing from your surgery. Enjoy your walk and movie. I'll drop you a line soon...turner
In the mean time,some light reading 
 

http://prostatecancerinfolink.net/2010/02/06/what-does-a-positive-surgical-margin-actually-predict-after-surgery/#more-8140


 diag 2/09 @ 3 wks before 50th bday and 2nd wedding :(
 psa 4.5
 t2b
 5 of 6 cores pos....5,20,50,25,5 %
gleason 3+4
 N/S RALRP 4-20-09
 Path: lymph node -
          seminal ves -
          margins -
          EPE -
          preineural inv-
          gleason 3+4
          stage pt2c
          tumor vol 40
Continence- 99%- @3-4 months post op
ED-gradual work in progress w/meds
       psa 7/22/09  0.1
      10/23/09  0.3
       11/23/09 0.5
       01/05/10 1.1
 Met with raidioligst 12-28
 Meeting prostate oncologist @Uof M 1-11
 Not like'n where this heading.  Surgery was and still is a walk in the park compared to what lies ahead :(
 01/26/10 scans all clear.Met w/Onc. at U of M. She has convinced me to go with Radation only at this time starting Mon feb.1. at St.Marys in saginaw.68.4 Gys @38 days What have i got to lose?
 Let the games begin...again 
 
 
 

Post Edited (turner) : 2/6/2010 6:05:31 PM (GMT-7)


Magaboo
Veteran Member


Date Joined Oct 2006
Total Posts : 1210
   Posted 2/6/2010 8:08 PM (GMT -6)   
Hi Mel,
 
I can only tell you about my story, but unfortunately, only you can decide which way to proceed. After my operation, my Doctor advised me to undergo ART, but my Urologist/Surgeon suggested to wait and see if the PSA would increase. I've decided to wait for the test results to to tell their story. For over a year everything looked quite good, but  at about 14 month post surgery the PSA started to climb and after 3 successive increases, when it reached 0.08, we decided to call it a recurrence and made arrangements for SRT. At the start of RT the PSA had reached 0.1.
The RT was rather uneventful with only minor issues including some anal discomfort and some bleeding.......nothing serious.
Had I opted for ART I would always wonder if it was really necessary, but I know now that my SRT was absolutely necessary to have a chance at a cure.
I don't know if this helps you in any way.....................I hope so.
In any case, what ever you decide, I wish you the very best in your journey.
 
Magaboo


Born Sept 1936
PSA 7.9
-ve DRE
Gleason's Score 3+4=7, 2 of 8 positive
Open RP 28 Nov 06 (nerve sparing), Post op staging T3a
Gleasons still 3+4=7
Seminal vesicles and lymph nodes clear
Catheter out 15 Dec 06, Dry since 11 Feb 07
All PSA tests in 2007 (4) <.04
PSA tests in 2008: Mar.=.04; Jun.=.05; Sept.=.08; 3 days before Rad Start=0.1
Salvage RT completed (33 sessions - 66 Grays) on the 19th Dec., 08.
PSA in Jan., 09=0.05; July 09=<0.04; JAN 10=<0.04

Post Edited (Magaboo) : 2/6/2010 7:11:01 PM (GMT-7)


tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 2/6/2010 8:28 PM (GMT -6)   
Mel:
You have gone through a physical & emotional shock and a major upset to your sense of mortality. It is very good to voice - verbally or in print - your upset and turmoil - those fears and anxiety that hit you in the pit of your stomach and fill your head with so many thoughts, you may feel like an old 33-1/3 vinyl record on 45 rpm !
Communicating with your doctors, your wife and us here is great. But you do have to get away from it at times - to let the subconscious self put it all in order.
Steve and I go for drives and antiquing. We go out for dinner. We have our own projects ( like my painting) which makes me put my concerns and fears aside - at least for a time being.

You are still at very early stages of this journey. You have to work out a routine to build on your old self-confidence and self worth. You are more than your disease.

