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Posted 12/9/2010 5:27 PM (GMT 0)
Well, I got my biopsy results back and am joining the cancer club.

Results:
PSA 3.2
Biopsy 24 cores 3 positive
Gleason 6
Posted 12/9/2010 5:34 PM (GMT 0)
Sorry about that -- we all feel your pain!!

I'll let others elaborate, but your results are very good (if it has to be PC). You might be a candidate for watchful waiting (active surveilance).

I would suggest you get a second opinion on the biopsy slides. Jon Epstein at Hopkins is excellent as is Bostwyck Labs (you can google them).

Mel

Posted 12/9/2010 5:35 PM (GMT 0)
Sorry for the diagnosis. Now the work begins, so much study, reading, research to do to make an informed choice as to treatment. AS you know, we're here for you to help in most any way we can.
Posted 12/9/2010 5:45 PM (GMT 0)
As it stands now, I'm having the doctors office schedule a CT scan and obtain a robotic surgery appointment/procedure asap. I will be using Dr. James Jensen, at Joan C. Edwards Cancer Center in Huntington WV. Dr. Jensen has performed over 1,000 of the robotic procedures and has an excellent track record.

Sounds like my little guy will be removed sometime early January. darn the bad luck....

Thanks again for the support.
Posted 12/9/2010 6:08 PM (GMT 0)

Well, you're now in the exclusive club of men that no one wants to join.  I know how difficult it was for my wife and me when we got the news that I had prostate cancer. Neither the urologist nor I were expecting it to be present (he said before the biopsies that there was probably a 10% chance of cancer).


Try to enjoy the holidays as you prepare for surgery.  Exercise will help you to be in the best possible shape and recover more quickly.  The members here are a great support and are here to help. 

Take care and hang in there

Posted 12/9/2010 6:21 PM (GMT 0)
Viper,

In the comment above Mel should have said "Bostwick" as the name of the pathology lab.

I was going to mention that the pathology and psa results would lead me to do thinks with calm. Deliberate calm, but without rushing anything, but I see you have plans in place.

It does sound like you have done some research already. I'm sure that others have suggested getting the Walsh book Surviving Prostate Cancer (2nd Ed.) - it will help you understand a lot of what will be going on around you. You might find it at your local library, and certainly it is available for purchase on line.

I did DaVinci about 14 months ago, then adjuvant IGRT.

Ask any questions you want, we are here to help where we can.
Posted 12/9/2010 6:29 PM (GMT 0)
OK so your having the surgery I did too in Oct. get your head around things. Your going to leak buy pads, You may piss yourself at night be mentally prepared for it. Your penis may not work the way it did before be prepared for that your sexual desires and your abilities may not match. I was lucky I could get erections with in a few weeks but I can't achieve true orgasms.I'm sure this is temporary.  You may not know when you need to go to go to the bathroom or the need may come on very suddenly. Your bladder will not hold what it used too. I'm not trying to freak you out I'm just trying to tell you what I wasn't told. The surgery it's self isn't bad it's not very painful I took one does of pain pills when I got home from the hospital. The catheter is the biggest pain in the butt. Keep you your mental attitude in check will help you the most.
Posted 12/9/2010 6:32 PM (GMT 0)
Viperguy -- Well, as PC goes, you've got a relatively small one, a relatively tame one, and a low PSA. You can take some comfort that your odds are very good and you don't need to rush into a decision. Go to to the SKMCC nomogram online calculator and see just how good they are.

www.mskcc.org/applications/nomograms/prostate/

Take your time, take a breath, get multiple opinions. +1 for exercise to be in the best possible condition before surgery if you go that route.
Posted 12/9/2010 7:05 PM (GMT 0)
Viperguy Welcome To Healing Well!

"I'm probably the biggest worry wart on the forum." I think not !!!

<--- Look at my screen name!

I too am wired to research and take data on everything. And I do mean everything.
You do what you gotta do.

