Help with dx and treatment options

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New Member

Date Joined Apr 2011
Total Posts : 15
   Posted 5/18/2011 7:19 AM (GMT -6)   
My husband and I met with Urologist yesterday and he was diagnosed with prostate cancer. Here is the information from the biopsy report in condensed form.
Age 61
PSA 10.44 3/11 up from 7.5 1/11
DRE Isolated nodule
T2a left mid
10 of 12 cores positive for cancer
3(4+3), 5(3+4), 2(3+3)
percents of cancer found in each core(25,26,32,36,40,46,50,57,67,89)
Gleason score 3+4=7
Perineural invasion found in 5 samples High grade PIN found in 1 sample
Bone and CT scan no evidence of spread
Okay, uro said there was a large amount of cancer found and because of that he classifies his cancer as highly agressive instead of the moderate which the gleason 7 reflects. He also said the cancer had only been there less than 2 years as he performed a TURP on my husband in Sept 2009 in which he removed 50% to 2/3 of prostate tissue all of which came back negative for cancer.What happened to the 10-15 years that it takes for pca to grow?
He said my husband had only 2 options for treatment. The first is the da vinci robotic surgery where he would remove entire prostate along with 3-20 lymph nodes and no nerve sparing promised. He said this was a 1 night hospital stay and 7 days home with catheter.
The second option is external beam radiation (5 days a week for 8 weeks) followed by 3 years of hormone shots.
He recommends surgery as if that fails then they can still do radiation but not vice versa.
He also said there is a 50% chance that the cancer has spread from the prostate .
He said whatever decision is made that my husband needs to make it immediately and he would do surgery right away.
I thought they would not do surgery that soon and protocol was normally 6-8 weeks post biopsy.
We have a Vegas vacation booked for mid July and the uro said he cant wait that long but if he absolutely had to he would give him a hormone shot before vacation and surgery upon return.
Does anyone have similar stats to my husbands and chose one of the treatments over the other? I would appreciate any and all responses. And do you feel an urgency in this as the uro has expressed to us.
Thanks in advance!

Forum Moderator

Date Joined Sep 2008
Total Posts : 4274
   Posted 5/18/2011 7:35 AM (GMT -6)   
Dear Packfan:
Sorry for the bad news and it looks like you two are in for a bumpy ride, at least for awhile.  With a potentially very aggressive cancer that has some probability that it has spread, I would recommend that you make sure you get treatment from an expert.  It may be that the advice from your urologist is correct...maybe not.  There is a school of thought that would NOT do the surgery but would go with a combination of seeds, IMRT and HT.  I'm certainly not qualified to advise on that point but would strongly suggest that you seek out the advice of a medical oncologist who has significant experience with prostate cancer.  There is a list of such oncolgists in one of the appendices of Dr. Scholz' book, "Invasion...".  If you tell us your geographic location, there may be members of this forum who can advise of such experts in your general area.
Best of luck and please keep us up to date on your proress.
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:

New Member

Date Joined Apr 2011
Total Posts : 15
   Posted 5/18/2011 7:53 AM (GMT -6)   
Thank you Tudpock. We live in Raleigh, NC and his urologist said that he wasn't eligible for the seeds due to the amount of cancer found. His specialty is the robotic surgery and says he has performed more of these than anyone in the area. He has excellent credentials but I agree that we should meet with an oncologist as well.

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 5/18/2011 8:09 AM (GMT -6)   
I wouldn't presume to give medical advice but you should keep in mind that IF the cancer has spread outside the prostate then it must be treated with radiation. If this is the case then you need good advice as to whether surgery would be of much use.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day
9 mo. PSA 0.00 -- 1 light pad/day ED remains
12 mo. PSA 0.00 -- still one light pad and ED
16 mo PSA 0.00 -- light pad just for security, ED still an issue

Forum Moderator

Date Joined Sep 2008
Total Posts : 4274
   Posted 5/18/2011 8:16 AM (GMT -6)   
Packfan, you are lucky enough to have the Duke Cancer Institute in your backyard.  My understanding is that the Duke Prostate Center (within the DCI) can offer you a multi-dilciplinary approach including oncologists who specialize in PCa.  That would seem to be a good option.
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:

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 5/18/2011 10:49 AM (GMT -6)   

I had similar stats to your husbands. In 2008, seeds were ruled out for me. I had open surgery, it failed within 9 months. I then had SRT, it has since failed. I would not want to make a reccomendation in your husband's case. On the surface, it looks like a single primary treatment may fail regardless, so some sort of combo-treatment might be a better fit. I agree with Jim above, if you have access to Duke, it might pay to get a higher level second opinion.

