Initial meeting with Uro after biopsy and bone scan

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Gleason 6
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Date Joined Mar 2011
Total Posts : 876
   Posted 4/18/2011 9:05 AM (GMT -6)   
Results:

6/18 areas positive - 2 in left base, 4 left apex. 6/40 cores pos. G6 (3+3). 33cc. T1c. Bone scan neg.

Uro said 2 in left base, 4 left apex, but looking at the path report, I see:
L apex anterior, L apex mid, L apex posterior, L apex lateral, L base mid, L base lateral
Seems to me that the whole left side in involved including the mid, but the Uro drew a prostate, divided it into 6 sections and put 2 marks in top left and 4 marks in the bottom left.

I got a copy of my scan and biopsy report.

Doc says he recommends surgery (and would not wait 6 months), although says that rad is an option also. He does not do robotic, but has Docs in his office who do. Does not recommend AS due to my age (61). I did ask how long I would live if I did nothing and he said that "they" say 17 years average. I did like the thought that someone posted that if you do AS, who knows what advancements may come about while on AS. The Uro I saw had RPS 5 years ago and everything is back for him (no ED and continent).

I feel like this is a good report and the best I could have hoped for (other than saying the biopsy was a mistake and I don't have PC).

My next step will be to set up an appointment with Mayo and see a Uro and a Rad doctor that have been recommended and get their opinion as soon as I can get an appointment. Hopefully I can see both on the same day. Then I have some tough decisions to make. Seems like the options all have advantages and disadvantages. RPS seems like it's a especially tough first 2 months, out of work for 7 weeks, invasive surgery, and tough 1st year, but then things get better and back to normal for most. Radiation seems like it's good up front, much less invasive, back to work the next day. with some burning for a month, not a lot of other problems, but later down the road ED and a possible bump in the PSA. No PS after radiation if radiation does not work.

Any thoughts about the results?


Edited to add signature which for some reason does not display.
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6

Post Edited (Gleason 6) : 4/18/2011 9:16:05 AM (GMT-6)


davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 4/18/2011 10:19 AM (GMT -6)   
Your results, all things considered, are great.

Your urologist gave you excellent advice in my opinion and I think your thought process is also excellent. Good idea to interview outside of his practice. How many robotic procedures did the guys in his practice have?

I'll only add that although your estimates on recovery time can be accurate in some cases, very often they are not. I was driving around and working from home after a week and if I had to, could have gone back to office at that point. I can work remotely so it wasn't an issue for me. Urinary functions were fantastic the day I took catheter out and I was having sex by the 5th week post op. Not allowed first 4 weeks anyway. In my opinion recovery wasn't tough at all. I understand it varies from person to person but don't be scared of it.

Good luck.
40 years old - Diagnosed at 40
Robotic Surgery Mount Sinai with Dr. Samadi Jan, 2011
complete urinary control and good erections with and without meds
Prostate was small, 34 grams.
Final Gleason score 7 (3+4)
Less than 5% of slides involved tumor
Tumor measured 5 mm in greatest dimension and was located in the right lobe near the apex.
Tumor was confined to prostate.
The apical, basal, pseudocapsular and soft tissue resection margins were free of tumor.
Seminal vesicles were free of tumor.
Right pelvic node - benign fibroadiopse tissue. no lymph node is identified.
Left pelvic node - one small lymph node, negative for tumor (0/1)

AJCC stage: pT2 NO MX

proscapt
Veteran Member


Date Joined Aug 2010
Total Posts : 644
   Posted 4/18/2011 10:37 AM (GMT -6)   
sounds like you are on the right track and have a good idea of the tradeoffs and the needs for second opinions. Your stats are good, you likely have a long and healthy life ahead of you whichever route you choose. Most important thing for both cancer elimination and minimizing side effects is to make sure you pick a doc who is highly experienced and competent at whatever treatment mode you select. That is more important than whether you pick radiation or surgery.
"If the tool in your hand is a hammer, then every problem looks like a nail."

DX age 54 12/2009
PSA 5.6, DRE-, high pre-op PSAV. Clinical stage T1c
Biopsy: Gleason 3+4 with PNI / 6 of 14 cores + / 10% of total length + / worst 45% +
DaVinci RP 2/2010
pT2cNx / Gleason 3+4 / PNI+ / SM- / SV- / EPE- / Tumor vol 3cc / vol 40cc / 63 gm
PSA in 2010: <0.01, 0.01, 0.01
PSA in 2011: 0.01

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 4/18/2011 11:14 AM (GMT -6)   
I agree. You have pretty favorable biopsy results, with the full spectrum of treatment choices. You are on the right path to investigating all your choices, and time to do it.

I had open Surgery by choice, and if you have any questions related to it.

Good luck as you continue forward, think you are doing great.

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 margin
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, 4/11 3.81
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

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 4/18/2011 12:58 PM (GMT -6)   
Hey, "Six" I agree, it's a good report --- aside from, as you said, being clean.

I'd encourage you to get a second read on your slides. I did and it played a major role in my treatment decision. I bet if you go to Mayo you could send your slides on ahead and get a great second opinion there.

Looking forward to your next report.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

Gleason 6
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Date Joined Mar 2011
Total Posts : 876
   Posted 4/18/2011 1:16 PM (GMT -6)   
I don't have the slides. I'm not sure if I would get them from the urologist or the hospital where I had the biopsy done. I guess they come in DVD format.
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6
CT scheduled for 4/12/11
Meeting Urologist 4/14/11 to go over biopsy and CT results

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 4/18/2011 1:25 PM (GMT -6)   
Yes, an overall good report but some tough decisions.
 