Jeff
DX ed last year at 56, PSA 23.2, Biopsy 7/12 up to 70%, Robotic surgery 7/21/09
Posted 12/9/2010 7:31 PM (GMT 0)
Viper:

I don't want to muddy the waters...but:

Are your docs. really pushing for a CT Scan??? Really, in your situation it is so highly unlikely that they would find anything. I know from my readings and my docs: they said the risk reward would suggest no such tests needed.

Just a thought. Maybe you should at least ask.

Mel

Posted 12/9/2010 7:52 PM (GMT 0)
Viper first of all take a breath and relax. PCa as yours allows for many options and time to educate yourself on them and their possible life altering side effects. There is no reason to panic and rush into any treatment. I too at first was leaning towards surgery then seeds, but wound up doing TFT a clinical study that has turned out great, with little impact on my my life. That said I'm not advocating any treatment but explaining why you shouldn't commit to any option too early. Once you have decided on a treatment or active surveillance I recommend to all they take a week off. Go somewhere, do your best to not think of cancer then revisit your decision. If you still think it's for you go ahead without looking back, for there are no do overs with any treatment. Once again I repeat take your time, weigh possible added longevity with quality of life issues that also include impact on relationships. It's very complicated as you'll learn over time. Good luck

BTW I agree with Mel and see no reason at all for a CT scan in your case.
Posted 12/9/2010 9:00 PM (GMT 0)
Viper, I think you just got some very good advice from Ziggy.  Dude...this is a big friggin' deal...if you don't at least take the time to get fully educated and discuss your options with some different medical professionals, then you may be making a huge mistake.  Please...talk with a provider who considers AS....and talk with a radiation oncologist and prostate oncologist.  And, read Walsh's book, Strum's book and the new Blum/Scholz book.

If after doing those things your decision is still surgery then great...go for it and we will all wish you well.  But please don't make the mistake of not looking at options now...getting educated after the procedure is a little late...

Tudpock (Jim)

Posted 12/9/2010 9:37 PM (GMT 0)
Listen to Jim, Ziggy and the rest of the guys. You have had 24 plugs taken (this is very good). Three were positive ------- this is good in that 3 positive out of 24 is not a lot. You have been given a Gleason 6 ------ today this is as low as it gets. The only thing missing in your stats is the percentage of tumour in the positive cores. By all means schedule your surgery but take the time to read and study and learn all you can about what you are dealing with. You can be almost certain that scans will reveal nothing. Have a good read here ........

www.yananow.org/Links.html

many personal stories by patients on the same road ...... from active surveilance to all the different treatments available. You need to know as much as you can in order to make an informed decision.
Bill
Posted 12/9/2010 9:48 PM (GMT 0)
viper,

you are getting excellent advice, slow it down, make sure this is what you really want to do, side effects can vary widely and range from easy to rough. you get once chance of doing your primary treatment, so choose wisely. surgery is always an option, widely used, but with your numbers, you have other options on the table

david in sc
Posted 12/9/2010 11:19 PM (GMT 0)
Very interesting comments.  The person scheduling the bone scan stated it was common practice with all the PC patients.  I'm not a big fan of xrays or any radiation

I have thought about the seeds and beam therapy but being a worry wort I would not rest easy knowing the PC can return and be very difficult to detect or treat.

For those of you that elected robotic surgery are there any regrets?  Once that little sucker is gone you shouldn't have to worry about PC anymore unless it moved

to the bone.  Do you feel that other procedures are better with less side effects? 

The thoughts of having cancer floating around in my prostate is something I can not mentally tolerate for too long.  I guess I need a little peace of mind.

questionsaboutit you had your prostate snatched in September, are you still incontinent with ed?

Posted 12/9/2010 11:31 PM (GMT 0)
Sorry to hear your diagnosis, But welcome to the club! Seems like you have many options in your situation. Take your time in deciding your steps and try to write down any questions you have when ever you think of one so you wont be wishing you asked it after its too late,unless you are one of those people that never forgets anything.Try not to go into information over load. If not for this great group on here I would have had a lot worse time going over this speed but in my life.  Good Luck!!

