Decision point for Radical Prostetectomy

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

Retire1965
Regular Member


Date Joined Jul 2010
Total Posts : 38
   Posted 7/20/2010 7:07 PM (GMT -6)   
Folks:
 
I am a recent addition to the forum.
 
I was diagnosed with PCA in October of last year.  My stats are below.  I recently consulted with a surgeon and oncologist (again).  My two options of choice would be active surveillance with curative intent or RP.  I basically have made the decision to get an RP in September.  I was wondering how my peers felt about the decision?  Do you think my decision was clear?
 
I lasted only six months on AS.
 
Retire1965
 
Age 44
Summer 2009, bout of prostatitus
October 2009 psa 11.8
November 2009 psa 9.5, free psa 7%
November 2009 12 core biopsy finds one core of gleason 6 (5% of core)
Chose active surveillance to rule out continuing infection
January 2010 psa 10
May 2010 psa 15
June 2010 psa 6.3
Scheduling RP for September
 
 
 

Post Edited (Retire1965) : 7/20/2010 6:12:50 PM (GMT-6)


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/20/2010 7:39 PM (GMT -6)   
hello and welcome to hw, retire

your stats are interesting. your young age is the most alarming part of the equation in my opinion. we have several other men in their early to mid 40s.
your free psa is definitely at the cancer suspect level and your biopsy found a single core, pretty low grade and low %. Because it was only a 12 core, and i assume it was your first and only biopsy so far, it is possible that there is more cancer than a 12 core is finding. it took 3 biopsies to find the heart of my cancer this time around. 2 diff 12 core ones missed it.

based on your numbers, it would still seem safe to extend a period of AS, and unless you have other health maladies to factor, you would be wide open for a primary treatment, including, but not limited to radiation, radiation by seeding, open or robotic surgery, etc.

at your young age, and not sure if you are married/kids, etc, the quality of life issues that come with surgery need to be strongly considered. obviously, once your prostate is removed in surgery, you will indeed be sterile, and your sex life, thought it can come back for most men over time - or with the aids of drugs/or/inkectibles - will never ever be the same after surgery. and of course, you have to consider the risk of long term incontinence, though most men here have gone dry after a reasonable period of time.

we are here for you, regardless of what you choose to do. good luck, and keep reporting back in with us.

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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19


cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 7/20/2010 9:33 PM (GMT -6)   
Doesn't anyone think that prostatitis could be driving psa fluctuations.  From May to June it dropped more than half! Prostatitis also affects free psa.I've read alot men have some cancer in their prostate after a certain age, and if biopsied Dr might find it,but doesn't necessarily need to be treated!!  RP seems extreme!!

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 7/20/2010 9:42 PM (GMT -6)   
Based on percentage of core, and number of cores, I would say that you have plenty of time. The high PSA is what causes me some concern.

I would think further testing would be in order. Color Doppler would certainly be a helpful diagnostic tool I would think.
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


Drums
Regular Member


Date Joined Mar 2010
Total Posts : 134
   Posted 7/20/2010 9:46 PM (GMT -6)   
Prostatitis might be present, but I think the core biopsy is pretty conclusive. Taking an active measure of some sort would seem justified to me, but that's my inclination, especially given your age.
Bill
Age 52 at diagnosis, father died of PCa
 
PSA: 10/16/09 - 2.8; 1/11/10 - 3.8
Biopsy 11/25/09, 11 core samples - HG PIN on right side
Biopsy 2/17/10, 11 core samples - left side, adenocarcinoma, Gleason 6, one core at 5%
Notified of dx on 3/12/10 (27th wedding anniversary) via phone by the nurse! (dropped this Uro!)
MRI 3/17/10 and bone scan, 3/23/10, indicate: gland volume is 27mL, PCa is confined to prostate, seminal vesicles and vas deferens are unremarkable.
 
RALP conducted 19 May 2010 by Dr. Lee at U. Penn Presbyterian
Pathology report on 10 Jun 2010: Gleason 6; gland involvement by carcinoma < 2%; tumor in peripheral zone on BOTH sides; no capsular, extracapsular extension, lymph node, or seminal vesical involvement; and no positive margins.
 
