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Posted 6/22/2012 2:32 AM (GMT 0)
Results of a biopsy revealed 6 out of 12 core samples showed cancer cells, Gleason of 4+3 and PSA of 9.4. He is freaking out and I'm not too relaxed about it either. We have a conference call with his doctor tomorrow and he has a CT next Wednesday. What can I tell him to make him feel better? We've done some research and realize this isn't a death sentence. But the big C is disturbing. Any responses would be appreciated.
Posted 6/22/2012 2:43 AM (GMT 0)
Sounds very close to my results, and I'm still here just under three years later. I'm told I don't look any worse for the wear, but the pads give me away.

Welcome to Healing Well. I'm not sure much will help calm him, but I did mentally use my inconclusive CT & bone scan to convince myself that I did not have "Dead Before mm/yy" tattoed on my forehead.

Nothing to be relaxed about, as a 4+3 is not innocuous, but at the same time give your evaluation of possible treatments a careful consideration.

And feel free to ask questions and just vent when you need to.

Posted 6/22/2012 2:45 AM (GMT 0)
Both of you take a deep breath and get through your call tomorrow. Then let us know what else you know. You've come to the right place. I'm fairly new here myself, but not new to prostate cancer. There are people here, including many wives, who have dealt with what you're going through in all it's many forms--not the least of which is shock and fear.

For what it's worth, I was Gleason 7 (3 + 4), PSA of over 9, and 7 of 10 core samples positive when I was diagnosed and first treated in 2002. Here I am 10 years later doing ok.
Posted 6/22/2012 2:57 AM (GMT 0)
Lucy's mom,

First let me welcome you to HW, the place you want to be for information, support, compassion and friendship. I'm sorry you have to join our world of Pca.
The big C is disturbing but, as you will see on this forum, it is manageable and becomes part of living. It's a journey, a real roller coaster ride with some ups and downs. Don't freak out, there are so many options available today. I would suggest taking one day at a time, gathering as much information as you can, so you will be able to make the best decision possible.
I'm sure you will hear from lots of members who have gone through what you are experiencing right now. The initial shock of having Pca is difficult but you will get past this quickly. Take a deep breath for now.
As for making him feel better, you may want to tell him that there is life after a Pca diagnosis. Life can still be good.
Zimac
Posted 6/22/2012 3:40 AM (GMT 0)
Welcome to HealingWell. You landed in a good place. There are lots of very knowledgeable and compassionate people here, and this is a great resource for information and commiseration.

I'm sorry to hear about your man's diagnosis, but you both should understand that this is far from a death sentence. He'll have to deal with this in one way or another, and it will be a journey for you both. However, you'll soon be hearing from the Gleason 8 and 9 guys who will tell you how well they're doing and how optimistic they are.

Hang in there and please stay in touch. Some more information may help people offer more specific advice. Age, percentage of cores positive, and general health are all indicators of how you might deal with this. He probably has several treatment options available to him. Best of luck with this, and hang on for a long ride.

Jonathan
Posted 6/22/2012 4:22 AM (GMT 0)
Lucy's Mom, welcome.
I promise you that once you (and your husband) have collected enough information and made a treatment decision, you will be in a much more peaceful place. I echo what the others have said on here - this is weighty stuff, but you will get through it and normal life will return. The likelihood is very high that your hubby will be around for a good long time. Probably the best resource is a book by Patrick Walsh, "Guide to Surviving Prostate Cancer". Get it and read through the relevant sections.

You're not alone - we are here to help.
Jeff
Posted 6/22/2012 6:02 AM (GMT 0)
Welcome to the club that hates to get new members. This is a good place to be for compassion and information.

Most of us vividly remember the day we were told we have PCa. It is one of the hardest days. It gets easier as you get used to the news, learn new information and start taking control of your destiny.

While you husband's stats are potentially serious, there are a number of us here with similar or worse stats who are doing just fine years later.

Don't panic, learn all you can, seek multiple opinions and come here to share.

Best of luck,

Greg B.
Posted 6/22/2012 1:06 PM (GMT 0)
Lucy's Mom,

I hear you when you say your husband is "freaking out" - I did as well.

I was diagnosed at the very end of an otherwise very positive routine physical by my family doctor - my psa, taken the week before was in the normal range (2.9) and I had no symptoms at all - none. Nevertheless I went from that moment to an RP in three weeks as I had an extra-capsular growth.

Almost three years later, I continue, now onto to HT (starting next month) and, yes it has been life changing on some levels and on others not at all. Get a medical support team in place - and one that you are both comfortable with; be a strong self-advocate and stay as positive as possible.

I am new to the HW Forum yet already I have found great support, excellent information and true inspiration here that has given me renewed energy and focus. Even as I "live' with this reality, there have been many blessings along the way...

