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yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/5/2011 12:05 PM (GMT -6)   
hey there---- i feel like a member of the club. i paid my entry dues (biopsy) and then got confirmed with my numbers (sept 28 psa 2.1 jan 10 gleason 3+3 t2b). yes it is like a kick to the stomach but you can get used to almost anything i have decided. i am 56 years.  i am scheduled for open rp on march1. i am doing everything in my power for it to go right(duh). i am upping my running to guaranteed 7/10 days rain or shine. also i am upping the distance. i run by time only and am up to about an hour. i will probably advance this in the next month. diet- i have cut out beef and pork and am sticking with fish and chicken. also am staying away from saturated fats as much as possible.  i was taking a protein (whey) supplement but after talking to my uro i dropped that. i read about dhea in walsh's book and then found out these supplements are unregulated by fda. call me paranoid! i am practicing stream pausing and am attempting klegel. 1 more month! is there anything i am missing? thanks . it's great to have a group to go thru this with. 

sept 28 psa 2.1 gleason 3+3 t2b

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 2/5/2011 12:45 PM (GMT -6)   
Sounds like you are on top of things. Only additional thing that I would recommend is a second opinion on you biopsy.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/5/2011 12:58 PM (GMT -6)   
You didn't mention your age or the number of positive cores in your biopsy. From your low psa and G6 you may want to consider Active Survelience as it may be the best option for you at this time. Please read "Invasion of the Prostate Snatchers" by Dr Mark Scholz to get a better idea of the options available to you as you may be over reacting to your condition.
JohnT

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 2/5/2011 1:00 PM (GMT -6)   
yobiks, welcome to the Forum. What's the details of your biopsy, if you don't mind or have them? Number of cores taken, number of cancer and % of the core found, previous psa results, what you do for a living, where ya live, etc, etc. We like to get to know our new friends, if they allow it. smilewinkgrin Again, welcome. Stick around and keep us updated as you go thru your journey..
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 2/5/2011 2:01 PM (GMT -6)   
First of all calm down, RELAX. Take a deep breath and cancel your radical surgery appointment. No one unless you're like a gleason 10 should go under radical surgery just 6 weeks past biopsy. You have time to educate yourself to all treatment options and all their possible side effects. Some may be quickly over some others can lower your quality of life permanently in a worse case scenario. Don't be one of these guys who spend more time considering buying a car than contemplating radical medical treatment . There is also the active surveillance for some.

Do educate yourself. At a point it will be overwhelming, when so I recommend you try your best to take a week off and not think about your PCa to gain some perspective. Then when back to it and you do choose what option to take again take a few days off then when sure go ahead and don't look back with any regrets. If you just do as one doctor told you weeks after your dx, you very may well later regret it as some here have. Good luck this is cancer after all. What comes next is not easy to decide or like getting something fixed in your life. Its your body and life after all give it the full attention it requires. For future peace of mind get another opinion, see a radiologist..etc Good luck.
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

Post Edited (Ziggy9) : 2/5/2011 3:13:29 PM (GMT-7)


billye
Regular Member


Date Joined Nov 2009
Total Posts : 24
   Posted 2/5/2011 3:28 PM (GMT -6)   
start taking metamucil two weeks before the operation and continue it for six weeks following---don't eat too much two days before the rp.  w

RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1268
   Posted 2/5/2011 7:40 PM (GMT -6)   
Yobiks,
 
Sorry to welcome you into the club, but you've come to a good place for advice on PCa.
 
I agree with the other posts that suggest a second opinion on the biopsy. 
 
Not knowing much else about your situation its hard to comment on your decision to do surgery;  however, I also agree that you might want to give consideration to other options (AS, Brach, Focused treatments) if you haven't already.  I say this because surgery can have some side effects that can be tough to live with.  There are more than a few guys that end up with incontinence or ED ...... and its hard to run in a loaded diaper. 
 