First off, get a second opinion on the slides from either Bostwyk labs or Jon Epstein at Hopkins.
 
Then, AFTER THAT, get a few more consultations. One thing for sure, you don't have to rush too much.
 
One argument for surgery: it seems that quite often (30%?), the pathology after surgery is worse than the biopsy results. So, with 6/18 cores positive (which isn't bad), there could be a G7 lurking somewhere. They would know after the surgery.
 
Also, regarding AS, there is a mental component. Can you handle that (as opposed to the desire do just do something)?
 
Mel

davidg
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Date Joined Feb 2011
Total Posts : 4093
   Posted 4/18/2011 2:37 PM (GMT -6)   
Gleason 6 said...
I don't have the slides. I'm not sure if I would get them from the urologist or the hospital where I had the biopsy done. I guess they come in DVD format.


your urologist will tell you exactly where you can go to collect your slides.

Gleason 6
Veteran Member


Date Joined Mar 2011
Total Posts : 876
   Posted 4/18/2011 2:50 PM (GMT -6)   
I think that is 6/18 areas positive but 6 of 40 cores positive. I guess they divide the prostate into 18 sections for the biopsy.
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6 (3+3)
CT bone scan neg
6/18 areas positive - 2 in left base, 4 left apex. 6/40 cores pos. 33cc.
Stage T1C
Uro said 2 in left base, 4 left apex, but looking at the path report, I see:
L apex anterior, L apex mid, L apex posterior, L apex lateral, L base mid, L base lateral

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 4/18/2011 3:30 PM (GMT -6)   
Gleason 6,

Thank you for sharing your experience and process with us so those that follow can be guided by your journey.

Your biopsy report is encouraging. I am also very impressed that you go through your process methodically, and that you are seeking multiple opinions so as to integrate into your decision. You said: "Seems like the options all have advantages and disadvantages. RPS seems like it's a especially tough first 2 months, out of work for 7 weeks, invasive surgery, and tough 1st year, but then things get better and back to normal for most. Radiation seems like it's good up front, much less invasive, back to work the next day. with some burning for a month, not a lot of other problems, but later down the road ED and a possible bump in the PSA. No PS after radiation if radiation does not work."

A sample of one (me) indicated the surgery (robotic RP) and recovery process was not too bad. I could move around quite well after the removal of the catheter (in my case 7 days). There were no pain or discomfort at the surgical sites and no surgical complications to speak of. From what I have seen here, the radiation guys did even better and most posts showed minimal side effects short or long term. However, as complier said, I probably cannot handle the mental component of AS.

Looks like you have a good handle on the situation and I hope whatever you choose will be right for you.

Good luck to you and cheers.
65 Dx June-2010 PSA: 10.7, biopsy: Adenocarcinoma, 1 core Gleason 6, 3 cores atypia; Clinical stage T2; CT, Bone Scan, MRI all negative

8-23-10 Robotic RP; Pathology: Organ confined, negative margins, Lymph nodes, Seminal Vesicle clear; PNI present; multiple Adenocarcinoma sites Gleason 3+3 with tertiary Gleason 4+. Stage: pT2,N0,Mx,R0

Catheter out 8-30-10 no incontinence, no ED. 3/2011 PSA: <.1

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 4/18/2011 4:09 PM (GMT -6)   
G6,
Your biopsy is a little confusing. Did you have 18 cores or 40 cores?
Did you have a saturation biopsy in a surgical center where you were put to sleep or a normal biopsy in the doctors office?
JT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Gleason 6
Veteran Member


Date Joined Mar 2011
Total Posts : 876
   Posted 4/18/2011 5:00 PM (GMT -6)   
This whole process is a little confusing to me!  I had a template or saturation biopsy (I was under during the process).  My understanding is that they divide the prostate into 18 sections and then take samples from each section.  My results showed 6 of 18 sections had cancer.  They took 40 samples, and 6 of them had cancer.  It would seem as if 1/3 of my prostate has cancer (going by the sections).  That is my understanding.
 
 
Age 61
PSA 4.3 9/10
PSA 5.5 2/11
PSA 7.1 3/11
Template Biopsy 6 pos out of 40 3/25/11 GS 6 (3+3)
CT bone scan neg
6/18 areas positive - 2 in left base, 4 left apex. 6/40 cores pos. 33cc.
Stage T1C
Uro said 2 in left base, 4 left apex, but looking at the path report, I see:
L apex anterior, L apex mid, L apex posterior, L apex lateral, L base mid, L base lateral

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 4/18/2011 5:31 PM (GMT -6)   
Gleason 6 said...
This whole process is a little confusing to me! I had a template or saturation biopsy (I was under during the process). My understanding is that they divide the prostate into 18 sections and then take samples from each section. My results showed 6 of 18 sections had cancer. They took 40 samples, and 6 of them had cancer. It would seem as if 1/3 of my prostate has cancer (going by the sections). That is my understanding.


I assume you were sedated. As a saturation biopsy vet I never heard of 18 sections.There is a template. I wonder how they decide how many cores to take. I've heard anywhere in the 30 - 90 core range. I assumed it was done by gland size. But I had 45 to your 40 with a slightly smaller prostate. No big deal. I have to admit the 3D Saturation biopsies are the current state of the art in locating PCa. Which is mandatory for tft I'm surprised you underwent one if you were expected to undergo normal radical treatments.
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
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