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Tudpock18
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Date Joined Sep 2008
Total Posts : 3991
   Posted 12/11/2017 1:41 PM (GMT -7)   
It's difficult to take a decision, all depend on the informations you've got and your vision on the treatment with less side effects.
I am trying to find out the solution for myself , my uro suggested RP(Robotic) or RT .
After all the searches I would prefer the AS ,but the surgeon says that the tumor is large on the RT and there are focis on the Lt.
Any recommandations?

age:67 PSA 12,8 diagnosed in sept 2017 with PC gleason 6.
MRI showed tumor 2 cm Rt periph zone + micro focis in Lt transit all gleason 6 .
prostate vol: 60ml .Pet scan done ,lesion confined ,no invasion.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 3991
   Posted 12/11/2017 1:45 PM (GMT -7)   
Hello Mike and welcome to HW. There are many options that my cure you and you also may consider AS. What I initially suggest is:

1. Get your biopsy slides re-read by an expert like Dr. Epstein at JHU.

2. Read the sticky thread at the top of our forum that is designed for new patients.

3. Speak with a variety of experts. This should include surgeons but also an expert who runs as AS program to see if that is appropriate for you. If you will give us your geographic location perhaps someone will have a specific suggestion. You should also speak with some radiation oncologists who specialize in various treatments that are likely to cure you including SBRT, LDR Brachy and HDR Brachy.

Stick with us...we are here to help.

Jim
Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1

Subdenis
Regular Member


Date Joined Aug 2017
Total Posts : 293
   Posted 12/11/2017 2:27 PM (GMT -7)   
Mike welcome. keep reading and get second opinions from experts as suggested. Finally, keep asking questions here, many guys are very helpful. Denis
65YO healthy man, PSA 5/17 4.6, MPMRI, 5/17 lesion. 13 core biopsy 3 positive 3+3 and 1 positive in a lesion, All cores less than 30% 8/17 - the second opinion Yale pathology shows a small amount of (3+4) in one core, < 5%, decipher test shows intermediate risks, looking at treatment options. Strongly leaning towards HDRBT, meet with Dr, Patel in two weeks. Denis

BillyBob@388
Veteran Member


Date Joined Mar 2014
Total Posts : 2691
   Posted 12/12/2017 8:42 AM (GMT -7)   
Welcome, Mike, sorry you have to be here, but I hope you will find some useful info!

If it is all G6 then certainly look into all options, including AS. Take your time to do your research, because you will have to live with the pros and cons of whatever treatment you choose. Don't let anyone rush you!
PSA 10.9 ~112013
Bx on 112013 at age ~65yrs, with 5 of 12 pos with one G9(5+4), 1 PNI, T2B.
RALP with lymph nodes at Vanderbilt 021914. (nodes clear, SV+, G9 down graded to 4+5, cut wide, but 1 tiny foci right at the edge of margin ) Pros. 106.7 gms!
At 15 months, not wearing a pad most days, mostly dry
PSA <.01 on 6/14 and all until 9/15 = .01, still .01 9/16, .02 on 3/17,6/17,10/17

Post Edited (BillyBob@388) : 12/12/2017 8:46:15 AM (GMT-7)


Michael_T
Veteran Member


Date Joined Sep 2012
Total Posts : 2573
   Posted 12/12/2017 9:38 AM (GMT -7)   
Hello and welcome to our community. I can certainly see why you would want to focus on AS with a Gleason 6 diagnosis. But to that point, do get a second opinion on your biopsy slides, specifically from Dr Epstein at Johns Hopkins. You do want independent confirmation that you are a G6.

If that's the case, consult with a few more docs. At the very least, you'll have lots of time to make a decision. My brother was a G6 and he and his family decided they were more comfortable with treatment than AS, but it took them a year to decide that. You do have lots of time.

Good luck to you!
Age 56, Diagnosed at 51
PSA 9.6, Gleason: 9 (5+4), three 7s (3+4)
Chose triple play of HDR brachy, IMRT and HT (Casodex, Lupron and Zytiga)
Completed HT (18 months) in April 2014
3/17: T = 167, PSA = 0.13

Tall Allen
Veteran Member


Date Joined Jul 2012
Total Posts : 9125
   Posted 12/12/2017 10:13 AM (GMT -7)   
You would think that there is some optimum set of criteria for active surveillance - there isn't. Some AS programs will take all low risk candidates, regardless of tumor volume, PSA density, number of tumors or where they are; some will even take candidates with small amounts of GS 3+4 (e.g.,U of Toronto/Klotz and UCLA/Marks). On the other end of the spectrum is Johns Hopkins which has very strict AS criteria - only "very low risk" patients are accepted.

