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Posted 11/19/2011 3:46 PM (GMT 0)
Hello Folks

I found my way here because I just recently found out I have PC.

in July,2011 I had a PSA of 4.8 and in Oct a followup PSA of 6.5
with % free PSA at 12.8
the DRE does not feel any lumps
on Oct 31 I had a 12 core biopsy showing 5 cores positive all on the left side
70% 60% 50% 30% 20%

after the biopsy, there was a
lot of blood for about 3 days

My doctor recommends a prostatectomy as the MRI doesn't indicate the cancer is outside the prostate and my bone scan didn't show any metatesis


So, I'm going to Houston to major cancer center on Dec 5 for an appointment with a surgeon

after a crash course on PC........I have learned a lot

One thing I can't find any info on is the % cancer cells in the biopsy cores

what can be determined by the 70% core sample numbers ?

I'm 52 yrs old, in good physical condition, exercise, don't over eat and consume alchohol in moderation
Posted 11/19/2011 4:15 PM (GMT 0)
Hello, and welcome to HW.

As far as the bleeding, that's pretty normal after a biopsy, and should clear up on its own, don't be surprised if your first couple of ejaculates are discolored as well.

Did your biopsy report give you a Gleason score, i.e. Gleason 6, Gleason 7, etc? It would really help to know this.

What you don't want to do, is to be rushed into a primary treatment without checking all options, and perhaps getting a second opinion on your situation..

3 of your cores, are pretty cancerous, especially the 50% and the 70% samples.

Without knowing your Gleason score and/or preliminary staging, its hard to advise anything.

Get you a copy of Walsh's "Surviving Prostate Cancer", either from the library or from places like Amazon. It's a good one volume primer on PC and all its aspects.

Please let us know what is going on, feel free to ask loads of questions, and please, don't feel pressured by your doctor(s) to make a rapid decision. You only get one shot at a primary treatment, and you want to make sure you are doing it as educated as you can be in advance, there are no re-do buttons. You have to make a choice that is best for you, and one that you will have to live with.

Best of luck,

David in SC
Posted 11/19/2011 4:18 PM (GMT 0)
Welcome to the group that know one wants to be a part of. I too was was diagnosed with PCa. I go tomorrow (11/21/11) to discuss my biopsy with my Urologist. Good luck in your journey and remember there are lots of folks here that have already been down our road. May God bless your journey!
Posted 11/19/2011 4:20 PM (GMT 0)
Purgatory I just bought "Surviving Prostate Cancer" book by Dr. Walsh. It has a wealth of information in it. Thanks
Posted 11/19/2011 4:21 PM (GMT 0)
Welcome Florabama
In a biospy the core is obtained by "stabbing" a hollow needle into the gland and removing a sample of tissue. Now if that sample was say 10mm long, then 70% basically means that 7mm of the sample was cancerous and the other 3mm was healthy tissue. Similarily 20% would means that 2mm of 10mm of the sample was cancerous. A "clean" core (0%) means that nothing was found in any of the millimetres.
But 70% could also mean thnat two 3.5mm bits were found in a 10mm core. Or that 3,5 mm ws found in a 5mm core or that 14mm was found in a 20mm core. This is therefore a rather vague way of describing the actual quantity of tumour found.

My biopsy actually gave the results in terms of mm not in terms of percentages.

I suggest you ask the doc to explain how big the samples were in "inches", rather than just get a description in terms of percentages. Get him to draw it to scale on a piece of paper perhaps.

70% does not mean that 70% of your prostate contains cancer, or anything like that.
7 of the 12 needles hit no cancer at all, so that means that there is a large chunk of the gland that has nothing nasty in it.

Alf
Posted 11/19/2011 4:38 PM (GMT 0)
I forgot to put the Gleason in my original post

all 5 samples were 3+4 or 7

T1c
Posted 11/19/2011 5:38 PM (GMT 0)
Thanks for that, very important.. A 70% core at G-7 will be a big factor in determining your treatment recommendation..Surgery is a good place to start, but today, the seeds plus IGRT combination treatment has equally good if not better results..At least look into it.. I second the recommendation to read Walsh's book..
Posted 11/19/2011 6:35 PM (GMT 0)
with a gleason 7 and that many positive cores i don't see how the doctor can assume the cancer is still contained.  i also had a 70% core and a bunch of smaller cores (both sides all 12 positive) and my doctor said i had a 60% chance that the cancer had escaped to the prostate bed and said i was not a good candidate for surgery.  he didn't want to remove the prostate when there was a strong likelihood i would need radiation anyway.  i would definitely get at least another opinion from a radiation doc.  good luck to you.

ed

Posted 11/19/2011 6:40 PM (GMT 0)
Flora,
Not sure I would agree with Fairwinds assessment on any evidence that says that brachytherapy is better then any other therapy. But that debate goes nowhere.

