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Prostate Cancer which has spread to pelvic lymph node

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Posted 1/29/2013 1:09 PM (GMT 0)
Hi,

My husband was diagnosed with cancer just after Chrismas, he had a needle biopsy the day after Christmas, (not the best Christmas ever).  His psa was 48.6 and the gleason 7 (not sure of the numbers). Told by Consultant that radiotherapy wouldnt really help him and he went straight on to hormone therapy.  We are both absolutely shattered by this news, we have been married 7 years and are sooo happy.  Between us we have 5 children and eight grandchildren.  He so upset that he wont get to see his grandchildren grow up.  I cannot think of anything else all day long. I dont know where to turn.

Posted 1/29/2013 1:37 PM (GMT 0)
Also everything I read gives conflicting information. I am researching diet things to avoid etc. Also I wish we lived in the States so he could see Snuffy Myers as he seems to be one of the best. I am positive in front of him but when im not all I seem to do is trawl the internet looking for hope. I found this forum during one of these many research sessions.
Posted 1/29/2013 1:37 PM (GMT 0)
Oh Dabby...how terrible that you and your family have to go through this. But, take heart: we've all been where you are now.

I too am a wife...my husband was diagnosed almost 5 years ago and is doing fine. A bit more information about your husband's diagnosis might help us to help you. You mention a PSA of 48.6...while that's high, there are some here who had much higher. When a sample is taken from biopsy, there are generally two Gleason numbers assigned to each sample (ranging from 1 to 5). The higher the number, the more serious the disease. You can have just about any combination of Gleason numbers comprising the actual (final) Gleason score. With a Gleason score of 7, the numbers can be Gleason 3+4 or Gleason 4+3. The difference is that the second combination is more high risk than the first. It's a bit confusing, I know, but knowing whether your husband's biopsy showed 4+3 or 3+4 can help alot.

Another key piece from the biopsy is a percentage of cancerous cells found in each sample, as well as the actual number of samples taken. In the U.S., biopsies generally consist of 10 or more samples taken. If 2 out of 10 are positive for cancer, that's generally better news than if 8 out of 10 were positive. Since a biopsy is kind of a hit or miss thing, it's hard to know the extent of the disease. This can only be determined through examination of a surgically-removed prostate, but it sounds like the consultant is not recommending surgery and feels that radiation wouldn't help your husband (which seems kind of odd).

If possible, ask the consultant for an actual copy of the biopsy report. This will provide valuable information about the extent of your husband's disease.

You will likely have a lot of questions and that's good...ask away and don't be afraid to question the doctor as well. Please do come back and let us know how things are going. You and your husband are still reeling from the news but, again, take heart for we have all been where you are now. Things will hopefully look better as you learn more about your husband's situation.
Posted 1/29/2013 1:38 PM (GMT 0)
Also everything I read gives conflicting information. I am researching diet things to avoid etc. Also I wish we lived in the States so he could see Snuffy Myers as he seems to be one of the best. I am positive in front of him but when im not all I seem to do is trawl the internet looking for hope. I found this forum during one of these many research sessions.
Posted 1/29/2013 1:39 PM (GMT 0)
This is news no one wants to get, but it also doesn't mean that your husband won't be around to see the grandchildren grow up.

Your post raises a lot of questions, though, and I hope you'll post more information. How old is your husband? How many cores were positive? Who is this "consultant," and have they discussed surgery or radiation options? I'm not understanding how a needle biopsy can lead to the decision to begin hormone therapy, but maybe I'm missing something.

Try to keep a positive attitude. There are many ways to keep prostate cancer at bay. You may want to seek a second or third opinion before committing to a course of treatment.
Posted 1/29/2013 1:43 PM (GMT 0)
Thanks Sephie, I appreciate your advice, we are due to see another Consultant in about a week for a second opinion. Will let you know more then. This is surreal, I cant remember what it felt like not to think of this every second and its only been a month. Best wishes to you and your husband
Posted 1/29/2013 1:46 PM (GMT 0)
Dabby, there is alot of conflicting information out there, especially about Gleason 7s. I can tell you from personal experience that spending too much time reading everything you can about prostate cancer will make you nuts (I drove myself crazy in the early days of my husband's diagnosis).

There is alot of hope so don't give up. Where exactly do you live (somehow I think in the U.K. based on your phraseology?). Changes in diet and lifestyle can help but, again, there is alot of conflicting information even here in the States. Whatever choices you make in lifestyle changes should make sense to you and your husband and beware of any claims about curing prostate cancer with vitamin supplements or special diets.

