Brother in-law.

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maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 784
   Posted 7/30/2010 10:36 PM (GMT -6)   
Hi everyone, just had a call from my brother in-law in Melbourne. He has been having trouble passing urine for some time, His PSA is 2.4 , he has an enlarged prostate, his GP has told him that although his condition could be managed, he recommends removing the prostate, talked to him about impotency ect.

All this with no biopsy, or other tests, he is seeing a Urologist on the 16th August, I have told him to wait and see what the specialist says before making any plans, an enlarged prostate is not always a indicator of Pca, I feel like his GP is jumping the gun somewhat, what do you guys think?

Regards Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept. Totally dry since catheter removed
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)
PSA 11th March 09 0.5
PSA 3rd August 09 0.6
PSA 25th November 09 0.6 (I am now 69)
PSA 18th Jan 10 0.6
PSA 27th July 10 0.6

IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 7/30/2010 10:41 PM (GMT -6)   
Hi mal,

Good to hear from you.

I agree with you on your friends GP... A bit of jumping the gun to recommend prostate removal w/o tests or seeing a Urologist first. A PSA could be normal for him, depending on hist age.

I'm glad he's seeing a Uro soon.

'Hope you're doing well.

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;
3/'10 <0.04; Latest PSA 6/'10 <0.01

maltratado45
Regular Member


Date Joined Jun 2010
Total Posts : 84
   Posted 7/31/2010 12:40 AM (GMT -6)   
 
Now remember I am a carpenter not a Dr.
 
Your brother in law has received advice far off base from routine treatment proticals.
 
Seek 2nd opinion would be my suggestion.
 
In my case after similar first findings I received a referal to a Urologist.  DRE.  Biopsy and Bone Scan.  Pathology to back up recommendation to treat clearly identified aggressive cancer.  That advice saved my life.
 
End of story.
 
Jim

*Age 60 when presented to GP on 3 Aug. 2004 with elevated PSA of 13.8.
*Referred to Urologist. Biopsy and bone scan in Oct 04.
*Pathology report in Nov 04. Initial Results are T2cNoMo carcinoma of prostate gland.
*Had a RPP on 14 Feb 2005. Boy talk about irony look at that date again.
*Dr. called 3 days after surgery. I want you both in my office tomorrow morning, we must talk now.
*"I wish to apologize because I misdiagnosed your condition. Biopsy of your organ says Staging is T3bNoMo. Please accept my apology."
*At that moment I fell in love with my Dr. and have never changed my mind.
*Followup radiation of the prostate bed started early June 05 and ran 42 sessions.
*All PSA checkups to date, 5 1/2 yrs, are undetectable.

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 7/31/2010 4:33 AM (GMT -6)   
Mal -
when in doubt - get another opinion - in this case - YES!!!
how long has your brother in law had this GP... I would start looking for another one who is more versed on men's health issues.
as per the Canadian Cancer Society - a PSA of 1-4 is classified under the same range ( even though with me it was not) ... so to advocate a prostatectomy without any other testings is very peculiar.
once again - another opinion is definitely needed.
all the best to you and your family

BRONSON
.................
Age: 54 - gay - with common-law spouse of 13 years, Steve - 60
PSA: 04/2007- 1.68 - 08/2009 - 3.46 - 10/2009 - 3.86
Confirmation of Prostate Cancer: October 16, 2009 - 6 of 12 cancerous samples , Gleason 7 (4+3)
Doctor: Dr. Mohamed Elharram -Urologist / Surgeon - Peterborough Regional Health Centre
Radical Prostatectomy Operation: November 18, 2009 , home - November 21, 2009
Post Surgery Biopsy: pT3a- gleason 7 - extraprostatic extension - perineural invasion - prostate weight - 34.1gm -
ED Prescription: Jan 8/2010 - started daily 5mg cialis - girth back to normal -but not much length - June/2010 -have trimix - tried it twice - Aug 2010 -just lacking motivation right now
Incontinence: Feb 2010- 3-5 pads/1-2 clothes changes/day- March 3, 2010 - week 14 after surgery -finally seeing improvement - March 29- incontinence better - 1-2 pads a day - one pad at night - May 25 - 1 pad during day - 1 pad at night for security (barely needed at all) - stress incontinence at work - lifting trees and shrubs - August 2010 - still at one pad for day and one for night - primarily for hygiene and security - still having good and bad days due to stress and what I have consumed.
location: Peteborough, Ontario, Canada
Post Surgery-PSA: - April 8, 2010 - 0.05 - I am in the ZERO CLUB - hooorah!
Next PSA - October 8, 2010 - TBA -
............

