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,
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.