Recently Diagnosed Prostate Cancer

Dear Pushisti:

With all due respect to your urologist, he said that the added testing suggested by JT would not change HIS (your doctor's) management of your case.  Since he has recommended surgery that is not surprising.  I suggest (again) that you speak with a medical oncologist with significant experience in PCa before you scold JT re the suggestions he gave you to try to help you. 

Tudpock (Jim)

We'll just use my name from now on - Mark!

Hear your suggestion, but respectively, we are not just cheerleaders, You asked for help, it is understood we are not doctors. You need to understand that and not pit us against your doctors. It is called tact.It is your responsibility to separate the wheat from the chaff. Add it to your knowledge base and then take responsibility for the questions you ask your doctors. When you dont, Its like saying I didn;t do it , they did. Most doctors would have reacted harsher to that . Yours graciously read the post, answered it and told you what he really thought you should do. Its your call we do what we do, and doubt if we will change nor should we. You were cool with it till the Doctor gently chastised you. Lets be real here. Know you meant no disrespect, you asked us, we answered you to the best of our ability. If you want us to just say good luck, have a nice day dont ask the question! You can't have it both ways. I have learned a lot from these guys and my own reading and research. Be honest , how much reading and research other than this forum, have you done in Your fight agains PCA. Again, no disrespect, you are a novice, we are not, but we are not doctors . It does not follow however that our advice is not worthy, if you think so...................

Hi logoslidat: I noticed your pathology; Gl 4+3 tertiary 5, and 2 cores 70%. That raises your risk of PSA rising in the future. You posted you are using standard PSA assay. Ultra sensitive PSA testing can identify a rising PSA sooner. That gives one time to compute doubling time before salvage radiation is considered. Some radiation oncologists are now saying salvage might start with PSA 0.1, and that improves long remissions.

Two recent clinical reports show 5 Alpha Reductase Inhibitors such as Proscar and Avodart increase time to progression, meaning they seem to slow the cancer. www.asco.org/ascov2/Meetings/Abstracts?&vmview=abst_detail_view&confid=104&abstractid=72231 www.europeanurology.com/article/S0302-2838%2810%2901196-6/pdf/Impact+of+5-Reductase+Inhibitors+on+Men+Followed+by+Active+Surveillance+for+Prostate+Cancer That should convince more urologists to prescribe them for early prostate cancer.

I'm pleased to post this followup.

It's been almost a year since my last post.

I had a number of very helpful consultations. I've become quite knowledgeable about prostate cancer, especially my own.

I had consultations with both a traditional radiation specialist and a proton radiation specialist, after my first urologist recommended surgery. I had many tests, including a CAT scan, bone scan, two biopsies, (12 and 14 cores respectively), a colonoscopy, and an endorectal MRI, which was recommended by the proton therapy specialist. I then spoke with a medical oncologist, Dr. C. Logothetis, who is head of the genitourinary oncology dept. at MDA. That consultation was immensely helpful. He helped me tie together all of the data and, without pushing a procedure, he helped me reach the most logical decision possible. He recommended I first meet with an MDA surgeon, and I chose to visit with MDA surgeon John Davis. A prince of a man. He was very down to earth, reinforced Dr. Logothetis' points, and then showed me the clincher: the video of my MRI. For the first time, I could see what was going on.

My prostate felt normal to every doctor who did a digital exam, and the MRI showed why.The enlargement consisted of a protrusion by the upper medial lobe into my bladder, constricting the urethra. This wasn't palpable by digital exam. Dr. Davis said this would worsen over time to the point that Flomax wouldn't help anymore. (It already was diminishing in effectiveness.) Even though I was evaluated as being at a low intermediate level of risk (Gleeson 3,4 was confirmed in both biopsies, with two positive cores each time and in the same area each time), a TUR was off the table because of the presence of the carcinoma. (All tests showed containment within the capsule.) Surgery was the only sensible way, since no assurance could be given that radiation would eliminate the prostatitis, and could exacerbate it. And it was the prostatitis that was giving me problems, not the cancer. We only found the cancer because of the prostatitis, which I've had for about 15 years, and ultimatley was the cause of my rapidly rising PSA.

I chose to have Dr. Davis do my surgery because by then all my test data was conveniently centralized on MDA computers, which any MDA doctor with whom I might consult could access at the push of a button. This seemed immensely valuable to me, especially if there were to be any unexpected findings from the surgery.

I had a radical prostatectomy on the Monday before Thanksgiving, 11/21. I went home Tuesday. On Monday morning, 11/28, the catheter came out, and that afternoon I went back to work and have been working ever since. My PSA is -0-. All the cancer was removed. I can't remember my plumbing working better, although I'm sure there was a time when it did. Dr. Davis was able to utilize a nerve-sparing procedure, leaving the nerves involved in erection intact. The old abdominal and back aches are gone. My sphincter was working the day the catheter came out. Never needed to keegle. I did use pads for a few days due to leakage right after urinating. I was Dr. Davis' 1305th DaVinci Robot case. I gladly recommend him to anyone.

And MD Anderson is a truly amazing place. You have to see it to believe it.
My best to all.

Pushisti (Mark)