Incontinence: first four days after catheter removal - only1-3 pads/day (but urethra was inflammed); 2d week (after inflammation) - 8-10 pads/day (sometimes more!); 3d week - 4-6 pads; 4th and 5th weeks - 3-4 pads; 6th week down to 2 pads. Of course, all this depends on how much I stand and it gets worse later in the day.
 
ED: started the pump the 4th week after the catheter removal. Four sets, twice a day per instructions. Not as fun as it sounded.


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6075
   Posted 7/20/2010 10:08 PM (GMT -6)   
Cooper , I agree with you on the prostatitus driving the psa flux. But the cancer is still there and surgery at this point may be extreme, but that is arguable. If the biopsy is not done by an expert in prostate cancer, every one should get them reread by the experts. At least you have a " better " idea of what you are dealing with.
age 67 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of Washington Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci, extensive PNI, That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 7/21/2010 7:14 AM (GMT -6)   
What concerns me most is your free PSA in November 2009 - 7.5% which is awfully low. Your post indicates that your options were active surveillance with curative intent - if this is what your doctor said, he told a fib as AS does not provide a cure. It simply means that you watch the situation through regular exams (DREs, biopsies and PSA tests) to see if the disease is stable or progressing.

If surgery is what you are comfortable with, then congratulations on this decision. I imagine that AS, for some men, is just too stressful (I suspect this would be the case if my husband chose AS).

As an aside about AS, I find it interesting that it was mentioned as an option for my hubby...since surgery was his treatment of choice we didn't have to agonize over the decision. But, had he chosen AS, I'm not so sure what the outcome would have been down the road since his surgical path report showed that he was a stage IIIa with extraprostetic extension. Of course, with a Gleason 3+4, I suspect the urologist wouldn't have been comfortable with AS in my husband's case even though his PSA was not that high (6.4) and the # of positive cores was two out of ten.
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!


cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 7/21/2010 7:56 AM (GMT -6)   
This quote makes me think the medical community is over treating some men!!!!! I have read this quite a few places.I don't quite understand why people seem to think a biopsy if negative should be followed by another and sometimes even more! Especially when psa is lower than 10! Wonder if the Dr just happens to find the needle in the haystack so to speak ,its very hard not to treat when a person hears cancer!!! Would someone explain this phenomenon!!              Quote "PSA picks up any prostate activity, not just cancer. Inflammation and other factors can elevate PSA levels. If the levels are elevated, the man is usually sent for a biopsy. The problem is that, as men age, they often develop microscopic cancers in the prostate that are clinically insignificant. If it weren't for the biopsy, these clinically insignificant cancers, which would never develop into fatal prostate cancer, would never be seen.”

profman
Regular Member


Date Joined Jan 2010
Total Posts : 55
   Posted 7/21/2010 8:32 AM (GMT -6)   
That's a good point, but the problem is that today there is not a good test to determine if someone's cancer is indolent (will grow slowly, not spread, not convert to a higher Gleason score) or if the cancer is aggressive. That is not to say in 5 years such tests won't be available, but today it is difficult to make that determination. As Zufus has often indicated, there are many tests which are not routinely done to classify one's PCa, but even with all that information it is still a guessing game.
Diagnosed 9/4/09, age 59
PSA 3.5, up from 1.8 year before
First biopsy showed 3/10 positive cores, Gleason 3+3, less than 10% involvement in all three cores, diagnosed as T2a; prostate size estimated at 32 gram
Thinking of Active Surveillance but
Second biopsy showed 5/10 positive cores, Gleason 3+3, left side (4 postitive cores) had 40% involvement
RRP on 12/15/09, home 12/16
Catheter out on 12/29/09 (failed cystogram earlier)
Path report was all good news, Gleason 3+3, no margin involvement, no perineural involvement, everything clean other than core of prostate, tumor on both sides, but more prevalent on left side, 5% involvement, 42 gram organ
Within two days down to one pad a day, pad free at six weeks
Back to work 1/4/10
First PSA 1/28/10 - nondetectable (<0.1)
Second PSA June 2, 2010 - nondetectable (<0.1)
Next PSA 12/16/10
ED present, although at times there is improvement with daily pump and 100 mg Viagra (or 20 mg Levitra)


geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 7/21/2010 9:02 AM (GMT -6)   
First of all, we are not here to judge your decision, but we will encourage you to consider all of your options. Given your stats you have lots of time to learn. That said, I think that the other members here have raised enough questions that you should be looking for a second and even third opinion. The side effects of surgery can be profound and life long. At your age you want to think about the future quality of your life especially in terms of sexual function. Surgery may still be the right choice for you, but it should be based on as much information as you can get.

Whatever you decide, know that we are here to help.
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
12 mo. PSA 0.00 -- still one light pad and ED


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 7/21/2010 9:25 AM (GMT -6)   
I first need to ask you where you live? The reason I'm doing so because of your stats I believe you'd be a prime candidate for the treatment I had which was Targeted Focal Therapy a clinical study. I had it done ion the Denver area you can see my initial stats below . Also included with such treatment prior is a saturated 3D mapping biopsy which will specifically locate and determine the extent of your PCa.

I understand somewhat those who feel paranoid doing AS but the possible lower quality of live side effects would outweigh that for me. You're a young man who may not only face incontinence problems, but will never have a normal sex life again postop.. If you're married that can have dire consequences for a relationship. I'm not trying to scare you away from treatment or to mine but make sure you realize what you are opting for when your stats for indicate there's no rush here. There are no do overs after any radical treatment, you live with the results the rest of your life. Which in your case may well last 40+ years.

The elevated PSA readings is a concern but I too suspect your prostatitus may be the cause there and would find out for sure before I'd do radical surgery. It is trending downward. Good luck with whatever you decide
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy
 
2/16/10 12 of 12 Negative Biopsy 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 7/21/2010 9:34 AM (GMT -6)   
cooper:

first, don't get mad at the doctor for finding the cancer, no point shooting the messenger. i have male friends, that refuse to go to the dr, will not have exams or tests of any sorts, let alone psa screenings, why? because when push comes to shove, they don't want to know if anything is wrong. since they are my friends I will say this: they are fools, and are in deep denial. in my own case: was having dre/psa every year since i turned 50, dre always negative, no known psa in either side of family, no prostate problems or issues, just a steadily rising psa each year. hit and passed the 4.0 threshold in 2007. My GP did the standard thing, sent me to urologist for biopsy. had a 12 core biopsy - no cancer, but some PIN found. should have been a happy ending. next year exam, PSA had more than tripled. dre - clean, still no prostate problems - new 12 core biopsy, no cancer found, but lots of HGPIN found. I was content to wait another year, but my very experienced uro was not convinced, said he saw shadows on the left side of prostate, beggd me against my personal thinking to have another biopsy done in 6 weeks or so. reluctently agreed. this time, only did 7 cores, which he guided into the shadows area. bingo: 7 out of 7 cores positive, with gleason 7 4+3 PC, and all cores high percentage.

morale of the story: screening finds cancer and can save lives. i will always be thankful that i had a dr that was smart enough and experienced enough to know that something was really wrong, when on the surface it seemed ok. i am thankful too. there is no telling how much and how dangerous my cancer would have been if i had blown off the 3rd biopsy. that was my gut feeling, and i would have been dead wrong.

if you have PC, then be mad at the PC, not the tests, or procedures, or the doctors involved. its a waste of energy. i hate my cancer with a passion, every day of my life has been affected by it for nearly 2 years now, but i love and respect all those professionals that are doing their best to help me along the way.

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: Aug 3
Latest:  7/9 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 - 17 days, Total Blockage, Cath # 20 - 7/19


SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 7/21/2010 11:02 AM (GMT -6)   
The PSA level would alarm me, the biopsy showing one of the 12 being postive, and say its at an a early stage take your time with your decision of treatment I disagree (my two cents),  u can see some very recent posts where they had one shot postive go into surgery and post path's being Stage t3...You have time but explore the options that are out there....
 