If you stick with surgery, I would recommend doing a lot of kegels pre surgery.  I think they helped me a lot.
PSA 2007 - 2.8; 11/24/2008 - 7.6; PCa Dx 2/11/09; age at Dx 62; RLP 4/20/09

Biopsy - Invasive moderately differentiated prostatic andenocarconoma; G 3+3=6; PT2C; No evidence of Seminal Vesicle or Extraprostatic Involvement; Margins clear; Tumor identified in sections from prostatic apex. 70 gram prostate. Continent after removal of cath.

ED - Trimix works well; levitra @ 90%
PSA - 7/31/09 <0.06; 12/1/09 <0.06; 3/29/10 <0.06; 8/4/10 <0.06

billye
Regular Member


Date Joined Nov 2009
Total Posts : 24
   Posted 2/5/2011 7:56 PM (GMT -6)   
re-read pat walsh's book------------------the biopsy means very little. the proof is in the post path. the walsh rule is under 70, remove, over 70, evaluate all the options. go to a world class place like hopkins or the cleveland clinic

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/5/2011 9:21 PM (GMT -6)   
hope this is coming as a reply as i am unfamilliar with your website. thanks for the advice. i do appreciate it. my biopsy came back as right mid 2mm of 25 adenocarcinoma-8%. left mid adenocarcinoma 1mm of 15-7%. Both diagnosed as gleason 3+3. the rest of the samples are clean. second opinion called it as te1a and te2a for the 2 samples sent to them. As i said i am 56 in good health and surgery looks like a nobrainer to me. if i have cancer, why would i wait?
 

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/5/2011 10:08 PM (GMT -6)   
the rest of the details------my dre was abnormal- that's what sent me to the urologist in the first place. my psa climbed from .73-.77-.97- then 2.1 in 18 months on the last interval. Interestingly enough i worked in the ag chemical bus for 20 years and was around a fair amount of 24-d and similar products. i am in a different line of work now. as my doctor says- that's all academic now.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 2/5/2011 10:12 PM (GMT -6)   
welcome our world, you have seen already, you will get a plethora of opinions real fast.

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 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/5/2011 10:32 PM (GMT -6)   
thanks purg------i know it sounds like i am moving fast but i see no advantage to wait. i don't have any fishing trips planned.
sept 28 psa 2.1 jan10 '11 gleason 3+3 t2b

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 2/6/2011 7:07 AM (GMT -6)   

yobiks said...
As i said i am 56 in good health and surgery looks like a nobrainer to me. if i have cancer, why would i wait?

Hi Yobiks,

Welcome to the site.
Newcomers here often are surprised by everybody telling them to take their time to do their research. It seems counter-intuitive, doesn't it, when you've got cancer in you? However there are good reasons in taking your time to figure out what to do next. The reasons for this are:

1. Prostate cancer is the slowest growing cancer by far - decisions are therefore not urgent, especially in the case of low volume low grade cancer that you seem to have.

2. You are making your decisions on biopsy results that may or may not be correct. Ideally you would organise an expert review of your biopsy slides. We have learnt that all pathologists are not equal and the person you want to rely on should have looked at thousand of prostate slides rather than 1000s of run of the mill diseases. Examples of expert pathologists include Bostwick and Epstein.

3. For someone with low volume, low grade cancer there are many treatment options. Surgery is the option that your urologist is likely to recommend as he/she is likely to be biased towards surgery. Surgery can be curative but a proportion of people come out the other side with incontinance issues and most with erectile issues. However there are other attractive options that you could explore, brachytherapy (seed therapy) is one of them. Less side effects but a similar likelihood of a cure. Or in suitable people even active survellience - carefully monitoring your cancer is an option because some low volume cancer does not progress.

4. If after reviewing your options you decide on surgery then you need to consider, which surgeon? The incidence of post-op issues is much lower in some surgeons than others - incontinance rates range from 2-40% depending on the surgeon. You need to research who has the best results and even if it means flying across the country it is worth going to them. You have your entire life to live with the consequences so finding a good surgeon is a decision that is not to be taken lightly. A similar story would be the case with brachytherapy - you would want the best you can get.

