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YaYa Princess
New Member


Date Joined Apr 2010
Total Posts : 11
   Posted 4/16/2010 10:52 PM (GMT -6)   
I have been reading this forum since the first of March when my hubby was diagnosed. I have gained a lot of knowledge from this website and seek advice on our journey. After receiving biopsy results, urologist options were surgery or radiation. He recommended surgery (too young and too healthy for radiation). Referred to dr (2 hrs away). He recommended robotic surgery within 6 mos. After visit with first dr, thinking about having surgery end of July. Referred to dr (4 hrs away) for second opinion. His recommendation was Watchful Waiting, check PSA in June and again in Oct and repeat biopsy next Feb. If PSA rises to 4, repeat biopsy earlier. After visit with second dr, the ww sounds better than surgery so that is the plan right now.
 
age at dx 59; PSA 9/08 .91, PSA 12/09 1.96, prescribed Cipro, PSA 2/10 1.91, 22% free; Biopsy x 6: 2/25/10, Prostatic Adenocarcinoma, GL 3+3=6, R Mid <5%, L Base 20%, L Mid rare atypical glands

Im_Patient
Veteran Member


Date Joined Aug 2009
Total Posts : 670
   Posted 4/17/2010 12:57 AM (GMT -6)   
YaYa, it sounds like your hubby is a decent candidate for watchful waiting. Having been through all of this, with his stats, I would have watched and waited. I'm voting with doc #2 as well.
Best Regards, Jeff
Gleason, 3+4; PSA, 7.9
Robotic Prostatectomy, March 2008 (Age 48 then), nerves both sides spared, post surgery analysis confirmed 3+4 Gleason,
pT2c, prostate 60.2g, margins: negative; perineural invasion: present; lymphatic invasion: present; 3 lymph nodes removed, clear; seminal vesicle invasion: absent; Gleason 4 comprises 5-10% of carcinoma
PSA consistently <0.1 since surgery until Oct 09, 0.1; retested Oct 09, <0.1,
Jan 10, 0.2
retest Feb 1 confirmed 0.2
CT scan, bone scan Feb 10 both clear
Mar 1, PSA 0.17; April 1, PSA 0.17


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/17/2010 6:22 AM (GMT -6)   
Ya, I too am surprised that your husband was sent for a biopsy with his PSA numbers but it looks like the doctor knew something.

The only reason I would consider treatment at this point is the fact that the biopsy found PCa in both the left and right portions of the gland, with the larger piece at the base which is close to other parts. The largest core on my husband's biopsy was 30% of a Gleason 3+3 (his was all confined to the left side) and turned out to be extraprostectic extension on his surgical pathology report with an upgrade to Gleason 3+4. Not saying this to scare you just to illustrate how inconclusive a biopsy can be.

With all that said, at this point I would tend to agree with doctor #2...
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA: 0.0 til July 2009. August 2009 - 0.1, September 0.3, October back to 0.0, December 0.0, March 2010 0.0. Next PSA in 6 months. Thank you God!


Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 4/17/2010 6:48 AM (GMT -6)   
Yaya,

Count me among those that counsel in favor of another opinion and the prospect of AS or WW.

With your husbands numbers I would have most certainly given strong credence in selecting that path in the beginning.

Sonny
60 years old when diagnosed
PSA 11/07 3.0
PSA 5/09 6.4
Diagnosis confirmed July 9, 2009
12 Needle Biopsy = 9 clear , 3 postive
Gleason Score (3+4) 7 in all positive cores
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5%
positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy

2/24/10 FIRST POST RAD PSA 1.0---CARRRP --waiting for the next test.
3/22/10 Second Post RAD PSA 1.5 Dammmmnnn stubborn son of a gun


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 4/17/2010 7:10 AM (GMT -6)   

Dear YaYa:

Active Surveillance (aka watchful waiting) certainly seems like the prudent course of action to me.

