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My 2nd opinion from Bostwick is back...

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Posted 7/20/2010 5:44 PM (GMT 0)
I received a single page report back from Bostwick.

Diagnosis

Prostate, Needle Biopsies

(a) Left Transition Zone: Benign prostatic tissue.

(b) Right Transition Zone: Benign prostatic tissue.

(c) Left Peripheral Zone: Adenocarcinoma (Gleason Score 3+3=6) involving 10% of the specimen. Immunostains for basal cell-specific high molecular weight keratin (34BE12), p63, racenase and c-myc support this diagnosis.

(d) Right Peripheral Zone: Benign prostatic tissue.

Comment: Thanks you for sharing this case with me. I fully concur with the diagnosis of malignancy. The architectural features warrant a Gleason score of 3+3=6. If follow up becomes available, I would your letting me know.

Comment: The special stain(s) are consistent with this diagnosis.

Their appears to be a disclaimer about the stains they use and the fact that they are not approved by the FDA. But I can't really make it all out. 

I guess it's good that it didn't come back worse than the original diagnosis. :D But I'm not really understanding the extra information, is that what was eluded to in their website info? I thought they were going to tell me something that could possibly hint at the aggressiveness of this. Or maybe this IS the confirmation that this is not aggressive.

Well there it is. I finally got the 2nd opinion done. Feedback? Thanks, Jim

Posted 7/20/2010 5:50 PM (GMT 0)
Saw your diagnose and started wondering about whether I am doing the right thing, I am scheduled for surgery in August, and I am wondering if I am rushing into things after seeing your diagnose.  I was under the impression at my age (58) there is no need to actively watch since it will only get worse, just wondering what the doctor told you since we both have the same gleason score....
Posted 7/20/2010 6:13 PM (GMT 0)
I'm in no hurry to do anything! Right now I am no longer feeding my cancer. I have changed my died and am loosing weight. Gone are the corn fed charcoal grilled steaks. I exist mostly on salads, soy based protein sources, and a little chicken. A good week for me is to eat meat for supper only once. There is a big debate as to weather diet has any effect on PCa. I am in the camp that believes, if there is stuff you can eat that can hurt you, then why couldn't their be foods that can help you. I have read that people have slowed or stopped the growth of PCA with diet. I have decided to give this a real serious try before I will let any doctor do anything to me period. :D

I sat down and had a long talk with my prostate. We both agree that I didn't treat my body that well so far. We both agree that we like each others company. I told it though, if you don't knock it off I will kill you!

I can't tell you what to do. I know for me this is the right thing to do. Good luck Minn,
Posted 7/20/2010 6:18 PM (GMT 0)
Forgot to mention my doctor isn't really that up on AS. If it were up to him I would have irradiated the little guy about 4 months ago. I'm the one making the decisions not him. Nice guy, but he just wants to treat. Just treat it! he says.
Posted 7/20/2010 6:47 PM (GMT 0)
Jim and Minn,
With low risk PC ( Gleason 6, less than 3 cores, psa under 10) AS is a very good option. The biggest risk is that the biopsy missed a higher gleason grade and this is why a 2nd biopsy is recommended within a year. There have been numerous studies that indicate that only 30% of low grade PC will progress and the 30% that does can be treated with similar cure rates as immediate treatment. The low risk of missing something is offset by the fact that 70% of the time you will never be treated and if you do you will have the same results if you were treated now.
It also gives the opportuntiy to delay your treatment into the future when there might be less invasive procedures available. Be sure to get a doctor that is experienced in AS so you can be carefully monitored.

JT
Posted 7/20/2010 7:18 PM (GMT 0)
Watch it like a hawk!

For the record, your case would NOT qualify for AS according to the Johns Hopkins criteria nor the NCCN criteria for active surveillance. While your tumor grade is small and the disease appears indolent, you are my age and have more than 20 years of life expectancy which would be outside those guidelines.

Thanks for sharing the lab results...

Tony
Posted 7/20/2010 7:47 PM (GMT 0)

TC-LasVegas said...
For the record, your case would NOT qualify for AS according to the Johns Hopkins criteria nor the NCCN criteria for active surveillance.

Eh, just call me a rebel then...
Posted 7/20/2010 7:52 PM (GMT 0)
Will do.

Certainly there is no urgency at this time. Was the August 2009 your first PSA test?

