1st Uro visit post biopsy

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hm austin
New Member

Date Joined Apr 2010
Total Posts : 6
   Posted 4/23/2010 6:32 PM (GMT -6)   
Greetings, Folks-
Well... Hello!  First Post.
2 days ago, I received the news from my Uro by phone that my biopsy was positive for PCa.  Yesterday, I spent all day trying to catch my breath, and today I spent visiting a bunch of websites to learn more, especially treatment options, of course. I can now rattle off 8 treatment options, with pros and cons. I have also scanned a bunch of threads on this forum that were pertinant to me at this early time. I intend to buy and read a couple of books recommended on this forum.  No doubt a well-informed, caring, and helpful group of folks here. 
My question:  I meet with the Uro next Wed. for initial consultation to go over the biopsy rpt and a bunch of other stuff I am sure. What should I not overlook to bring back from that initial meeting?  I have written down a lot of questions or topics to cover if not addressed in the review.  I just don't want to forget something I don't know yet (huh?!). 
Now, understand I know virtually nothing as compared to what I will know after that meeting.  Here is all I know.  PSA done at the internist was 6, after trending from the 3's to a lower 4, then the jump.  The Uro says Gleason 6, slow growth, early onset. Nothing more - the rest I learn on Wed. Now these nmbrs dont necessarily jive with those spoken here in what seems like a foreign language, a language in which I necessarily will soon become proficient.
So, advice on preparing for the first consultation with the Uro to review biopsy results would be appreciated.
Thank you,
age 55

Veteran Member

Date Joined Jan 2010
Total Posts : 1011
   Posted 4/23/2010 7:03 PM (GMT -6)   
Welcome Hal, sorry that you have to be here, but you have found a good spot for your questions. Others will weight-in. I can only tell you about my boipsy experience and initial meeting with Uro. My biopsy glaeson was (3+4 = 7). My Uro told me about the same thing that yours told you. Slow growing, early onset. He tended to down-play the seriosness of the condition. The problem was that I ended up having a gleason 8, and the 3.5 months that I waited to have surgery was probably ill advised. I don't want to worry that your biopsy was mis-read. Just strongly consider getting a second opinion on the biopsy.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31

Ed C. (Old67)
Veteran Member

Date Joined Jan 2009
Total Posts : 2458
   Posted 4/23/2010 7:55 PM (GMT -6)   
My biopsy showed a very aggressive PCa so I opted for immediate robotic surgery. I'm glas that I took action right away. If you are in Austin (I live in Austin) and if you opt for surgery then you have access to one of the best robotic surgeons in the country.
Age: 67 at Dx on 12/30/08
PSA 9/05 1.15; 8/06 1.45; 12/07 2.41; 8/08 3.9; 11/08 3.5 free PSA 11%
2 cores out of 12 were positive Gleason (4+4) and (4+5)
Negative CT scan and bone scan done on 1/16
Robotic surgery performed 2/9/09 Dr Fagin, Austin TX
Pathology report:
Prostate weighed 57 grams size:5.2 x 5.0 x 4.9 cm
Posterior lateral lesions measuring 1.5 x 1.4 x 1.0 cm showing focal capsular penetration over a distance of 3mm in circumference.
Prostatic adenocarciroma accounts for approx. 10-20% of the hemisphere.
Gleason 4+4
both nerve bundles removed,
pT3a Nx Mx, Negative margins
seminal vesicles clean, lymph nodes: not dissected
continent after 5 months
2 months PSA test 4/7/09 result <0.1
5 months PSA test 7/9/09 result <0.1
8 months PSA test 10/9/09 result <0.1
11 months PSA test 1/21/10 result 0.004
14 months PSA test 4/19/10 result 0.005

Elite Member

Date Joined Oct 2008
Total Posts : 25380
   Posted 4/23/2010 8:45 PM (GMT -6)   
Hal, welcome to our corner of the world.

With your initial stats, the good news is that you have plenty of time to study, learn, and ponder any potential primary treatment. Don't let your doctor push you into some just because. Its even possible, once you see the full results of your biopsy report, that no immediate action is even needed.

