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Posted 12/3/2009 3:25 AM (GMT 0)
Continuing my saga of trying to meander through this unknown territory...

I see many of you have had assorted scans. Invariably, it shows nothing. I read articles that say these scans are a waste of time. I will be looking into a color doppler.

My question: Did some of you have results similar to  mine (see the signature) and have no further tests but started treatment (such as surgery)?

At some point, I will be meeting with the Umich team (I hope to get a call tomorrow). I wonder if they will order another different batch of tests.

Mel

Posted 12/3/2009 3:36 AM (GMT 0)
Mel, Sorry about the results. I was really hoping for a clean plate. When are you meeting with the Uro? He will go over options . I would suggest that you have your slides sent in for a second opinion. Real some of the post on the board that are some great tips for the meeting with the Dr. I would also suggest have a second opinion with a different Dr.

Jeff T
Posted 12/3/2009 3:48 AM (GMT 0)
I talked to Radiation people and Surgeons, but chose Surgery being a Gleason 7 with high velocity PSA. I didnt see any point of any further tests, wasn't going to change anything for me.
Posted 12/3/2009 3:58 AM (GMT 0)
Mel,

All the scans in the world will still show you have PC. The color doppler will give you a more exact location, might indicate an EPE, but until you either have the walnut removed, and have the pathology done, you will not know any more than what you know now.

That may not be important to everyone, or some guys have medical reasons why they don't have surgery, some guys have chosen radiation based on side effects, simplicity, etc.

You can study this thing to death, analyze it, nomogram it, talk about it, etc., but until the pathologist gets that thing in his hands, you won't know much more.

Based on your inquisitive nature you have demonstrated here on HW, I really don't think you will rest until you get it into the pathologists hand. And then guess what, you still will have a hard time knowing what the future holds. A high percentage of men are "cured" by surgery. A good percentage of men have little problem with incontinence, a good percentage of men recover from the ED.

But no surgeon, radiologist, or faith healer can accurately predict precisely what your outcome will be. That is prostate cancer.

My advice is to begin a study of each potential treatment, and its curative rates, and potential side effects. Calculate your odds based on your own numbers, and pick one.

Once you pick it, stop, and go do it. You will drive yourself crazy with all of the what if games, if you don't. The odds are with you, no matter which treatment you pick statistically. You have got to slowwww downnnn, and be rational about this whole thing, and make your treatment decison.

Good luck, and stay with us here.
Posted 12/3/2009 4:46 AM (GMT 0)
For an interesting skeptical view on the superiority of color doppler, see Predictors of Prostate Carcinoma: Accuracy of Gray-Scale and Color Doppler US and Serum Markers. by Kuligowska et al., Radiology 2001

I realize the article is a bit old. I asked some radiologists about color doppler recently. They said that it had a 5% advantage over gray scale. I know that some people on this forum had great results with color doppler. But we don't know whether those were quirks. Or do we?
Posted 12/3/2009 4:56 AM (GMT 0)
Mel,

In answer to your questions. I had one biopsy, one CT Scan and 1 skeletal survey. I had my slides sent to Vattikuti before I went up to interview the doc.

I had decided on surgery as the right option for me and didn't feel the need to do anymore but get it done.

There is nothing I would have changed. The biopsy was almost spot on, except a change of the gleason following the path report.

Surgery was my choice for a number of reasons. Seems like it was a good one as I am now availing myself to radiation as a backup plan in case surgery didn't get it all.

I have always been prone to systematically getting the facts on anything, weighing the alternatives and making a decision. Analysis paralysis is not something I fall prey to very often.

As I told the Radiation doc's PA, in my visit today, when she asked if I had been given any hormone therapy before the radiation; I had the diagnosis of PCa and it was confirmed and verified, I had what I feel was one of the best surgeons in the country, I now have what I believe to be one of the top notch Prostate Radiation Oncologists available and state of the art equipment, if all of this fails, I just have one really stubborn and kick arse case of PCa and I will be done trying to kill it.

I will move on and spend the rest of my days not worrying about it and enjoying all of the time I have with my beautiful wife and living large.

