New member and newly diagnosed "high-risk" PCa patient here, hoping to gain as much insight and guidance as I can going forward. I've been diagnosed as a relatively 'high risk' patient with a high Gleason score, so I'll probably post something over in the 'Gleason-9 Crew' area as well, but for now, here's my introduction and my story:
Following a rather progressive and rapidly rising increase in PSA value through much of 2017, I finally had a single biopsy early this year, and I was quickly diagnosed with PCa (Gleason 9). A subsequent review (2nd opinion) of the initial biopsy slides by another (independent) pathologist effectively 'downgraded' the initial Gleason score from 4+5=9 to 4+4=8, but I'm told that there's really not too much significance to that change (i.e., its basically all bad).
Multiple advanced imaging tests have been done, all of which have been relatively normal or uneventful, except for a recent 3T-MRI which clearly showed a large (1" diameter) nodule at the base of the otherwise normal-sized/normal-appearing prostate. However, the degree of containment, or conversely, the degree of extra-capsular involvement remains unclear, largely because of the radiologist's report which said that the nodule itself was "inseparable from the right seminal vesicle", yet the report goes on to say that "both seminal vesicles were normal", and that there was "no lymphadenopathy". Hence, at least as I understand it, accurate tumor staging could be T3b or possibly T3a? Not really sure.
As for symptoms . . . I'm told that I have few (if any) of the classic urinary symptoms of prostate cancer; I have a relatively strong stream, with no pain, burning or obvious constriction, no leakage or strain, and although total urine volumes seem to be down per incident from what they used to be, I still only need to go 1-3 times per night, depending on fluid intake in the evening.
In a perfect world, I'd like to have either
open- or robotic-assisted RP going forward (just get the dammed thing out!), and yes, I'm well-aware of the likely ED and incontinence consequences of such surgery, but it doesn't appear to matter much, because I'm finding that most surgeons won't agree to perform the procedure on someone of my age, weight and diagnostic particulars. Consequently, radiation (of some form), combined with hormone treatments (ADT/HT?), are likely to be the only option available to me.
Rightly or wrongly, do I remain convinced that surgery is the best option for me? Yes. Do I still hope to identify a qualified surgeon somewhere in the country who will agree to the surgery some time soon? Yes. Am I weary from the incessant gloom-and-doom language and dire predictions? Indeed I am. Will it all be resolved to my satisfaction in time? No clue. Meanwhile, I'm on 50mg of daily Casodex. And I guess I'm here largely in hopes of learning from the experiences of others that are in similar (or near similar) circumstances, and for any meaningful suggestions or recommendations for me going forward.
Thanks to all for listening, and thanks ahead-of-time to all who choose to respond.
Large/Heavy: 6'4"/300 lbs.
Age at Dx: 65
Diagnosis: High-Risk PCa (01/18)
DRE (3x): Nothing found
PSA Initial: 15 ng/dL
Biopsy: 6/12 cores '+' (5-60%)
Gleason-1 (Initial): 4+5=9, Gleason-2 (2nd Opinion): 4+4=8
PSA post-biopsy (04/18): 40 ng/dL
CT, Bone, PET Scans: Normal
PSA Current (06/18): 67 ng/dL
3T-MRI: 1" Nodule (no lymph or seminal vesicle involvement)
Tumor Stage: T3b or T3a?
Post Edited (Balladeer) : 6/16/2018 1:40:11 PM (GMT-6)