_____
Age 62, dx @ 60, PSA 2.9 ; dre 11/09 post-prostatectomy path: ext. extra growth 60% tumor b/lobes; perinural + l seminal vesicle - lympho-vascular invasion; Stage t3b Gleason 7 (4 +3) tertiary pattern 5; Lymph nodes:14 right obturator; 9 left pelvic clear; 10/11 adjuvant radiation 8 weeks; 5/12 psa doubling @ 6 mos. - ct scan 1 lymph gland involved; enlarged adrenal gland; 6/12 psa 1.5; 7/12 start HT
Posted 6/22/2012 1:45 PM (GMT 0)
Lucy's Mom,

You have already been welcomed, all the advice I can think of has been given.

My HUGS and best thoughts to you and your Dad.

Bud
Posted 6/22/2012 1:49 PM (GMT 0)
yes, freakout is the first emotion after getting that call.

The good news is you've got plenty of treatment options and every chance of doing just fine. Don't let the 'c' word get to you too much. We all know people that have had very bad things happen to them after hearing that word but times are changing.

Start learning about PC and your treatment options. It is disturbing and your life will change but you will still have life.

and what can you say? How about: We can get through this, we have options.

Let us know the results of the CT and what his doctors say. Also don't rush into a treatment - you've got plenty of time to make a good informed choice. Get second opinions.

We're here if you have other questions.
Posted 6/22/2012 3:53 PM (GMT 0)
Welcome.

When I first found out I had cancer and got the news was my lowest point in this journey. It's a shock hearing that you have cancer.

Take a breath, take your time and educate yourself. As suggested by IM get the book Patrick Walsh, "Guide to Surviving Prostate Cancer". Find the best urologist and radiologist you can find with tons of experience. Get at least two opinions from each type and explore ALL your options. Do NOT rush into anything. You have time. Ask any questions you want to on this forum.

You and your husband are going to be okay. A year after my treatment, my life is as it was before.

You can read what I went through by clicking on the link in my signature.
Posted 6/22/2012 4:31 PM (GMT 0)
Hi,

I'm sorry to hear that your husband has joined the PCa club. I hope the knowledge you gain helps you to understand that things are not nearly so dire as you might fear.

You have received plenty of great advice. I can really only add one further suggestion. It is not uncommon for biopsies to be incorrect. The biopsy only samples a tiny bit of the prostate, and is usually unable to sample some areas. Also not all pathologists are experts in prostate cancer, making their readings less accurate. Perhaps 30% of the time this results in a Gleason score that is too high or, more often, too low. It happened to me (G7 -> G9) and to many others on this forum.

The Gleason score is fundamental to proper treatment planning, particularly if you are considering options other than surgery. For surgery, it is important, but the operation will be followed up by a pathology report that looks at the whole prostate, so you will know your Gleason score for certain at some point. Even with surgery, some decisions such as nerve sparing and lymph-node removal, can also turn on the Gleason score. For this and other options, it would be advisable to have an expert review your biopsy slides. This is simply done by requesting that your doctor send the slides to one of the expert labs, such as Bostwick Labs, or to Epstein at Johns Hopkins.

As you're reading more about the disease, see if what I say doesn't make some sense.

I wish you and your husband the best.
Nellie
Posted 6/22/2012 5:01 PM (GMT 0)
Lucy's Mom,
Welcome to Healing Well. You and your husband are now a member of a very special caring and supporting group. We have all been in the same place you are in now. We know how much fear and anxiety you are dealing with. Take a deep breath and get educated about PC. The more you know the less fear you will have. Ask your doctor a lot of questions about your treatment options and get second opinions. Consult with an oncologist. Your husband has several treatment options and you have time to think and evaluate. Good luck.
Posted 6/22/2012 5:34 PM (GMT 0)
Gleason scores can go in all directions ... as you can see from my signature, I started with an 8, second opinion at Johns Hopkins raised it to a 9, and post RALP pathology rated it a 7. I sometimes wonder if I should get a second opnion on the post RALP rating, but I think I'll wait to get my post Op PSA reading ... if that's a zero, who cares about the Gleason?
Posted 6/25/2012 2:41 AM (GMT 0)
Thanks everyone for your words of encouragement. We'll know more, of course, after the CT on Wednesday this week. My husband is leaning toward radiation. . .so we'd be interested to hear from anyone who opted for that treatment.

Thanks so much.
Posted 6/25/2012 3:11 AM (GMT 0)
Lucy's Mom,
Sorry you have to be here, but the prognosis is very good. I had a combo seeds/external radiation with a G4+3 and a psa of 40 and at three years no sign of cancer and no side effects. Radiation, especial the seed/IMRT combo with a short course (6 months) of hormone therapy has proven very effective for both cancer control and limited side effects. What your husband has is very cureable.
JohnT
Posted 6/25/2012 6:31 PM (GMT 0)
Lucy's mom,

There is much to be encouraged about for both of you right now! My husband (G7, 3 +4, PSA 6.7), had 45 sessions of IMRT. It barely affected his daily routine and he never missed more than 30 minutes of work. He's had few side effects and we are hopeful the cancer is behind him now.