I have a similar pathology to you - see signature below - and yes, I do worry about it
- but the Sloan-Kettering Nomogram was comforting - http://www.mskcc.org/mskcc/html/10088.cfm
-and also the fact that my doctor ( who does 2-3 open RP a week) wanted the post-op PSA 12 weeks after our pathology report discussion - and 20 weeks after surgery - he's not worried about the findings - so I shouldn't -

Please focus on what is good in your life. What good things you need to direct your life towards. Let your body recover. Let your mind recover. And let your relationship with your wife recover too. It can. It will. You can. You will.

quiet gentle hugs
BRONSON

P.S. I use my dvd player as white noise to help focus on "the now"... but blocking out that little voice in your head that complains a lot ! :D
............
.................
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
............


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 2/6/2010 8:57 PM (GMT -6)   
Mel,

All of us have been in your shoes. This disease can take hold of your heart , soul, and mind, and drag you where it feels like dragging you. We have watched you attack your pc with 332 posts to date. You have learned every thing you possible could about it, made an educated treatment choice with a top notch surgeon and team.

In my own case, I decided I was tired of being drug around, worrying about my surgical pathology, my Gleason score, and all of the othyer things we can worry about. Started to feel pretty down. It wasn't fair, I had grandkids to see grow up, a lovely wife, employees depending on me, etc.

In spite of nanograms, surgeon's opinions, urologist opinion, etc, I pretty much decided that I would most likely die of cancer within the next few years. I'm not the lucky type.

But finally, after talking on this forum, seeing a lot of guys who have it much worse thsn me, like the guy who had a 3200 PSA and lung tumors , etc, that I just wasn't going to let it drag me around anymore. I ecided it was time to move on. I had done all I could control, and the rest was just going to happen. I considered adjuvant radiation, and decided that for the 5 or so percent increase in advantage over salvage radiant, that the potential side effects weren't worth it for a man my age.

With a Gleason 9, my potential for bad things is certainly much greater than most. But I have been able to get on with my life, working, lovin my wife, kids, and grandkids, being involved in church, school board. I honestly have been able to arrive at a place where whatever happens, happens. I will deal with it then.

I am sure once you return to the classroom, you too will be able to forget a lot of what is running through your mind. Sitting around, bowsing on the computer, thinking about PC 80 % of the time can be depressing.

As the song goes, Don't worry, be happy ! You can really control a lot of your worry by just moving on with your life. Spending time loving your wife, maybe a little travel, getting into your work, will make life seem a lot cheerier.

Sorry if I sound like I am preaching a little, but I just wanted wth you my journey so far in PC. I really believe I am a better man because of it.
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,  9 month PSA < .01


compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 2/6/2010 9:40 PM (GMT -6)   

Thanks. There are a whole bunch of excellent responses.

 

Don't forget that all this is new and very raw as I received the pathology report about a week ago. I'm sure I will adjust and life will go on.

 

It will help a great deal if I get a good PSA result on 3/1.

One of my frustrations is merely the fact that every test seems worse than the previous one!

'nuff said.

We had a nice time and enjoyed The Edge of Darkness -- good movie!

 

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%)

 Surgery with Dr. Menon at Ford Hospital,  1/26/10. He says all looked good. Spared nerves. Awaiting pathology report, set for 2/2/10.

Pathology Report: G 4+3 (65%-35%). Cancer in 15% of gland.

Lymph Nodes: Clear

Perineural Invasion: yes. Seminal Vessical Involvement: No

Extraprostatic Extension: yes

Positive Margin: Yes-- focal-- 1 spot .5mm

Final Weight is 52.7 gms

Incontinence: just joined that club-- definite leaks-- my guess is 1 pad during the day -- at night??? First night tonight!

 

 

 