My opinion being diagnosed at an early age like myself surgery looks like the way to go, the side effects are there and very real my opinion is these are the cards we are dealt with and to make the best of it.
 
Good Luck!!!
Age Dx 37, 7/2008, First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008, Biopsy: 6 out 12 Postive all on right side, Gleason 7 (3+4). Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008, Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008, PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
6 Post OP PSA's from 9/2008 to 6/2010: <0.1
 
 
 


cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 7/21/2010 4:54 PM (GMT -6)   
I wonder why there is not much said about color doppler especially if done by the experts [Dr Lee] being one of them! My husband had color doppler done by Dr Lee [careful scanning of the prostate as he put it in the report] biopsies can be much more targeted with doppler also. He saw no suspicious areas to biopsy Dr Lee in my husbands case is thinking prostatitis and we'll go from there! We would have traveled wherever to have this added assurance. I'm not saying no one has prostate cancer BUT I wonder if every man had a biopsy how much cancer would be found!! I guess in my research and its been plenty [crash course,internet,all the recommended books] I would not jump to any conclusions to quick! We did jump to conclusions when our regular Dr had my husband go for gray scale ultrasound after psa of 5 then a year later 7, and 3 hypoechoic areas were seen and Dr Lee didn't see any, just one soft area that is most likely prostatitis. Yet family Dr said probably prostate cancer,get biopsy and look into da vinci. Now if by chance biopsy would have shown cancer we would be going down an entirely different road! I guess what I'm saying is check and recheck anything Dr's tell you and do your best to see the real experts if possible! My husband only waited a week for the appointment with Dr Lee and he is only in the office 1 day a week. It was an entirely different experience and we were told very different things between our family Dr & the urologist he recommended and Dr Lee who, has spent his life involved with prostate cancer! This is just our experience for what its worth!!!

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 7/21/2010 6:18 PM (GMT -6)   
cooper,
I echo what you said about Dr Lee. I had the reverse experience when he found a great deal of cancer where 5 other doctors and 13 biopsies could find none. They all said I had BPH because they couldn't find anything; they didn't know where to look.
JT

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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/21/2010 6:44 PM (GMT -6)   
Cooper good info on prostatitis and fPsa, here it is from Dr. Strum's book p38
"Prostatitis can be a non-cancerous cause of an eleveated PSA. However, prostatitis can result in low free PSA percentages that make laboratory distinction for PC treacherous." Further allow 6 weeks after anitbiotic (Cipro) before rechecking PSA.

(p.39)- "Lower free PSA percentages, in multiple studies, have been shown to correlate with greater risk for non-organ-confined PC." Not what anyone wants to hear. (have to clear up the prostatitis to know how accurate your fpsa percentage would be)

Maybe another fPsa test might show 25% or higher, which is the good side of this test area, nothing is a guarantee in PCa it seems, not even biopsies.

3-types of prostatitis I believe, some do not respond well to drugs, but your body may clear it up on its own....see: www.marinurology.com         www.wmfurology.com
 
(Retire1965-best to you)


RobnTexas
Regular Member


Date Joined Apr 2010
Total Posts : 24
   Posted 7/21/2010 6:58 PM (GMT -6)   
Brothers in PC. I do not understand why it is mentioned in this thread that a normal sex life is impossible after having surgery. This is not always the case. If this is to imply that being able to create a life from sex then I am in total agreement. However, it is possible to have a wonderful sex life, while being infertile, soon after surgery. It is also possible to regain consistency very soon after surgery.

Retired, I wish you the very best in whatever you decide to do. Your youth is a very positive advantage.

Rob
Age: 49, Height 5'11, Weight 190
Problem with urgency and frequency
No family history of C
Biopsy: 4/10 - 4 of 12 Positive 2@ 30% 2 @ 60%, Gleason 3+3=6, T2A
RRP: 5/18
PostOp: Gleason 3+4=7, 45g, 2cm tumor
6/1 - Catheter out YES!!!!
Pad Free after 2 days
No problem with ED


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3891
   Posted 7/21/2010 7:43 PM (GMT -6)   
Retire, you got a lot of good advice and I think Drum and Purgatory gave you the BEST advice..