I am nearly your twin when it comes to the disease. I wouldn't trust the imaging scans. The bone scan is accurate enough but the MRI cannot determine well enough whether the disease is contained or not. It didn't for me. I went the surgical rout and had positive margins and bilateral seminal vesicle invasion.

But I also just had my five year mark from diagnosis with excellent disease control. For that reason it's easy for me to be biased towards surgery especially for the intermediate and high risk cases. I was the latter. I thought it was very important to have the dissected prostate in deciding to add therapies as opposed to just adding them blindly.

No matter your choice of therapy, it will be very important to make sure you have a very experienced doctor. More so for you than for most. There should probably be a plan to treat or dissect Iliac lymph nodes as well. This is a good question to ask.

I wish you good luck in the decision process.

Tony
Posted 11/19/2011 6:41 PM (GMT 0)
BTW, my cores were 80% positive...

Tony
Posted 11/19/2011 6:46 PM (GMT 0)
cool   Here is a link to a great overall website, segment herein is on pathology explanations:  www.yananow.org/StrangePlace/forest.html#gleason 

Tidbits:  subjective analysis, only a few reknown experts or super labs deserve to be called experts in this, the rest are average or lesser. Your sample is like a thread of hair and maybe 1/4"-3/8" long (although they use metric figures) put onto typical lab slides and somehow they are split-like sliced and analyzed side by side, sealed in wax (last forever almost and can be reviewed anytime).  At 100X magnification you can actually see even if you have PNI  (i.e. hit a nerve within the biopsy you sampled), at lesser magnification you can see cell structures and various appearances and maybe get an idea yourself on how ominous or normal the cells appear.

Gleason scores combined now start at (3+3)= 6, no longer do they seem to use the prior grades 1,2 or see (2+3)=5 scores. In your case 3+4=7 is better than having 4+3=7 because the first number represents the dominate grade level found in that sample and by percentage of envolvement. Since the actual grade of individual grading is a max of 5, the 4 is the second highest grade of PCa cells. (5+5=10) is grade 5 found in two samples that they combine is the worst level you can have. I had 12 biopsies, I picked up my slides, you get 6 slides for 12 biopsies, some slides may have 4 samples or atleast two on each slide (they cut them as I mentioned).  If you are really curious about pathology to the maxium read this by Dr. Strum/Dr. Bonkhoff on pathology:

www.yananow.org/Mentors/BonkhoffStrum.pdf    (it will be over your current understanding, but this is what experts can actually decipher from your samples, of course costs extra money and not available just anywhere).

Posted 11/19/2011 6:55 PM (GMT 0)
Hey FloraBama,

Welcome to Healing Well.
If you look at my specs you'll see I was a little further down the road when I was diagnosed: 7/12 up to 70%. With a G7 and PSA of 23 it was really a gamble but I took it. I had the surgery. My PSA has been <0.01 since. Whew.

I won't lie to you, the side effects of the surgery were not the best. But at least I am on the top side of the grass/snow.

Good luck to you.
Jeff
Posted 11/19/2011 8:10 PM (GMT 0)
Hey FloraBama, sorry you found us, but you found a nice place. I was also a 3+4=7 I had 6 positive cores out of 12, 2 cores 21%, 2 cores 80%, 2 cores 100 %. I went the surgery route and at 21 months all of my psa results have been 0. That's my journey so far,but we are all different. You should look at all of your options.
Let us know how you are doing.

Neal
Posted 11/20/2011 9:44 AM (GMT 0)
Hey Flora - you did right coming here. Take on board as much as you can given your mind will be in a spin with concern, that's natural. I was at least where you are in terms of cancer involvement. My surgeon was a pioneer of daVinci robotic in our region and sold the benefits well. Subsequently I learned that he would have had less than 200 procedures of this type behind him but the cancer prognosis looks promising after 3.5 years. Where he fell down is downplaying the risk of ED, his results when I took to other guys make depressing news. However as they all say this is intricate surgery and the first objective is getting the tumour out clean if possible. Sometimes this results in losing one or both the main nerve bundles, I appear to have lost one with bruising significant to the other. A lack of accuracy a specificity in the reporting has been disappointing. Having urethral scarring raise itself a year out from surgery and ongoing is another blow.

However RARP (robotic surgery) is one of the most favoured and probably THE most favoured treatment for G7/8 tumours. These are too serious to safely invite watchful waiting with dietary dilligence, yet low enough to give hope of capsular containment and therefore no need for additional treatment forms. This is a big generalisation and reading the materials suggested I would also advise. The plus for surgery of G7 is that the pathology of the removed gland will give strong indicators of capsular containment in many cases. This was great peace of mind for me and I'm sure many others who chose this way.

I'm not sure whether the radiation options really provide dramatically improved continence and ED scenarios, so much as inverted scale where the ED gradually worsens with time out to 2+ years. I am going on what I have read and there are others here I am sure who can personally vouch for these treatments. Seek out several considered opinions and if you suspect anyone is giving an open and shut case for one over the other (I'm not) discard. There are some good options available with your diagnosis and you have some good company with your numbers of people in the "zero club". Best wishes for a complete recovery and many good years ahead of you.

