82 Yr Young Husband Facing PCa Treatment Choices

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SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 7/20/2007 3:34 PM (GMT -7)   
My husband was diagnosed September 2006 after biopsy based on elevated PSA. Nine of 13 cores came back positive with Gleason of 4 + 4. Because he had a markedly enlarged prostate (but no symptoms, probably due to turp in 1999), he was put on Lupron to reduce prostate size as a pre-treatment step. He is being treated at Sloan Kettering in NYC, and has had consultations there with a medical oncologist, radiation oncologist and two urological surgeons. One of the latter specializes in laparoscopic surgery. Husband's bone MRI last fall was negative. However, abdominal MRI raised questions about a borderline enlarged abdominal lymph node. Is his PCa stage 1 or stage 3? He will have a second MRI of the prostate done next week, so if this lymph node has shrunk (as a result of the HT) it's probably involved. Of course, we're hoping this doesn't prove the case.

Because my husband is in quite good health for his age (only some knee arthritis and glaucoma), the doctors have offered him as tx options to consider: laparoscopic radical prostatectomy or IMRT. Even though a part of his prostate rests against the bladder, the radiation oncologist said he can be treated with IMRT. We've been told the side effects/risks of both surgery (sexual dysfunction, urinary incontinence) and radiation (ed and urinary constriction). Overall quality of life is understandably very important to him/us. The sexual side effects are least important compared to the urinary flow issues.

I'd welcome feedback, suggestions or personal experiences that we'd find helpful at this point, including
-Has anyone been treated with so-called "cyber-knife" radiation therapy? This therapy cuts the treatment period down to one week from 6-8 weeks. Only a handful of facilities nationwide possess this (expensive) new technology.
-Can anyone speak first hand about post-IMRT urinary obstruction/constriction?

Right now my husband is leaning towards IMRT, but I am worried that he is minimizing the side effects.

Why don't the MDs recommend continued HT or watchful waiting? Well, my husband's father lived to 100.

My thanks in advance.

bluebird
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Date Joined May 2006
Total Posts : 2542
   Posted 7/20/2007 5:34 PM (GMT -7)   

Hi  ~ SueBee &  Loved Ones,

 

A   “Special”  Warm Welcome  to  You!   yeah   

 

We know ~ we can “all” make “Your Journey” smoother just by being here for you! 

This is truly a great forum!!! ~ You have joined!  You are now part our forum family ~ a group of wonderful individuals who are so willing to share...  It helps “all of us” ~ to help you ~ if we know where you are on your path. So ~ Please stay with us and take our hand when you need it!  Keep posting.... OKAY!!

  

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Your decision will be the right decision for you!!!

 

Keeping you close in thoughts and prayers as you move forward in your search for answers…

 

In Friendship ~ Lee & Buddy

 

“God Bless You”

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aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 7/20/2007 7:03 PM (GMT -7)   

Gleason 8 is a higher risk cancer: watchful waiting is not a viable option.

As you've said, radiation or surgery can be options: often hormonal treatment is used in addition.

It's worth reading Dr Myers book on hormonal therapy, which covers these various options and the logic behind them.

Dr Myers underwent radiation and hormone treatment himself some years ago.

John

 


aus
Regular Member


Date Joined Sep 2006
Total Posts : 211
   Posted 7/20/2007 8:01 PM (GMT -7)   

Probably the reason continued HT alone was not suggested is that although it can work as a sole treatment, no one knows how long it might keep working for, so it's mainly used for someone with short life expectancy or health problems who might not tolerate surgery or radiation treatment well.

It depends on the individual, hormone treatment works very effectively for some men who have used it for years, but in other instances it's less effective.

For someone in good health, a local treatment is usually suggested, and it's thought that if hormone treatment becomes necessary later,  or is used as an additional option, it is considered to be more effective in that setting.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8122
   Posted 7/21/2007 12:43 AM (GMT -7)   
Hi SueBee,
You left out an important piece of information... What was the PSA level. Then type in Partin Table into your search program. The Partin is the generally accepted histogram for determining the probablies of the different stages. If you will post your PSA scores we can do that for you, but it is very ambiguous. The Gleason is in the high risk catagory that would sway me to surgery. And given your husbands good health, the surgery using robotic, sometimes called LRP or da Vinci, is VERY tolerable. Most importantly, to be too enamoured by the professional's self described skills in whatever treatment you choose. Do your research, and your can improve the final results. If its surgery then get a very experienced person regardless of the type of surgery. Again I endorse LRP as it is minimally invasive, and will get to the bottom of the true staging better than IMRT or Proton radiation. Then you might decide on HT. I agree with everything aus stated. HT can be a very effective long term treatment or as an intermittent treatment. But look at the Partin Tables. Then re-evaluate the treatment selection.

