Uhh... where am I? What to do next?

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ThorBlackheart
New Member


Date Joined Aug 2010
Total Posts : 1
   Posted 8/20/2010 1:33 PM (GMT -6)   
Age 62, Caucasian, good health, little over weight, a couple of squamous cell ca removed with clean margins.
Almost 2 years ago the Internist said she felt a "lump" on my prostate. Go get it checked. I didn't.
5/10 she felt it again. Go get it checked. I did.
5/10 biopsies
GS: 3+3
1% of 1 of 18 cores
PSA: 2.8
Velocity: unsure, am checking.
Da Vinci scheduled for 2010/08/07

My brother, age 45, dx Prostate CA in 2000, PSA: 200(+); GS: 5+5; Radical and Radiation; positive margins, bladder, nerves, basement involved. This week he found his PSA is back on the move. So, you would think that I'd be careful.

Looked at Loma Linda Proton beam and it looks appealing.
Looked at Gamma West's approach with what looks like great results.
Found a Mayo trained surgeon at Huntsman at the top of his game.

Five daughters. I am not interested in leaving this planet any time soon.
Wife's father died of PC so she's not too involved with mine.

Retirement wiped out by the melt down and fingers pointing in all directions. Stress.

I guess I'm just venting. My current thinking is that radical is the gold standard? No? I don't want any of the little buggers getting out of the box and getting loose. There is a thought that radiation will nuke any that leaked out. With the radical, "clear margins" ...hmmm... I'm not certain what that really means. IF it means, "all the margins we looked at are clear" then I'd worry about the margins that were not looked at and I'm sure it's impossible to look at all of them.

Ideas? Alternatives?

Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 8/20/2010 1:47 PM (GMT -6)   
Thor, you have many good options with that pathology. I think the "gold standard" is whatever the doctor your consulting with at the moment has for a specialty.

You may wish to check out Cyberknife as an option.

Good luck.
============================
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
 
 
 

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 8/20/2010 3:10 PM (GMT -6)   
When did you have your biopsy? You have low risk numbers that most here would love to have. That's the good news along with the fact you have plenty of time to decide on any treatment or even none by doing active surveillance. Learn all you can and when it becomes overwhelming and it will, take a week off and just relax and not think about it to later gain some perspective. Don't panic and don't let any doctor scare you into any treatment prematurely. There are no do overs. Any treatment you choose you'll have to live with whatever side effects after. In the meantime take a deep breath and realize most men diagnosed with PCa will die of something other than that in time.
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

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2460
   Posted 8/20/2010 3:42 PM (GMT -6)   
Your numbers are so low (good thing). With a Gleason on 6, low PSA and only one out of 18 cores being positive you have plenty of time and options. Educate yourself and talk to different doctors (Urologists, oncologists and radiation docs). You may want to look at seed implant along with radiation. It has the same cure stats with less side effects. Good luck.
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

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 8/20/2010 3:46 PM (GMT -6)   
Thor:
IF the G sum is right, you have time to wait. Did the urologist do a DRE? Surely he must have. What did he find there? Ultrasound looked normal? I think it unusual to have a palpable lump discovered by even a GP, that on biopsy has such insignificant amount of cancer. Did the uro target the biopsy to the lump area, assuming he felt one, assuming he gave a DRE? If not, then next time DO IT.
Only 10 core biopsy? I say at least 12, probably 18 to know as much as possible whether Active Surveillance is reasonable. Whatever the Gleason, the slides should be sent for second opinion to Bostwick Labs or another expert pathologist, not just the hired hand the uro uses to maximize office profits. G sum is key for decision making.
You DEFINITELY have time to check out your options and consider all, including no invasive treatment at this time. Your surgery date is August 7, so you already passed that point.

knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 654
   Posted 8/21/2010 8:16 AM (GMT -6)   
It looks like you might need more info before you start seroiusly looking at the many options that are open for you. For a case like yours where almost any treatment and possibly even none might be options, I think you should go to a large cancer center in your area and get their opinion. You have time to get as many opinions as you need, so that your time and gather info from the pros. Good luck and as others have said, it looks like you have a very small tumor that is not very agressive.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 8/21/2010 8:26 AM (GMT -6)   
Have you read "Guide to Surviving Prostate Cancer" by Dr. Patrick Walsh ??

You should read that book cover to cover so you KNOW exactly what you are dealing with..
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 12 core 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. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 8/21/2010 10:18 AM (GMT -6)   
Thor,
First, was the positive biopsy on the nodule? This is real important because if was on the nodule you need treatment. If the nodule was clear then you really have nothing to worry about. The 1% indicates that it probably just insignificant cancer clusters. This would be like a freckle, a mutation in cells that have no significance, and you would never cut your arm off because you have a freckle.
As everyone says, you have plenty of time and you chances of ever dying of prostate cancer is much less than getting hit by lightning. Men just don't die from what you have.
Please read Dr Scholz's book "Invasion of the Prostate Snatchers" before you decide anything.
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


Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 8/21/2010 2:24 PM (GMT -6)   
Thor, John T, as always, has great advice. Heed it.

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, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

eyetat
New Member


Date Joined Aug 2010
Total Posts : 5
   Posted 8/21/2010 9:26 PM (GMT -6)   
Time is on your side wait and watch a PSA jump would be time to go futher if it ever ocurs.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 8/22/2010 10:02 AM (GMT -6)   
Whatever you do, keep a close eye on that PSA, a test every 4 months is not too much..If it goes up .5 in any 4 month period, it's time to move on it..
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 12 core 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. I'm also looking at seeds combined with IGRT which seems to be having good results with high-risk patients..
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