2nd Biopsy Report

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YaYa Princess
New Member


Date Joined Apr 2010
Total Posts : 11
   Posted 3/10/2011 2:30 PM (GMT -6)   
We finally got the results of the 2nd biopsy. I don't think it is much different from the 1st one. Please tell me what you think. Urologist (not a surgeon) who did the biopsies is pushing for surgery. Dr. Shah (surgeon in Atlanta) recommended active survelliance last year when Pca was diagnosed, keeping check on PSA. Hubby does not want to have a biopsy every year and is leaning toward surgery in the fall. Urologist says this is ok if PSA does not go up very much. PSA scheduled in 3 mos.
 
Right Mid: One core 10% (Gleason 3+3=6)
Left Mid: One core 5% (Gleason 3+3=6)
age at dx 59; PSA 9/08 .91, PSA 12/09 1.96, prescribed Cipro, PSA 2/10 1.91, 22% free; Biopsy x 12: 2/25/10, Prostatic Adenocarcinoma, GL 3+3=6, R Mid <5%, L Base 20%, L Mid rare atypical glands
PSA 7/10 2.47
PSA 9/10 1.52

Julietinthewoods
Regular Member


Date Joined Sep 2010
Total Posts : 309
   Posted 3/11/2011 10:43 AM (GMT -6)   
YaYa Princess,

I was surprised no one had answered your post, so really just wanted to bump it up. Lots of the guys who post here can give you more guidance, but I wanted to ask if your husband had considered other treatment options. It seems he would be a good candidate for a few others if he is, indeed, ready to move beyond active surveillance.

Also, have you read some of the books frequently recommended here? That might be a good step at this point.
It could help you understand PSA velocity, among other issues.

Can someone else help her?

Juliet

Tigerfan53
Veteran Member


Date Joined Jan 2011
Total Posts : 929
   Posted 3/11/2011 11:26 AM (GMT -6)   
Has your husband been seen by a radiation oncologist?
Best advice we got was -if it is possible - to go to a cancer center - MSKCC, Hopkins, MDA - where you can be advised on all of your options.  We saw both a surgeon and radiation oncologist in a one day visit.
My husband has been told he can do active surveillance, surgery, or brachytherapy - we are still trying to decide which path to take.
Best of luck.
tigerfan53's wife
Diagnosed Dec 2010
PSA 5.3
Biopsy 1 of 12 cores 30% Gleason 6

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3738
   Posted 3/11/2011 2:18 PM (GMT -6)   
I don't think postponing treatment another 6 or 8 months offers anything but more risk...You would seem to be a perfect candidate for Brachytherapy..Effective treatment with low side-effect risk..I would start looking for a doctor who specializes in this treatment and get it done! JMHO....If not that, then surgery..But do something...Early detection is the key to success. Why fritter that chance away?
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Mackattack
Regular Member


Date Joined Jan 2011
Total Posts : 78
   Posted 3/12/2011 7:34 AM (GMT -6)   
Personally I agree with Fairwind that I would want to do something and get it out of my body. . My age and diagnosis were somewhat different than yours. That being said, I would have a hard time living every day waiting for the next PSA test knowing that I have cancer inside me.

Your stats certainly make you a candidate for AS. You need to do some soul searching and decide if emotionally and mentally this is the right answer for you.
PSA 3.9 - October 2010 at annual physical
PSA 4.1 - November 2010 after a month of antibiotic, DRE Normal
Age 41 in December 2010 at Dx of 6 of 12 cores positive T1C and Gleason 3 + 3

open RP on 2/14/11 at Mass General

Post Surgery Pathology Report: Gleason 6, T2, Cancer in 35% of Prostate, All Margins Clear

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2447
   Posted 3/12/2011 8:29 AM (GMT -6)   
As Juliet said, I am also surprised that your post was not picked up sooner by some of the more experienced and knowledgeable folks here.

In my experience, if I had been diagnosed with your husband's numbers in June 2009, I would have opted to learn more, seek out a good Prostate Oncologist, and chose WW or AS.

2 cores out of 12 is minimal, especially with only 5% and 10% of Gleason 6. It seems that 6 is about the lowest number that is ever report here and is always a good candidate for AS.

From what you have said you have seen only a Urologist and Surgeon. There is much to learn and the Prostate Oncologist is the place to start right now.

No matter the form of treatment, they are all accompanied with some side effects (earlier or later) than can have an effect on Quality of Life. It would appear that you and your husband have plenty of time to learn a lot more about Prostate Cancer than you know now. Use this time to become really informed.

I know that you stated your husband does not want to biopsy every year. I can't say I blame him. But given the choice I would have rather done that than go through surgery or radiation and face the potential of lasting side effects.

As this conversation keeps getting bumped to the top others with greater experience than I will chime in.

Step back, take a few deep breaths and research, learn and consult. Time is on your side right now and it is early yet in your travels through the PCa journey. Use the time to your advantage.