Tony

SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 7/21/2007 7:10 AM (GMT -7)   
Re. PSA level. My husband's PSA ran high for many years...in the 15-17 range. He had numerous biopsies in the 1980s and 90s - all negative. Then in Summer 2006 his PSA shot up to 26.5, which resulted in the last biopsy, etc.

I'm familiar with the Partin tables and nomograms, thanks.

We will have more information in about 10 days, after the follow-up MRI of prostate and meeting with his oncologist. We should know: 1) how much his prostate has shrunk in size; 2) if there's been a change in the right abdominal lymph node size. A biopsy of the lymph node may be called for.

Thanks to everyone who has responded and offered their welcomes, thoughts and suggestions. We will check out Dr. Myers' materials. Next steps/options should be clearer by the end of this month.

SueBee

jetguy
Veteran Member


Date Joined Sep 2006
Total Posts : 741
   Posted 7/22/2007 3:20 PM (GMT -7)   
Dear Sue,
 
I completed 43 Image Guided IMRT's on March 23 and to date have no side effects. I am of the opinion that IMRT is unlikely to cause urinary problems.  ED may be an issue, but you are not concerned about that.  Best to you in your research and decision making.
 
Regards,
 
Bill
Gleason 3+3=6, T1c, one core in twelve, another pre-cancerous.
62 years old and good health.  Married 37 years.  To same woman!
Began IGRT January 23, 2007. 


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 7/22/2007 8:38 PM (GMT -7)   
Dear SueBee

You are obviously a loving and concerned wife! I don't know why your husband would want surgery at his age, especially if he is still young for his age. As you can see from my footnote, I recently had proton radiation therapy. I am much younger than your husband, but I decided at my age that I would rather deal with any side effects from radiation than surgery. This does not mean that I might not have to deal with impotence or some minor rectal bleeding in the future. After treatment I have had no urinary or bowel problems. In fact, I believe that my urinary flow has improved, although it was pretty good before treatment. I suggest that you read my thread entitled "Proton Radation Therapy--My Journey With Prostate Cancer".

I am familiar with MSK as I live close to New York--it is considered one of the top notch cancer centers in the US. My primary care physician suggested that I look into IMRT (x-ray radiation) at MSK, but I decided that I would be happier with Proton Radiation as it is considered a safer form of radiation treatment, although it isn't as widely available as IMRT radiation treatment. There are now several proton radiation treatment centers in the US, but there is none in the New York area. At this time, there are really no definitive longer term studies comparing the outcome of both IMRT (or IMGT) and Proton radiation from the standpoint of cure rates and side effects. IMRT and IMGT is very sophisticated today compared to earlier forms of x-ray radiation which documented some nasty side effects after treatment. I am not sure that MSK does the robotic prostate cancer surgery yet--they have been slow to adopt this new way of surgical treatment. One of their surgeons (perhaps that is the one you have consulted with), is considered an expert in the laparoscopic surgery. Dr. Scardino is considered an expert in open surgery. One of the best robotic surgeons in the New York area is Dr. Ash Tewari at NY Presbyterian Hospital (Cornell). I consulted with him, but decided against surgery. If I had elected surgery, he would have been my 1st choice.

Considering your husband's high Gleason score of 8 (4 + 4) he should really not delay treatment. Best of luck and all good wishes in whatever treatment he elects.

Dave
68, 29-core biopsy 9/27/06, PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area],  Gleason 6 [less than 5% in two other areas], negative DRE, bone scan and Endorectal MRI. Completed 39 Proton radiation treatments 2/22/07-4/18/07.
First PSA test to be taken 7/07.

Post Edited (pcdave) : 7/22/2007 9:45:25 PM (GMT-6)


SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 7/24/2007 7:07 PM (GMT -7)   
Dave,

I very much appreciate the information you supplied. We consulted with Dr. Guilloneau at MSK, one of the pioneers in LRP. Interestingly, until we got to MSK, none of the MDs we consulted even offered surgery as an option...we guess b/c of my husband's age.

