New PCa Diagnosis - Decisions?

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Pocketman
Regular Member


Date Joined Aug 2010
Total Posts : 121
   Posted 8/27/2010 2:22 PM (GMT -6)   
I am new to PCa and this forum.  Like most everyone else here, I have decisions to make.  I've read several threads and find coinsiderable information, some helpful, some not so.  I do know I am not alone.
 
This morning I had my consultation with an oncology radiologist.  He was very informative and, like my urologust, made no specific recommendation.  Given my situation I apparently have lots of options.  This is good, but makes decisions that much more difficult.  I meet with da Vinci surgeon next Monday.  Feels like buying a car.
 
Given my early detection and availability to quality healthcare, I know my prognosis is good.  I have a few friends, including my father, who have gone through this.  As confirmed by the posts on this forum, not everyone has the same experience using the same therapies.  Is this going to kill me, probably not.  Is it going to change my life, quite likely.
 
Until today I was leaning toward surgery.  The radiologist today mentioned Brachytherapy.  Seems like a no brainer considering the short term risks and benefits.  Given my age, I hopefully need to also consider 10-20 years down the road.
 
I appreciate everyone's candid sharing here.  Such discussions will no doubt help be through this challenge.

Age 61, Diagnosed July 2010
PSA 04/09 - 2.5; 05/10 - 3.7; 07/10 - 4.7
DRE and Ultrasound - Negative
T1C, 3+3=6, 1 core of 12 60% positive

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 8/27/2010 2:43 PM (GMT -6)   
There are a lot of strong proponents for both surgery and radiation for early stage PC like yours, and the choice may not make much difference in your likely outcome. I went the surgery route myself after considering both. In my case, I was influenced by wanting the feeling I could "get it out of there" (which isn't as true as it sounds); the desire to have the path lab report afterward to tell me exactly what I'm dealing with; and the knowledge that in the next 10-20 years there could be side effects of radiation that are not yet fully understood. (I'm a bit younger than you so that matters a bit more perhaps.) But there may not be an obvious right or wrong answer in terms of cancer control, and it could come down a question of personal preference and your tradeoff between ED right away with a good chance of recovering much of it -- or no ED at the outset with a good chance of some developing over time.

You might try a couple of things: (1) use the Sloan Kettering nomograms to see if there's an appreciable difference in outlook either way. (2) go to a major cancer center and get a second opinion, if you haven't already. At least at some of these centers they have well worked-out protocols so you're less likely to get the situation of duelling opinions where each specialist recommends the particular procedure they are skilled at performing. In my case I went to UCSF and consulted with both a top surgeon and a top radiologist there, each of whom had been recommended to me by my GP, Urologist, and others. I was surprised that that even the radiologist recommended that I go the surgical route given a combination of my cancer in the medium to more aggressive range (Gleason 7, short PSADT, PNI); but which seemed (from doppler ultrasound) to be still capsule-confined, and my relatively younger age and otherwise good health. So that made the decision a lot more straightforward.
DX at age 54 12/2009
Initial clinical profile: PSA 5.6, DRE-, high pre-op PSAV. Clinical stage T1c
Biopsy: Gleeson 3+4 with PNI / 6 of 14 cores + / 10% of total length + / worst core 45% +
TX: Robotic assisted RP 2/2010
Pathology: pT2cNx / Gleeson 3+4 / PNI+ / SM- / SV- / EPE- / Tumor vol 7% / prostate vol 40cc
PSA - post-op 0.01

Post Edited (proscapt) : 8/27/2010 2:01:15 PM (GMT-6)


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 8/27/2010 2:59 PM (GMT -6)   
I would agree with Proscapt.

In addition, I would suggest that you understand *all* options, even if you are unlikely to choose one of those routes. You don't want to find out later that there was a treatment modality better suited to your preferences and situation. For example, have you considered protons, HIFU, or cryo? How about external beam radiation (IMRT/IGRT) without seeds? Or combined with them?

I had a DaVinci prostatectomy and regret that my surgeon was low on the learning curve. I came out with positive margins and later needed radiation. Was it because of his inexperience? I'll never know, but it is likely. If you choose DaVinci, make sure your doc has done tons of the procedure, and is getting good results. Get the best surgeon you can. This is your big chance.

I like the book "Patrick Walsh's Guide to Surviving Prostate Cancer" (2007 ed.) It's widely available in bookstores and public libraries.

