I have decided one thing, my current game plan

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Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 4/10/2011 9:17 PM (GMT -6)   
My next schedule PSA test is for May 22, and with a final surgical consultation with my Uro.  Between now and then, I will be making up a package of my medical records from A-Z, and I am pretty close to deciding on a noted medical oncologist in my general area.  He is not connected in any way to my current doctors, hospital, or radiation clinic.
 
I am expecting this next PSA reading to be well above 6.0, and perhaps, and hopefully not, as much as 8 -10.
 
Soon as I get this next reading, I will meet with the new Medical Oncologist, and let him go through the whole journey and give me an honest opinion.  I do not plan  to bias his thinking with any of my current feelings or sense of direction.
 
Depending on what this next PSA ends up being, and if indeed its still skyrocketing toward the moon, and based on what the new doc thinks, then I will re-evaluate my entire situation.
 
If I were putting my thoughts in terms of percentages, right now, tonight, I am still 80% opposed to HT, and 20% possibly for it.
 
If I were convinced it could buy me another 10 years, I would possibly be more favorable.  If I went through HT, and it went refactory quickly and I ended up with a slew of negative side effects,, then it wouldn't be worth it to me.  Would rather have less years, with a higher usefullness in terms of quality of life, then more years with problems.
 
That's the best I can come up with right now.  I think it would be foolish to expect my PSA to mysteriously go down on its on, I don't see that being in the cards.
 
This plan will give me a month and a half to settle on a new Oncologist, and get my ducks lined up.
 
David in SC
 

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 9:33 PM (GMT -6)   
I'm no doctor, but I cannot think of a single scenario whereby any oncologist wouldn't recommend starting a form of hormone therapy now.  It has, of course, been pointed out to you many times that one can stop HT at any time, and any SEs you may experience will reverse fairly quickly.
 
I think you should anticipate that the doctor will tell you HT will bring you prolonged quality years.
 
Of course the choice is yours and yours alone, but I'm still scratching my head looking for a realistic downside.
 
 
 

Post Edited (Casey59) : 4/10/2011 8:41:28 PM (GMT-6)


Purgatory
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Date Joined Oct 2008
Total Posts : 25393
   Posted 4/10/2011 9:41 PM (GMT -6)   
Casey, aside from the side effects issues, there is much controversy ,as you well know, even among the 'experts", of when to start after a failed surgery/radiation combination. One school says now, while its lower, and the other, just as adamantly , says wait till its above 10-15. Both sides make convincing arguments.
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,

Casey59
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Date Joined Sep 2009
Total Posts : 3172
   Posted 4/10/2011 9:51 PM (GMT -6)   
well, you've missed the "lower" school of thought...

compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 4/10/2011 9:51 PM (GMT -6)   

Sounds like a plan.

Of course, make sure the doctor is accepting new patients!

It sure does seem like some form of HT is the next step!

 

Mel (I'm still probably right behind you!!)


compiler
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Date Joined Nov 2009
Total Posts : 7269
   Posted 4/10/2011 10:14 PM (GMT -6)   
David:
 
Another thought is to see this doctor BEFORE your next PSA and discuss what ifs.
 
I hope you will continue to share the expert opinion you glean.
 
Feel free to mention the name of the doctor, too.
 
Mel

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 4/10/2011 10:17 PM (GMT -6)   
David,
Sounds like a good plan, after all why make any decisions now before talking to the expert. Find a good guy, keep an open mind and go with what feels right for you.
Best
Dave
Dave in Durango CO

07-06 PSA 2.5
01-08 PSA 5.5 (Dr never told me)
09-09 PSA 6.5
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5
03-01-10 Age 55 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson
03-16-10 Path' G-8 (4+4+5) Bilateral involving 21% of left lobe, 3% of right lobe, SVI, Focal positive margin, pT3b NO MX

All PSA as of 1-25-11 <0.04

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/10/2011 11:15 PM (GMT -6)   
casey, hope you meant that last remark in an innocent way. no one expected my psa to jump from .06, to 1.24 in 6 months time, i only skipped a single psa test by choice.
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,

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/10/2011 11:21 PM (GMT -6)   
mel, i am hoping you will stop following me, and that your srt will work and stop your forward motion.

dave, not much i can really do in between then and now, just going to keep chilling. still have my hands full trying to adjust to life with a urostomy, battling daily bouts of severe fatigue, etc, and somehow, trying to enjoy a few things here and there.

and the 2nd part mel, not interested in playing what if ahead of time, quite certain the new doctor will want that next reading. in my area, never have had problems getting quick appointments.
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,

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 4/11/2011 5:56 AM (GMT -6)   
David, sounds like a plan to me. I tend to agree with Casey and believe that the oncologist will recommend HT. Of course, the crux of the problem, as you stated, will be deciding on when to begin treatment.

You already know that no matter your decision, you will hear from those who agree and those who don't. Remember to take what you need and what makes sense for you (and for Peg, because this is not something that affects just you), and discard the rest.