Muz
Posted 11/22/2011 2:44 AM (GMT 0)
my PSA went from 3.08 in aug 2009 to 6.5 in Oct 2011

what can I learn from that ? anything ?
Posted 11/22/2011 2:56 AM (GMT 0)
that you have a very slow doubling time for G7 PC or perhaps the cancer has grown more aggressive.  now there may be other interpretations but the latter is the one that gets my attention.  i would work on getting a plan fairly quickly and putting it into action.  my numbers were similar and my urologist said we need to act quickly, and we did.  good luck.

ed

 

Posted 11/22/2011 10:49 AM (GMT 0)
I've just dug out the file to re-read my biopsy report to give the actual numbers:
-12 cores: 6 on the right and 6 on the left.
-Total length of cores on the right was 47mm and they found 2mm of tumor in one core. (ie a core 7mm long had a section 2mm long that was cancerous, and 2mm in that instance translates to about 30%)
-Total length of core on the left was 40mm and in one core they found tumor in two places with a total length of 2mm (ie another core that was 7mm long had cancer 1mm long in it twice, and that was also about 30%).
-Gleason score was 3+3.

Now that wasn't very much cancer on the face of it.
No two patients are the same, but I'm very glad I went for surgery, as the post-op pathology gave a very different picture. Firstly, most of the cancer was along the top of the gland so was missed by the biopsy. Secondly the cancer had spread backwards into the seminal vesicles and upwards into the bladder neck. And thirdly the Gleason was upgraded to 3+4. And the cancer must have been pretty active as my PSA rose from 0.1 to 0.4 within 6 months of surgery.

So I reckon patients need to check with docs about what the biopspy can tell you and what the biopsy can't tell you.

Alf

Post Edited (English Alf) : 11/23/2011 12:06:51 AM (GMT-7)

Posted 11/22/2011 3:26 PM (GMT 0)
Welcome Flora, I was where you are just 8 months ago with a PC diagnosis. I had 2 cores or 12 positive with 15% and 20% both G7 (3+4). I elected to have the robotic surgery last June and I am doing very well. I am fully continent but even with both nerves spared I am seriously ED. After my surgery the pathology for me confirmed my G7 grade but my tumor was 60% of my prostate which surprised my URO as the biopsy didn't indicate that large a tumor. Fortunately the tumor was 100% organ confined and located in the center of the prostate. I did not have any MRI or bone scans prior to surgery as my URO didn't see any reason for them at the time. I investigated both radiation and surgery options and my wife an I decided that for me surgery had the best percentages and out come for long term survivor ship.

You will learn a lot in this forum from a lot of great guys but you will be the one who has to live with your treatment decision and what ever you choose it will be the right decision.  Best of luck to you on your journey.

Terry the Water Guy

Posted 12/8/2011 3:12 AM (GMT 0)
I just returned from Houston and my RALP is set for Jan 11 , 2012

the surgeon says the left nerve cannot be spared and the lymph nodes will be removed.

and the surgeon and his PA both can feel a nodule on the left side.

my local urologist both reported a clear dre on recent exam, so I was concerned about the report of a nodule and the removal of the lymph nodes.


well, when I had my biopsy there was a lot of bleeding for several days......I mean a bunch of blood came out of my rear end......the biopsy needle may have created the nodule.

so, I have a month to prepare, doing kegle and walking everyday and drinking lots of water.

what else would you suggest ?

Post Edited (FloraBama) : 12/7/2011 8:15:56 PM (GMT-7)

Posted 12/8/2011 4:11 AM (GMT 0)
good luck on that upcoming surgery, flora.

least you can get through Christmas without dealing with it.

hope it all goes smooth for you, and soon you will be on the recovery side.

to give you some glimmer of hope on the ED side, my left side was removed, right side left intact, but damaged, and
i have never had a day of ED, so it is possible with just one set of nerves.

david in sc
Posted 12/8/2011 6:06 AM (GMT 0)
FloraBama...Love that place! good luck on your journey. Lots of great information here. Has really helped me in the learning process. Geaux Tigers!
Posted 12/8/2011 6:42 AM (GMT 0)
I'm no expert, but "nodule" sounds like it coukld indeed be scar tissue or swelling casued by biopsy. Hence the thinking that you have to wait several (6) weeks or so after a biopsy before having sugery (and also wait a while after a biopsy before having a PSA test)
My understanding from talking to surgeon etc is that there are not "two" nerves, but several nerves spread all over the surface of the prostate, maybe as many as fifteen, but they can be grouped in a couple of areas, thus removed one bundle is not necessarily a problem for the future. Someone said the nerves on the surface of the prostate can be a bit of a network and look like the white stuff on the surface of a peeled orange (the trick is thus to remove the orange without damaging too much of the white stuff!)

Good luck in January - meanwhile enjoy the holidays, though get yourself fit, so don't overeat etc
Alf
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