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What tests are available to increase the confidence of the diagnostic (Color Doppler, S-MRI)?

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Prostate Cancer
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Posted 1/23/2012 8:01 PM (GMT 0)

55 years old still evaluating options. I had my biopsy on the 15th December (without having any symptoms at that time). There are more than four weeks since and it seems to have some discomfort from time to time in the pubic bone area, and I am unsure if it is related or not. When I contacted the biopsy doctor's office they told me to get treatment from the oncologist...

I do want to get treatment, but I need to understand the disease a little more. What type of test may give more confidence in the T1c low risk diagnostic? Many thanks.

Here is my timeline:

Goals:

0. Understand the agressiveness of the disease. 1.Cure cancer 2. Maintain continence; 3 Minimize other side effects.

Date Event Test/Results/Recs
Aug-09 Gleason: 3+3 2.8
Sep-10 Routine PSA 3.4
Oct-11 Routine PSA 4.2
11/10/2011 I requested repeat of PSA
total 3.7
free 0.8
PCA3 40.6
12/15/2011 Biopsy (J. W.)
Ultrasound estimated size 44.6 cm3
12/20/2011 total 12 core/ultrasound guided T1c : 2 positive
core 7 "Left Lat Apex": 1.2 cm tan core <5%
Gleason: 6 (3+3)
core 8 "Left Med Apex": 1.2 cm tan core 5%
Gleason: 6 (3+3)
No Perineural invasion present.
1/9/2012 Appointment with Dr. A. W. (Surgeon) Surgery, but Active Surveiance (AS) possible
1/17/2012 Appointment with Dr. M. F. (Radiologist) EBRT, hypofraction clinical trial, brachytherapy.  I am a candidate for AS.
1/18/2012 Appointment with Dr. M. M.(Surgeon) Surgery, but Active Surveiance (AS) possible
1/24/2012 Appointment with Dr. P. M (Radiologist  - Brachytherapy)
1/25/2011 Appointment with Dr. G. H. (Radiologist  - Cyberknife)
Within a week Get the biopsy slides from Henry Ford and send to Dr. Epstein.

Post Edited (NewDiag) : 1/24/2012 7:27:42 PM (GMT-7)

Posted 1/23/2012 8:18 PM (GMT 0)
I am sure that many more will chime in shortly.

One thing you didn't list was your age. That can be a big factor on how you address it at this point.

With only 2 positive cores, 5% involved and GL 6, I would think you are an ideal candidate for AS. Active is the key word here. Monitoring closely allows you to take action very quickly. You are already well ahead of the learning curve given the appts you have already had.

AS is the only approach that you can take at this point that will give you any assurance of no side effects. All forms of treatment carry with them the risk of side effects, be they great or small.

They only thing you have left out of your very thorough approach would be to have your slides read for a 2nd opinion. Bostwick is the one that is most touted here and seems to have the highest regard amongst our members.

Dr. Menon was my surgeon, is well regarded and if he says that AS is an approach for you, I would consider his words wisely.

Best of luck and welcome to the club that nobody really wants to be a member of,

Sonny
Posted 1/23/2012 8:29 PM (GMT 0)
Thank you very much, Sonny.  I updated the post.
Posted 1/23/2012 8:52 PM (GMT 0)
Your numbers look a lot like mine expect the my GS is 3+4. My urologist ruled out AS for me because of the +4 part. She said if it was 3+3 they recommend AS and I was all set to go that route. But the pathology report made it clear that I needed to so something so we decided mine needed treatment. The only treatment I ruled out was surgery because I've got heart/lung problems. I chose beam radiation because it had a high percentage to get the cancer first time (my RO quotes 80% ) and had less trauma to the body than surgery. The only concern I have about treatment is that one round of radiation might not be enough and I'll need more.

Wait for the second opinions to come in but you should research radiation options more. It might be the way to go.

Don't know personally what the SE on that is going to be but there are plenty of threads here where the guys go over that.

Andrew
Posted 1/23/2012 9:11 PM (GMT 0)
you are ceratintly approaching this correctly. I assume you are in the MI area. I have had both the MRIS and the CDU and much prefer the CDU as it is less invasive and provides much more information. Dr Fred Lee in Rochester is the best CDU doctor around; the next best would be Dr Duke Bahn in Ventura Ca. The CDU was critical in both dertermining my cancer and its extent and was the primary reason for switching my treatment from surgery to Brachy/IMRT, as it showed surgery to be a poor choice due to both nerve involvement and in the APEX. The benefit of a CDU if you choose AS is that it establishes a baseline in which any future growth of the tumor can easily be seen and will determine if you can safely continue with AS.
JT
Posted 1/23/2012 10:14 PM (GMT 0)
Thank you very much for the info, JT.  I will contact Dr. Lee.
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