Best wishes.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 8/27/2010 3:15 PM (GMT -6)   
You seem like the PERFECT candidate for seeds...G-6, detected very early, small volume, excellent prognosis for a cure with very low side effect risk..But you will want an EXPERT who uses the latest seed placement technology to realize these benefits..

The negative side? There is no going back and doing it again if it fails, and the side effects can get worse, not better, as time goes on...

You have plenty of time, no need to rush into treatment with your numbers, so talk to the surgeon and keep an open mind.. His product is the one all the others try to equal and copy. He can offer you the best overall chance for a cure but with a fairly long recovery time and a nasty basket of side effects which are hard to predict in advance. But with surgery, you will know where you stand and in the unlikely event it fails, radiation is still there for you...

My prognosis is considerably worse than yours but I have decided to keep my date with the surgeon on Sept.3 and hope for the best...But that's just me responding to my overall situation. You need to do what's best for YOU....Have you read "Surviving Prostate Cancer" by Pat Walsh? That will give you a strong foundation to work off of..
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 8/27/2010 3:25 PM (GMT -6)   
Please read "Invasion of the Prostate Snatchers" by Dr Mark Scholz before you rush into any decision about treatments.
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


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/27/2010 4:31 PM (GMT -6)   
Hello and welcome,

This is a great place to be once you got that dreaded PC dx. You already sound like you got a good attitude going into this.

Based on the simplicity of your stats you posted, you very well could make an excellent candidate for seeding, or seeding along with RT or HT.
And of course, any surgeon would love to get their hands on you. You should have the full slate of choices for you, and you already know you don't need to be rushed or bullied by any doctor along the way.

I am an open surgery/salvage radiation guy with a lot of complications, not the usual incontinence//ED issues, so things can go wrong with any treatment choice.

Please keep us posted of your journey, and there's not thing as a dumb question among the brethren here. Good luck as you work your way through all your choices.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Retire1965
Regular Member


Date Joined Jul 2010
Total Posts : 38
   Posted 8/27/2010 8:21 PM (GMT -6)   
Hi Pocketman,
 
First I am sorry to see you posting on this forum.  I do think it is a great support for men in our situation, but I do hate to see new people joining.
 
My history is very similiar to yours.  Do take some time to make a decision and do not make a decision until you are comfortable.  Each treatment appeals to men because of their unique personality, pathology and lifestyle.
 
I agree that you should get Dr. Patrick Walsh's book.  It has been described to me as the "bible" for pca patients.
 
However, remember, we are dealing with cancer that is not completely predictable and with diagnostic tools that are imperfect.  You do not know now how big or small your cancer is (although there is a likelihood that is is small).  The tough part is striking the balance between being logical, practical and methodical but not crossing the line into apathy or overconfidence.  That has been the toughest part for me.
 
All in all, I certainly agree you are lucky because you do have options and have every reason to be optimistic.
 
Retire

Retire1965
Regular Member


Date Joined Jul 2010
Total Posts : 38
   Posted 8/27/2010 8:25 PM (GMT -6)   
Sorry,
 
Might help if I included my signature.
 
Retire
45 Male
Prostatitus in Summer of 2009
PCA diagnosed in November 2009 due to elevated PSA level
12 core biopsy, 1 core positive 15% 3X3
T1c
PSA started around 10 at the end of last year escalated to 15 and is now around 5.0
RP scheduled for mid September
Still confused how my psa can drop by 2/3 with no infection

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 8/27/2010 11:34 PM (GMT -6)   
One important thing that most doctors fail to take into account when diagonosing or suggesting a treatment is not what the cancer is, but what it is doing. Is it stable, is it very slow growing, or is it agressive. Without this information you are only getting a partial picture. If it is stable or very slow growing then the best action is to do nothing, because anything that you do will cause you more harm than the cancer. The best way of determining this is with multiple scans, MRIS or Color Doppler after a baseline is established. These will show any changes or the rate of change in your tumor. Prostate cancer can only hurt you once it has escaped the confines of the prostate; as long as it's in the prostate it is harmless. This may be a hard concept to accept, but it is absolutely true. If a tumor is not growing it can't hurt you.
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


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/28/2010 7:46 AM (GMT -6)   
Welcome to the twilight zone on choices in PCa, including A.S./W.W. and say one should hope to get the best 'assessment' of your PCa case. John T (and some others herein) are among the better informed lay persons in PCa in totality from what I can see(I rarely if ever have disagreement with his words on PCa) and I have been looking at this stuff over 8 yrs.+ and read alot and question everything (with valid proven reasons which many have been confirmed from my suspecions). I questioned alot of things early on with this, as given a prognosis of maybe a couple years, that helps motivate one just slightly.

