Posted 4/3/2007 3:27 PM (GMT -6)
Hi peeweeaz and newbie,
Sorry this is happening to you, too.
Newbie, Dutch's words are sage about a free PSA. For some reason, PSA can be bound up in prostate cancer cells, and so there is less circulating. I posted a blurb from the American Journal of Family Practice that came out in 1998 or 99, that said that free PSA percent might avoid biopsies, if the percent comes out above 20 or 25 %. Mine, unfortunately was 8, and so I thought, I am toast. But my doc said no, it doesn't mean spread cancer, it just means more likely that it is cancer than infection or BPH. Try to get a free percent before the biopsy, although the biopsy wasn't as bad as I thought it was going to be.
peeweeaz, I am not a surgeon, but as anyone who has read any of my posts can tell you, I am VERY OPINIONATED about surgery vs. any kind of radiation therapy. Granted that both these doctors to be mentioned are surgeons, but you owe it to yourself to have a look at both Dr. Patrick Walsh's book on surviving prostate cancer, and Dr. Peter Scardino's Prostate Book. My doctor, again who is a surgeon, gave me the long-term statistics: 91% chance of no recurrence with surgery vs. 75% chance of no recurrence with radiation, cryosurgery, or HIFU. I worry a lot, so the extra 16% was a comfort to me.
Surgeons will tell you have surgery (if they think surgery will cure you), and radiation guys will tell you to have seeds, beam radiation, proton etc. They are all good docs, who are also trying to make a living. My standpoint is related to Hawfan's. Look up some of his posts after his surgery. Our preference is to have the darn thing out of our bodies and in a jar of formaldehyde somewhere, where we know exactly how far the cancer cells got to in the gland: in my case, contained in the capsule, and in his, unfortunately, with some penetration. Biopsy can often be an inaccurate estimate. Mine said cancer on only one side, the right and only in the base. When the post-op pathology report of examination of the whole gland (which you give up when you have radiation, as contrasted to surgery) came, I had cancer, albeit scattered small collections of cells, all over the gland. Hawkfan was likewise, except that a close examination showed the capsule had been breached.
To me, seeds and radiation are like shooting fish in a barrel, and hoping you got 'em all, without being able to see if you did. Surgery is like diving into the barrel with a net and getting everything out, while being able to look around to see that everything is out, but still worrying that there are some fish eggs that still may be left to grow up some day. One can shoot them then, if they grow up--radiation after surgery is preferable to most doctors, rather than surgery after radiation when there is radiation fibrosis (scar tissue all over the area). Seeds and beam radiation are not without their side effects, and I didn't want to deal with complications to the colon and rectum.
peeweeaz, are your DVTs gone, or are you on continuous Coumadin? I learned all about DVTs and Lovenox and Coumadin after my surgery. Prior to my surgery, my doctor's staff hounded my about wearing my TED hose and keeping my feet up and exercising after surgery, and I followed their instructions faithfully. However, they didn't ask me to wear TED gloves or walk on my hands or keep my hands up, and I got a DVT in my right ARM(!), elbow to armpit, I believe, because the nursing staff at the hospital didn't flush my IV enough after they stopped the IV fluids and antibiotics before I left the hospital. So, two days after discharge from the surgery, I was back in getting anticoagulated for the arm DVT (the first arm one my urologist had in over 2500 open and robotic prostatectomies). DVTs are a risk, I know, but maybe you can work with your internist or hematologist and a urologist to get the (IMO) less-long-term risky prostatectomy. If you get a robotic laparoscopic procedure, the blood loss is minimal- they usually don't ask you to donate your own to put it away for this kind of surgery.
Just my "high horse" thoughts, but keep us posted, guys.
PSA (10/04): 2.9; PSA (2/06):4.4, on Androgel (serum T about 450) at age 56; negative DRE, no symptoms.
PSA (5/06):5.7 with a free PSA% of 8, OFF Androgel (serum T 163).
Biopsy (5/06): 4/12 samples positive; postitive samples only on right side; max Gleason 4+3=7 (in 2 of the 4 -from area nearest bladder. One was 40% of sample, the others less than a mm. thick.
DaVinci robotic-assisted laparoscopic radical prostatectomy + bladder lift + Right nerve plastic surgery (8/23/06).
Catheter out 4 weeks postop, due to internal pinhole leak at bladder-urethra junction.
Pads-Not needed after about 2 weeks post-cath, but gotta go a lot more often.
Final pathology report:T2c-both sides,but in capsule; neg. margins, neg. lymph nodes, neg. seminal vesicles; final max Gleason still 4+3=7.
1st Follow-up PSA (11/7/06): <0.008 !!!; serum T: 195 - still OFF Androgel (at present). Low T may delay return of erectile function (in presence of one damaged nerve).
2nd Follow-up PSA (3/19/07): <0.003 !!!; serum T: pending
Testosterone Level (3/19/07): 163, down from November 2006!
Uro-Endocrinology Consult (3/28/07): Prescribed Testim gel 1% once a day, and recheck PSA and T-level in a month.