BillyMac
Veteran Member


Date Joined Feb 2008
Total Posts : 1858
   Posted 2/6/2010 10:02 PM (GMT -6)   
Mel,
As I was saying on chat the other day my stats are somewhat similar to yours. PSA 4, biopsy 4+3, 4/10 cores involved, a couple up to 80%, perineural invasion not evident. Post surgery upgraded to 4+4, very extensive tumour within the gland, extensive perineural invasion and nerves could not be spared. Lymph nodes and seminal vesicles clear. Focal extention present (through the capsule) but surgical margins clear. about 6 months following surgery I came across a paper on adjuvent radiation and after some valuable input from Tony (TC-LasVegas) I investigated if there would be any added benefit in me having follow up radiation. Both a respected radiation and medical oncologist said no extra treatment at that stage. Mind you I had over six months of undetecable at the ultrasensitve level by that time. (I also had them check the post op specimen which downgraded Gleason back to 4+3 and specifically graded the cells at the focal extention as grade 3. Statisics say the further a relapse occurs post surgery the more likely it is to be local. Given your stats perhaps you could watch the PSA at the ultrasensitve level for six months and see how it plays out. PSA of .02 then .04 followed by .06 although strictly undetectable, to me would reveal a pattern ( for this reason I have 3-4 monthly checks) and early intervention could be planned rather than pulling the trigger now and perhaps having unnessarsary additional treatment. You will always have that radiation canon in reserve should things not go as planned
Bill


1/05 PSA----2.9 3/06-----3.2 3/07-------4.1 5/07------3.9 All negative DREs
Aged 59 when diagnosed
Biopsy 6/07
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007
Post-op pathology:
Positive for perineural invasion and 1 small focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct 07 <0.1 undetectable
PSA Jan 08 <0.1 undetectable
PSA April 08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August 08 <0.001 undetectable (disregarded due to lab "misreporting")
Post-op pathology rechecked by new lab:
Gleason downgraded to 4+3=7
Focal extension comprised of grade 3 cells
PSA September 08 <0.01 (new lab)
PSA February 09 <0.01
PSA August 09 (2 year mark), <0.01
PSA December 09 <0.01

My Journey: www.yananow.net/Mentors/BillM2.htm


deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 2/9/2010 2:45 PM (GMT -6)   
It seem to be a journey that most of us have take sooner or later i put my off for a while i don't know if i made things worst or not but i was luky so for no real bad complicatons a little discorfort in the bowel dept bt it clear up some when you got you got to still go take a leak about every 2 to 3 hrs I gues this is the stander for us getting better trying to get my strenth backso i can go back to work the doc said he was't free . He always ask me if i'm retire and ask him if he's free yet Lots of luck I'm sure things will turn all right in the long haul. Deerhunter

deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 2/9/2010 2:58 PM (GMT -6)   
You are right about the roller coaster ride but tried to stay positive the information you recieved is overwhelmening at times but just remeber its your life no the docs
Deerhunter

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/9/2010 3:28 PM (GMT -6)   
Brother Michigander Mel-  yeah it sucks alright, I am sure my old words ring a little harder in your memory. This is the jungle, twilight zone etc.  You will likely hate doing the norm of ADT1-3 combo drugs, it has a wide range of influences on men. So, much is unknown for almost any diagnosis as you probably comprehend. The experts cannot be experts, cause they cannot get their hands around proper diagnosis.  Protocols and treatments there are many that are not even so called mainstream. Wonderful world for us to be in.  Keep reading and studying their is an  excellent PCa seminar monthly nearby here and is independantly given, this is not biases and coombye ya stuff, no sales. Contact me if you wish to witness this group.
 
Suggest you get second opinion psa tests done in the near future and compare notes.  You should perhaps wait and see what these tests reveal before jumping into anything so as to know how might this surgery fair out.  Note that Crittenton Hosp. in Rochester, Mi. has walkin testing for anyone at $15 and results mailed to you....seriously consider a drive down sometime.
 
The good news is jerks like me can live atleast 8 +yrs. with fatal looking stats and heavy duty treatments.turn
Youth is wasted on the Young-(W.C. Fields)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/9/2010 3:44 PM (GMT -6)   
Mel, although I have not walked in your shoes with regard to your current case presentation, think about these:

(1) After diagnosis, I (also) felt like I read a ton of info and educated myself very throughly via many different resources. Once I found a doctor I highly trusted, NEVER did I feel that I knew as much as he did. As much as I've read today, I still feel that I only understand things from very much a layman's perspective. There are intricacies that make my case different from the next guy that I don't pretend to understand. Take a good inward-focused assessment on where you are placing your trust.

(2) Give yourself, and your wife, a "cancer-free" day once a week. Don't come to this web site. Don't talk about your cancer. Don't do any reading on it. Six days per week is enough. Your idea of going to the mall, to dinner and a movie were right on-track. Formalize it with her.

Offered for your consideration...
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