Positive biopsy.

I am 50 years old. I have had my PSA checked yearly since age 45 as part of routine labs with my job. They were always within normal range up until last year when it shot up to 6.43. I wasn't shocked because both my older brother and dad had BPH and had TURPs in their 50s so I figured that's what it was. I immediately made an appointment to see a Urologist, who several members of my family have used dating back to my dad. I had a normal DRT. I was given antibiotics and had my PSA rechecked and it was still elevated at 7. I was given a different antibiotic and had it rechecked and it was 6.7. Each time my DRT was normal. I had a biopsy with 6 samplings and all came back normal. Antibiotics and rechecked in 3 months and was 6.3 and normal DRT. 4 months later in Feb of this year my PSA came back at 8.53. DRT normal. My urologist decided to do another biopsy with 12 samplings. This time 1 came back positive. The first call I received was that they had to be sent off for a second opinion and stained. Then a few days later, this past Friday afternoon my Dr called me to tell me that 1% of 1 sample showed cancer. He explained the staging and told me I was T1C with a Gleason score of 5. He briefly told me what my options of treatment were and told me to call him Monday for an appointment to discuss everything. He advised me to research things and make a list of questions to bring with me. My appointment is next Tuesday. I really like this guy and feel very comfortable with him.
I am pretty overwhelmed with all of this. I am in excellent, excellent health. I am a very healthy eater and I am very active. I excercise at least 5 times a week. Other than reflux I have no other health problems. I am currently single and consider myself to have a very healthy sex life. I have been doing a lot of reading on the internet and feel confused. I can't imagine having surgery but I really don't want this in my body. I feel like I am too young to have this happening. I have a very close relationship with 2 adult daughters and 2 grandchildren. Of course being cancer free is most important to me. I do hope to be in a relationship again one day but I feel like that may be doomed now especially reading about all the possible complications that could arise.
I have ordered Dr Patrick Walsh's book and have spoken with a family friend who had this same thing at age 49. He had a RRP 8 years ago and highly recommends it. I am really confused. Really just venting I guess.
Dobdon

it is overwhelming. it will rapidly become less so.

your numbers are really low, i think the lowest I've seen both here and over on Yana. This gives you options and time.

I believe in surgery for many reasons. You will understand and agrre or not with these in the next few weeks as you research the issue and discuss it with your urologist.

Regarding sex, I am one of those who was able to have it right out of surgery ( well, 4 weeks out of surgery ). With and without meds. Better with meds but progressively improving without also. I am not alone in this. Yana has many testimonials of guys who were able to perform after surgery. The key factor here is having a great surgeon.

I will tell you, however, that having a wife for 20 years made the process of regaining security in that area very helpful. I felt no pressure from her. One of my first posts here was to mention how hard it must be on guys who are dating. Sex initially is very mechanical and that cannot be helpful on a first date. I think you'd have to find some pretty special dates and people you can really communicate openly with about the topic becaus eit will take you minimum a few months to get comfortable with yourself and your performance.

You should also look into radiation and seeds. Not that those don't have side effects btw. I'm sure you'll get all sorts of advice here.

Finally, sounds like you have a great relationship with your urologist that includes family history. I'd only suggest to consider with going the best of the best in whatever field you select.

Wow, what low numbers. Hard to believe tha was picked up on a biopsy. 1% of 1 core? And at this time, a Gleson 5 is not considered to be PC by most standards. Don't know your whole story, nor am I your doctor, but on the surface, I would strongly suggest AS as your starting point. I would not be in a rush to do either surgery or RT methods at this time.

Good luck and keep us well posted, I think you have the lowest biopsy numbers I have seen here in 2 1/2 plus years.

David in SC

Suspect,
Welcome to the forum. 1% of 1 sample and a Gleason 5 at that. We all should be so lucky. The figures for prostate cancer incidence run roughly in line with age. Autopsies (deaths due to all causes) show that about 50% of those in their 50s have evidence of Pca. Now, obviously 50% of men do not die from Pca and that means that much prostate cancer is indolent (non-deadly) and simply sits there. The initial reaction of most men on getting the diagnosis, no matter the Gleason score (including myself) is "I am doomed, I must do something now". Nothing could be further from the truth. Try to put aside that first reaction and get to thoroughly know the disease. Then you can make an informed decision on your best course of action which could range from active surveillance (N. B. -------- this does not mean do nothing about it) to the range of treatments and their side effects.
Bill
.............................................................................................................................................