5. Read Read Read Read and Read ..... the internet, books, this forum.

The reason why people would tell you to slow down is that we have all been through that horrible feeling when we or our significant others got diagnosed. We remember how urgent it felt to get the cancer out. But you have time, a couple of months won't change the outcome of what happens to you. If you do 1.-5. you will need a couple of months but you will be making a treatment decision from a position of strength and knowledge and based on a clear understanding of your situation.

Hope this helps,
An


Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01

Post Edited (An38) : 2/6/2011 6:17:13 AM (GMT-7)


billye
Regular Member


Date Joined Nov 2009
Total Posts : 24
   Posted 2/6/2011 8:13 AM (GMT -6)   
the biopsy is only inferential---it means what they found, not what's there. i would go to a teaching hospital where they do thousands of removals, i elected open, think about fox chase, cleveland clinic, anderson, mayo. these people specialize in taking it out. thousands, not hundreds. eric klein at the cleve clin ballantyne carter at hopkins. there's only one you. get the best. the best means experienced. don't fall inlove with all the robot advertising. its the person, not the method.

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/6/2011 8:19 AM (GMT -6)   
an38- This is no doubt an ongoing debate with everyone that has pc. My thought is- "if it quacks like a duck...". you seem to be a good example of what I'm concerned about. Who's to say the path report will come back gleason7? I feel like I am on the cusp and need to act decisively. If some want to call it panic that's there viewpoint not mine. I want it out of me.
sept 28 psa 2.1 jan10 '11 gleason 3+3 t2b

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/6/2011 8:30 AM (GMT -6)   
billye- I cannot agree more on the robotics issue. After looking for some time I found a few articles witch looked like certain advantage with open over robotics. Ihad to wade thru all the glossy photos to find it. I want this guys hands in me with his full complement of biologic nanofeelers. I am quite happy with my surgeons at this point. I live in portland oregon- no surgeon here does this procedure exclusively but mine has about 250 under his belt. his surgical partner is the vet urologist in town with nothing but 4 star ratings. Based on his age my guy is at the top of his game. I don't think that johns hopkins has a monopoly on good surgeons.
sept 28 psa 2.1 jan10 '11 gleason 3+3 t2b

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 2/6/2011 8:34 AM (GMT -6)   
yobiks said...
an38- This is no doubt an ongoing debate with everyone that has pc. My thought is- "if it quacks like a duck...". you seem to be a good example of what I'm concerned about. Who's to say the path report will come back gleason7? I feel like I am on the cusp and need to act decisively. If some want to call it panic that's there viewpoint not mine. I want it out of me.

You are right, there is a chance that the cancer will be upgraded like my husband's was. But if you rush there is also there is the chance that at some point in the future that you wished that you had chosen a better surgeon because of persistant incontinance or some cancer left behind - we have had cases on this site where inexperienced doctors have treated people like guinea pigs and sliced through the prostate and the cancer leaving a chunk behind. We have also had people who had a local recurrance following surgery probably wishing that they had brachytherapy which may have both killed the cancer within the prostate and a few mm beyond - in effect doing radiation and surgery in the one hit.

Dr Strum, an expert in this field is fond of saying "status begets strategy" - he likes spending some time pulling together as much data and results as possible in order to get a clear picture of the cancer. This allows you to be decisive and choose the correct strategy to dealing with it. You have years and years of anxiously waiting for PSA tests after your surgery and a little investment in time now is likely to result in fewer regrets.

My husbands cancer was upgraded but I am confident that the three months wait between surgery and biopsy did not change a thing. The prostate cancer has probably been in him for a decade before it was found and three months changed nothing.

An

RCS
Veteran Member


Date Joined Dec 2009
Total Posts : 1268
   Posted 2/6/2011 8:44 AM (GMT -6)   
Yobiks

2,4 D and 2,4,5 T were also used in agent orange (defoliant used in Vietnam). The military has a program covering PCa treatment for guys who were in country. You may want to check with the company you were with to see if they have a similar program that covers guys who used it in ag.

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 2/6/2011 8:55 AM (GMT -6)   
There was an article I posted recently on this site showing prostetectomy outcomes vs surgeon experience. There is a steep learning curve for this complicated surgery which starts to plateau around 300-500 surgeries. At a 1000 or more surgeries the results are optimal.