I think Johns Hopkins is confusing two separate questions: (1) is it safe to watch as of now? and (2) is there are higher risk of progression later?

A critical question is whether the initial biopsy missed some of the significant cancer. A second opinion from Epstein at Johns Hopkins can correct pathologist error, but only a confirmatory biopsy within a year of the first one can give assurance that the diagnosis was valid. At UCLA, a patient is not officially on the program until after the confirmatory mpMRI-targeted biopsy. That's what makes AS safe NOW.

Certainly, the more risk factors you have, the higher your risk of progression later. That's why AS has to be active. One could probably ease up on the number of PSAs and biopsies after convincing stability has been demonstrated, but one can never stop surveillance entirely. Even GS6 that has been confirmed and seems to be indolent may someday progress.
Allen - not an MD
•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
SBRT 9 yr onc. resultsSBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs
my PC blog

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/12/2017 12:40 PM (GMT -7)   
Jim,Denis,BillyBob,Michael_T and Tall Allen , I am so touch and grateful for the warm welcome and advises.Yet I feel a kind of brothership and at home despite thousands of mile distance(since I live in Beirut,Lebanon).
I am going to read as much threads as I can and have more informations .My wife is absolutely for a RP
afraid that it may progress.
Jim, I wished to sends slices of the biopsy to Dr Dr. Epstein at JHU as you advise ,but the American University Hospital(AUH) in Beirut don't provide CD ,they just give a report.

Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 3991
   Posted 12/12/2017 1:02 PM (GMT -7)   
Mike, I totally understand how your wife may feel. My wife was "get it out" all of the way until she understood that "get it cured" it really the right attitude. She is so thankful that she took the time to understand options with me and that we made a great choice.

Re the slides, I really don't know what to tell you based on the distance. Perhaps you should call Dr. Epstein's office and get some advice from them. I know he views non-USA slides so perhaps he could coordinate with AUH. I just know that it is very important to get an expert opinion on these slides and with all due respect to AUH I doubt if they have the same expertise in prostate pathology as does Dr. Epstein. Other members...any ideas to help Mike on this?

Jim
Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/12/2017 1:23 PM (GMT -7)   
Jim, I am going to email all the documents to Dr Eipstein wish I can have any alternative opinion.
I hope and I am sure you're doing great,hope to always hear good news, and by the way a big thanks to HW for the support that let you feel not in community but in family .

dbell
Regular Member


Date Joined Nov 2017
Total Posts : 77
   Posted 12/12/2017 2:01 PM (GMT -7)   
Tudpock18 said...
Mike, I totally understand how your wife may feel. My wife was "get it out" all of the way until she understood that "get it cured" it really the right attitude. She is so thankful that she took the time to understand options with me and that we made a great choice.

Jim


Mike I think you initial gut reaction is always "GET IT OUT" it least it was for me. And the Uro, who is a surgeon is usually happy to schedule the surgery! You have time and do not make an emotional decision. As was mentioned, the best thing you can do is research online, here (some great people on this site), and with different Oncologists (RO and Surgeons). Keep in mind, also look at the SE of various treatment(s) options. Good luck! Dave
Age 53
DX 11/17
PSA 5.1
G 3+3
1 core of 12 - 35% involvement, confirmed by MSKCC
AS currently - awaiting MRI 1/18

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/12/2017 11:11 PM (GMT -7)   
Dave We feel like vacillating, and time is running out. you're absolutely right I have to reconsider and take more time despite my wife's worries. I keep on reading and searching hope to take a good decision.
Hope MRI in 1/18 will be clean.
The Best for you! Mike

Post Edited (mike950) : 12/12/2017 11:22:26 PM (GMT-7)


mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/13/2017 12:17 PM (GMT -7)   
Today ,visit to another uro for a second opinion.
Proposed treatment :AS , Focal therapy ( does not exist in Lebanon yet) or simply RP
The Dr says that AS is very convenient for my case but should consider that Biopsy could have missed a higher grade target.
Choosing AS as Allen mention should be active.I will take more time and look for recommandations

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/26/2017 6:48 AM (GMT -7)   
Thursday 12/21st , RALP at AUBMC (Beirut) Dr Albert Hajj who has a great team.
Disch on the 23rd ,Foli to remove on Tuesday 01/02.
Pain is reasonable ,just abdominal cramps on deep breath now seem to disappear.