Best of luck to you and your husband,

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Completed Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9

knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 654
   Posted 3/12/2011 10:58 AM (GMT -6)   
Everybody has an opinion here as most of us had to make up our minds on what treatment to have or not to have. Althought your husbands numbers may qualify him as a canidate for AC, that may not mean that is the best for him.
If it was me sitting with those numbers, I would consider myself very lucky and would seek treament with some confidence that i had a good chance of knocking this thing out before it gets a better toehold. I am pretty sure that this course of action that I would choose for myself may not be completly backed up with medical facts but this type of cancer is left, to a large extent, what the paitent wants to do. That's what I would want. However, that said I would not be in a big hurry to make the call.
Meantime, I might want a second opinion on the slides as sometimes there is a significant difference is the labs opinions. And do like others sugested in seeing an oncologist. Most of the members here don't seem to be as lucky as your husband in that we usually need treatment then maybe an oconlogist later on if something goes wrong and there is a recurrance.
Anyway, welcome to the site and hope you and your husband have a good result, however you go at it. Really, it's great news that you have so many choices at this point, but the more choices sometimes the more disconcerting, but I like your position.
Ron
06-08 1st biopsy neg psa 4
10-09 psa 5.5 2nd biopsy 1/12 pos. 10%, G(4+3) age 65
12-15-09 RRP Tulane NOLA Dr Lee
Path, 1%, clr marg, no EPE, no SVI, nodes cl, G(4+3)
100% incontinent @ 12 months
ED, pre-op severe, post op total
10/10 Dr Boone, Methodist recomended AUS
AUS/ IPP performed 1/11/11 Methodist Houston
post op psa's 0.04,<0.1,<0.1,<0.01@12 mo.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 3/12/2011 11:22 AM (GMT -6)   
I agree with the sentiments of Brother Sonny's post above. With 2 cores, Gleason 6, low percentage, and low PSA, I would be comfortable at least doing additional AS. I don't feel that waiting another 6 months to a year would put your husband at any great risk. He is fortunate, that he should be able to choose when the time comes, the full spectrum of primary treatment options. With many of us, the choices were severely limited by our initial stats.

The Seeding, or seeding plus RT could be a good choice for him, even though I am a surgery guy. I wanted seeding, but didn't meet the critera.

Surgery is always the obvious treatment choice, and most popular by number, but as you well know I am sure by now, comes with the most risks of life changing side effects. Some men are lucky with virtually no incontinence, others battle with it for years. Some men, even with extensive nerve sparing ops, end up with perm. ED, while others, like me, won the "luck" raffle and suffered no ED with only a single nerve bundle spared. Point - you never know what you are going to get.

In my opinion, this is still the time to think long and hard about all of it, and talk to as many professionals as you have time and resources for, then when a decision has been made, you can live with it - before and after.

Good luck in any event,

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 2/11 1.24
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 9/10,

YaYa Princess
New Member


Date Joined Apr 2010
Total Posts : 11
   Posted 3/12/2011 8:50 PM (GMT -6)   

Thanks everyone for your responses. My husband did not want to see an oncologist. I thought we should see one last year after the diagnosis just for opinions and options but he said no, his choice for treatment was surgery. We saw a dr in Savannah GA and went to Atlanta for a second opinion. He said he will go to Atlanta for the surgery when that time comes. If we want the slides sent to a 2nd lab, what do we need to do?


age at dx 59; PSA 9/08 .91, PSA 12/09 1.96, prescribed Cipro, PSA 2/10 1.91, 22% free; Biopsy x 12: 2/25/10, Prostatic Adenocarcinoma, GL 3+3=6, R Mid <5%, L Base 20%, L Mid rare atypical glands
PSA 7/10 2.47
PSA 9/10 1.52
2nd Biopsy (2/17/11) R Mid 10%, L Mid 5%, GL 3+3=6

Tigerfan53
Veteran Member


Date Joined Jan 2011
Total Posts : 929
   Posted 3/12/2011 9:32 PM (GMT -6)   
To get a second opinion on the slides you could call a cancer center and request.
I know Johns Hopkins Hospital does second opinions.  Your urologist may also be able to advise you.
We just had to call our local pathology lab and have the slides mailed.
 
Also everything I have read says to make sure your surgeon is experienced.
 
Tigerfan53's wife
Diagnosed Dec 2010
PSA 5.3
Biopsy 1 of 12 cores 30% Gleason 6

knotreel
Veteran Member


Date Joined Jan 2006
Total Posts : 654
   Posted 3/13/2011 6:09 AM (GMT -6)   
If you want to pursue the second opinion on the slides, I would sugest that you start a new thread asking for help on that subject. There are a good number of people on this site that have done that and you could get some good help on that if you want. I think you would first contact, say, Johns Hopkins and make the request and then you may have to go to your local dr's office and sign a release form. THere is a guy at Johns Hopkins that has been mentioned a lot that seems to be the "go to" guy for that and if you start a thread, I am sure somebody will give you the info.
Ron

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4106
   Posted 3/13/2011 6:58 AM (GMT -6)   
YaYa, I am one of those low number guys that chose to have the surgery. Whas it the right thing to do? I think I did what I needed to do for myself. Like you husband I wanted that stuff out of me. You are oding the right thing by getting knowledge. Glad that you guys went to get a second opinion from another Uro. Sounds like you guys have made up your mind and that is one of the hardest steps. Yes there can be issues after surgery and be prepired for that as well but youth is on his side. There are many guys that have had surgery with no side effects we just dont see them here very much on this site.

Do keep us posted as to the progress we are here to walk with you through the process. As others have said dont be a a real ruch..(I was but not completely iinformed) Best wishes.

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
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