We've been in a waiting game with pre-adjuvenant drug therapy (Lupron) for coming up to 7 months to get my husband's very enlarged (but asymptomatic) prostate reduced in size. It was 101 ml at time of biopsy last Sept and 61 ml this April. We'll have most recent MRI results next week. A complicating factor is that the prostate protrudes against the bladder. This does not rule out IMRT, but this may increase the probability of radiation side effects such as urinary constriction or bowel irritation.

I've researched the proton beam centers, including Mass General and Loma Linda, and will read your thread for sure.

We have fingers crossed about our meeting with MSK oncologist next week to review MRI results. With the Gleason 8, moving into treatment phase is definitely on our minds, as is the staging. For now, the assumption is T1c, but that borderline enlarged abdominal lymph node ...we just hope it hasn't shrunk significantly in the past 3 months as a result of the HT.

SueBee

pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 7/24/2007 8:21 PM (GMT -7)   
Dear SueBee

Nice to get your reply to my post. Life is precious at any age and having to deal with prostate cancer can be very difficult, especially if there are complicating factors like those you husband is faced with. I hope that you get some positive news which will facilitate a treatment decision in the near future. For those who have been treated for prostate cancer at MSK, especially surgery, I have heard nothing but praise in how well they treat their patients. In today's world, the majority of the older population are living longer and are more youthful in their older age. Assuming that we are in good health despite prostate cancer, it should not preclude us from medical treatments that otherwise would be reserved for younger people. My Mom is almost 92 and still going strong, which is a real blessing in life. People are amazed when they hear her age! It's not about chronological age, it's all about looking at the total person that counts. Good luck to you and your husband in your journey to have a successful outcome in overcoming his prostate cancer. God Bless!

Dave

P.S. Dr. Guilloneau is the physician who came to my mind when I posted my previous reply. I am sure that he is top notch. He may well be doing robotic surgery by now.
68, 29-core biopsy 9/27/06, PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area],  Gleason 6 [less than 5% in two other areas], negative DRE, bone scan and Endorectal MRI. Completed 39 Proton radiation treatments 2/22/07-4/18/07.
First PSA test to be taken 7/07.


wiggyann
Regular Member


Date Joined Apr 2007
Total Posts : 171
   Posted 7/24/2007 10:10 PM (GMT -7)   

Dear SueBee,

My husband completed treatment for prostate cancer the last of this past April.  He had the radiation combo of  25 IMRT (radiation treatments) and he suffered no side effects from the IMRT. He also had 90 palladium seeds implanted into his prostate the last of April and  suffered no side effects from this surgical procedure, except some burning when he urinated the rest of that day. He is doing very well. He is 68 and was working part time as a security guard three days a week before he was diagnosed.  He was able to continue working the whole time of his treatment.  The only day he missed was April 25th, which was the day of his brackytherapy (seed implant) Whatever treatment you and your husband decide on, my prayer for is that he will be completely and totally healed.

May God Bless You both and  may He  hold you in His arms of love and tenderly guide and comfort you.

Wiggyann

 

 

 

 


SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 7/31/2007 3:16 PM (GMT -7)   
UPDATE, 7/31/07

Husband had a follow-up MRI of prostate last week. We met with oncologist at Sloan Kettering yesterday. The news was disappointing on several counts.
1. HT (Lupron x 3 months) had no effect on shrinking prostate size, which is the same at 79 cc volume. In other words, still very large.
2. There's been a slight decrease in size in the questionable lymph node, suggestive that it's responded to the HT and therefore involved.
3. Husband has been extremely fatigued and somewhat dizzy on standing. This is a big change for him over his usual chipper self.

Our MD is concerned that with the large prostate size, its placement protruding into the bladder, possible lymph node involvement, the radiation field of necessity would be large and damage considerable adjacent tissue. He quickly consulted with two radiation oncologists at MSKCC, and called us back this morning. The next step will be to do a radiation "simulation" to determine the feasibility of IMRT. [In any case I'll see if husband is a candidate for proton beam radiation, but will wait until after consult and opinions with MSKCC rad specialists.]

MD is not convinced yet that the lymph node size reduction is indicative of Ca, since it was borderline enlarged in the first place. (Only a biopsy will tell for sure.)