Tony
Posted 7/20/2010 8:05 PM (GMT 0)
Jim, it's hard not to comment, "but, remember, the rebels lost!" -- but that would be smartass, and your life is not something for me to be smartass about.

That said, Tony's information is total serious. This is your life, your decision, but as I read it, you are playing the wrong side of the odds for your age --- especially as a whole reange of treatment options is available to you now. I don't want to push, or encourage you into treatment. That is your decision. But, I do want to be sure you are in total possession of all the information and make your decision accordingly.

One comment too on JT's post. One further aspect of AS I think PCa people need to take into account is that they may be healthy enough now, mainly cardiovascular I'm thinking of, to easliy handle treatement now, especially surgery, but a few years down the road that might not be the case. When I was a Gleason 6 and thinking about AS I thought what I was really waiting for was the cancer to be worse, more aggressive, at which time I'd need treatment, and I could hear my doctor saying, "You know, it's too bad we didn't treat this 10 years ago when it would be easy for you, but I'm sorry to tell you there is no way you can go into the OR now with that heart of yours!" Ouch!

Sheldon AKA Sleepless
Posted 7/20/2010 8:28 PM (GMT 0)

TC-LasVegas said...
Will do.

Certainly there is no urgency at this time. Was the August 2009 your first PSA test?

Yes Tony it was my first PSA test. I have read where PSA can range wildly from day to day, and even range wildly during a day, and I do not believe the two tests are enough to establish a trend yet. Will see what the next one reads. I am still evolving my methodology to cope with this. I am quite sure there is not enough urgency, right now, to make me hurt myself with a "cure". 
Posted 7/20/2010 8:39 PM (GMT 0)
This is more to minn1951. With t2b and volume you mention, and I bet this is with no reread of slides, you are no way near AS parameters IMNSHO. You need to be treated, What treatment is up to you. For that matter, no treatment would be up to you. As much as we would lik e to have it all go away, it usually wont. AS is a very viable option if you meet the criteria. I have this feeling that the criteria is a window of opportunity of knowing you wont be killed by this, migrating to a window of opportunity of a cure. I dont know if there is a good prostate cancer, but again, I believe the longer it is there it will get more aggressive over time. The amount of time is the Big unkown isn't it. The older you are with the "good" cancer the AS makes more sense, conversely........... Its a B---h!!!!
Posted 7/20/2010 8:45 PM (GMT 0)
You are certainly doing good things with your diet, Jim. Make sure you get enough protein. I decided some time ago that I wasn't going to give up the red meat. I have always had a diet with good grains and veggies so I decided to be the rebel there and keep the occasional steak. But all in all I eat healthier, more fish (love the sushi), poultry. If this stupid cancer doesn't kill me, it just might make me live longer.

Yes, I would watch that PSA trend closely. You might want to set your guidelines as to what might change that would make you consider treatment. I am not too high on active surveillance studies as most are not mature enough to give a guy in our age group useful information. What's good for a 65 year old median aged prostate cancer patient, does not always apply to a man under 50.

Stay well and good luck in October!

Tony
Posted 7/20/2010 9:15 PM (GMT 0)
Jim,
I have no problem with the concept or use of AS, but I agree with Tony above, that due to your sub-50 age, there is more gamble to AS then meets the eye. Your dietary changes are good for your general health, couldn't imagine any health prof disagreeing with that, but at your age, a dietary change is not going to stop or slow down any cancer in you. Some feel the way that you do about the dietary part, others strongly disagree. I respectfully agree to disagree there, but regardless, eating healthy is still a good thing. All the medical and radiation oncologists I have spoken to over the years have agreed on the same point, that dietary changes after the cancer dx is worrying about the horse being out of the barn after the fact. That you aren't going to have enough of a change a half century into your life to make any significant change. With you current stats, I agree there is no reason to rush into any treatment, especially if you are not of the mind set yet to feel you need treatment. Good luck as you ponder your own future with cancer. We are here for you regardless of our own personal choices and opinions.

