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Dan0
Regular Member


Date Joined Jun 2011
Total Posts : 163
   Posted 6/20/2011 8:40 PM (GMT -6)   
Hi all, I have been reading this site for awhile and have learned very much. I
thought it time to actually sign in.

I was dx'd in August 2010 after the routine one month antibiotic regiment for high PSA (7)
Gleason 6, 1 core out of 12 only 5% volume
had a subsequent Saturation bx in March to hopefullly gather
more intell, 31 cores, all negative.
I am now 47 and in fair health (other than PC) and am
having a tough time, psychologically, with this dz.

I am having PSA rechecked next month and if it is higher than 7
will seriously consider some type of treatment. I have all manner of treatment
available and have considered the big three, will probably go the surgery route if needed.
I would be just as happy to not treat it at all for the rest of my life.

Anyway, just saying hello. I can't chime in every day due to work but will try at
least once or twice a week. Thanks for helping so many, me included.

Dan0

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 6/20/2011 9:03 PM (GMT -6)   
Hey Dan. Interesting approach to do saturation biopsy after diagnosis; not many do that. Your idea, or the doc's? In any event, you might talk with urologist about "active survailance" -- could help you defer treatment, potentally forever. There are some docs who are really knowledgeable about AS. If you can talk with one of those, all the better. In any event, sounds like pretty early stage, low grade disease. Best wishes to you.

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 6/21/2011 2:55 AM (GMT -6)   
Welcome to the site no one wants to be a member of shocked

Ed C. (Old67)
Veteran Member


Date Joined Jan 2009
Total Posts : 2458
   Posted 6/21/2011 7:53 AM (GMT -6)   
Dan,
You have low volume low Gleason PCa so you have all options available to you. AS is certainly one option that may give you many years with good quality of life before deciding on treatment. Consider all of those option by consulting with different doctors. Best of luck.
Age: 67 at Dx on 12/30/08 PSA 3.8
2 cores out of 12 were positive Gleason (4+4)
Davinci surgery 2/9/09 Gleason 4+4 EPE,
Margins clear, nerve bundles removed
Prostate weighed 57 grams 10-20% involved
all PSA tests since (2, 5, 8, 11, 15, 18, 21, 2 years <.008? ) undetectable
27 months: .005

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4229
   Posted 6/21/2011 9:33 AM (GMT -6)   
Dan,
What is the size of your prostate? Your psa may be due entirely due to the prostate size. Also did your doc calculate a psa density? As long as it is below 1.5 you should be in good shape. I would read" Invasion of the Prostate Snatchers" by Dr Mark Scholz as it has the most information on indolant cancers, which appears that's what you have?
There are a lot of people that have cancer cell clusters, these are not tumors and may never turn into a growing tumor. A biopsy may by chance hit one of these, and subsequent biopsies will never hit it again. It certaintly doesn't warrent any drastic action on your part.
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.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 6/21/2011 4:24 PM (GMT -6)   
It's not too late to have your original biopsy slides read by an expert lab..The G-6 5% one out of 12 could simply be wrong..I would ask to have the original pathology repeated by an expert laboratory that specializes in these things..
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

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/21/2011 6:22 PM (GMT -6)   
Based on the info you provided, it does seem like you would be an ideal candidate for AS. Definitely worth thinking about, as all primary treatment choices come with no guarantees and the likelihood of side effects and other issues. I hope you get to stay out of the club long term, that's the best possible outcome. Please keep us posted.

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, 6/11 5.8
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

ChrisR
Veteran Member


Date Joined Apr 2008
Total Posts : 825
   Posted 6/21/2011 6:38 PM (GMT -6)   
I would agree that a second opinion of all of your slides from both biopsies would be the smart thing to do. It is also my opinion that you are too young for AS. You would not qualify for most if not all AS programs because of your age. Also don't be fooled by the biopsy. You never know what you've got until your prostate is out. Your PSA is pretty high for the small amount of cancer found.
 
Dx @ 42 years old on 4/2008 PSA 2.76
1st PSA ever @ 38 years old 2.4
Gleason 6 (50 Point Biopsy) (6 Cores positive - Small Focus Each)
open RP 10/08  Johns Hopkins  Dr. Partin
pT2 Organ Confined Gleason 6 (tertiary score 0)
1/15/2009 (3 Month) <.1
10/15/2009 (1 Year) <.1
10/15/2010 (2 Year) <0.03

Post Edited (ChrisR) : 6/21/2011 6:56:03 PM (GMT-6)


Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 6/21/2011 8:26 PM (GMT -6)   

Hi Dan0, and welcome.

