Newbie here

Was diagnosed less then 2 weeks ago it PC.

PSA 2006 4.3

PSA 2007 5.8

PSA 7/2008 12.3

PSA 9/2008 14.9

Had 1st biopsy 9/7 Neg

Had 2nd biopsy 8/8 PIN + plus 4 "suspicious" areas

Had 3rd biopsy 9/8  Positive, had 2 areas, 4+3=7 and 3+4 = 7

All 7 cores tested positive with 60-80% cancer

Last week, had Bone Scan(s) and mutiple CT, awaiting results and

final consultation with doctor.

His thinking is that this is pretty aggressive, suggesting conventional surgery, non-

robotic, and min. of 40 RT treatments.  Wants to operate 3 - 4 weeks from now.

My PSA doubling was very fast.  Any comments or similar cases to mine.

Oops, I am 56 years old, had first PSA done at age 50, was over 4.

No known PC in family history, least none diagnosed.

Thank you.

Welcome to the forum, Purgatory.  From your posted statistics, looks like your PSA doubled from 6 to 12 in one year.  PSA velocity is often considered a better indicator than absolute numbers.  Mine quadrupled in one year even though the absolute number was in normal range for my age group.

I don't think that there is any difference between the open vs. robotic with cancer like yours.  There are some bells and whistles with robotic--usually less invasive and shorter recovery time; able to use magnification to see the prostate better--but the open works well, too.  The important factor seems to be the surgeon's experience.  

Hope to hear more from you.  Take care and hang in there...Tim

P.S.  I hope you have another name we can call you besides Purgatory. Nothing personal, but.....   

Your cancer was already developing a couple years ago with your PSA higher than 4.0ng/ml. Unfortunately, very few men know to request their biopsy tissues be sent to a pathologist who has expertise in reading prostate cancer presence. And you escalating PSA since 2006 confirmed whoever was your physician was not providing sufficient concern. I would be apprehensive of a urologist who only recommended "open" surgery. Obviously that recommendation is because he is not trained in robot assisted laparoscopic radical prostatectomy - a much less invasive procedure with less blood loss and faster recovery. The 4+3/7 Gleason grades/score is of concern and prior to surgery it would be appropriate to have blood serum testing for PAP, CGA, CEA, and NSE to determine possibility of metastasis. Early development is unlikely to show up on MRI/CT scan. If these blood tests indicate possible metastases, neither surgery nor radiation will completely eradicate all cancer, although physicians might still recommend these options to "debulk" the majority of cancer. Your report is a bit confusing in identifying two tissue samples with one 3+4 and the other 4+3, but then commenting "All 7 cores tested positive with 60-80% cancer." You should identify what Gleason Score was assigned to each individual tissue sample, and what percentage of PC was present on each individual tissue sample. If the pathology report doesn't indicate these numbers, then the pathologist did not provide an appropriate report. And if that's the case, you should ask that your biopsy tissues be sent to a pathologist with PC expertise, namely Bostwick Laboratories/ Pathologist David Bostwick
Virginia - Corporate Headquarters 4355 Innslake Drive, Glen Allen, VA 23060
Phone: 1-800-214-6628
https://www.bostwicklaboratories.com/patientservices/primary.html
Fax: 804-288-6568
(and when samples are sent in, they should be accompanied by a request that ONLY Dr. Bostwick perform the review)

Jon Epstein (Hopkins) 410-955-5043 or 410-955-2162 (Dr. Epstein does not do ploidy analysis)

David Grignon, Centennial Professor of Pathology, Vice Chair for Clinical Programs, Indiana University School of Medicine, Clarion Pathology Laboratory, 350 West Eleventh St. Room 6014, Indianapolis, IN 46202 317-491-6685

Jon Oppenheimer, Owner and Chief Pathologist, Oppenheimer Urologic Reference Lab, Nashville, Tennessee, 888-868-7522 [email protected]

M. Scott Lucia, Director, Prostate Diagnostic Laboratory, Co-Director, Prostate Cancer Research Laboratories, University of Colorado, Denver – School of Medicine at Fitzsimons Dept. of Pathology, 303-724-3470 E-mail: [email protected]

And, in the meantime, I'd check around to find out if there are urologists in the area who provide robotic assisted LRP. And if there is and you are comfortable, I would add that you direct the physician to include the removal of lymph nodes adjacent to the prostate gland as well as seminal vesicles, since if the cancer has migrated, those are the key pathways.

Like another suggested in replying to your report, purgatory isn't the most appropriate name to use in a setting of patients fighting cancer.

You might also want to check out the treatment charts and case histories on the yananow site

www.yananow.net/progress_chart.html

and the treatment experiences here

www.yananow.net/Experiences.html

Bill

Welcome to HW! Sorry about your dx, but you have found an excellent resource for support and patient education. I know this is arguable, but my father's first urologist wanted to do an open procedure because he wanted to get all the pelvic lymph nodes he could and he wasn't confident in his own ability to do that with the Da Vinci. We elected to go with another surgeon who had more experience. I'm thinking that this might be his reason for encouraging you to go open. The important thing right now is to get all the information you can and know that you have options. Please stick around and stay strong!