What to do...3+3 <1% in 1 of 12 cores

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RCDD
New Member


Date Joined May 2011
Total Posts : 2
   Posted 5/2/2011 5:55 PM (GMT -6)   
Just had second biopsy 1st one 5-years ago 6 cores, all negative.  This one 12 cores.  11 negative, one core graded 3+3, core size 126mm, lesion size .5mm.  PSA is 8.5, no other symptoms.
 
Had TUMT procedure two years ago, all is good.
 
Need to decide now what to do.  Doctor says it is so tiny that he recommends Wait and See. 
 
Anyone want to offer a suggestion?

goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 5/2/2011 6:19 PM (GMT -6)   
That really is a great result. I would recommend sending the slides out for a second opinion, and do some studying on Active Surveillance. It is certainly a good suggestion for such a small amount found.

It is important to remember that biopsies can miss the main source of the PSA, particularly if it is in transitional zones. You are only seeing the result of 12 needle sticks. Unless you have an infection of the prostate, 8.5 may be a little high for just a small portion of one core.

I think that certainly for the next 3 to 6 months, while you decide what to do, and get PSA tests every 90 days, that watching it will most likely not cause any negative impact on your ultimate treatment.

Welcome to HW, and good luck as you enter the world of PC.
Goodlife
 
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 5/2/2011 6:45 PM (GMT -6)   
What was the size of your prostate? You should have this from your biopsy. If your psa density is less than 1.5 you are in real good shape.
PSA density= psa divided by (prostate size X.1 ).
A good book on an Active Survelience protocol is "Invasion of the Prostate Snatchers" by Dr Mark Scholz. A color doppler ultrasound will also give you confidence that you are dealing with a small indolant cancer and not something more serious.
JohnT
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.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25394
   Posted 5/2/2011 6:57 PM (GMT -6)   
Based on what you posted, I would say you would be a prime candidate for A.S.
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

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 5/2/2011 7:17 PM (GMT -6)   
How old are you? Your age can mean the difference between "Let's wait and see." or "Let's celebrate!"

Welcome to HealingWell.
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

RCDD
New Member


Date Joined May 2011
Total Posts : 2
   Posted 5/2/2011 7:26 PM (GMT -6)   
I am 61 going on 40...perfect blood pressure, non-smoker, good cholesterol levels, taking no medications.
 
I think the TUMT procedure must have caused an increase in my PSA levels over the past two years, coupled with the biopsy finding of this week.
 
My Dr. says that even a tiny lesion like that can cause a rise in PSA because of the sinsitivity of the test.
 
I appreciate all the input.
Thanks!

Worried Guy
Veteran Member


Date Joined Jul 2009
Total Posts : 3743
   Posted 5/3/2011 6:59 AM (GMT -6)   
"61 going on 40" (I was 56 going on 35) If I had your stats I'd enjoy my prostate as much as possible. After all, frequent use is GFMPH (Good For Men's Prostate Health).
Get tested regularly and be consistent around the time of your PSA testing.
Here are some well known rules:
1) Always go to the same lab.
2) Don't have sex 48 hours before the test.
3) Refrain from doing anything that disturbs the prostate like: riding a bike, or getting a DRE at least 478 hours .
There is plenty of data on the above. I add the ones below but have no data to back them up. They just seem directionally correct.
4) Do the test at the same time of day.
5) If you must eat, eat the same food before the test. (I fast for at least 8 hours.- Test in the morning no eating after 10 pm)

You want to keep an eye on this so you can respond quickly and decisively if the need arises.

Now get out there and empty that prostate!
Jeff
Age: 58, Mar 35 yrs, 56 dx, PSA: 4/09 17.8 6/09 23.2
Biopsy: 6/09 7 of 12 Pos, 20-70%, Gleason 4+3 Bone, CT Neg
DaVinci RP: 7/09, U of Roch Med Ctr
Path Rpt: Glsn 3+4, pT3aNOMx, 56g, Tumor 2.5x1.8 cm both lobes and apex
EPE present, PNI extensive, Sem Ves, Vas def clear, Lymph 0/13
Incont: 200ml/day ED: Trimix
Post Surg PSA: 10/09 .04, 4/10 .04, 7/10 <0.01, 12/10 <0.01
AdVance Sling 1/10/11 Dry

Newporter
Regular Member


Date Joined Sep 2010
Total Posts : 225
   Posted 5/3/2011 7:59 AM (GMT -6)   
In your case, AS is certainly an option. However, that said, there is a possibility that cancer is more extensive than indicated by the biopsy. Sometimes, post surgery pathology report indicates higher Gleason score and more extensive cancer. Also, since you are 61 and very healthy, you have a long time to live and that is a factor to consider.

When diagnosed @ 65, I had a PSA of 10.7, density of <1.5 and 5% of one out of 12 cores contained cancer of Gleason 6. Post op pathology report indicated cancer was quite extensive throughout the prostate and some places with higher Gleason scores. I was fortunate I decided to take it out or it might have spread if I waited.
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

JoeFL
Regular Member


Date Joined Oct 2009
Total Posts : 420
   Posted 5/3/2011 11:30 AM (GMT -6)   
Based on what you have shared, if I were in your position I would wait one more PSA test to see if it goes down from 8.5. If it does, I would wait some more. If it doesn't (or goes up), then I would be asking the doc to find out why.
Age 68 PSA 4.5 Biopsy 9/4/09 Bostwick Labs 5 of 8 sections (5 of 11 cores) positive-Gleason 3+3=6 Stage T1
BT on 12/11/09 (84 seeds of Palladium 103) Home same day/no catheter. Some burning, frequency, urgency for 6 weeks. No incontinence, mild ED. 25 IGRT sessions ending 3/22/10 - some fatigue until 30 days after last treatment. PSA as of 4/14/11 - 0.1

SHU93
Regular Member


Date Joined Aug 2008
Total Posts : 328
   Posted 5/3/2011 11:50 AM (GMT -6)   
I would agree with goodlife, a biopsy is 12 shots at your prostate. It could miss!! Not an exact science... In my case the biopsy i had 12, onde side all 6 were postive the other side was neg for the six. After surgery the side that had no hits had more cancer then the side that did!!!
Age Dx 37, 7/2008, First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008, Biopsy: 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Da Vinci Surgery 7/2008, PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
7 Post Op PSA’s from 9/2008 to 11/2010: <0.1
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