MD also discontinued Lupron for now, noting that dear husband "is not the same." I was not even aware until last week that husband was feeling exhausted! He self-diagnosed himself as borderline anemic and was taking iron pills. But once I became aware, I went online and saw that fatigue is a common side effect of Lupron. Our oncologist agreed completely.

[GUYS, please keep your partners in the loop as to how you're feeling. ]

Next steps look to be: conduct radiation simulation; possible biopsy of questionable lymph node.

We are grateful to have such great expertise at Sloan Kettering available to us. Plus we'll seek the expertise wherever it is, if need be.

At age 82, the prospect of ANY surgery - with all side effects and risks - gives one real pause. Quality of remaining life is important, and really impacts decisions.

We've been married 35+ yrs. I'm some 20 years younger that hubby and still working full-time. Hubby has MMC: marital managed care, deluxe life-time policy!

Thanks to everyone for their good wishes, support and suggestions. I haven't yet gotten down to reading a number of suggested books, but this will happen soon.
Husband diagnosed 9/06 at age 81; after PSA test of 26.5 (baseline was 14-16 for many years);
Biopsy highest Gleason 4+4=8; prostate size 100
Started HT 12/06, 4 months, prostate size 75 (Apr 07); additional 3 months HT, prostate size 75 PSA .14 (July 07).
Dx: Stage T1c or T3c? one slightly enlarged abdominal lymph node
TURP 1999 negative for PCa


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 7/31/2007 7:10 PM (GMT -7)   
Dear SueBee

Thanks for giving us an update on your husband's medical condition. There is no question in my mind that radiation treatment, compared to surgery, should hopefully result in a better quality of life for your husband at his age. That's why I decided to do it at 68. While all of us have a responsibility to read the side effects of drugs prescribed to us by our doctors, I think that doctors who prescribe Lupron also have a responsibility to tell their patients about all of the potential harsh side effects from taking this drug. I have an uncle in his mid-80's who has been on hormone therapy for a number of years and all of these drugs take their toll, especially when it comes to somewhat chronic fatigue.

I think you are taking the right steps and hopefully MSK will help your husband to come to a conclusion about starting an appropriate treatment for his PCa. I think you are also wise to pursue 2nd or 3rd opinions from top experts regarding a propsed treatment for him. As far as proton radiation treatment is concerned, I think that most of the newer proton centers are very selective in the patients they will take (i.e., preferably those in an earlier stage of PCa with no known complications). Based on my knowledge, I think that Loma Linda might be the only proton treatment center that would consider taking him as a patient. I was not treated at Loma Linda--the proton facility that I was treated at is very selective and only allocate time for up to a maximum of 12 patients during any 8-week treatment period. I hope and pray that your husband can get his present medical delima behind him. All the best.

Dave

IMPORTANT P.S. i just noticed in your footnote that your husband had a TURP in 1999. Based on what I have learned on this message board and elsewhere, if you have prostate surgery sometime after a TURP, there is a much greater likelihood of some form of permanent incontinence. Please research this just in case you decide on surgery if it is finally determined that radiation is not an option (I hope this is not the case).
68, 29-core biopsy 9/27/06, PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area],  Gleason 6 [less than 5% in two other areas], negative DRE, bone scan and Endorectal MRI. Completed 39 Proton radiation treatments 2/22/07-4/18/07.  First PSA test 7/19/07 (3 months after treatment) was 2.1 or a 70% reduction in my PSA before treatment (this was better than the average expectation of a 50% reduction in PSA at this juncture, according to my radiation oncologist).
 

Post Edited (pcdave) : 8/1/2007 7:54:13 AM (GMT-6)


SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 9/3/2007 6:10 PM (GMT -7)   
Greetings. I can't believe a month has gone by since I last posted!

My husband had his radiation simulation last week at Sloan K. Hopefully, he'll get the green light to proceed with IMRT after the radiation oncologist and physicist review his field scans.

Actually, we did check into whether he would be a candidate for CyberKnife radiation, but - having had a TURP - he's not. Something about post-TURP scar tissue and the higher-dosing rate of the CyberKnife compared to IMRT.

Currently, he's off Lupron as well. He was feeling extremely fatigued on it, plus he was having memory and cognitive problems...something he'd never had before. But we'll need to determine whether this "Lupron-vacation" is a mini or longer.