Not saying for you to necessarily do this, but you could and nobody herein will likely mention it. You could take casodex or other control drugs(TIP) and either crush this opponent fast and hard, and get a very long duration of control (especially in light of your low end stats), maybe a long shot but total remission is never guaranteed but is not 100% excluded either.

Plus you could still later get surgery or whatever type of major therapy you might wish to get and if failed surgery or other (no guarantees in PCa), still do further drugs and with Provenge and DCVax on the current choice lists and other stuff in the pipeline, who knows. Hey Zufus are you Dufus? Bob- this sounds insane???? I am waiting for Rick K. to hopefully post his story, I talk with him occassionally been following his "insane" protocol for 15 yrs. now....no PCa found on recent biopsies by Dr. Fred Lee under Dr. Bob B. (surgeons-directive) to see Lee. His psa is low and normal for a guy with a working prostate, he is still in no hurry to decide anything. Best of all normalcy as a man returns and is all his to enjoy. Of course no uro-doc will mention it is even a possible consideration, but some onco-docs will endorse such(he did ADT3 per the Dr. Leibowitz protocol method). My brother is like 6 yrs. now of A.S./W.W. and no psa movement, normalcy for him...appears sane and he did no drugs only minor diet or lifestyle changes, which he was kind of health nut to some degree anyway. He was assessed with basically indolent PCa, a little lesser than your stats of course.

Suggest books: Dr. Scholz book and Dr. Strums book, then read Dr. Walsh's book or others, get a huge perspective on this dragon and get multiple opinions. You have time to look it all over, you could even take casodex for a few months while waiting to make the decision of a lifetime, not many docs will tell you this. Some patients have done just that and got surgery alittle later or whatever. Dr. Stamey has stated history will show this is one of the most over treated diseases, interesting quote.  NBC or ABC did stories a few years ago, calling PCa a cottage industry...sounds like a lot of cashin being done to me. This cancer is not equated as apples and apples to other types of cancers...although alot of people try to say so..the facts and stats prove otherwise.  Best to you in whatever you decide, read the top post on this forum page, tells you exactly what you need to prepare for in doing surgery and may apply to other methods with some overlapp.

Post Edited (zufus) : 8/28/2010 7:03:17 AM (GMT-6)


AJ 47 (Maryland)
Regular Member


Date Joined Aug 2010
Total Posts : 64
   Posted 8/28/2010 8:16 AM (GMT -6)   
This is my first post on the forum after just having undergone a RP robotic at Henry Ford in Detroit. My postoperative experience was very good, having no leakage from the moment the catheter was removed. Nonetheless, if I have one word of advice or caution it is this: Preoperative biopsy results unfortunately cannot be relied on to a great degree in preparing for what the postoperative pathology will show. I am a perfect example. I am 47 with - family history for any cancers. My PSA jumped from 1.6 to 3.2 in one year. My first 12 core biopsy was negative in 11 and positive for atypia in 1. My second 13 core biopsy done at Hopkins and read by Dr. Epstein was negative in 11 and positive for Gleason 3+3 in two, with less than 5% cancer volume in each. Gland size 25. T1c right? Wrong. Postoperative Gleason 3+4, focal extracapsular extrusion, - seminals - lymphs - margins, but still, Stage III not stage I. The point of this is that the best models and predictors are incapable of determining with certainty how aggressive your cancer is. I had consulted with many providers and was told by many that the cancer was low risk and that I had lots of options. As it turns out, I thank G-d I had that gland removed when I did. Until the standard of care requires intraoperative pathology of the prostate, margins, etc., it's somewhat of a crap shoot In my case, I was the perfect candidate for the "Super VIP" nerve sparring surgery I underwent. With the ECE in hindsight, one wonders whether that was the right choice. Had an interoperative pathology been performed, an entirely different surgery may have been done and all the nerves might not have been sparred. Now, time will tell.

