Just diagnosed with PC

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RayPat
Regular Member


Date Joined Apr 2010
Total Posts : 104
   Posted 4/7/2010 4:11 PM (GMT -6)   
I'm 63 years old. Have had a problem with frequent urination for over five years progressively getting worse.
On Jan 26 my primary care doc did blood work and PSA was 9.
She referred me to a urologist. DRE was normal. He did blood work and PSA was 11. (different lab)
This was on Feb 25. He scheduled a biopsy for March 26.
Today I met with him and he said I do have PC.
Gleason score was 6 (3+3). He said he did 14 samples and cancer was present in 3 all on the right side.
He said it is stage one and that if my PSA was under 4 he might advise watching and waiting but
because of my PSA he is advising treatment.
We're to meet again next week to discuss treatment.
He told me several times not to worry that I have very little cancer.
Can anyone advise me on what questions I should ask him?
Or on which treatment I should select. His choices to consider were removal of prostate, external beam radiation or seed implantation.
One thing I wonder is if the cancer is as small as he says and my prostate isn't enlarged why am I having a problem with frequent urination? Can't help but wonder if something else is at work that would elevate my PSA though he did a urine analysis an no infection was found. Does PC cause frequent urination if the prostate isn't enlarged?

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 4/7/2010 4:35 PM (GMT -6)   
Welcome to Healingwell RayPat...sorry you had to join our little corner of the world. Frequent urination can be a symptom, but not necessarily caused by PCa. I was having trouble with frequency probably 10 years before my diagnosis and had no infection. However, I did go the surgery route and I still have some frequency today. So I think that there can be other causes beside PCa for frequent urination.

Based on your story, you do have some time to look at all the possibilities for treatment, but first and foremost, I would have a second reading of your biopsy slides for a second opinion by a leading prostate pathologist. Most folks here will recommend someone from many of the leading cancer centers around the country.

Again welcome and there are many folks here very knowledgable that can guide you much better than I can.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08
                 12 month Oct 2009 .09 


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 4/7/2010 4:46 PM (GMT -6)   
Sorry to hear the news of your diagnosis.  You are likely to get a lot of good advice here.  Sometimes your prostate can push up against your urethra, causing urinary symptoms, even if your prostate is not particularly large.  There are also some bladder issues that can cause urinary symptoms, which have nothing to do with the prostate.  In terms of questions to ask -- I would first get a copy of your biopsy report, so you can see some of the detail.  Then I would ask the urologist to arrange for a second opinion reading of the biopsy slides, by a pathologist who has expertise in prostate pathology.  Gleason scoring is important, but it is not so easy.  Before you use your Gleason score to make treatment decisions, you want to make as sure as possible that it is right.  Experts you might consider include  Professor Helmut Bonkhoff www.prostapath.de  (don't worry about the fact that he is in Germany -- that is no impediment -- he is accustomed to working with overseas docs and patients);  Jon Oppenheimer (www.ourlab.net) ;  David Bostwick  https://www.bostwicklaboratories.com/patientservices/primary.html; or Jon Epstein at Johns Hopkins.   You might also ask your doctor whether he sees any value in getting a PX+ test by Aureon.  This is a relatively new test that purports to evaluate the agressiveness of prostate cancer.   If you are considering this urlogist as a surgeon, ask him whether he does open or laproscopic surgery, and how many times he has done each.  If you are going to go the surgery route, you want someone who has done at least hundreds of them.  This is one type of surgery where experience really matters, in terms of outcome.   I would also suggest you ask him for the name of the best radiation oncologist he knows -- preferably not one affiliated with his institution.  You can talk with that person about the radiation options, which, as you point out, would include external beam radiation (these days, mostly IMRT), or seeds, or sometimes both of those.  Urologists (who are surgeons) and radiation oncologists often have different perspectives -- so it is worth hearing from both of them before you make a treatment decision.  You might want to read a book or two about prostate cancer too.  There are dozens of books.  The one I like best is Steven Strum's "Empowered Patient's Guide."   Strum is a leading expert on prostate cancer, and you can get a terrific education by reading this book.  It would also give you good ideas for questions to ask your doctor.    Best wishes, Medved
Age 45.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.6
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/7/2010 4:52 PM (GMT -6)   
LV-TX right on get the pathology reviewed by guys like Bostwick, OppenHeimer or Esptein and get the copy in your hands, find out here or other wise, what it all means (important stuff).

Go see PCa oncologist (drug doc but hopefully one that specializes in PCa) just for his opinion and also ask him about the various treatments and why one may be better for you than another, maybe tape the conversation and review those details. If you have good insurance will pay for mulitple opinions, I got 8 of them all convered by Big Blue...what a learning experience..you cannot learn such from a book. It is enlightening to say the least to hear opinions from mutliple protocol angles and ask some tough questions in the process, maybe you will detect truth from wishful agenda or thinking, etc. Careful of the doc with a guarantee cured program..that verbage should not even exist, a wise doc would never say it as such.


Youth is wasted on the Young-(W.C. Fields)


142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6983
   Posted 4/7/2010 5:03 PM (GMT -6)   
Questions for the doctor - here is a link to a list online - I was given the same printed out before I knew about HW. It is a pdf file, so you can download and print it.

http://www.yananow.net/questions.pdf

Some of them seem pretty simplistic, and others will be answered as you talk in general, but if you don't have a list, and check them off, you WILL forget. I took a small memo recorder and taped the session with each doctor. None of them was the least offended that I asked - no one can take notes well enough during a discussion of this magnitude.

Welcome.
I can't help with the questions on pre-surgery issues, as I had no symptoms until the PSA and followup DRE, both absymal, followed by a worse biopsy, then off to see the robot.

RayPat
Regular Member


Date Joined Apr 2010
Total Posts : 104
   Posted 4/7/2010 5:32 PM (GMT -6)   
Thanks to all for the replies.
My urologist did mention getting a second opinion.
He is a surgeon but said I should talk to a radiologist and he said all three treatments should be effective.
"142" the link you gave had some great questions that I'd have never thought of.
I've got a lot to think about before deciding which course of treatment to pursue.
Still kind of in shock but not really too worried at this point.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4237
   Posted 4/7/2010 6:44 PM (GMT -6)   
Ray,
You stats indicate you are borderline for watchful waiting. Using PSA density would give your a better idea or have your doctor download PC tools from the Prostate Cancer Research Institute website and plug in your numbers to find out your tumor volume.
Any local treatments should give similar results. I would have your doc looks closely at your uniary problems as this could influence your treatment options. Radiation could make any urinary issues worse if it is caused by anything other than a large prostate. Frequency is a much less issue than any constrictions.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/7/2010 7:01 PM (GMT -6)   
Raypat:

You mentioned 3 positive cores, do you recall the % of cancer found in each one? Should be in the biopsy report.

Welcome, too, we are here for you and your husband, fire aways all your questions.

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, no problem post SRT
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  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


RayPat
Regular Member


Date Joined Apr 2010
Total Posts : 104
   Posted 4/7/2010 7:44 PM (GMT -6)   
Purgatory, I don't have a husband since I'm a guy. LOL
From the pathologist report it says....

"The neoplasm involves one of six biopsy cores comprising 7mm out of 61mm for approximately 11% of the submitted tissue. Immunohistochemistry with high molecular weight cytokeratin K903 revealed an absence of basal cell layers around gland within the neoplastic appearing support of malignancy."

I have no idea what that means but it was referenced from the Prostate right biosy that said "moderately differentiated adenocarcinama (gleasons grade 3-3)"
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