Post Edited (mike950) : 12/27/2017 11:20:14 AM (GMT-7)


suttersmill
Regular Member


Date Joined Oct 2011
Total Posts : 27
   Posted 12/26/2017 2:45 PM (GMT -7)   
Wow......interesting to follow our members' information and your decision making. I hope your recovery goes well and that your decision provides a healthy and wonderful life. To you Mike and your family please be safe in Beirut.
Age 67, T1c, No SYM, DRE OK
DX 10/14/2011, 54 gm, 32 core sedation biopsy, 2 positive core, 2%, 3+3=6, PSA 5.49, AS.
DX 06/04/2013, ? gm, 12 core sedation biopsy, 2 positive core, 2%, 3+3=6, PSA ? , AS
MP MRI 6/16/2017, 3 Tesla, 14 mm Lesion PIRADS 4, EPE 3, 78 cc, abut capsule mild
PSA & FREE
09/2011 5.49 19.67%
10/2012 5.44 14.71 %
12/2013 6.31 ? %
06/2014 6.01 13.64%
03/2016 6.88

Skypilot56
Regular Member


Date Joined Mar 2017
Total Posts : 347
   Posted 12/26/2017 3:14 PM (GMT -7)   
Mike here's hoping for a fast recovery. If able start walking and then walk some more helps tremendously with continence.

Larry
Male 61 DX @ 60
Father had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo in Mn
Path Report: Gleason 9, pt3b, Seminal vessels and one nerve removed, neg.margins, 35 LN removed no cancer, Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 psa 0.13
7-19-17 psa 0.12 MRI clear
10-11-17 psa 0.16
10-12-17 Lupron
12-13-17 psa <0.10
12-18-17 SRT

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/27/2017 3:54 AM (GMT -7)   
Larry,absolutely right walking and be careful not to sit more than 45 min.
Now meals back almost to be regular ( fibers ++) to avoid constipation.
Good luck
Mike

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/27/2017 3:57 AM (GMT -7)   
suttersmill Hope the best for you and feel supports from our HW fellows gives great relief.

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/28/2017 10:15 AM (GMT -7)   
Just have a phone call from the Dr office ,Gleason 3+3 and 3+4 15% T confined Negative margins, negative lymph nodes,
Waiting for foli removal ,have a bit discomfort in the jonction tube - body and pain in some movement at the inguinal rt hernia (op 5 yrs ago)

tennisplayer
Regular Member


Date Joined Nov 2016
Total Posts : 349
   Posted 12/28/2017 10:26 AM (GMT -7)   
Good pathology report! Relax and get better!
Age at diagnosis-66 Diagnosed 6/16
RALP 10/16 at U of Chicago, Dr. Shalhav. Experienced internal bleeding post op requiring transfusion of 2 units.
Pathology Gleason 3+4=7, tumor volume 15% Margins negative except for one focal margin, .1mm
pT2c,N0,MX,R1
PSA @ 6 wks <0.02;16 wks <0.02; 5/17 <0.02; 10/17 <0.02
My storywww.healingwell.com/community/default.aspx?f=35&m=3777359

mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 12/29/2017 1:26 AM (GMT -7)   
Tennisplayer yes Relax is a good world,writing these my wife next to me is suggesting a trip after
catheter removal.I am inspired after reading your story ,hope to find you well

Post Edited (mike950) : 12/29/2017 5:55:46 AM (GMT-7)


mike950
New Member


Date Joined Dec 2017
Total Posts : 13
   Posted 1/3/2018 1:52 PM (GMT -7)   
foli removed yesterday without problem,
by early night 38.4 c run to the ER ,blood test & chest x-r dx bronchitis with emphysema (25 cig a day since I was 17).
Consult Dr Chami pneumo prescribe Symbicort and Tavanic 500
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