Please keep us posted, and when you get more info, set up a signature at the bottom of your posts, makes it easier for people to understand where you are at in your journey.

Good luck

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, next one:  July
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- 27 days, Cath #15 - 26 days, Cath #16 - 4/23 put in

Regular Member

Date Joined Apr 2010
Total Posts : 83
   Posted 4/23/2010 9:12 PM (GMT -6)   

Sounds like you do not need to hurry. I opted for surgery because I thought it had better chances of getting rid of the cancer, and better options if it didn't get rid of it. Glad I did now. Every case is different, so I think that after you study the options and ponder what best suits you, one of them will feel right. Ask the Doctor what happens if your PSA rises after the first tretment and compare options at that point. Keep us posted.
Dx age 62 - March 2009 - Gleason 7
Surgery - da-vinci RP on April 29, 2009 Gleason upgraded to 9
Started VEGAN diet June 2009
3 month PSA - <.04
6 month PSA <.04
9 month PSA .05
12 Month PSA  .16

Veteran Member

Date Joined Jul 2009
Total Posts : 1267
   Posted 4/23/2010 11:21 PM (GMT -6)   
Hey, Hal, bummer news. I remember how freaked out I was when the doctor called --- and he was so calm about it, he just left a message on our answering machine. There's a reason my user name here is "Sleepless.' "Basket Case" would have done as well.

Lots of good advice above, and more will come. However, one critical thing stands at the top: Get Your Slides Re-read. Pathology is an art as well as a science. Two top prostate tissue people can come to different conclusions. If they do, then you go with the worst case in making your treatment plan. If they both agree you are a 3+3 Gleason then you can take the summer to golf and figure out what to do next.

I had my slides re-read and while it didn't make a difference to urgency of treatment, it did make a difference to my treatment decision.

Keep us posted on what you learn.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23 test again less than 0.02
PSA on Jan 8 less than 0.02
PSA on April 9 less than 0.02 

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 4/24/2010 8:23 AM (GMT -6)   
Welcome to the club, sorry you had to join... smilewinkgrin Your experience so far seems to match mine, psa's slowly increasing from 3 to 4 to 5, with a sudden increase to 7.6, antibiotics and recheck to 6.7. I will be interested in hearing what the uro has to say. I can't offer much advice for you now, as the others have covered it good, so be sure to come back and let us know what the discussion was, ok?
James C. Age 63
Gonna Make Myself A Better Man www.youtube.com/watch?v=a6cX61oNsRQ&feature=channel
4/07: PSA 7.6, Recheck after 4 weeks Cipro-6.7
7/07 Biopsy: 3 of 16 PCa, 5% invloved, left lobe, GS3+3=6
9/07: Nerve Sparing open RRP, 110gms, Path Report- Stg. pT2c, 10 gms., margins clear
32 Months: PSA's .04 each test since surgery, ED continues: Bimix- .3ml PRN, Trimix- .15ml PRN

Cajun Jeff
Veteran Member

Date Joined Mar 2009
Total Posts : 4110
   Posted 4/24/2010 8:46 AM (GMT -6)   
Hal, Sorry you are having to be here. Some told you that the G score went up after surgery. Mine was different biopsy was 3+4=7 after surgery it came back 3+3=6. I was one of the lucky ones.

One of the question I whis I had asked my Dr was. "What % of his patients with a 3+3 G score after surgery not no ED problems or should I say Have ED Problems? Same question for Continence.

That is the one questions that I did not ask.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1 pre cancer core
10/08 Nerve-Sparing open radical
Surgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clear

3 month: PSA <0.1
6 month: PSA <0.1
10 month:PSA <0.1
1 year: PSA <0.1
16 month:PSA <0.1

ED - Started Cialis at 3 months, tried all 3, 6 months added pump, 9 months Tried MUSE (YUCK) Bad experience.
1 year mark Found new Urologist visit was at 14th month post surgery
Started Injections, Caverject! (Success)
17 month: ED making improvements : Oral Meds gets me 85%

Veteran Member

Date Joined May 2009
Total Posts : 2691
   Posted 4/24/2010 12:08 PM (GMT -6)   
Be sure to get copies of all your reports as well. The doctor will read and tell you a lot of stuff, but if you get written copies of the report, you can review and study it later when you can think more clearly.