Biopsy
4 of 10 cores positive for Adenocarcinoma-------bummer!
Core 1 <5%, core 2----50%, core 3----60%, core 4----50%
Biopsy Pathologist's comment:
Gleason 4+3=7 (80% grade 4) Stage T2c
Neither extracapsular nor perineural invasion is identified
CT scan and Bone scan show no evidence of metastases
Da Vinci RP Aug 10th 2007

Post op
Positive for perineural invasion and 1 focal extension
Negative at surgical margins, negative node and negative vesicle involvement
Some 4+4=8 identified ........upgraded to Gleason 8
PSA Oct '07 <0.1 undetectable
PSA Jan '08 <0.1 undetectable
PSA April '08 <0.001 undetectable (disregarded due to lab "misreporting")
PSA August '08 <0.001 undetectable (disregarded due to lab "misreporting"-----it is not possible for any lab to get a reading of less than .003)

Post op checked by new lab:
Gleason downgraded back to original 4+3=7
Focal extension specified as being comprised of grade 3 cells
PSA September '08 <0.01 (new lab)
PSA through ‘09 Feb <0.01, May <0.01, Aug <0.01, Dec <0.01
PSA through ’10 Feb <0.01, May <0.01, Aug 0.01, Dec <0.01

www.yananow.net/Mentors/BillM2.htm

Suspect,

If your numbers are correct, do not rush into anything.

You will be doing yourself a disservice if you do not read "Invasion of the Prostate Snatchers" by R. Blum and Dr. Mark Scholz.  This is not the only book you should read, but it should be one of the first.

In my opinion(mine only), you should not choose anything other than AS at this time.  Should treatment be indicated down the road, you will suffer no adverse effects by waiting.

I would also recommend getting a second opinion on your biopsy slides.

bachez

Thank you everyone for your replies. I am feeling better about this. I am definitely not going to be rushing into anything. I will be getting a second opinion.

If anyone could help with a couple of questions I would be most grateful. Of course I will be asking my Dr these questions also.

If my biopsy slides have already had a 2nd opinion should I get a 3rd?

Why is my PSA so high (8.63) and why has it become increasingly higher each time I have it checked?

I have had symptoms for the past 3 years which include urgency, frequency and dribbling after completing urinatation, and sometimes not being able to empty my bladder fully. (my older brother had these symptoms at my same age with his BPH) I passed a flow test.  My Dr tells me my prostate is not overly enlarged. I have also had problems with ED which is very receptive to Cialis daily. Are these symptoms from PC?

Thanks,  Dobdon

Most pathologist won't even report a G5 anymore. I'm surprised that it was even reported. You may want a 2nd opinion on the slides from Bostwick labs. A g5 with 1% is about as low as you can go, As Billy Mac and others have said if you took a random saturation biopsy of all the 50 year old men 50% will have what you have.
Right now it is harmless and there are only three possible outcomes. It will never grow into anything as it is a cancer cluster and not a tumor. It will grow very slowly and you will live out the rest of your life without any clinical symptoms. It will begin to grow more rapidly and you can get treated with a very high likelyhood of cure (98%). My guess if that if you had another biopsy tommorrow you would come up clean as these small cancers are very difficult to hit again.
Please find a doctor that specializes in AS and get another biopsy within a year along with getting your psa monitored every 3 or 4 months. You can also get a color doppler ultrasound that will be used as a baseline to monior futher progresssion.
98% of the patients on this forum would exchange stats with you in a minute.
I have never heard of anyone ever dieing with a G5.

JohnT

Suspect,

I've been reading about PC for almost 1.5 years here on HW. You are the first poster that I have seen with a Gleason 5. If I had a G5 I would seriously look at
AS for the time being.

Joe

Fairwind is correct; that's why you need a follow up biopsy within a year.
JT

G5 in 1% of 1 core sounds excellent!! But there is always the possibility that there is more cancer in there that was simply not detected. If you check the signatures of people on this board you'll see several whose cancer was missed or under-staged because it was not lying in the usual places and the biopsy needles missed it. So I agree with the advice to watch your PSA quarterly and if it keeps rising quickly go for a saturation biopsy next time (20-40 needles) just to be sure it's not hiding somewhere out of sight. Unless you find more cancer no need to rush into treatment, you're a great candidate for AS at this time.

Well, I had my follow up appointment with my Urologist. I came armed with plenty of questions that I had written down. Actually most of them were answered in his initial report and review of the findings. He concurred that AS is the best route to go for now which includes PSA every 3 months. He informed me that 10 years ago that what I have wouldn't even be called cancer but with the high tech staining methods of today they detect the smallest. The 2nd opinion lab that was used was Gemzyne Genetics. I told him I was considering a 3rd opinion and he was very agreeable. Also, I told him I would be seeking a 2nd opinion and he actually encouraged it. He told me he couldn't see removing my prostate at my age with such a small Gleason.

I expressed my concern of my high PSA results and he agreed that it was of concern. I will have my PSA checked in a couple of months and if it is still high he suggests a saturation biopsy. The cancer was found in the mid left lobe and he would concentrate on that area.

My Dr has been practicing for 38 years and I have a lot of confidence in him as do other family members and friends. I have an appointment in 2 weeks with another Urologist for a 2nd opinion. This Dr does the robotic surgery.

I appreciate everyone's advice and feedback it really helped put me at ease.

Dobdon