David in SC
Posted 7/20/2010 9:54 PM (GMT 0)
David,
There is more and more evidence that diet will affect the rate of growth of PC. You can't cure it but you can sure slow it down. Preliminary evidence form the UCSF AS program indicates that none of the patients on a diet showed any signs of progression while there was progression in some of the control group.
JT
Posted 7/21/2010 12:03 AM (GMT 0)
John,

I know that you and a few others here strongly feel that way about diet. With 4 bouts of cancer in my life, having used a total of 2 medical oncologists and at least 4 radiation oncologist, don't you think its odd that none of them agree that dietary changes make any difference after cancer is dx? I know they are human, and can have biases and make mistakes, but they are all capable doctors. Even my GP of 13 plus years feels strongly about that. My most recent radiation oncologist, said that she has read all the studies over the years, including current ones, and that at best, you can not draw any conclusions that diet helps, not with any convincing evidence. She is in favor of the healthy heart diet, regardless of cancer prescence or not, and is the most anti smoking dr. I ever met. She feels there's no point talking about health prevention at all to a smoker that won't quit. Her opinion, not mine.

So what do you consider the best overriding evidence of diet helping cancer patients for real? I would love to read up on the "other side"

Respectfully,

David
Posted 7/21/2010 12:14 AM (GMT 0)
There are individual stories of patients on both sides of this, pro and con to doing it. Alot depends upon the overall assessment of what you have, is it indolent PCa as defined by Brady Urology (Tony eluded to this), those people fitting that criteria or perhaps near that criteria (as John T likely was eluding to) would have low risk factors in general and likely not be insane to consider A.S. or W.W. Guys in the group Tony mentioned are the best candidates for successful A.S. with monitoring.

Now for the pro A.S. my brother diagnosed with PCa 5 yrs.+ ago now, was found with indolent PCa as defined by Brady Urology Dept.(John Hopkins), he elected A.S, so far likely not insane, his psa has never moved higher and was like 1.0 or 1.1 when he was detected, with one core less than 5% found and Gleason (3+3). He does monitor and diet is excellent and exercise/fitness.

Now for con on A.S. another forum, a guy posted don't do A.S. based upon his own case. Well his parameters were a little high to begin with Gleason 7 and I think psa was alittle above 4.0 and such (who knows if pathology was reviewed etc.). He did fail successful A.S. within shorter time frame than my brother and also may have to get SRT. So yes in his case as he pointed out it was not the right path.

Best to you Jim (sorry got caught up in the A.S. thingy)

Posted 7/21/2010 12:34 AM (GMT 0)
David,
She should reconsider her position on talking to smokers. My wifes grandmother smoked heavily until she turned 58. She is 96 now. Smoking is a huge contributor to terminal lung cancer. But the fact is that we are better at treating the disease today. my step father died of the disease and he had a poor diet. When you consider that we live in a nation of 40-50 million smokers, less that 80,000 die per year of lung cancer and I know about that number dies of cardiopulmonary disease relating to smoking. But that means a lot of smokers should watch their diets because the stupid habit won't kill them.

Just a thought.

Personally I am a proponent of a healthy diet. The benefits are real...

Tony
Posted 7/21/2010 12:47 AM (GMT 0)
Tony, I am a bit surprised on your stats on smoking related deaths in the US, those are all much lower numbers than I have seen. I went from being a non smoker, to a late in life smoker (started at age 50, quit the night before my open surgery) to being back to a non smoker, so I have no personal anti smoking agenda or moral issue about smoking. Live and let live. My mother, still alive, has smoked heavily for almost 67 years of her 83 years, and her drs still say her lungs are good, and she has already survived a quad bypass years ago, and a moderate stroke in recent years.

And you should be able to tell from my post, that when I speak of the dietary part, I am referencing what my doctors have told me, not my personal opinion. I believe you can what you want, in moderation as a general rule. I eat little red meat by choice, lots of chicken/seafood, been caffine free for almost 25 years by choice, dont smoke any more and I don't drink by choice. My worse dietary vice is too much sweets, but I never have had any problem with chorlesteral or diabetes. I admit, I do have a sweet tooth that is never satisfied, so if cancer is cause by sugar, I am screwed, lol.

Good diet is always a good thing, I would never argue against that.

david in sc
Posted 7/21/2010 1:11 AM (GMT 0)
First, sorry to Jim. I don't mean to hijack this thread...

It is too low. SEER says 158k will die of lung cancer this year. When pulled the stat I was looking at cancer in males. That stated, less than 15% of smokers will get lung cancer. I heard somewhere that smokers will likely die of other smoking related illnesses. But that also stated, many won't die of a smoking related illness. And doctors should stress a healthy diet whether they smoke or not.