Hope this answers your questions to some degree,

Sonny
Posted 12/3/2009 4:58 AM (GMT 0)
When my Urologist told me of the positive biopsy results we discussed options for care and, on the spot, after some Q&A I made the decision to have surgery . . . without further testing, medication, etc.  I knew the Urologist had spoken with my primary care physician and that he (the primary care) had complete confidence in the Urologist and I had confidence in them both.  Each of us has a unique health history and few conditions/situations are exactly the same - so what the right decision may be for you or me may be the wrong one for the next guy in line.  My advice:  find the best medical advice you can and then follow it.  Best wishes for successful treatment of the challenges you face.
Posted 12/3/2009 11:29 AM (GMT 0)
My older brother had brachy several years ago so I had some exposure to PCa before I discovered I had it as well. I had also made up my mind that if I ever did get PCa, I wanted it surgically removed. When my Doc got worried, I found the right uro and, after nine months of watchful observation and testing, it was six weeks from biopsy to surgery. I told him my three priorities: get the cancer, avoid incontinence, and avoid ED as much as possible, in that order. So far, two out of three ain't bad. I have a PSA test next week so we'll see. I've never had a second thought and would do it again had I to do it over. That doesn't mean my approach was the correct one for everybody but it was for me. I didn't spend a lot of time (or money) getting other expert opinions because what I was told was what I wanted to do in the first place and I trusted my uro, an important point. Others here do extensive diagnostic tests with multiple consultations and I have no prob with that. PCa can be a tough nut to crack. That just wasn't the approach I took.

That's it. Good luck in however you choose to beat your PCa.
Garth
Posted 12/3/2009 12:22 PM (GMT 0)
Mel,
There are lots of medical sites that will give you all the options available. It's simply impossible for us to guess what your doctors will go for. The research you need to do now involves the heavy reading part. This place is really good for hints, support, etc, but you need to get all the PCa books and read up on it. Patrick Walshes book is still the gold standard, but there are newer ones out there. Anybook store has the latest ones. The internet quickly peters out of new information because the medical sites have to keep it real general.

You have a great library at the old U, plus the public library. There are medical journals available as well. None of this is rocket science. There are pros and cons to each choice and you need to learn all about them so that you feel in control. You now have the job of becoming a student of your own case so that you are able to understand all the options the doctors talk about.

You probably would benefit from a real life Prostate Support group. That way you can sit down with someone and talk. Ustoo.org has sites all over the world. Amercian Cancer Society has lots of PCa groups as well.

You are naturally seeking info like crazy, but most of the information you really need can't come from the internet. Time to hit the books and current medical literature.
Paul
Posted 12/3/2009 12:48 PM (GMT 0)
You shouldn't be worried about additional non-invasive testing such as a CT or Bone Scan. While the consensus seems, for people with stats similar to yours, that they don't tend to indicate additional concerns, the testing does establish a baseline that can be used for comparison should they be needed later.

I'd suggest that you expand your research so you can make a good decision on the treatment that is right for you. The majority of what is important to know is in your hands now, your age, your PSA, your Gleason score, your stage, the biopsy report and the size of your prostate. As you do your reasearch, you'll find just how important that data is in the decision process. Considering your stats, you're in a good postion with an early diagnosis that allows you time to make a decision, as well as having an excellent prognosis for long-term recovery.

Consider books, like Scardino and Walsh that provide useful fact and understanding of PCa; look over forums, like HealingWell to get a perspective on real people and their journey through PCa; go to leading web sites so you can get a feel for the wide variety of help that's available; don't overlook new research that's breaking almost weekly and that is updating studies, books and articles previously written; and finally, use all these as help, not gospel as you move towards making the decision that's right for you. We can give you all the advice in the world, you can seek it from people with similar stats as yours, but in the long run, you make the call for you and your family's needs.
Posted 12/3/2009 6:30 PM (GMT 0)
Compiler,
I had a higher Gleason than you have but I still opted for surgery. The 12 core biopsy showed only 2 cores with cancer. My Uro suggested surgery with radiation as a backup if the surgery does get it all. I had extra prostatic extension but lucky enough to have negative margins. So far I have had 3 PSA test all zeroes.
Posted 12/3/2009 8:14 PM (GMT 0)
You are right -- for men with biopsy results like yours the chance of metastasis is small and thus most CAT scans and bone scans end up negative But your doctors get a vote on this too. How much do they hate it when they do surgery and it turns out to have been completely useless? Right now -- the choice of tests is pretty much their call as to what they need to plan your treatment. If, for example you want to give stronger consideration to radiation, then your radiation onc gets to choose tests.
Posted 12/3/2009 8:24 PM (GMT 0)
WIth Mel's dx being a Gleason 7, additional  tests and opinions really aren't going to change his list of primary treatment options.