Since your biopsy in August, you undoubtedly have felt like you have begun drinking from a firehose, but I’ve got a suggestion for what I think is some very good information.  Memorial Sloan Kettering (MSK) is known as one of the top, if not THE top facility in the world for treating Prostate Cancer…perhaps you already know this.  They have an excellent webcast available free online that I have recommended to many newcomers; many found it very useful.  Here’s the LINK.

The webcast features three doctors discussing their respective areas of PC treatment specialty, which are (perhaps you’ve already learned) are the three primary modes of aggressive treatment of PC:

·         James Eastham, MD, is a surgeon

·         Michael Zelfsky, MD, is a radiation oncologist

·         Michael Morris, MD, is a medical oncologist (dealing with hormone therapy)

If you spend the roughly hour plus that it takes to listen to this entire webcast, you will learn a tremendous amount about the treatment modes—the pros and the cons—directly from the lips of some of the world’s leading experts…it would be time very well invested.

In fact, pay particularly close attention to the surgeon’s words; Dr Eastham mentions that for patients who present with low risk cases he often recommends a collaborative physician/patient approach of “Let’s see what happens.”  The point is that some PC cases don't need aggressive treatment.  This is because PC can exist in some men for years or for decades and never cause anyone any problem…and for these patients a careful surveillance program rather than aggressive treatment might be the best approach. 

The main advantage of the “active surveillance” (AS) approach is an avoidance (or deferral) of the collateral damage and loss of function that are associated with a decrease in the quality of life as an outcome of the aggressive, invasive treatment modes.  But please note that the criteria for entering and staying on a careful and “active” surveillance program is stringent.  A good AS program administered by a knowledgeable physician will include a strict diet and exercise regimen…and quite frankly some men just aren’t willing to give up their juicy (fatty) steaks.  The criteria is especially stringent for younger men, but the more developed programs do not have age restrictions…but the likelihood of eventually exiting AS is higher for younger men.  I wish that the webcast had also included Dr Ballentine Carter and Dr Jonathan Epstein who are in charge of AS at MSK…both are world-renowned (Google them).

While you are pondering possible treatments, you might as well make sure that you are doing everything in your power to possibly avoid the knife, or the beam, or all the invasive treatments.  Take a look at this very good article for newly diagnosed men like you published on the website of the Prostate Cancer Institute called “I Have Prostate Cancer, Now What?  I’ll tell you now what one of the very smart, very important first steps is:  make immediate lifestyle changes.  The article will help tell you how.

best wishes…



Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4157
   Posted Yesterday 5:24 AM (GMT -6)   
Hi Casey:
 
Just one small correction to your excellent post - Drs. Ballentine and Epstein are at Johns Hopkins not MSK.
 
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:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

Dan0
Regular Member


Date Joined Jun 2011
Total Posts : 163
   Posted Yesterday 5:43 AM (GMT -6)   
Hi all,
John T, prostate size at the time of first bx was 28grams, psa was 6.0 I think, I will check my records.
I have read Scholz, and Walsh's books as well as a few others. I have plugged my numbers into the nomograms, all good news. I am on AS by default (not willing to be aggressive in treatment just yet). My psa has been somewhat up and down but never lower than 2.9 in the past year, and as high as 7. I do have chronic prostatitis also.
I had the second (saturation) bx (my idea) because I wanted more definitive info. I had my original slides reviewed by a local well known medical center (UAB) which agreed with the dx, and also had a second opinion from UAB urologist. The only thing that argues for treatment now is my relatively young age and good health, but I am holding on for awhile yet.

sorry for the rush of info, it is early and I am getting ready for work. Thanks for all the replies.
May 2010 PSA 6.9 up from 3 May 2009
July 2010 PSA 3 after anitbiotics
August bx, 1-12 cores PC 5% volume G6
Saturation bx March 2011, 31 cores all neg..
now....confused

Dan0
Regular Member


Date Joined Jun 2011
Total Posts : 163
   Posted Yesterday 8:18 PM (GMT -6)   
Thanks for the video suggestions Casey59, I will watch them.
ChrisR, you reply about my age being a factor against AS is well received, thanks,
it is the dilemma that I face, to treat or not to treat. A part of me wishes my gleason score
was higher to make the decision easier. Death doesn't scare me as much as not living.
May 2010 PSA 6.9 up from 3 May 2009
July 2010 PSA 3 after anitbiotics
August bx, 1-12 cores PC 5% volume G6
Saturation bx March 2011, 31 cores all neg..
now....confused
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