For now, kind regards to all.
Husband diagnosed 9/06 at age 81; after PSA test of 26.5 (baseline PSA was 14-16 for many years);
Biopsy highest Gleason 4+4=8; prostate size 100 cc
Started HT 12/06, 4 months, prostate size 75 (Apr 07); additional 3 months HT, prostate size 79 cc PSA .14 (July 07).
Dx: Stage T1c or T3c? one slightly enlarged abdominal lymph node
TURP 1999 negative for PCa


bluebird
Veteran Member


Date Joined May 2006
Total Posts : 2542
   Posted 9/3/2007 6:23 PM (GMT -7)   
Hi ~ SueBee,
It’s nice to know that you are staying close….
Thank you for your update.
Keeping you close ~
In Friendship ~ Lee & Buddy

mama bluebird - Lee & Buddy… from North Carolina

 

v          We invite you to visit our personal thread:  Click Here:  “Our Journey” ~ Sharing is Caring 

April 3, 2006  53 on surgery day

RRP / Radical Retropubic Prostatectomy

PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate

3rd PSA 08-07-2007 Less than 0.1 Non-Detectable :)


IdahoSurvivor
Veteran Member


Date Joined Aug 2007
Total Posts : 1015
   Posted 9/3/2007 7:11 PM (GMT -7)   
Hi SueBee,
 
It is good to "meet" you and to know that you and your husband are progressing in a treatment plan with health care professionals you can trust.  Your journey has taught us much already.  We'll be happy to hear about your husband's treatments as the progress.  We will be here to support you throughout.
 
Kind regards,
 
Barry (a.k.a.) Idaho
 

Da Vinci Surgery July 31, 2007… 54 on surgery day
PSA 4.3  Gleason 3+3=6  T2a  Confined to Prostate

Waiting to take that first post-op PSA

My awareness web site: http://pca-info.blogspot.com

 


puget
Regular Member


Date Joined Mar 2007
Total Posts : 237
   Posted 9/3/2007 9:48 PM (GMT -7)   
SueBee, all the best to you and your husband. From your posts, it sounds to me like you're a tremendous source of comfort and support for him. Good luck with your treatment. I don't have the expertise or experience to comment on what's best. I can only share that my prostate was estimated at 65 cms at biopsy (and turned out to be over 90 cms). I was told that the size made seeds and/or radiation questionable and would have to be preceded by several months of HT, which might or might not work to reduce size. I finally opted for robotic surgery. I was up walking the same day and was discharged the next. Back to work in 2 1/2 weeks. It appears you have excellent medical advice, so I am confident all will turn out well. Good luck and let us know how things are going from time to time. Best regards to you and your husband.
'
puget
Puget
60 years old
Dx March 2007
Pre-Surgery Gleason 3+3 = 6
Clinical Stage: T1c
Biopsy: 1 in 10 positive
Da Vinci: June 7, 2007 
Post-Surgery Gleason 3+3 = 6
   Clear at margins
First Post-PSA Sept 07


uncledan
Regular Member


Date Joined Aug 2007
Total Posts : 120
   Posted 9/5/2007 3:53 PM (GMT -7)   
Dear SueBee, I was diagnosed at 67 with Gleason 7 and stageT1c. I read several books before opying for the da Vinci robot assitted. I was in surgery longer than most, due to hernia surgery leaving a lot of scar tissue that had to be removed. I was out of the recovery room by 7PM on the 14th August and up and walking by 9PM. I was dismissed at 8PM on the 16th. I have really had no bad results and considering my pathology report my Gleason score was closer to (4+3) 8 than 6 I would have expected to be under the weather for awhile. I would recommend that you get a copy of Dr. Pactrick Walsh's Book on Prostate Cancer and read it front to back. It has much to say about several different treatments available. Please continue to keep us posted. Remember we are not doctors, but we do care and pray for you. God Bless, Uncle Dan
Age 67
10-06 PSA 5.44 01-07 PSA 6.47
CT and Bone scan negative
Biopsies 05-07, 2 of 6 positive
Gleason Score 7 (3+4) Stage T1c
Dr. Dasari - Baptist Hospital da Vinci surgery 08-14 RAP,
Surgery five hours, hospital 8-14 to 8-16
Lymph nodes 2 R & 1 L, R & L seminal vesicles. Negative
Pathology report cancer encapsulated Stage T1c
Gleason changed 7 (4+3)
8-31 Use pad when out, Sleeping without pad.


SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 9/19/2007 12:43 PM (GMT -7)   
Greetings on a beautiful September day. Again, my thanks to everyone's caring and helpful responses and observations, and especially to those of who who reported on your own surgeries.

The latest chapter in this journey:

We had a big disappointment last week when the radiation simulation results indicated that my husband is NOT a candidate for radiation (IMRT) treatment. His anatomy - prostate protrudes into the bladder - would mean that too much healthy tissue would have to be included in the radiation field. This was what our oncologist at Sloan K suspected back in late July.

So, we're waiting for a call back from our oncologist as to steps/options. Since receiving the news, my husband has been speaking about not wanting surgery b/c of bladder control concerns. Quality of life at 82.5 years is very important to him, and -as far as I can tell from reading about survivors' post-op experiences in this forum - even with the best surgeons, there's no guarantee about the continence/incontinence after effects. This is my husband's current state of mind. (And, until we got to SK, no doctor even raised the possibility with us of surgery...I guess b/c of his age alone, though otherwise in fine health.)

We'll want expert opinions about survival rates with drug therapy (Lupron, etc) alone. Also, we'll want to know what new treatments/protocols are in the pipeline.

Needless to say, we are up in the air and need more information and . My father-in-law lived to age 100, but then he had his prostate removed when he was in his 60s.

No "easy" or clear best choice.
Husband diagnosed 9/06 at age 81; after PSA test of 26.5 (baseline PSA was 14-16 for many years);
Biopsy highest Gleason 4+4=8; prostate size 100 cc
Started HT 12/06, 4 months, prostate size 75 (Apr 07); additional 3 months HT, prostate size 79 cc PSA .14 (July 07).
Dx: Stage T1c or T3c? one slightly enlarged abdominal lymph node
TURP 1999 negative for PCa


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 9/19/2007 1:29 PM (GMT -7)   
SueBee,

I can't say as I blame your DH for his current state of mind about surgery. I'd have to give pause myself. I'm a quality vs. quantity person myself. I can understand his dilema. Time to ask the oncologist more questions.

Is it possible he could do just as well for years on hormone treatment? I know it's an option that many choose when age is being considered? A neighbor of ours lived a very active life on hormone treatment for 26 years.

Thoughts and prayers, Swim
 


SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 9/19/2007 2:05 PM (GMT -7)   
Swim,

I just got off the phone with the oncologist and got a "reality check." Without surgery he puts DH's longevity at less than 5 yrs due to Gleason score of 8 (4+4) and number of cores affected. He's ordered a PET scan by way of current assessment , and we'll also consult with the surgeon, Dr. Guilloneau.

The big follow-up questions are: by how much would surgery likely add years? Various scenarios based on post-surgery pathology results? Is he a candidate for Da Vinci surgery? What's the post-surgical recovery for someone in his 80s?

Thank you for your thoughts and encouragement,

SueBee
Husband diagnosed 9/06 at age 81; after PSA test of 26.5 (baseline PSA was 14-16 for many years);
Biopsy highest Gleason 4+4=8; prostate size 100 cc
Started HT 12/06, 4 months, prostate size 75 (Apr 07); additional 3 months HT, prostate size 79 cc PSA .14 (July 07).
Dx: Stage T1c or T3c? one slightly enlarged abdominal lymph node
TURP 1999 negative for PCa


SueBee
New Member


Date Joined Jul 2007
Total Posts : 11
   Posted 11/4/2007 7:53 PM (GMT -7)   
Update: Surgery scheduled for December

Husband has decided to have surgery after all! He's already been medically cleared. The PET scan he had last month did not show any disease progression outside the prostate. Though not 100% conclusive, his doctors at MSK determined that he was a candidate for surgery. Dr. Guillonneau will perform laparoscopic RP. Surgery date is mid-December.

DH found it very helpful to talk with several men who had been through it, including some who are managing well despite ongoing incontinence issues. Attitude IS everything!

I'd welcome suggestions or advice while we still have 5 weeks+ to plan. I'm a little concerned post-op in that we live 60 miles from Manhattan. DH has been told to expect to have catheter in for 10 days.