Of course, the number of surgeries is only one factor and should be a pre-requisite. Additionally, the T2+ rate, the continance rate and the reputation of the surgeon needs to be considered.

At 250 surgeries, the surgeon is still quite new at what he does, and this would have raised a warning flag for us.

Regards,
An

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 2/6/2011 12:42 PM (GMT -6)   
An is giving you some very good advice. The chance of you dieing with a contained G6 in 15 years is .0003. So now that you know you won't drop dead tommorrow what's the hurry. For low risk PC every treatment option produces the same results, so side affects of the different treatments should play a very important part of your decision. Younger men have much more to lose by poor decisions as they will have to live with undesirable side affects much longer.
The three most important considerations in achieving the most favorable outcome:
1. Know the biology of your individual cancer. get 2nd opinions on your slides and even a color doppler or MRIS to size and locate the tumor to see if surgery will have a high probabiity of a good outcome.
2. Choose the best treatment option for your particular type of cancer. The main consideration for low risk PC should be to minimize the side affects as all treatments produce similar results and death from low risk PC is rare. For advanced PC, the most agressive treatment is usually called for.
3. Choose the best artist to perform the treatment. There is a vast difference in outcomes from the best to the worst doctors.
If you follow these steps you will significantly increase your probability of a successful outcome.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/6/2011 3:00 PM (GMT -6)   
this gives me pause...what I am going for is the proverbial cure. I am thinking 30 years down the road not 15. Why not? My dad is 92 and has gotten across a few humps in his time. I'm hoping for the best but realize there are no guarantees.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4271
   Posted 2/6/2011 3:18 PM (GMT -6)   
Youbiks, welcome to the site and I'm sorry you have to be here. 
 
IMHO, you have received some excellent advice from An and JohnT.  Your "I gotta get it out" is not a totally unusual reaction but the LOGIC should tell you to take your time, get educated and evalutate your options.  My "no brainer" after significant study was to go for brachytherapy because of the quality of life issues...please read over some of the other threads on this forum to understand what CAN happen after treatment.
 
If surgery is your final choice then good luck, but please review your options so that you don't look back later and wonder why you didn't...
 
Good luck,
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 2/6/2011 3:24 PM (GMT -6)   
Yobiks, Many have posted comments. I will saw I am one of the guys that went with open. After 2.4 years out I am in good shape. I was diagnosed at 57. incontanance was never a problem. Ed on the other and was an issue. As your Dr specific questions about that. Most Uro's tend to gloss over that or avoid it completely. Ask he what is he plan for treating ED if that should be a result. Probably a good time to ask what percentage of his patients have ED after he has done the nerve sparing surgery.

Only you can decide what path to take with the PCa. I am pleased with my choice. For a long time I was very angry that I did not do DeVinci Surgery. After being here for a while I have found that there is little difference between the 2 kinds of surgery other than getting the Cath romvoed a bit sooner.

I had the same thoughts as you. Get this Cancer out of me ASAP. My gleason actually went down after surgery from 3+4 7 to 3+3 6

Do keep us posted. Know that we are here to answer your questions and support you.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

yobiks
Regular Member


Date Joined Feb 2011
Total Posts : 39
   Posted 2/6/2011 6:04 PM (GMT -6)   
thanks again for all the info and wisdom. I will call my uro next week and quiz him.

Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 2/7/2011 3:02 PM (GMT -6)   
Yobiks,
You asked the question "what else before". As much sex as you can. Things often are not the same after. My surgeon waited for my psa to be over ten. Good luck and keep us posted.
Mike
Age 48 w/diagnosed
10/06 PSA 3.0
11/06 PSA FREE %13.2
10/07 PSA 3.4
12/07 Biopsy-neg
1/09 PSA 4.6
6/09 psa 5.8
2/10 psa 8.7
7/10 PSA 10.8
8/2010 3rd biopsy GG 3+3=6, one of eight cores -2%
Lap 10/22/10 Dr. Troxel
Path- Neg Margins, Gleason 6, Nerves spared, 85 gm
Jan 20, 1 pad/day psa < 0.1, ed an issue
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