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 7/31/2010 5:31 AM (GMT -6)   
Mal, your BIL's doctor may be recommending removing the prostate simply because it is enlarged not because he suspects any malignancy. A second opinion - from a urologist - is definitely in order.
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!

Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 7/31/2010 7:11 AM (GMT -6)   

Yikes, this takes the concept of over-treatment to a whole new level.  If your BIL had headaches, I would hate to see what the doctor would recommend...cut his head off?

 

I would think that a TURP is a much more conventional treatment for BPH that is causing urinary issues.  A drug regimen using something like Avodart could also shrink the prostate.  Since the urinary issues are most likely caused by the enlarged prostate pressing on the urethral tube, Flomax or even Advil might make a difference.

 

I wouldn't walk away from that urologist...I would run as fast as I could.


============================
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.  Side effects:  None
 
 
 

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/31/2010 7:43 AM (GMT -6)   
Maybe this is a new 'Kreskin' type of doc that schools are churning out...or maybe he went to a leading business school prior to medical schooling.

He also could be right, based upon a hunch or guess....do you want it removed on a hunch??? Maybe all men after becoming 50 should have them removed, no agendas.
My Kreskin like smell test says, it stinks find a doc whom uses science to prove his bias's.
No violation of the hypocratic oath here-LOL :-) :-)
Youth is wasted on the Young-(W.C. Fields)

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/31/2010 8:44 AM (GMT -6)   
He is jumping the gun unless there is mitigating circumstances. There is a doctor here in the US that will do RP on patients with extreme and chronic prostatitis. But we are talking really extreme situations.

but no. There is a good reason here to find another doctor...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/31/2010 9:59 AM (GMT -6)   
Hey, Mal.

Geez, a good GP would have referred him to a good urologist with the info you provided, not suggested/pushed for a radical treatment. Be a shame to have the prostate removed, and all the misery that goes along with that, and find out there's no cancer or real reason for removal. Doing this without at least being under the care of a urologist at this point would be nuts in my opinion.

Whoa, Nellie!

David in SC
Age: 58, 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

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 7/31/2010 8:59 PM (GMT -6)   
Hi Mal,
I can't believe that a doctor could suggest such a drastic measure without doing a biopsy first. I'm glad your friend is going to see a uro first.
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
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

Jstars
Regular Member


Date Joined Oct 2005
Total Posts : 489
   Posted 8/1/2010 9:47 PM (GMT -6)   
Yes prostate removal IS a legitimate treatment for enlarged prostate. My urologist said that he could remove the prostate to cure my BPH -- and that was before the Biopsy was done (he said that even if the Biopsy was negative he could still treat the BPH with surgery). Not sure it is a common treatment but it sure worked for me!! Gushing like an 18 year old now. But I surely would have been grumbling and moaning and very miffed (ED and all) about such a drastic treatment if it was only for BPH -- lucky for me I did have PCa. So that was that.
Age 59, 57 at DX, PSA Aug2008 7 4 ... June2007 4.7 (BPH + LUTS)
11/2008 Biopsy: 1 of 12 cores 5%, Gleason 3+3 - Sona showed size 140+ cc (110 grams post op).
02/03/09 open RRP surgery ,Nerve sparing, 1 day in hospital.
02/18/09 Cath out -- passed 1 cm oblong bladder stone (not kidney!).
Pathology Report: All margins clear - No Invasive spread - no change in Gleason score.
04/09, 07/09, 10/09, 01/15/10 PSA <0.1
03/2009 Levitra@20mg / Viagra@100mg/Cialis@20mg -- (nocturnal stirrings started 02-03/2010).
08/09-09/09,02-03/10 MUSE@1000mcg 80-90% (with some ache )
10/09-11/09 TrimixGel@(500/300/100mcg): 60,70,80%,
02/10-03/10 TrimixGel@1000/300/100mcg - 80-90% - just @ usefulness.
Gel + MUSE 500mcg -- 100% for 30-60 mins and 80-90% for hours after that).

