New dx and brief hello

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PeatyMalts
New Member


Date Joined Feb 2010
Total Posts : 8
   Posted 2/15/2010 1:39 AM (GMT -6)   
Hi All: Just a quick intro for now. Been looking in off and on over the last three years, and now it's time to join in, with a new dx, (which actually is somewhat of a relief.) All the data is in my signature, which I hope I did the right things so that it shows up. I'll give my thoughts about the process, the dx, and my selected treatment a little later when I get some more time.

For now I'll just say Hello.

Steve
Age: 58 at Dx, 1/2010.
PSA 2/07 12.10; 3/07 9.19, 12.23
neg. 13 core bx 3/07.
PSA 7/07 9.31; 12/07 11.59 (0.74 free); 8/08 8.42 (0.56 free)
neg. 13 core bx 9/08 (focal active chronic prostatitis)
PSA 7/09 7.10; 12/09 8.10 (free 0.56)
bx 1/10 1/6 cores pos. on right - Gleason (3+3), 1mm, 3% of core,
no perineural invasion, HGPIN on left.
scheduled for DaVinci 5/10/10.


RickyD
Regular Member


Date Joined Dec 2009
Total Posts : 163
   Posted 2/15/2010 2:17 AM (GMT -6)   
Sorry for the need to be here, but this is a strong family and a source of great comfort and information.
Your stats are close to mine. I to will be having RALP surgery. I hope all goes well with you Steve.
Age 55,  PSA = 4.97 on 11/17/09, DRE negative,
Biopsy 12/2/09: 1 of 12 cores positive with less than 5% volume
Gleason 3 + 3 = 6
Prostate Size Estimate on 12/2/09 = 28 cc
RALP is scheduled for April 7, 2010 at Vanderbilt University MC with Dr. Joseph Smith (over 3000 RALPs)


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 2/15/2010 2:19 AM (GMT -6)   
Welcome to the club that hates to get new members.

Given your stats, you have a very indolent cancer. Let me urge you to learn more and consult a radiation oncologist. Surgery is clearly an option, but seeds might be another. I am a surgery guy, but my younger brother (with stats worse than yours) did seeds and 6 years later is cancer free and, more important, reports no side effects not dealt with by a blue pill.
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
9 mo. PSA 0.00 -- 1 light pad/day ED remains


skeener
Regular Member


Date Joined Dec 2009
Total Posts : 214
   Posted 2/15/2010 6:20 AM (GMT -6)   

Welcome to a great group.  You will find the guys here very helpful in providing info and very supportive.

From your stats, you should be in no rush to decide how to manage your situation.  Take your time and learn as much as possible  before you make any life altering decisions.

Skeener



Age:  63 
Biopsy: May 09 showed 2 of 12 cores positive for prostate cancer -- 1 at 5% and 1 at 25%.  Cancer indicated as non aggressive.  Gleason Score: 3+3.
RRP on Oct 23/09 in London, Ontario.  Excellent surgeon. 
7 Weeks Post Op -  The fears I had about bad things about the operation and recovery did not materialise except of course ED!!.  Otherwise, everything went very smoothly.  Incontinence not a problem.  Wear a pad when out just in case. Pain was never a problem.
Pathology:  Unremarkable 
First followup PSA and Visit: Feb 11/10 - 0.0.
 
Next PSA May
Next doctor's visit in 6 months      


Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 2/15/2010 7:12 AM (GMT -6)   
Steve: Good luck and do keep us posted.

Jeff T
Cajun Country
Jeff T Age 57

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

10th month PSA <0.01
1year psa <0.01
ED- 5 mg Cialis daily, pump daily, going to try MUSE next. Next step injections.
15 months out injections Caveject (success)


60Michael
Veteran Member


Date Joined Jan 2009
Total Posts : 2222
   Posted 2/15/2010 7:32 AM (GMT -6)   
Welcome Steve. You lurked longer than me, about 6 months here. Glad you signed in and keep us posted.
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
Starting IMRT on 1/18/10
Great family and friends
Michael


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 2/15/2010 8:17 AM (GMT -6)   
Hi Steve,

It looks like you’ve had some prostatitis off-and-on for a while which has kept you busy. Unfortunately, your most recent biopsy found some cancer…a very tiny amount of cancer. I guess that if you are going to find prostate cancer (PC), then you want to find it early and you want it to be a very tiny amount, and you want it to be low risk.