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

Veteran Member

Date Joined Dec 2010
Total Posts : 3887
   Posted 5/18/2011 10:56 AM (GMT -6)   
Check out High Dose Radiation brachytherapy.   This is where the radiation seed is not left in the body.   It is very effective in locally advanced situations.   I used it along with IMRT (for the gland, margins and lymph nodes) and HT (Eligard and Jalyn) to weaken the PCa and starve it if it has spread but can't be found.   My numbers are similar to yours, but PSA was much higher.
Best info is at   Dr. Jrffrey Demanes at UCLA is the pioneer of HDR and has 15 year numbers you can see.   I had mine done is Atlanta.   I will be happy to ask my uro and rad-oncs for people in your area that perform HDR.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 5/18/2011 11:02 AM (GMT -6)   
I had even worse stats in psa, gleasons, volumes back in 2002 and figured I was leaving the planet very soon and some people thought so too. I still will be leaving (actually we all do some day), maybe sooner than I wish..the good news is this can be fought in various methods and ways. I was denied surgery by the righteous Dr. Menon and another surgeon whom is NOT righteous Dr. K (michigan) guaranteed me curative and 1% chance of incontinence...he was scratched off my list immediately as a nice salesperson.

Run some nomograms and partin tables, your odds for curative surgery are low, is my guess right up front. Various pathways in fighting this and plenty to consider as to your side effects, costs-envolved, future travelings, multiple doctors and such.

Contact: Jacqueline at    her husband did not survive PCa, she is a big advocate on PCa issues, well informed and being a gal you would probably prefer listening to her. Just an idea (-:

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 5/18/2011 11:49 AM (GMT -6)   
I would certaintly get other opinions. The PC seems to be fast growing so I would not wait too long, but a month or two shouldn't matter. Since he has had a Turp, radiation may cause additional problems, so you need to be very careful and ask a lot of questions about this. He can also take Casodex in pill form and this will stop any growth until you make a decision.
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.

Veteran Member

Date Joined Feb 2010
Total Posts : 3993
   Posted 5/18/2011 12:01 PM (GMT -6)   
packfan -- my numbers are similar except my PSA was lower and no nodule.  my doctor said i had a 60% chance that the cancer had jumped the capsule but was in the prostate bed.
you can see my treatment path in my signature...HT + BT + IGRT.  if you're probably going to need radiation does it make sense to remove the prostate?  good luck in whatever you decide.
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Veteran Member

Date Joined Sep 2009
Total Posts : 6079
   Posted 5/18/2011 2:26 PM (GMT -6)   
Keep your spirits up packfan, in an odd way the fact that it has been arguably fairly well " confimed " to have been there only 2 years, via the Turp, to me is a positive. Aggressive yes but short term in PCA world, is a positive,IMO. HAs He had bone scan to rule out discernible mets? He is highly treatable , this is not false hope, this is hope for breakfast and dinner. How is his health otherwise, prior to diagnosis? I,m not sure what to reccomend. I like Surgery in a lot of cases due to post op pathology availability. The fact your doc will dissect lymph nodes is a good thing. rcroller is has/had surgery today 3.5 weeks post 12 core biopsy, which is less damaging to prostate. The reccomendat is 6-8weeks , all things being equal, but things never are. A good surgeon can do a successful op close to biopsy, but it is more difficult and would think could cause complications, not fatal, just cause other things to deal with, maybe. Its a cost/benefit analysis, like so many things. Cost ,not in a financial sense. Thing that concerns me is open surgery has tactile feel, which could come in handy in complication from quick surgery How quick is quick here BTW? Of couse he could and would switch to open if need be. I think he is a smart man and for sure has your back on this but 2nd opinion from the facilities you have there would help and you could still keep your sugeon
Diagnosed 8/14/09 psa 8.1 66,now 67
2cores 70%, rest 6-7 < 5%
gleason 3+ 3, up to 3+4 @ the dub
RPP U of Wash, Bruce Dalkin,
pathology 4+3, tertiary5, 2 foci
extensive pni, prostate confined,27 nodes removed -, svi - margins -
99%continent@ cath removal. 1% incont@gaspass,sneeze,cough 18 mos, squirt @ running. psa std test reported on paper as 0.0 as of 12/14/10 ed improving
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