Tudpock


Age 62, Gleason 3 + 4 = 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 4/10/10.  6 month PSA 1.4 and now 1 year PSA at 1.0.  My docs are "delighted"!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/17/2010 9:02 AM (GMT -6)   
YaYA, not to sound like a bleating sheep, but I join the same flock here too:

If anyone had the stats for safely starting WW or AS, it's your husband, you guys and the dr. can keep a close eye on things while he can continue to function normal for as long as he can, even perhaps forever. Dozens and dozens of us only wished we had had the options, but didnt have the stats to do so safely.

Good luck and keep us posted.

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, 4/8 .04
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


Sharp18
Regular Member


Date Joined Mar 2010
Total Posts : 78
   Posted 4/17/2010 1:28 PM (GMT -6)   
It probably would not be a bad idea to have a 2nd pathology opinion...

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 4/17/2010 2:18 PM (GMT -6)   
I would only add that because of the low PSA and the mulitple locations, that a color doppler or some other test that can show exact locations and extent of tumors might not be a bad interim step.

To find three locations with 6 probes, is some indication that something is fairly widespread. Too many times the Gleason is upgraded after surgery because the biopsy did not hit best sample spot.

Overall tho, I would agree that you don't need to be in a hurry on this.

Welcome to HW, and good luck to both of you.
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
1 year psa (364 days) .01


YaYa Princess
New Member


Date Joined Apr 2010
Total Posts : 11
   Posted 4/25/2010 10:02 PM (GMT -6)   
Thanks everyone for your opinions. He seems okay with watchful waiting but I am still a little anxious about it. The next PSA will be in June. I will post our progress and PSA results. This site is a great support for me, thanks to each of you for sharing.
 
 
age at dx 59; PSA 9/08 .91, PSA 12/09 1.96, prescribed Cipro, PSA 2/10 1.91, 22% free; Biopsy x 6: 2/25/10, Prostatic Adenocarcinoma, GL 3+3=6, R Mid <5%, L Base 20%, L Mid rare atypical glands

Post Edited (YaYa Princess) : 4/25/2010 9:06:00 PM (GMT-6)


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 4/25/2010 10:19 PM (GMT -6)   
Hi YaYa,
 
You may not wish to hear this, but I received several opinions.    You may wish to get 3-4 opinions.
 
There are ways you can do this and not spend too much money.  You may have friends or friends of friends who are experienced with PCa diagnosis and treatment.  You already have enough information to ask those friends what they think about your plans in general.
 
The one problem with any positive diagnosis of finding cancer is that you know for a certainty that you have cancer inside of you.    That is both scary and creepy to some.   It was to me and I wanted it out or dead!
 
Due to my age, I chose surgery.   Any treatment or non-treatment path forward has risks and benefits.   Your hubby does not need treatment immediately, so you do have some time to ask around.
 
Find out more about the pros and cons about deferring or having treatment.
 
Maybe that'll help.
 
Barry
Surgery: Da Vinci; July 31, 2007; 54 on surgery day;
Pathology: PSA: 4.3; Gleason: 3+3=6; T2a; Confined to Prostate;
Post RP PSAs: 09/'07 <0.04; 12/'07 <0.04; 03/'08 <0.04;
06/'08 <0.04; 12/'08 <0.04; 06/'09 =0.06; 09/'09 <0.04; 12/'09 =0.05;
Latest PSA 3/'10 <0.04


Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3742
   Posted 4/26/2010 5:58 AM (GMT -6)   
Yaya,
You didn't mention if the DRE was positive or if hubby has been having any other symptoms. I will assume the answer to both is "no".
If you select Watchful Waiting rename it to "Active Preparation". Don't spend these next 6 months on the couch. Educate yourselves, eat right and get your bodies in shape. Do kegels, run, walk, crunches, light weights... anything you can do to improve muscles, pelvic floor, aerobic capacity and lose excess weight.
Start today. It will never be easier. If in 6 months the PSA is still 1.9 or lower you both be ready to enjoy a new life.
Oh, and empty that prostate - often. Tell him I said so! In the words of Joni Mitchell: "Don't it always seem to go that you don't know what you've got 'til it's gone."
Good luck to both of you.
Jeff
Married 34 years, DX Age 56. First routine PSA test on April 8, 09: 17.8. Start 2 weeks of Cipro to rule out protatitis. May '09 PSA: 22.6, 3 weeks later: PSA: 23.2.
Biopsy 6/10/09: 7/12 scores positive, 20%-70%, Gleason 6=3+3. Bone and C/T scans neg.
RP DaVinci -7/21/2009 @ Univ of Roch Medical Center
Left nerve gone, right partial spared.
Catheter removed - 7/31/2009 Pathology report received:
Gleason 3+4=7, Tumor size: 2.5 x 1.8 cm, location: both lobes and apex.
Extraprostatic extension present; Perineural invasion: present, extensive.
No Malignancy in Seminal Vesicle, vasa deferentia, lymph nodes 0/13
Prostate mass 56 grams. Pathologic Stage: pT3aN0MX
Post Surgery Status:
Potency - 12/11 5 months, Still no activity, zip. Using pump daily since 11/11. No effect with 20 mg of Cialis or 100 mg of Viagra. Shots next See Uro 1/22/10 Trimix #1. Try 0.08- 25%, 0.12-25%, 2/26/10 try 0.16 First Success! 90%.
Incontinence - 8/20 4 full pads per day
.. 9/7 3-4 full pads per day (Try cutting down on fluids. Bad idea. I know.)
12/11/09 5 months: 3 pads per day, 400-450ml/day
02/26/10 7 months: 3 pads but leak is now 320 ml (5 day avg.)
03/22/10 8 months: 3 pads per day, 280 ml/day (5 day avg.) PT says all muscles are tight and working properly. There must be another issue. Uro mtg 4/23. Did I waste 6 months?
Post Surgery PSA - 9/3 6 weeks - 0.05; 10/13 3 months - 0.04, 1/14 6 months - 0.05.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 4/26/2010 11:42 AM (GMT -6)   
There are risks in any decision and certaintly risks in any treatment and no 100% garentees.
The largest risk in AS is underestimating the initial biopsy results, this is why it is imperative to get another biopsy or a color doppler ultrasound within 6 months.
If it truely a G6 then there is a 70% chance that it will not progress. This is well documented by studies from Hopkins and Klotz. If it does progress to a G7 or if psa doubling time is less than 3 years then treatment should be given and the results are exactly the same as if treatment was given immediately. This is also well documented. Progression, if it occurs, almost always happens within 3 or 4 years.
These are simply the facts, but are often overridden by emotion, as 25% of those on AS choose treatment without any signs of progression.
The treatment success in a G6 is in the high 90% regardless of the treatment chosen. The chance of permenant side affects are well over 50%. You have to do your own risk benefit analysis, but the risks of AS seem very favorable especially when you consider that 60% of men your husband's age have some sort of PC and only 4% actually die of it and these are almost always those with G8 or G9 cancers.
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


YaYa Princess
New Member


Date Joined Apr 2010
Total Posts : 11
   Posted 4/28/2010 9:48 PM (GMT -6)   
I need correct the number of biopsy samples taken, it was 12 instead of 6, 2 in each section. His DRE was negative and he was not having problems at the time of his checkup. In the past he has had problems with many kidney stones. Dr Shah (Atlanta) said his odds of dying at age 80 with prostate cancer were 1 in 10. We'll know about the PSA in June. Thanks for your support.
 
 
age at dx 59; PSA 9/08 .91, PSA 12/09 1.96, prescribed Cipro, PSA 2/10 1.91, 22% free; Biopsy x 12: 2/25/10, Prostatic Adenocarcinoma, GL 3+3=6, R Mid <5%, L Base 20%, L Mid rare atypical glands
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