Welcome to HW. We will go with you on your journey.
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

Veteran Member

Date Joined Sep 2009
Total Posts : 663
   Posted 4/24/2010 1:11 PM (GMT -6)   
Best of luck to you.

1. What my background pattern is in the biopsy samples.

2. Number of positive cores and the location of the individual cores

3. Percentage of each positive core

4. Estimated volume of prostate

5. Have a copy of the complete pathology report in your hand when you exit the office, You’ll kick yourself if you don’t. (the report is yours don’t let the office staff keep you from having a copy). If they tell you it is going to take an hour …wait, read a book, change your oil in your car, do what ever, just get the report.

Age 51, PSA 08/31/2009= 6.8, DRE Neg.
Biopsy 9/24/09 =10 of 12 positive. Gleason 6. involving up to 75%
da Vinci at Wash U, Barnes on 11/02/09
Modified Pathology, Gleason 4 + 3 = 7. Gleason 7 present throughout Prostate.  Negative surgical margins
4 of 4 periprostatic Lymph Nodes Negative, 10 of 10 pelvic Lymph Nodes Negative. Seminal Vesicles tumor free. No prostate extension
Post-op PSA 12/10/2009, Undetectable
12/12/2009, Pad Free and Started jogging.

hm austin
New Member

Date Joined Apr 2010
Total Posts : 6
   Posted 4/24/2010 3:12 PM (GMT -6)   
Thanks Folks - this is what I was looking for. I've added more lines of interest to my 1 1/2 pages of notes I am preparing to take to the consultation. I appreciate your insights.
A bit off topic, but relative:  should I advise the Uro at this mtg of my interest in visiting with a Da Vinci surgeon and a Oncology Radiologist (assuming those remain options)?  Do most Uros encourage the patient to get other professional opinions?

Forum Moderator

Date Joined Jan 2010
Total Posts : 6983
   Posted 4/24/2010 8:02 PM (GMT -6)   
HM - Again, a welcome.
If you only have 1 1/2 pages of questions, you need some more. I don't have the link in front of me, but there is a list on another site, also the link is in a post from the past here - look for 'Stan Klein'. I'll check it later and update here.

Also, at the top of this page there is a thread for info. It is a combination of a lot of experience, so we all will want you to read it.

If the Uro does not insist that you talk to each of a DaVinci, open, and radiation oncology specialist, he should have, and you should undertake that on your own. You need all those opinions, knowing that all will suggest their specialty, but at least get success, ED, and incontinence estimates from each, if they were to do what they suggest.

Take a mini recorder with you to each session. If you ask, the docs will likely say sure, no problem. I was amazed how much I missed.

hm austin
New Member

Date Joined Apr 2010
Total Posts : 6
   Posted 4/24/2010 8:59 PM (GMT -6)   
142:    Haha, I hear ya. Did I mention its a legal pad with 2 columns of Q's?  It's been 72 hrs since the notice and I've been all over the web, etc; after that exercise in both basic and detail knowledge, I have found this forum and its wealth of knowledge and reality filling in a lot of the blanks, and for that I thank you all.  I've got 72 more hours to add to that list before the app't.  I see the sticky, but haven't gone there - yet.  I have not used the search function as I should because current posts keep my brain, and gotta admit, emotions at full throttle.  Scratched one Q off - I was gonna bring a recorder and hope he says yes.
To the participants of this forum - your compassion, experiences and love to those of us new to this cancer is so important and is invaluable.  For those of us over 50, 'man-talk' around the campfire rarely includes whats going on with our crotch.  (BTW - spouse perspective, to me, is very important - spouses, keep posting, please).  It's nice to have a place to go where you can be open and honest. We're all in this together...   
Thanks, y'all

Forum Moderator

Date Joined Jan 2010
Total Posts : 6983
   Posted 4/25/2010 2:39 AM (GMT -6)   
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