As to your PSA in May, while it might be foolish to expect it to go down (or not go up) on its own, never say never - stranger things have happened!
Husband diagnosed in 2/2008 at age 57 with stage T1c. Robotic surgery performed 3/2008. Stage upgraded to T3a (solitary focus of extraprostatic extension). Perineural tumor infiltration present. Apex margin, bladder neck and SVs negative. Final Gleason 3+4. PSA 0.0 thru July 2009. August 2009 - 0.1, September 0.3, October 0.0. PSA has remained undetectable since then.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/11/2011 7:33 AM (GMT -6)   
David:
 
How far will you have to travel to see this doctor?
 
Mel

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/11/2011 8:26 AM (GMT -6)   
That's inmaterial at this point, Mel. Give you a hint, it will 2 full counties away. Why do you ask?
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,

DaSlink
Veteran Member


Date Joined Feb 2011
Total Posts : 713
   Posted 4/11/2011 9:31 AM (GMT -6)   
David;
Sounds like you have decided on a plan that works for you and puts your mind at ease for a while.

Good Luck; Slink
Every minute you fish or ride,adds an hour to your life!

Age 52 Dx age 53 daVinci surgery
prostate volume 32 grams
Biopsy 12 cores with 7 positive
Gleason score of 7
1st PSA 38.7 10/05/2010
2nd PSA 49.9 11/23/2010
CT neg.
BS Negative
RRP on 01/25/2011
PT3a -40% involved
margin involved-Left anterior
lymph nodes -clear
1st post op PSA-0.26-03/16/11

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 4/11/2011 10:31 AM (GMT -6)   
Congrats on deciding on a plan Dave. You seem to be at peace with yourself and this is what best for you and your family. I hope all goes well with it. As I keep saying if anyone deserves a break or just a little good news is sure is that guy from SC. Good luck

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/11/2011 11:20 AM (GMT -6)   
David:
 
I was just curious. In fact, the 2 doctors I'm thinking of going with (or at least consulting) if SRT fails:
 
1 is at a major Comprehensive Cancer Center (Dr. Hussein at Umich) and the other is not (Dr. Scholz in LA).
 
I keep reading about advantages and disadvantages of going to a major Center.
 
Did you consider one venue vs. another and pick one, or just go with an excellent medical oncologist independent of venue (I'm leaning towards the latter but as I said I seem to be considering one of each).
 
Mel

John T
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Date Joined Nov 2008
Total Posts : 4268
   Posted 4/11/2011 11:33 AM (GMT -6)   
David,
Good luck
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.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/11/2011 2:32 PM (GMT -6)   
mel, i am not into the whole "venue" thing, i am searching for a quality medical oncologist who has no former connection to me or my current doctors, just to have a fresh spin on my situation, also working with limited resources, and got to get the most bang for the buck with what i have to work with.

ziggy, thank you. that inner peace is not always easy to find or achieve. it's working for me ,so that should be the most important thing. my wife is in the ring with me, and respects any personal decisions made by me.

thanks, daslink, and sephie, and john.

david
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,

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2845
   Posted 4/11/2011 3:25 PM (GMT -6)   
David -
- you know you have our love and support in whatever path you choose in this segment of your journey

- having a fresh non-biased analysis of your situation, stats and journey (so far) would be a little scary and exciting at the same time ....

- I am very glad you have found that calm-spot within yourself so you can listen to and hear the interpretation of what makes your PCa such a bugger to deal with as well as the possible suggestions for the next stage in your journey.

-wishing you all the best

hugs,
BRONSON & STEVE
Age:55 -gay with spouse of 14 years, Steve -Peterborough, Ontario, Canada
PSA:10/06/09 3.86
Biopsy:10/16/09- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy:11/18/09
Pathology:pT3a -Gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
PSA:04/08/10 -0.05 -Zero Club
PSA:09/23/10 -0.05 -Zero Club
PSA:03/24/11 -0.02 -Zero Club
PSA:03/24/12- TBA

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7269
   Posted 4/11/2011 3:55 PM (GMT -6)   
David:
 
Good luck to you. Hopefully you will get a fresh view and some new insight or even a confirmation of your owwn insight, but hopefully a new idea or two and some kind of plan!!
 
Mel

Jerry L.
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Date Joined Feb 2010
Total Posts : 3072
   Posted 4/11/2011 4:10 PM (GMT -6)   
David,

It's good to have a plan. I anticipate reading a post 6 months from now that things are going good. Hang in there...

Jerry

Post Edited (Jerry L.) : 4/11/2011 4:55:05 PM (GMT-6)


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 4/11/2011 6:56 PM (GMT -6)   
David,

One option would be to go to Casodex only. Much easier side effect profile and very effective. My medical Onc doc said that if my PSA would go up, that's what she would recommend. Her cut off point is PSA = 10

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/11/2011 8:15 PM (GMT -6)   
jerry - i truly wish that comes to be in the future, so far, on a runaway train. good luck in your situation

geebra - will check out that as a possibility, its possible at the rate of my PSA acceleration post SRT, I could be at that level in another 3-6 months
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,
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