Point of this is not to make you more nervous than you already are, but know that your preoperative pathology might not tell the full story. So, in your decisions about what treatment to get, know that if the prostate doesn't come out, you'll really never know the entire story with the cancer staging and growth despite some improvement in MR imaging, etc. For some, this is a deal breaker that causes them to elect the RP with all of its potentially negative side effects.
Preoperative: PSA 1.5 to 3.2 in 11 months after 10 years of level psa. First 12 core biopsy on 2/10 negative in 11, atypical in 1. Second 13 core biopsy on 5/10 at Hopkins positive in 2 with Gleason 3+3 (focal). Robotic "Super VIP" Henry Ford on 8/10. Postoperative Gleason 3+4 (70%/30%). Focal ECE at right posteriolateral mid. Negative margins, lymphs, seminal vesicles. First PSA on 9/14

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 8/28/2010 8:37 AM (GMT -6)   
AJ:
 
I had my surgery at Ford also (with even more disappointing pathology).
 
Did Dr. Menon do yours?
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. Next PSA late Sept.

Pocketman
Regular Member


Date Joined Aug 2010
Total Posts : 121
   Posted 8/28/2010 9:00 AM (GMT -6)   
I find myself actually enjoying reading these replies. While the subject itself is not pleasant, there is some comfort in just being noticed at the onset of this journey I do not want to take. It is more confirmation though that there are few definitive answers.

When first diagnosed my urologist mentioned some less aggressive treatment options, but my brain screamed "out out darn spot." I hadn't sriously considered hormone therapy or watchful waiting. While I know I have some time, AJ brings up a good point too.

I've not talked at length with him yet, but a friend went through hormone therapy and did not fare well with side effects. He also had an RP, the "old fashioned" way. I now know why he is sometimes a bit cranky. wink

Quite frankly it the cure that's bothering me. I have no physical symptoms and was actually quite surprised at my diagnosis. I now know this is typical. I am a bit concerned that my PSA is rising as quickly as it is. I think I saw a post on another thread where someone said, this is important and needs to be a focal point. I'm fortunately at a state in my life where I can remove distractions and do something about this affliction.

As I stated in my initial post, this is not unlike buying a car. I'm waiting for one of the doctors to show up with white bucks and a flashy smile. I am being a bit facetious, so far the three doctors involved have been very candid and gracious. Thank you for all the words of advice and encouragement. I figure I'll be involved in this community for some time.
Age 61, Diagnosed July 2010
PSA 04/09 - 2.5; 05/10 - 3.7; 07/10 - 4.7
DRE and Ultrasound - Negative
T1C, 3+3=6, 1 core of 12 60% positive

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/28/2010 9:31 AM (GMT -6)   
Pocketman,
,
Our new friend AJ makes a good point, I have preached this point since I have been here, but some will say its just a biased view toward surgery because I had surgery (I really didn have a lot of choice at the time). At best, the biopsy is but an educated "estimate" of "damages" inside you. I wish we had better and more accurate testing. AJ's examaple is perfect, at face value it appears to be a low grade, indolent case, perhaps could even "wait and watch" awhile. Only through surgery, do they get the whole thing out, and from that post surgical pathology, see that he indeed there was a dangerous situation going on. I can only hope for him, that they were able to get most of it. He is all but certain to need at least secondary treatment in the future, and yes, with what is known now, nerve sparing should have been out of the question and wide margins would have been a better choice.

The point, just based on a positive biopsy, is that all? Or did it still miss the bulk or spread of the cancer? That is where the big gamble comes into play.

I am one who often  talks about PSA velocity being a serious issue to consider. My case has been all about velocity from the start. If you have velocity issues that are steady and rising with no evidence of infections or other prostate illness, its a serious sign.

Like most men here, I never felt a thing. Never had a urinary problem in my life. Never even had a UTI before. Felt perfectly fine, as my PSA climbed and climbed each year, then finally was like a rocket about to take off that last year prior to treatment.
 
There is no need to rush a decision this big, but there is risk in waiting needlessly in my opinion.

David in SC

Post Edited (Purgatory) : 8/28/2010 8:35:30 AM (GMT-6)


AJ 47 (Maryland)
Regular Member


Date Joined Aug 2010
Total Posts : 64
   Posted 8/28/2010 9:42 AM (GMT -6)   
Indeed I used Dr. Menon who I had total confidence in.  My ECE was focal (less than a mm) in the mid posteriolateral region.  I asked the doctor whether he would have sparred the nerves had he know, and he said "yes" -- that the extrusion was some distance from the nerve bundles.  He did do a wide excision of about 5 cms of tissue.  I'm have been reading my ass off on this forum and others to see what this all means.  The Hans Tables are fairly encouraging but I just don't understand how they group together people with + margins, + lymphs and + ece into one group of C no matter the extent of involvement or whether only one of several "outside the prostate" factors exists. 
 