You have cancer at a young age and it's not going to get any better. It can only get worse.

Have you read Dr. Patrick Walsh's book, "a guide to surviving prostate cancer"?? be sure you get the revised 2007 edition. Nobody here can make treatment choices for you. Every case is different and you will have to decide for yourself which primary treatment to choose..AS is really not an option for someone in your situation...
Age today: 68. Married, 6', 215 pounds, active, no health issues.
PSA at age 55: 3.5, DRE negative. Advice, "Keep an eye on it".
PSA at age 58: 4.5
PSA at age 61: 5.2
PSA at age 64: 7.5, DRE "Abnormal"
PSA at age 65: 8.5, DRE " normal", biopsy, 12 core, negative...
PSA at age 66 9.0 DRE "normal", BPH, Finesteride. (Proscar)
PSA at age 67 4.5 DRE "normal" second biopsy, negative.
PSA at age 67.5 5.6, DRE "normal" U-doc worried..
PSA at age 68, 7.0, third biopsy positive for cancer in 4 cores, 3 cores Gleason 6, one core Gleason 9. Finesteride discontinued, still no urinary symptoms, never had any..From age 55 to 65 I had no health insurance.

I have a date with the robo surgeon on Sept 3 but I'm keeping my options open. A "top" radiation oncologist here in Denver, equipped with the latest IMRT/IGRT/RapidArc machine says he can do better by me..


Retire1965
Regular Member


Date Joined Jul 2010
Total Posts : 38
   Posted 7/22/2010 1:01 AM (GMT -6)   
Gentlemen:
 
Thank you so much for your perspectives.
 
I agree that there are some characteristics of my case that are "borderline".  However, I think there is a real danger in our situations of psychologically looking for what will make you more comfortable.  My best wish right now is to not have to treat my pca actively.   Therefore, I will tend to grab onto perspectives/data that will give me a pass on facing the problem head on.
 
The major fact I have had trouble getting past is that I have no way of knowing when/if the cancer will progress.  Biopsies are inherently flawed as are PSA readings.   This information can be helpful, but it can also lead to false comfort.  
 
The irony of this disease is that it eventually demands a leap of faith from the men who have it.  You either treat it or you gamble that it will not spread.  Unlike the casino, you are not given the odds of success.
 
I do hope my pca was caught early, but the cancer on the biopsy is more likely the "least" that will be found.  I will likely attack the problem head on.
 
All my best,
 
Retire

IKE-D
Regular Member


Date Joined Jun 2009
Total Posts : 77
   Posted 7/22/2010 1:50 PM (GMT -6)   

Retire,

See my signature below. It's always tricky for those of us diagnosed young. But as you can see, I went round in circles a bit and then realized treatment was the only way to be at peace knowing that the longer I waited the worse off I may be.

I have no regrets at all with my decision to treat. Think thru carefully and do what makes you most comfortable.

 

Regards

 


>Age 41 (At Dx-July 05) -Psa during annual physical went from previous 2.8 to 3
>Biopsy by 'primary' Urol Aug 05 - Gleason 6 low grade. 2nd opinion at  Hopkins confirmed Dx
>Chose Active Surv (AS)- modified diet etc.
>Around Oct 07 Psa moved up to 5.5. I decide to treat at Hopkins. Not sure what kind yet. My doctor decided on re-biopsy first.
>2nd Biopsy Dec 07 at Hopkins was NEGATIVE for Pca! Nothing found in 14 cores!
>'Primary' Urologist baffled. Planned a saturated biopsy (22 cores) to settle issue once and for all. I wasn't going to do 22 cores wide awake!
>July 07 - Did MRI just for comfort. Nothing significant found. No spread. I'd live! Still in AS mode.
>July 08 - Saturated Biopsy performed. Cancer confirmed again (of course, you took 22 cores)! Same Gleason score, same grade, similar numbers but Urol says treat very soon! I am thinking not so fast - numbers are same and you told me it means not aggressive! In any case I agreed with Urol that I will go the way of the Seeds. I research seeds more and I don't like it.
>July 08 - Dec 08 I re-lapse back into AS mode but seriously researching/considering treatment options beside surgery - went on to Mass Gen and Georgetown to explore proton therapy and Cyberknife respectively. Anything but Surgery! Both experts who are about my age were unanimous in strongly declaring they will chose surgery 'if they were me'. In addition, I learn that if either if these radiation methods (and seeds too!)  failed, no backup plan (or will be complicated)! I got the message!
>Jan 09. Went back to see my doc at Hopkins. I decide to put my fate in the hands  of the 'Da Vinci Robot' then!
> May 09. Had surgery. some Pain and discomfort but normal. Pathology all clear. Gleason 6 as before. Feeling very lucky. I gambled (based on my numbers and got 4 more years!) on the slow nature of the cancer and took my time. Very happy I finally did it. Hoping for a great recovery of all 'key' functions. Great wife and family helping out.
> Sept 09 - 3month PSA - Undetectable!
> June 10 - 1year PSA Undetectable!


Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 7/22/2010 3:16 PM (GMT -6)   

Retire,

Obviously its your decision but if I were in your shoes I would be conulting with more than your surgeon (who is going to recommend surgery) and an oncologist (most of whom recommend surgery).  There are several other possibilities of treatment that pose far fewer threats of long term side effects such as radiation, brachytherapy, HDR brachytherapy, IMRT, proton radiation, HIFU, CyberKnife and so forth that you would be an excellent candidate for. 

Most of the posts on this and other forums are from men who chose surgery and it is certainly an option that has worked well for many, many men but at the same time almost a third of men who have RP come back later for salvage radiation.   And while most men who have RP recover long term continence it can take a year or so for everything to settle out and get back to normal, although many men gain continence much earlier.  There will most likely be some form of ED even if you are able to achieve erections "sufficient for penetration."  You will no longer have the ability to ejaculate, and your effective penis size is reduced by as much as an inch when the surgeon reconnects the urethra from the bladder to the base of the penis.  The dark side of surgery is well documented in the heartbreaking stories of men who suffer severe incontinence issues, sexual dysfunction, a follow on need for pumps, implants, artificial sphincters, and so forth. 

Of course there are potential side effects with radiation too, but they are usually less severe and shorter in duration.  And the long term survival rate for men who choose some form of radiation is pretty much the same as men who elect surgery. 

In my case, I was fortunate enough to have statistics that gave me many options that suggested similar efficacy.  Given that, I chose a course of treatment that minimized side effects while providing a long term cure.  While its still early (I finished my treatments a month ago) I have had zero side effects and my treatments did not interfere with my normal work and travel schedule.

Like others who responded to this thread, I would guess that your bouncing PSA is most likely caused by a temporary inflammation, having sex too soon before the biopsy, or just a quirky laboratory reading. 

Regarding AS versus doing something:  You're never going to have less cancer than you do now and you're probably never going to be in a situation where your cancer treatment options are as many and varied as they are now. 

Before you lock yourself into something, I think it would be prudent to seriously and methodically investigate other treatments.  With your statistics, your are most likely a poster child candidate for all of them.  You don't want to wake up next October after having undergone surgery and wonder if you did the right thing because its too late at that point.

Best of luck to you.


============================
Age:  59
Dx:  March 2010
PSA @ Dx:  4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason:  3+3=6 (confirmed by second pathologist)
Biopsy:  1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
DRE: Normal
Stage:  T1c
Bone scan and chest x-rays:  Negative
Prostate Volume: 47 cc
PSA Velocity:  0.19 ng/ml/yr
PSA Density:  0.092 ng/ml/ccm
PSA Doubling Time:  > 10 Years
Treatment Decision:  CyberKnife radiation treatment in June 2010
 
 
 


Minn1951
Regular Member


Date Joined May 2010
Total Posts : 21
   Posted 7/22/2010 4:00 PM (GMT -6)   
I am 58 with a relative low PSA of 3.5.  I have vistited several radiologists and surgeons, and they all said the same thing, your too young to do anything but surgery.  The radiologists would not even look at me.  They all said that if I don't remove it there is a very good chance it will be back before I get into my 80's.  (if I live that long!).  So I have opted for Robotic surgery with hopes that life can be "normal" for me (and my wife). 
Diagnosed with Prostate Cancer 4/10/2010
 
Age 58
Stage: T2B
Greason Score: 3+ 3 = 6
PSA: 3.0
Prostate volumne 19cc
Tumor present in 3 of 5 cores on both the right and left with 6 of 55  mm or 11% on the right  and 4 of 59 mm or 7% on the left
 
No angiolymphatic or perineural invasion.  No high grade prostatic intraepithelial neoplasia.


Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 7/22/2010 4:43 PM (GMT -6)   
Minn1951 said...
I am 58 with a relative low PSA of 3.5. I have vistited several radiologists and surgeons, and they all said the same thing, your too young to do anything but surgery. The radiologists would not even look at me. They all said that if I don't remove it there is a very good chance it will be back before I get into my 80's. (if I live that long!). So I have opted for Robotic surgery with hopes that life can be "normal" for me (and my wife).


Contrary to yours and some others popular belief there are more options than just radiation and radical surgery. For an example look at my sig below. No matter how much hope you may have, sexually postop will never be "normal" again for you and your wife. The best you can hope for will be dry orgasms without ED. That's a rare best case scenario. That's just how it is.

It's also utter nonsense that at your "young" age that radiologists would not even look at you. You're the same age I was upon dx. That anecdote will not be believed by anyone here around your age. In fact I would've gone the seeded radiation route if I hadn't heard of the TFT clinical study.
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A
 
2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study
 
4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal
 
7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy
 
2/16/10 12 of 12 Negative Biopsy 


Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 7/22/2010 4:44 PM (GMT -6)   

Min,

 

Wow...as we're similar ages with not too different pathologies, I just don't understand your comment about several radiologists saying you were too young for radiation and had to have surgery.  I met with several radiologists as well and none of them told me anything at all like that.  All of them wanted to treat me...just like the surgeons I talked to.

 

Hope your surgery works out well for you.


============================
Age:  59
Dx:  March 2010
PSA @ Dx:  4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason:  3+3=6 (confirmed by second pathologist)
Biopsy:  1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
DRE: Normal
Stage:  T1c
Bone scan and chest x-rays:  Negative
Prostate Volume: 47 cc
PSA Velocity:  0.19 ng/ml/yr
PSA Density:  0.092 ng/ml/ccm
PSA Doubling Time:  > 10 Years
Treatment Decision:  CyberKnife radiation treatment in June 2010
 
 
 


reachout
Veteran Member


Date Joined May 2009
Total Posts : 739
   Posted 7/22/2010 9:13 PM (GMT -6)   
This is a tough decision. My PSA bounced around a lot before I was diagnosed with Gleason 7 PC. Given your age, and the low grade of the biopsy results, if I were you I would have a repeat biopsy before doing the surgery. There's a lot of uncertainty but at your young age, there's no need to deal with the side effects unless you have a clearer indication of PC at an advanced enough stage to do something about.
Age 64 yrs
DX 5/2009
8 out of 12 cores positive
PSA 5.6
Gleason Score 3+4=7
Stage T2a
Da Vinci Surgery 08/07/2009
Upgrade Gleanson Score 4+3=7
Stage pT2c
Neg Margins and Nodes
Extracapsular extension noted but neg Extraprostatic Extention (??)
Dry immediately
Daily Cialis 5mg slow recovery
First PSA 3 Nov 09 <0.1
Second PSA 2 Feb 10 0.01
Third PSA 1 Apr 10 <.014
Fourth PSA 19 May 10 <0.1
Starting trimix July 10

New Topic Post Reply Printable Version
Forum Information
Currently it is Friday, September 21, 2018 3:10 AM (GMT -6)
There are a total of 3,005,361 posts in 329,225 threads.
View Active Threads


Who's Online
This forum has 161774 registered members. Please welcome our newest member, Audreyli.
215 Guest(s), 4 Registered Member(s) are currently online.  Details
73monte, Todd1963, Hibee, fdgdfhdff8801