The National Comprehensive Cancer Network (NCCN) has created a new definition of prostate cancer patients with “very low risk.” These are the characteristics they use to define “very low risk”:
• having a stage T1a tumor
• having a Gleason score of 6 or below
• having a PSA level below 10 ng/mL
• having fewer than 3 positive biopsy cores (with <50% cancer in each)
• having a PSA density below 0.15 ng/mL per gram.

You didn’t mention your prostate size, but I’m sure that it was determined during your biopsy, using the ultrasound…perhaps you would want to go back over your biopsy/urologist’s records to find this info and calculate your PSA Density results...because when your prostatitis is under control, you do otherwise fit the category of “very low risk.” That’d be a good thing to know.

Here’s a link to the NCCN: http://www.nccn.org/about/news/newsinfo.asp?Newsid=235

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 2/15/2010 9:30 AM (GMT -6)   
Hello and welcome Steve,

Unless you have PC running in your immediate family, father's side ,you definitely are posting a very minimal PC case, with just 1 core att 3%. That is the good news, and it also means you are fortunate enough to have most all treatment methods available to you. Even though you have a surgery scheduled, you still have time to meet with at least a good radiation oncologist to look over other methods including IMRT, Seeding, or both. Depending on your whole picture, you might be a good candidate for AS.

I have both surgery (open) and salvage radiation, and they can be tough paths, but my numbers had dictated my path so far. You are in a unique spot to consider it all, if you haven't done it so far. You definitely got time on your side.

Regardless, its your body and your cancer, and we are here to support you no matter what you decide. Once you execute a primary choice in fighting PC, there is no turning back, and there is no re-do. So all of us have to make the best choice we possibly can.

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, 1/19 - Corr Surgery #4,  Caths #11 and #12 in at the same time, 2/8-Cath #11 out - 21 days


James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4462
   Posted 2/15/2010 10:20 AM (GMT -6)   
Welcome to Hw. Glad you came, hoping you will have an uneventful procedure and easy recovery.
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
32 mts: PSA's: .04 each test since surgery, ED Continues-Bimix .3ml PRN or Trimix .15ml PRN


PeatyMalts
New Member


Date Joined Feb 2010
Total Posts : 8
   Posted 2/15/2010 11:39 PM (GMT -6)   
Hi All: Here are some more details that you have suggested, and some of my thoughts so far.

I know that my biopsy results are about as minimal of PCa you can get, but these are my concerns:

1.my PSA density, at best, is 0.19, not under 0.15,
2.my free/total ratio is 6.9%, both putting me at higher risk.
3.I don't know my family history.
4.there is a 5 mm lesion in the right transition zone, hypovascular on Doppler, targeted on the 2nd bx, and still seen on the third TRUS

Right now, I just want the whole thing out and under a microscope to know what really is there. It scares me to here about some who get significantly upgraded and upstaged on resection. But does it make a difference in survival; I'm not sure yet. I am seeing a radiation oncologist this Friday, and based on your advise, the surgery is scheduled a ways out. I'm open to other opinions, and I have time to decide. If I had had a saturation biopsy with, say, 1 of 40 cores positive, then I would probably be more receptive to considering brachy therapy. But the urologist I saw who does the Da Vinci said he was glad that I had not had one as it makes the dissection around the nerves harder because of scarring.

Here is my frustration. It seems that we are between a rock and a hard place. TRUS can help to see lesions in the peripheral zone. Random transrectal biopsies can miss PCa's in some zones. Doppler helps, but not always. Same with MRI/MRS. It may take several TRUS- guided 12 or 20 core biopsies to make a dx of PCa, but can cause scarring. That risk goes up with saturation biopsies, but no one will treat until there is a dx of PCa.