While your medical consultant has said that radiation won't help your husband, was there any discussion about surgery or does he feel that this treatment wouldn't do much good either? If he's only recommending HT, there must be a reason why since HT doesn't cure prostate cancer but can provide long-term benefits.
Posted 1/29/2013 1:49 PM (GMT 0)
My husband had surgery on his ankle in early December, at the pre-op they found blood in his urine which they advised him about and he went to GP to get a PSA check. After the biopsy he also had a bone scan and a MRI scan which showed no spread to the bones but did show a spread to pelvic lymph node. Because the cancer had spread the Consultant (Oncologist) said that he was recommending hormone therapy straight away. There was a team of specialist who met and they have not recommending radiotherapy as well. Im not sure if figures were 3+4 or 4+3 but I will be asking when we go to see another specialist for a second opinion in a week or so.
Posted 1/29/2013 1:49 PM (GMT 0)
Dabby, thank you and I know exactly what you mean. In the 7 weeks from biopsy to surgery, there wasn't a morning I didn't wake up and think "my husband has cancer." It was awful but once we had a plan of action in place and once we sat down with the doctor and discussed treatment options, things looked up and I felt better.

I'm glad you're getting a second opinion...good for you! Right now, it all seems so overwhelming but you're strong (I can tell from your posts) and you will get through this as will your dear husband.
Posted 1/29/2013 1:49 PM (GMT 0)
Oh and he is 55 years old
Posted 1/29/2013 1:51 PM (GMT 0)
Dabby, just saw your post about the spread to lymph nodes...that explains the need for HT. Hopefully the consultant you're seeing next week will give you more information and reason for hope for the future.
Posted 1/29/2013 1:53 PM (GMT 0)
Too many men being diagnosed at an early age. We've got a few guys here who were younger at diagnosis (one was only 44 and was diagnosed with advanced PCa and is doing fine.) My husband was 57 at diagnosis, and there are many who were/are in their early to mid 50s. Hopefully you'll hear from a few of them soon as they have alot to offer in the way of information and hope.
Posted 1/29/2013 2:02 PM (GMT 0)
Dabby, my apologies for missing the mention of lymph node spread in the title of your thread...that's what happens when you do things too quickly!
Posted 1/29/2013 2:08 PM (GMT 0)
Thats ok Sephie your posts have already started to make me feel a little more sane. I have spent some time reading posts on this forum and they do give me hope and make me feel like we are not the only ones going through this.
Posted 1/29/2013 2:37 PM (GMT 0)
Dabby, I'm glad that you're feeling more sane. You are definitely not the only ones going through this but when it's happening to you, it's the loneliest feeling in the world! As I said before, we will help you both get through this intact...right now is the most frustrating and scariest time because there is so much you want to know. It'll come...in a few months, you'll know more about PCa and HT than you thought possible! After 5 years of this, I can sit down with my husband's urologist and talk like I actually know what I'm talking about. Once he even asked me "how do you know this stuff?" Simple answer: I belong to the prostate cancer forum at Healing Well!
Posted 1/29/2013 2:54 PM (GMT 0)
Dabby,
You are most definitely not the only ones going through this and glad you found us!
A very heartfelt hug coming your way, as Sephie says, we have all been where you and your husband are right now. Take a deep breath; things are going to be OK. Honestly it does get easier from here, the period right after diagnosis and before treatment plan is hell but stay positive and believe it will all be OK.
Are you in the UK Dabby? If so, when your husband was given his diagnosis he should have been given access to someone at MacMillan – please contact him/her. Seriously, even if your hubby doesn’t feel he wants/needs to do this you will find it so beneficial. The counsellor will have access to his medical notes and can sit you both down and explain everything to you and talk through what will happen next and what options are open to you. Also, for you, to have someone you can talk through all your fears with can only help.
Please stay around and let us know how the second consultation goes next week.
Stay strong and make sure you take extra good care of yourself at the moment – don’t let your own health suffer.
Thinking of you both and sending you very positive vibes.
Susan
xxx
Posted 1/29/2013 3:25 PM (GMT 0)
Dabby,

Welcome to the forum. I am sorry you need to be here but you've found a good place.

When the scans show that the cancer has spread to the lymph nodes hormone therapy is usually the first thing the doctors will want to do. It stops the cancer from growing (usually knocks it back a bit) and gives the patient and his doctors time to look at their options. That is good because while hormone therapy is the first thing they will do, it is seldom the only thing they will do with a patient as young as your husband.

I didn't quite understand what you said about the team's recommendations on radiation.

you said...
There was a team of specialist who met and they have not recommending radiotherapy as well.

It sounds like they didn't recommend radiation. Did they say why?