Talking to a good Radiation Oncologist needs to be done along with the surgical opinion.

I think we would agree that AS is out of the question, with a known Gleason 7 at this point.

He may still be ok for Seeding or Regular RT
He can still have open or Robotic Surgery.

He can have any of those options with/without HT added in.

His biopsy results are "best estimate" at this point.

David in SC

Posted 12/3/2009 8:44 PM (GMT 0)
Mel: 

In answer to your original question, your docs may ask you to get a CT scan and/or a bone scan.  With your PSA level, these tests will undoubtedly show nothing and a baseline showing nothing is essentially useless.  However, many docs practice defensive medicine and ask for these test anyway...in reality, just driving up health care costs.  But...even though the tests won't hurt you, you shouldn't worry that they will show anything because they most likely will not.

I agree with the advice you got in one of the other threads you started, i.e. if you are going to get another test, get a color doppler.

Tudpock

Posted 12/3/2009 10:07 PM (GMT 0)

Ohio State:

You are getting more and more strident in your replies. Is it because I sought help at Univ. of MICHIGAN? (<g>).

At this point, I am awaiting a call from Umich. Supposedly, they set up a consultation with a team (I assume a radiation guy, surgery guy, general guy, etc. -- I'm just guessing). I want to get their input. I will mention color dopler at the meeting. I almost get the impression that this is an "alternative" test. I guess it might be a bit out of the mainstream. I am reading Dr. Strum's book and I also have the Walsh book. Strum does put down those other imaging tests for many situations. However, he does seem to say that with my Gleason 7 and a low PSA, it could be an aggressive cancer and so one of those tests MIGHT be advisable (I forgot which one). Frankly, I am starting to feel an information overload. I am absorbing what I can.

You know, if a test works for us and maybe saves our butts, we sometimes get evangelical about it. I definitely now sing the praises on the PCA-3 test. While I didn't like the result, it did do the final convincing for me to get the biopsy.

But, speaking of treatments, I do have another question. I'll post it seperately regarding ADT as adjuvent therapy.

Mel

Posted 12/3/2009 11:13 PM (GMT 0)

Yep, those folks at U of Mi. are sure backwards.

Whatever.

Thanks for your input. Understand I am not rejecting it at all (either the color doppler or having the slides reread by experts). I am still exploring some things. I am awaiting an appointment with the Umich team.

Incidentally, I do not work there. I am 120 miles away from them.

Mel

Posted 12/4/2009 12:04 AM (GMT 0)
Ok, gentlemen, cool it. There's no need for Part 12 of Guys Behaving Badly. Walk away clean....
Posted 12/4/2009 12:11 AM (GMT 0)
Oh, shoot...James, I was afraid you would show up.  I missed the whole last dust up when I was away for a weekend...I was looking forward to a little HW excitement!  LOL..............

 

Tudpock

Posted 12/4/2009 12:39 AM (GMT 0)
Compiler,  Here's my little story r.e. the CT and Bone scans I had.

My Uro at the time explained the tests for me, then asked me a number of questions such as

Doc: "Do you have lower back pain?"  

Me: "Yes"

Doc: "Any bone pain in other locations?" 

Me: "Yes, my left heel and left shoulder.  Heel was treated for plantar faciitis.  Shoulder hurts so much some times I've been thinking I should go get a cortisone shot"

Doc: "Well, for your level of biopsy, these tests don't really show anything, so you don't need it."

Me:  "WHAT!?  What were the questions for then??  I said yes to every one!"

Doc: "Well, we can do them for 'peace of mind' then."

