Got just a little cancer - VA says "Wait and See." Does that work?

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forJD
New Member


Date Joined Aug 2010
Total Posts : 3
   Posted 8/31/2010 8:53 PM (GMT -6)   
Last October, my doc said the "LEFT" side of my prostate was hard. Another VA doc confirmed this. PSA was 0.4 then 6 months later went to 0.9. Went to the VA for a biopsy which resulted in 1 of 12 needle samples showing 3mm of cancerous cells on the RIGHT side.

Today had a follow up at the VA. That doc recommended a "Wait and See" and scheduled another PSA test in 3 months. I have coronary artery problems (8 stents) and he made it clear that surgery for the prostate was too dangerous. I told him that at this time, I was in good shape for surgery and that 6 or 12 months from now, I might not be in shape for prostate surgery even if my PSA went up.

I'm going to see if I can get a 2nd opinion. Might cost a bit, but probably worth the effort. If 2 experts agree on waiting, then I guess I'll learn to relax. But if they don't, time to flip a coin? Then again since I'm 64, maybe waiting won't make much of a difference?

Sunbird
Regular Member


Date Joined Apr 2008
Total Posts : 140
   Posted 8/31/2010 9:14 PM (GMT -6)   
forJD,

I'm surprised the VA physicians have not suggested brachytherapy. With the small amount of cancer you appear to have and your heart stent history, you might wish to pursue seed implants........
1996, Age 48, Stage III Colon Ca, Colon Resection followed by 18 chemo treatments.
 
2000, Colon Ca Metastasis to upper left lung lobe.  Lung lobe surgically removed.  24 chemo treatments scheduled.  Took 1, declined the rest.
 
9/08 PSA is 2.8, 12/08 PSA is 4.56??  Chalk it up to prostatitis due to urinary retention after Nissen Fundo Surgery.  VA docs prescribe 30 days of Septra.  Prostate feels normal.  PSA hovers around 4.1.  VA docs want prostate biopsy but can't seem to get me into the schedule.  Continue through Spring and Fall of 2009 thinking I have prostatitis.  Bacteria cultures are always neg.  PSA drops to 3.1 10/09.
 
12/09 Prostate Biopsy performed
3 of 10 cores positive, 5%, 25%, & 35%, 3 + 3= Gleason Six with perineural invasion.
 
Doc wants CT Scan due to prior Colon Ca. Findings: "The seminal vesicles are irregular & there is nodularity in the periprostatic fat such that local extension cannot be excluded.  Shotty lymph nodes in both groin measuring 2.3 cm."
 
Doc wants Endo-rectal MRI (OUCH!) Findings: Mild central zone BPH, no discrete focus of carcinoma is identified, no evidience of invasion into the periprostatic fat or seminal vesicles.  Normal size iliac chain lymph nodes.
 
2/08/10 Open RP surgery.  Findings: Gleason Six upgraded to Seven.  3 + 4, Stage pT2c, Bilateral w/perineural invasion, No pos lymph nodes,  margins uninvolved, no extraprostatic extension, no seminal vesicle extension,  39 grams, blood loss 1200 ml (didn't want a transfusion & didn't get one) nerve bundles spared bilaterally.  current age-61

Radical
Veteran Member


Date Joined Mar 2009
Total Posts : 739
   Posted 8/31/2010 9:53 PM (GMT -6)   
Did they mention what gleason score, the sample was, thats definately a consideration here.........................Kev

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 8/31/2010 10:19 PM (GMT -6)   
Like Kev said, your Gleason score more than anything else will determine your treatment. It's part of the biopsy result. With your very low PSA number, there is no rush to go into treatment.

To learn more about what you are facing, find a copy of Dr. Patrick Walsh's book Guide To Surviving Prostate Cancer and read it cover to cover..

Treatment options are based on PSA number, Gleason score and PSA velocity, how quickly that PSA number grows. For small, slow growing Gleason 6 cancers, Watchful Waiting can be your best option...
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..

forJD
New Member


Date Joined Aug 2010
Total Posts : 3
   Posted 8/31/2010 10:26 PM (GMT -6)   
Yep, got a Gleason score of 6 (3+3). Also got a lot of leakage after urinating and when lifting stuff (stress?). And I'm also Type II diabetic and IHD. All attributed to Agent Orange. Got 4 older siblings who don't have any of these so heredity is questionable.
I'm thinking that I've managed to avoid a heart attack or out of whack blood glucose because of good luck and by recognizing the symptoms. This cancer thing takes me by surprise - which I really don't like. Guess if it wasn't for flunking a DRE and some leakage, I'd be happy, dumb and maybe having a very unpleasant surprise in the future.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 8/31/2010 10:32 PM (GMT -6)   
A psa of less than one certaintly is quite low, actually normal or below normal. If Gleason score was 6 then I see no problem at all in waiting. Read "Invasion of the Prostate Scatchers" by Blum and Scholz to get a good idea on Active Surviellance.
I think you are safe. With your condition surgery would be a pretty drastic response for your condition.
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 : 3892
   Posted 8/31/2010 10:42 PM (GMT -6)   
So now you have two books to read! (You can find them both on e-Bay). Between the two of them, you will have a far greater understanding of what you are facing and what your options are. But know one thing..Very, very few men ever die from Gleason 6 prostate cancer...Perhaps a simple 'scope of your urethra and bladder can spot the "leakage" problem. It's probably unrelated to your cancer...

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 9/1/2010 8:39 AM (GMT -6)   
Also, if you are 'nam vet, ask about increasing your disability payments, now that they have confirmed the presence of PCa. Tha'ts worth full payments until treatment and somewhere around 2/3 lifetime after that, I think. Welcome, by the way.

forJD
New Member


Date Joined Aug 2010
Total Posts : 3
   Posted 9/1/2010 9:00 AM (GMT -6)   
Reading your posts gave me some major stress reduction. Thank you much! I think I'll still go through the process of getting a 2nd opinion. From your info, I'd expect that to also recommend a "Wait & See." But it should be interesting, some local rivalry is involved. The doctors at the VA are part-timers from Duke U, which just happens to be across the street from the VA hospital. The 2nd opinion I'll be getting will be from UNC. Arch rivals. so I'll try not to become a football.
Thanks again,
Tom
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