The tips of my seminal vesicles were left in as part of the nerve sparring.  They were tested intraoperatively.  I truly believe there needs to be some advancement in the ability to get instant path results before the operation is concluded.
 
I'll glad to have joined this group and appreciate the wide range of opinions, experiences and information!

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1100
   Posted 8/28/2010 1:11 PM (GMT -6)   
AJ mentioned intra-operative pathology.  Is that not done at all, in prostate surgergy?  Only in certain cases or by certain surgeons/hospitals? (I know it is done in certain other types of surgery).
 

Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 486
   Posted 8/28/2010 3:12 PM (GMT -6)   
medved,  you asked about intra-operative pathology.   I had intra-operative pathology during my surgery at the expense of an extra 15 min. on the operating table.   I can't believe this isn't done on a routine basis.  The fact that it isn't suggests that the frequency of positive margins is very low.
 
Carlos

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 8/28/2010 4:28 PM (GMT -6)   
AJ,
This is why I always recommend anyone diagonosed to either get a color doppler or an MRIS scan. These will pick up extra capsualr extension, probable seminal vessicle invasion and accurrately measure the size and location of the tumor. I would never opt for either surgery or Active Surviellance with out these scans. Surgery without a scan showing that the tumor is contained and not near the margin or any other hard to get to place is just a crap shoot.
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


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 8/28/2010 9:44 PM (GMT -6)   
I think you are asking for an awful lot from a color doppler ultrasound and an MRIS scan John..have these tests been proven to be definitive in their ability to detect the extent and spread of this cancer??

If that were the case, I would think they would be MUCH more widely used...
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..

cooper360
Regular Member


Date Joined Jul 2010
Total Posts : 161
   Posted 8/28/2010 9:51 PM (GMT -6)   
Its like banging your head against the wall! JohnT I don't know how you take it LOL!!!! [not really funny though]

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 8/28/2010 10:09 PM (GMT -6)   
Cooper360,

Although John has a fair point so does Fairwind. John is right in that you need to work out as as far as possible that the tumour is contained and color dopler or MRIS are the best weapon we have to do this. However Fairwind is also right in that the screening tests we currently have are far from perfect and relying on them completely is asking a lot of them.

I know that you understand and sympathise with John's point of view but your post would indicate that John is some sort of long suffereing person who is passing on pearls of wisdom to a bunch of ignorant people who are just not listening to him. I do not think this is correct or fair. I don't think there is a person on the planet who knows the answers on prostate cancer. At the moment we have distinctly different approaches in handling this disease and from all the studies and work that has been done there are several different conclusions an educated person can make and in different circumstances they may all be right.

An

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 8/28/2010 10:10 PM (GMT -6)   
I too was hoping Volunteer (he posted here as Windquest on 8/13) would come back and write another page of his journey..I hope he did not find something he really didn't want to find...

Cooper, stop banging your head! Just back up your claims! Is there some vast conspiracy of surgeons who work day and night to suppress any data that might interfere with their cash flow?? Maybe Scholz figures he can make more money writing books than treating cancer, since he seems to feel most treatment is a waste of time..

Don't get me wrong..I have the DEEPEST admiration and respect for John T's knowledge and insights. He has forgotten more about PC than I will ever know..

I just disagree a little about Dr. Scholz's book...(I should have my copy Monday)

Post Edited (Fairwind) : 8/28/2010 9:18:26 PM (GMT-6)


Sancarlos
Regular Member


Date Joined Feb 2010
Total Posts : 242
   Posted 8/28/2010 10:25 PM (GMT -6)   
Fairwind said...


I just disagree a little about Dr. Scholz's book...(I should have my copy Monday)


Fairwind,

Should you not read the book first before disagreeing?

I am waiting for my copy.

Sancarlos

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 8/28/2010 10:29 PM (GMT -6)   
I would hope it would be considered normal to read a book yourself, before having an opinion about it.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3887
   Posted 8/28/2010 10:32 PM (GMT -6)   
Right.. yeah
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