Brachy or brachy plus IMRT are good options today, and you can learn a lot about the procedures by reading past posts on this forum. Most of the guys here have done well as far as side effects from radiation as a primary treatment, but some of the guys undergoing radiation as a secondary treatment have had more issues. Deciding on treatment is a big deal, and most men are relieved just to have made the decision and gotten that part over with!

Best to your husband....

Juliet
Posted 6/25/2012 7:14 PM (GMT 0)
We're concerned if he goes the radiation route, he won't be able to have surgery should the cancer reappear later. Any thoughts on that?

We may be premature in trying to think this through before the Ct scan to see if it's contained in the prostate.
Posted 6/25/2012 11:40 PM (GMT 0)
I don't think you're premature. It took us a bit of time and a LOT of reading before we felt we had gathered enough information. One thing you will learn is that every man's cancer is different. Also that every man has his own unique set of circumstances, preferences and lifestyle concerns. So I hesitate to give much advice because it really just depends on so many different factors!!

But since you asked, surgery after a failed primary radiation treatment is not a good option. Fortunately, there are other good options, especially HDR brachytherapy. Why don't you start a new thread with your question in the subject line? You might get more responses. We have some posters here who were very helpful to us when we were in the decision-making stage.

Bottom line for us, on the question of what to do after failed radiation....we felt confident enough of the likelihood of a cure that it pretty much wasn't an important factor into our decision-making. We felt less comfortable about his chances for a surgical cure without adjuvant therapy. But that is us. Your comfort level may vary.

Good luck!

Juliet
Posted 6/26/2012 1:27 PM (GMT 0)
My view on the can't do surgery after radiation:

1) The "cure" rate is about the same for both when used as the primary treatment, but there are less SE for HDR or LDR seeds..

2) If Surgery or radiation fails there are good options for both. Obviously, none of them as good as getting it the first time around.

Be sure to write down all the questions that pop into your head and get them answered by the surgeon and radiologist that you see (and write down the answers too...you might think you'll remember everything, but you won't. Start a journal NOW and you'll have everything in one place).

You can read what I went through by clicking on the link in my signature.

Good luck to you.
Posted 6/26/2012 5:19 PM (GMT 0)
Lucy's Mom,

Any salvage treatment, either with surgery or radiation, are dependent on weather the disease is local or systemic. If systemic, outside the prostate gland and bed, no salvage treatments will work.

Primary treatments fail mostly because the disease is systemic.

In surgery local failures are caused by prostate tissue left behind after surgery or small positive margins that have leaked into the prostate bed. Radiation should take care of these as a primary treatment as radiation treats up to 15mm of the prostate bed and the entire gland.

Radiation local failure happen when too low a dose if given or in the rare case that the cancer cells are resistant to the isotope used. Normal external radiation is given in a dose of 81 greys which should kill most cancers; in the older radiation 65 greys were given and local faiures were more common. Combination brachy/IMRT is given in doses from 130 to 150 gy which is more than sufficient to kill almost all but the most agressive cancers. It also has two different isotopes in the event that one may be resistant.

For local radiation faiures reseeding with a different isotope, HDR Brachy and cryosurgery are the most common salvage treatments.

JohnT

Posted 6/26/2012 6:10 PM (GMT 0)
Dear Lucy's Mom:

First of all welcome to HW.  There are lots of caring folks who post here with some very good advice and support.

What can you tell him to make him feel better?  A:  With his stats and a prediliction for radiation, there is a very good chance that seeds + IMRT will provide both a cure and leave him with minimal side effects.  No guarantees of course but that should be comforting. 

Jim

Posted 6/26/2012 7:16 PM (GMT 0)
Welcome to a great place. Sorry you need to be here but keep the faith and stay with us.

My wife and I have dealt with this for about a year and we are greatful now for so much in our

lives not the least being so many new ,good ,knowledgable friends on this forum . Please keep

us informed of you progress. We are here for ourselves and for each other.

Jim and Marie

Posted 6/26/2012 7:46 PM (GMT 0)
Lucy's Mom,

Lots of great advice found here and lots of caring support. I went with PBT (Proton Beam radiation therapy) at MDAnderson in Houston, TX and could not have been happier with my decision. I'm waiting on my first post therapy PSA tests, but I found the treatments easily tolerable and the side effects to this point have been minimal. I strongly would recommend that you investigate this facility and therapy before rushing into any decisions, especially surgery.
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