We are in a position of not knowing whether we have PCa or not. When I first saw my urologist with a PSA over 12, he said specifically, or I got the impression, that I had a 50:50 chance of having PCa. After the second negative 12 core biopsy, he said I had a 25% chance of PCa. He did not seem too concerned after the second negative bx, and wanted to follow the PSA longer. He was not really in favor of doing the third bx, but said that if that turns out negative, then my risk of PCa would be down to 12%, but not zero. I wanted a third bx, but from my point of view if it had turned out negative, I had already decided to go off in search of a saturation biopsy. My PSA's were bouncing all over the place. Let's me guess – was it BPH, prostatitis, or PCa?

This will be my final venting for now. How can we make an intelligent decision? We can ask the urologists, radiation oncologists and medical oncologists what the odds are, but they are limited by the same medical studies. There are no studies that address my situation, with one positive core on a third random bx, with high PSA density and very low free PSA, randomized to surgery or brachy therapy, and followed for at least 20 years. That's my goal – 20 year + survival, not 5 or 10.

Help me out here. Am I off base? I don't think anyone can tell me now what I actually have, or what my expectations are with either treatment. That's why I want it out and in the bucket. But having said that, with my consult with a radiation oncologist of Friday, I will try very hard to step back, ask questions and listen.

I will stop, and promise to listen and keep an open mind, for now. I still have lots of time, as you have taught me, and want to avoid the approach of “ I've made up my mind, don't confuse my with the facts.”

Thanks for listening,

Steve
Age: 58 at Dx, 1/2010.
PSA 2/07 12.10; 3/07 9.19, 12.23; prostate 37 ml on TRUS
neg. 13 core bx 3/07.
PSA 7/07 9.31; 12/07 11.59 (0.74 free); 8/08 8.42 (0.56 free)
neg. 13 core bx 9/08 (focal active chronic prostatitis)
PSA 7/09 7.10; 12/09 8.10 (free 0.56)
bx 1/10 1/6 cores pos. on right - Gleason (3+3), 1mm, 3% of core,
no perineural invasion, HGPIN on left.
scheduled for DaVinci 5/10/10.


worried-wife
New Member


Date Joined Feb 2010
Total Posts : 14
   Posted 2/16/2010 8:11 PM (GMT -6)   
Steve,

I totally understand where you are coming from, my husband is in a similar sitution as you. He had a biopsy done the beginning of January which was read by 2 different labs, the first lab called 1 core out of 12 suspicious and the 2nd lab (Hopkins) reported the 1 core cancer less than 1mm which also showed HGPIN. He's uro suggested to have another biopsy performed in April. We are going for a second opinion on March 11th to see if they agree with performing another biopsy.

Good luck with your research and decision.

Angela

PeatyMalts
New Member


Date Joined Feb 2010
Total Posts : 8
   Posted 2/17/2010 9:29 PM (GMT -6)   
Angela,

Thanks. It was a shock when my third biopsy was positive, but sort of a relief as I can now move on to seek some treatment. Looking back, I wish my urologist, or myself, had been more aggressive, like seeking additional imaging like MRI to help target the biopsies, and not wait so long between biopsies. It was a long three years with PSAs going up and down, and not knowing.

Good luck to you guys.

Steve
Age: 58 at Dx, 1/2010.
PSA 2/07 12.10; 3/07 9.19, 12.23; prostate 37 ml on TRUS
neg. 13 core bx 3/07.
PSA 7/07 9.31; 12/07 11.59 (0.74 free); 8/08 8.42 (0.56 free)
neg. 13 core bx 9/08 (focal active chronic prostatitis)
PSA 7/09 7.10; 12/09 8.10 (free 0.56)
bx 1/10 1/6 cores pos. on right - Gleason (3+3), 1mm, 3% of core,
no perineural invasion, HGPIN on left.
scheduled for DaVinci 5/10/10.

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