Posted 12/9/2010 11:37 PM (GMT 0)
viper,

there are many of us here, who's PC has returned even after surgery, requiring a secondary treatment of radiation in some form. There are no guarantees in the PC world, don't let any doctor fool you on that part. All treatments have risk factors and side effects.
Posted 12/10/2010 12:19 AM (GMT 0)
Having had robotic my regret is that I chose it without knowing as much as I should or could have known. That doen't mean I would not select that option again but rather would understand completely why I was choosing it. Surgery is certainly no guarantee of cure ------ it's not like the prostate tumour cells look markedly different to the naked eye, enabling the surgeon to snip here and snip there removing it all by sight. Many guys have a post surgery pathology that includes a positive surgical margin ----- this is not a slight on the quality of the surgeon but rather the tumour seldom jumps directly from within the gland to the bone. It normally infiltrates surrounding tissue well before that step. Positive margin usually results in follow-up radiation. The advantage of surgery can be that you know the amount of tumour in the gland and if it is confined. The disadvantage could be a pathology that says very small amount in one location which could have been watched over the years thus retaining your functioning gland or having radiation (with or without seeds) and generally having fewer side effects than surgery. This is why gathering all the information you can before committing is so important.
Bill

Post Edited (BillyMac) : 12/9/2010 6:22:50 PM (GMT-7)

Posted 12/10/2010 12:20 AM (GMT 0)

Purgatory said...
viper,

you are getting excellent advice, slow it down, make sure this is what you really want to do, side effects can vary widely and range from easy to rough. you get once chance of doing your primary treatment, so choose wisely. surgery is always an option, widely used, but with your numbers, you have other options on the table

david in sc

 

Dave, given my scores what procedure would you recommend?

Posted 12/10/2010 1:10 AM (GMT 0)
ViperGuy, I had open surgery. I wanted DeVini but was not available near me. Sometimes I wish I had gone out for the robot but I really dont think the outcome would have been any different. The biggest difference between the 2 surgery is the time with a Carh. I am 2 years our and have never really leaked but ED is an issue but my friends that danced with the robot have had similar results and may not as good. The choice of surgon is most important.

Now for the hollidays I recomend that sexual activity be increased to at least 1 a day if not more.

Cajun Jeff
Posted 12/10/2010 1:18 AM (GMT 0)
viper,

as much as i would want to, wouldnt dare answer your question directly. i am not a doctor, nor pretend to be one. i would trust you to turn to your medical professionals to determine what is best for you, with your consent of course.

how old are you? didnt see that. do you have any other PC in your immediate family? the fact that you had a 24 core biopsy is a good thing, as its less likely to miss as much cancer. you must remember, a biopsy is just an estimate of what is going on.

you had 3 positive cores, but do you know what the % of cancer was found in each one? that can make a big difference too in determining a treatment choice.

you are a gleason 6 based on biopsy, that is good, but gleasons are sometime upgraded after surgery when the entire prostate can be examined in the post surgery pathology, if you chose surgery.

also depends where you live - do you have good surgery facilities/hopsitals, good radiation clinics available to you? if needed, are you willing as some men are, to travel further to a higher caliber facility? Not saying you need to do that?

on the surface, without knowing the other answers asked above, you might qualify for AS, and not do anything immediately, and keep a close eye on things. you might be a good candidate for seeds. and of course, any surgeon would love to get their hands on you for surgery.

the gamble with surgery, is does it get all the cancer or not. no guarantee, no promises, not even any logic some time. and with side effects, varies so very much, even if you go to a top notch center with a top notch doctor. we have men that had extensive nerve sparing surgeries, and still have total ED 2 years later. then you have guys, rarely, i am one of them, that had left side nerve bundle removed, but have never experienced a day of ED. with incontience, ranges from guys that are 100% dry from the day the catheter is removed, to guys that have total incontinence even years later. while most times its not to the extremes, it can be, and that is where the luck comes into it.