Post Edited (JimStars) : 8/3/2010 10:03:12 AM (GMT-6)


ejn
Regular Member


Date Joined Jun 2010
Total Posts : 87
   Posted 8/2/2010 6:54 AM (GMT -6)   
I dont think I could have stayed in the room long enough for him to finish that sentence

Age @ DX  53

Pre OP PSA: 1/2008=5.9, 2/2010=6.0 (free=9%)

Biopsy, 4/10/2010 This was my 2nd Biopsy.  The Uro put me out and took 36 samples.  3 samples positive 1%, 2%, 2% no evidence of perineural invasion. T1c

Dx Date  April 2010

Gleason:  3+3=6
CT Scan: Negative
DaVinci:  Coming up 8/11/10, Dr David Bryan, SSM DePaul-St Louis
 


fertree
Regular Member


Date Joined Jun 2010
Total Posts : 118
   Posted 8/2/2010 12:30 PM (GMT -6)   
I had a similar situation with my GP who was female. She simply didn't have the knowledge of prostate issues to have an informed discussion. However, she knew that, and was quick to refer me to a urologist. I have also found that a GP will do a DRE and not find anything, when an experienced urologist may say "Hmm, that's not right'". I think the GP should check for UTI's, prescribe Cipro, and then refer you to a good urologist.
PSA 2.1 on Avodart
Biopsy: 1 of 12 cores positive >5%, Gleason 8
open RP: 05/10/2010 Dr. Gary Steinhoff, Victoria BC
Pathology: pT2c Gleason 3 (80%) 4(20%)=7, no lymph invasion, no extraprostatic extension, negative margins, tumor 5% of tissue.
Nerve bundles removed (based on original Gleason 8)
Incontenence: 6+pads for 9 weeks, dropped to 3 pads in 1 day.
First PSA >.01

Bowler1952
New Member


Date Joined Aug 2010
Total Posts : 2
   Posted 8/2/2010 6:31 PM (GMT -6)   
Thanks for this feedback everyone. I'm a bit overwhelmed at this moment however i am very grateful knowing i can talk about this stuff.

maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 784
   Posted 8/2/2010 7:07 PM (GMT -6)   
Think that is my brother in-law Nick guys, will confirm, thanks to you all for your help.

Regards Mal.
age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7 right side tumour adenocarcinoma stage T2a
RP on 30th July,

Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck,are free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.

Post op PSA 0.5 26th Sept. Totally dry since catheter removed
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4
PSA 30th July 0.5
PSA 27th Oct 0.4 (I am now 68)
PSA 11th March 09 0.5
PSA 3rd August 09 0.6
PSA 25th November 09 0.6 (I am now 69)
PSA 18th Jan 10 0.6
PSA 27th July 10 0.6

Post Edited (maldugs) : 8/2/2010 7:10:50 PM (GMT-6)


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/2/2010 7:27 PM (GMT -6)   
No problem,
Mal has been a great friend of this forum and it sure is nice to meet you. And Malcolm is a personal friend as well. We're thousands of miles apart but brothers in this war...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Bowler1952
New Member


Date Joined Aug 2010
Total Posts : 2
   Posted 8/3/2010 2:12 AM (GMT -6)   
Thank you once again, sorry i didnt introduce myself properly to you all. Your right Tony and Im very fortunate to have Mal as a member of my family.

Regards Nick.
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