Try not to be too scared. Prostate cancer is seldom a death sentence. It's more like being required to take up an unwelcome new hobby.
Posted 1/29/2013 4:16 PM (GMT 0)
Dabby,

As another caring spouse of a G7 with lymph involvement, I want to welcome you one of the best, most caring and knowledgeable groups on the web.
We've been where you're at....not a moment when you're not thinking about PCa. The guys and gals here have helped us so much.

Many more will chime in with their knowledge, books to read, hormone therapy side effects, other treatment options. They cheer you on when the PSA goes down (which is one of the good effects of HT!)
It may take a few months but the constant fear will subside.
Take care and stick around!

Marie(mswampuscat)
Posted 1/29/2013 4:24 PM (GMT 0)
I cant tell you how glad I am to have found this place. I must admit Im almost scared to ask about the correct figures that got the gleason 7 im scared it will be the worst one, but I realise that we need to know. I am extremely worried about how long the hormone therapy will work (if it works) and then what. One thing I have gathered from all the lovely people on this forum is that a sense of humour works wonders. I cant wait to get mine back!!
Posted 1/29/2013 8:13 PM (GMT 0)
My heart goes out to you both. I know how numb I and my wife were upon diagnoses of my cancer. I dont think I will ever absorb all the medical info available nor really understand doctor speak. What I find most comforting here in these forums is the concern we have for each other and, for people like me, the slow spoon feeding of knowledge offered here. It does take time to learn though.

There are those here who would offer Spiritual advice if your so inclined. I have drawn on scripture and prayer for the most of my needs and fears. Nothing like the comfort that brings.

So welcome to this forum. Im sure it will help stabilize you both emotionally.
Posted 1/29/2013 11:22 PM (GMT 0)
Dabby, just a little something to ease some of your worry about your husband's Gleason 7. Remember, that there are 3 more Gleason scores after this: 8, 9 and 10. And even a higher Gleason score does not a death sentence make.

Hopefully after the meeting with the consultant next week, you will have more information and will come back and share what you can with us. Til then, stay strong and take deep breaths...
Posted 1/30/2013 5:39 AM (GMT 0)
Dabby, the hormone treatment will work,the question is for how long. It is not a death sentence in the sense that you think. i.e.. , automatically and necessarily. Having said that your husband is not without control in this, I f he has a weight problem , lose it. If he doesn't not take part in a regular exercise program, Just do it. If his diet sucks, change it. If he has a sullen attitude, change it. None of these things can be done overnight. But these are the way he can change outcomes and take a proactive part in this trial your experiencing. Its not good, but its a way lot better than you think now , in all probability. good luck.
Posted 1/30/2013 6:08 AM (GMT 0)
Dabby sorry your family is going through this. It's tough. Hopefully the next appointment will provide some answers.
Posted 1/30/2013 8:09 AM (GMT 0)
Hi there,

Having a Gleason 7, as one of the others pointed out, is not as bad as having an 8, 9 or 10. A Gleason 7 is just one step removed from the lower aggressive Gleason 6. Especially if it turns out to be a 3+4 instead of a 4+3. In either case, it means that some of the cancer cells are only mildly aggressive (the 3's). If it turns out to be a 3+4, many of these cases are practically like a Gleason 6.

If they can control that one positive lymph node, and it has not spread anywhere else (Gleason 6 rarely goes to distant parts of the body and you have every reason to hope the same for a 3+4 or 4+3), there might very well be a chance to cure him.

Have they said anything about surgery and/or radiation somewhere down the road if they are able to control that one lymph node?

In any case, with today's treatments, I'll bet that he WILL be around to see your grandchildren grow up. Tell him to keep a positive attitude and to plan on attending their weddings many years from now.

Take care,
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-erections now happening 14 months post-op & slowly getting a bit stronger.
Posted 1/30/2013 9:01 AM (GMT 0)
Dabby,

My husband's PSA was in the same range as your husband's. He also had positive lymph nodes and metastasis to his bladder. His Gleason was a 4+3. We were also told there were no other options available except hormone therapy.

Now, for the great new... The hormone therapy resolved a couple of the lymph nodes within 6 months and also reduced the tumor load. Enough so, that be became a candidate for surgery or radiation. He chose radiation, as we knew surgery was going to leave positive margins and he would need radiation afterwards. Also, surgery was going to require the removal of his bladder.

Just because your husband has no other option at the moment, doesn't mean that hormone therapy won't open some other doors down the road.

After a year and a half of dealing with this beast, we are currently celebrating a PSA of .02!

I also spent every waking moment researching everything that I could about prostate cancer. It might have driven me a bit nutty, but I don't regret those hours of gaining knowledge that would be needed for the fight.

Best of wishes with hormone therapy and may it open many other doors down the road.
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