if you want surgery, then go for the best surgeon you can get with the most experience. the robot vs. open surgery debate goes on forever and isnt as important as the quality of the surgeon. but even then, bad things can and do happen. we have guys here that went to brilliant level surgeons, and ended up with instant recurrance of cancer.

this is why the other guys are trying to encourage you to seek all options, and to slow down any treatment decision until you are comfortable with what you are doing. with 3 positive cores and a gleason 6, waiting a few weeks or even a few months to make the right choice is far more paramont then making an instant decision.

ask lots of questions, visit other doctors, talk to the radiation and oncology doctors, think hard about what you are getting into, there is no second chance button with PC.

david in SC
Posted 12/10/2010 1:28 AM (GMT 0)
David, very well said.

Cajun Jeff
Posted 12/10/2010 1:45 AM (GMT 0)
questions, your list of things not to drink are good, but add any fruit juices, anything with caffine, anything carbonated, and alcohol for the most part. to prevent infections, my uro has me on cranberry juice pills, which do the same thing without the effect of the juice. in my case, cant stand the tasted of cranberries. on your ED statement, 3 months out of surgery is way too early to be thinking about implants, hope you were kidding.
Posted 12/10/2010 1:57 AM (GMT 0)
Viperguy, read this.

http://prostatecancerinfolink.net/2010/01/06/an-update-on-gleason-grading-system-today/

http://prostatecancerinfolink.net/2009/09/22/surgical-outcomes-for-patients-with-organ-confined-gleason-6-prostate-cancer/

It is always possible that your Gleason score could upgrade after surgery.  It's a door we all have to go through.  But if you stay Gleason 6 and organ confined this will be your prognosis if you have surgery at Johns Hopkins.  You are close enough you could drive there.

I live in Columbus, OH and was dx. by a guy named Merrick in Wheeling, WV.  He does brachy therapy and if one of the best in the country at it.  He does a lot of research.  I would get my biopsy slides read at Johns Hopkins to make sure they agree you are a G6.  If so, go see Dr. Merrick in Wheeling he will tell you straight up what you should do.  He is one of the few Dr. I know that will actually give you his opinion and he has been in the business quite a while and is not slouch.

I had stats. the same as yours and waited 6 months before I had surgery.  Not one Dr. I saw recommended a bone scan.  If you search the web for studies about bone scans for PSA under 5 and G6 you will find that nobody was found with metastatic cancer and the bone scan is not recommended.  I would not take the radiation unless it was absolutely necessary.  Your Dr. should be charged with malpractice for trying to get you to do a bone scan with your stats.  It's a money maker for them.

Merrick will get you an appt. with Dr. Partin at Johns Hopkins if you need him to.  He did for me and then told me to go have surgery with Partin at Johns Hopkins. 

Because of their published stats. in the above article is why I went there.  Nobody else has published stats. this good for G6 organ confined prostate cancer.  At lease I know what to expect in the next 15 years.  After that who knows.

At your age my dad simply had radiation 10 years ago with the same stats as you and his PSA is still undetecable.  But it's only been 10 years.  G6 if it comes back it probably runs a 20-30 year course in my opinion.

It is hard to believe, but G6 dx. today, after 2005 is a very treatable cancer.  Johns Hopkins claims that 99.6% of their patients are cured, and the ones that did have it come back had a low and stable PSA suggesting minute cancer that is highly improbable to progress. 

 

Post Edited (ChrisR) : 12/9/2010 7:04:05 PM (GMT-7)

Posted 12/10/2010 2:21 AM (GMT 0)

I agree with what Chris has written.  I had my biopsy slides read at Johns Hopkins for a second opinion.  And I waited several months before surgery. With a low Gleason score, there's no rush.  A bone scan is not really needed with a Gleason 6.  I had my surgery performed in the Pacific Northwest, but Johns Hopkins is one of the best prostate cancer hospitals in the country, and Dr. Partin is tops. I'm still cancer-free after 4 years.

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