Spent several nights before the tests scared witless by my shoulder and foot pain.  Time to get my affairs in order, etc.  Tests ultimately came out clean.

FWIW.

PS. had the surgery done by a different Doc, LOL.

 

Posted 12/4/2009 3:48 AM (GMT 0)
Brother Mel and fellow Michigander (lol), I also went to U of M for an opinion but saw a radiation onco-doc and (drug) onco-doc while there. Nice consultation and couple more DRE's that I did not need in seeking 8 opinions (lol). The rad-doc was an excellent guy and called me at home (even though I was not a patient, yet) and answered my questions about a lymphendectomy (sampling of nodes-without doing surgery)-doing it prior to confirm yes or no, I opted out of such but it might be worth someone elses consideration and has some risk too.

He was my second choice for radiations, almost got hired, but I found a better radiation protocol above the normal IMRT(in may ways), since that was my primary treatment, went for the big bang.

Mel- you could pay the additional money and have your pathology slides read as to plodity testings, this reveals the possible 3 types of DNA conditions of the strands in PCa, diploid being what you want to hear. The further ploidities basically reveal a more stubborn (if you will) cell structure and may be harder to treat . Suggest you call Dr. Bostwick and ask him some questions..(800)214-6628  or  Dr. Grignon (Michigan)  313-745-2520  or Oppenheimer  (888-868-7522) or John Epstein (410-955-5043)

It is another test that you don't have to sacrifice anything except some money to find out.

Andrew- peace love dove mi amigo  (I know you are passionate on this and me too)

David- peace love dove mi amigo (your journey has been unreal,  hope it gets better)

 

Posted 12/4/2009 4:40 AM (GMT 0)
This thread is getting a little wierd.

I have also been to UofM and seen Dr.Maha Hussien, who is an emminently qualified oncologist. She is on presidential panels, FDA boards, etc. I respect her, and thhink tha U of M is a very fine cancer center.

But I have also been to Cleveland Clinic, where they also have some fine "hotshot" doctors. And we have hundreds, probably thousands of men on this site who have been to some very fine doctors. To discredit them because they are not in a university setting, where sometimes things can become very theoretical and experimental, certainly sounds like some wierd advice.

You can spend a lot of time doctor shopping and opinion seeking, and color dopplering, while the PC continues to grow. Find a doctor or doctors you trust, and move ahead. At some point, this discussion must move out of committee work, and head for implementation.
Posted 12/4/2009 4:50 AM (GMT 0)
LOOK OHIOSTATE:

Many of us are certainly under stress and perhaps you are having a particularly bad day. This is a support group.

First of all, perhaps you should reread my post. I think  I inserted a little <g> by that comment. Regardless, it was a JOKE!!!

I am reading the Walsh and Strum books and, AS I ALREADY SAID, I am considering ALL opinions.

I would appreciate it if you would drop the attitude or maybe just not respond to my posts.

Frankly, I would suggest that you caress an idea, not strangle it.

Did you just undergo a new kind of procedure where they replaced your prostate with a burr?

Mel

 

Posted 12/4/2009 4:57 AM (GMT 0)

Goodlife:

I agree with you totally!! Keep in mind that I was just dx. 2 days ago.

I have been playing phone tag with Umich trying to schedule that follow-up with a bunch of their doctors. I absolutely want to move on this, learn, get more information, and then DO SOMETHING. I'm not going to dawdle...nor rush into it.

My preconceived view remains surgery. But I will get the slides reread by Ford Hospital (the VUI). I think (but I am not sure) that they also send them to Johns Hopkins. I will ask about Color Doppler at Umich.

Mel

Posted 12/4/2009 5:05 AM (GMT 0)
Mel,

I wasn't insinuating anything to you. I actually am also getting frustated by some of the other posters who appear to be a littleoff the wall. For a bunch of guys who may be lacking in some testosterone, we sure seem to display a lot of it here.

Good luck to you. I really believe you have a wide open playing field. Whatever you decide will work for you based on your biopsy.
Posted 12/4/2009 5:19 AM (GMT 0)

Goodlife:

Uh...oh...tough day. I'm not at all saying you were insinuating anything.

I agree with you totally and I appreciate your advice.

Mel

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