Tony
Posted 7/21/2010 2:38 AM (GMT 0)
Out of curiosity, I googled up calculator on the smoking/lungcancer issue and was totally shocked at the results. Try it yourself. These are rough estimates from these calculators but they are close. Actually I will use the one with highest incident of smoking, that I imputed You can input whatever factors u want in the calculator. For 40 years of smoking 5, I said 5 packs a day, the risk factor for getting lung cancer is, drum roll please, 4 to 5%. Whod a thunk. Probably most people who have lung cancer have smoked, or drank milk for that matter. But the truth is that the vast, vast majority of smokers will never catch lung cancer from smoking. Having said all that, smoking is the worse thing anyone can do for their general health, in many,many areas. There is a reason people don't like those first puffs of cigarettes till they get hooked. apologise for the rambling!!
Posted 7/21/2010 3:05 PM (GMT 0)

John T said...
David,
There is more and more evidence that diet will affect the rate of growth of PC. You can't cure it but you can sure slow it down. Preliminary evidence form the UCSF AS program indicates that none of the patients on a diet showed any signs of progression while there was progression in some of the control group.
JT

Hi John, Thanks for the support...

I quit smoking about 20 years ago. What a terrible waste of everything involved.

Funny thing about this forum. And I'm not really saying anything bad, but here it goes.

If you have Gleason 3+3=6 you will be told the interesting facts. Things like at age 50 and up the age equals the percentage of men with PCa. The fact that if you do nothing you might feel the effects in 10 to 15 years. The fact that a very high percentage of men will die with, but not from PCa. The fact that all treatments offer roughly a 97% chance of survival no matter what treatment is chosen. You will be instructed to not react too fast, not to treat the fear, instead of the cancer, etc. You will be told to consider AS. You will be told that AS means you do everything you can to slow this down primarily diet, secondarily supplements.

However if you do walk this path you better have some thick skin. Be ready to here, diet will have no effect on your cancer. Be ready to here, you're in denial. Be ready to defend yourself.

I know that the overwhelming majority of people in my situation will take the easy way out the have it treated. I have dug in my heals. I'm not budging. Who knows, there may be a vaccine in 5 years... I would never forgive myself if I read that a breakthrough was discovered while I was recovering from surgery. I know the facts. I know the risks. I am at peace with myself, my body and my maker.

I like coming here, but it takes a lot from my work. I gotta go...

 

Posted 7/21/2010 3:06 PM (GMT 0)

TC-LasVegas said...
Stay well and good luck in October!

Tony

Thanks Tony!!!
Posted 7/21/2010 5:05 PM (GMT 0)
>>>I know that the overwhelming majority of people in my situation will take the easy way out the have it treated

Hmmm...Easy way out??
Might want to re-think that statement. After reading many stories here, and watching my father go through treatment, there is nothing easy about it. Not at all.
I guess I am in the camp of why bother watchful waiting.......waiting until its too late??

Everyone is different. After witnessing my fathers current battle, if I am found to have PCa, I want it out.
Posted 7/21/2010 5:58 PM (GMT 0)
"The easy way out" ?????

I found that very offensive, to each and every man that has had to deal with either their primary or their primary and secondary treatments. None of it easy, my friend. PC surgery is complex and invasive, regardless of open or robotic. And the side effects in dealing with long term incontinence and/or ED are not easy. Physically or mentally. And for our advanced brothers, there is nothing easy about fighting for those extra months of lifes, taking toxic meds to try to stay alive.

And for some/many men, radialtion can be grueling to the body and immune system. Thats not an easy ride either.

You can here and asked questions and opinions, and you got them. Thats all they are, is our opinions based on our first hand experiences and countless hours of research. No one will tell you what to do or not to do, the info here is just more data for you to digest.

You may hate me for saying this, I mean no disrespect, just talking bluntly, but you do or not do what you think is right and best for you, we are big believers in that, but I still underneath it all, you are fighting denial. Just my personal opinion.

No one is going to tell you what to do. You have prostate cancer, at best, your biopsy is an estimate of the extent and range of that cancer. It may be just what it says, but it may turn out to be more. How would you feel if 2-3 years from now, that instead of some "vacinne" being invented to spare you treatment, that your biopsy was wrong and your cancer was much larger and much more agressive? That is where the gamble comes in.

I hope yours stays low and indolent, then the whole concept of AS makes perfect sense, the gamble aspect is yours alone to make. Its your body, your life, and even your cancer.

Respectfully

David in SC
Posted 7/21/2010 6:41 PM (GMT 0)
Gaaa! I didn't mean to offend, I only meant AS is not looked at as difficult. I only meant it's not easy either.
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