I am hopeful AND anxious. As so many people have said on this board, the surgeon's skill is critical.

FYI- Medicare coverage does not typically cover PET scans for prostate cancer. I don't know about private health insurance companies. However, MSK is part of a national study to determine if PET scans are useful in detecting/treating prostate cancer. So my DH's scan was covered.
Husband diagnosed 9/06 at age 81; after PSA test of 26.5 (baseline PSA was 14-16 for many years);
Biopsy highest Gleason 4+4=8; prostate size 100 cc
Started HT 12/06, 4 months, prostate size 75 (Apr 07); additional 3 months HT, prostate size 79 cc PSA .14 (July 07).
Dx: Stage T1c or T3c? one slightly enlarged abdominal lymph node
TURP 1999 negative for PCa


Swimom
Veteran Member


Date Joined Apr 2006
Total Posts : 1732
   Posted 11/4/2007 8:33 PM (GMT -7)   
SueBee,

My goodness, I am so sorry I missed your post! Don't know how that happened. Please know it wasn't intentional.

I really wish I had a great and comforting answer to your question. It appears you've found some answers of your own thank goodness, starting with a surgeon who has a wonderful reputation. Your DH is in good hands.

A plus side I do see to his situation...besides hopeful news on the PET scan and his otherwise good health, is the size of his prostate. A large prostate can harbour a rather large cancer however, it can also contain it too! I wish you all the best and continued success in your DH's treatment. By the numbers you gave, things are looking quite promising. Thoughts and prayers.

Swim
 


biker90
Veteran Member


Date Joined Nov 2006
Total Posts : 1463
   Posted 11/4/2007 10:40 PM (GMT -7)   
Hi SueBee,

Here's hoping your DH fares well with his surgery. I had an open prostatectomy last December by an excellent surgeon. My recovery was very fast physically and I went back to teaching school 3 weeks after the surgery. My PSAs have all been 0.00 for the last year and I was dry the day after the catheter came out. I am taking Viagra and Trimix shots and my wife and I have resumed our sex life only on a new and better level than before surgery.

Its great to hear that you husband's age was not a deterrent to surgery. I was 72 when I had mine and only hope for the best possible outcome for him.  My main reason for choosing surgery vs radiation was that I now know exactly how much cancer I had and am reasonably certain that it all came out of me with with the prostate.

Jim


Age 73. Diagnosed 11/03/06. PSA 7.05. Stage T2C Gleason 3+3.
RRP 12/7/06. Nerves and nodes okay.
Pathological stage: T2C. Gleason 3+4. Cancer confined to prostate.
PSAs from  1/3/07 - 10/17/07 0.00. 
Started Tri-Mix on 8/7/07.  .05 ml and 50 mg Viagra.  It works!!!
Next PSA test on 1/15/08
 
"Patience is essential, attitude is everything."
 

Post Edited (biker90) : 11/4/2007 10:43:40 PM (GMT-7)


pcdave
Regular Member


Date Joined Oct 2006
Total Posts : 444
   Posted 11/4/2007 11:29 PM (GMT -7)   
Dear SueBee

It has obviously been a long journey for both you and your husband. I am glad that he has decided upon a treatment. MSK is a wonderful hospital and the doctor he has chosen for his surgery has an excellent reputation. I hope that the surgery will help to get your youthful husband back on the fast track again. It is heart warming to hear about his youthful vigor which qualifies him to have surgery to hopefully eradicate his PCa. My Mom will soon be 92 and is doing very well for her age--longevity can be a wonderful blessing for many. Best of luck. God Bless!

Dave
68, 29-core biopsy 9/27/06, PSA 7.1, Stage T1c, Gleason 7 (3+4) [less than 20% in one area],  Gleason 6 [less than 5% in two other areas], negative DRE, bone scan and Endorectal MRI. Completed 39 Proton radiation treatments 2/22/07-4/18/07.  First PSA test 7/19/07 (3 months after treatment) was 2.1 or a 70% reduction in my PSA before treatment (this was better than the average expectation of a 50% reduction in PSA at this juncture, according to my radiation oncologist).  The following is a link to My Journey With Prostate Cancer -- Proton Radiation Therapy.  http://www.healingwell.com/community/default.aspx?f=35&m=726381
 

Post Edited (pcdave) : 11/4/2007 11:43:48 PM (GMT-7)

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