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Prostate Cancer
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Posted 5/30/2013 4:19 PM (GMT 0)
What else do we need to Know or ask our dr?

We know
PSA, CT Scan, Bone scan, and two opinions of stage and Gleason.
We don't know Tumour cc size
What else do we need to know now for baseline


Thank you
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Age 52 - father of 4, husband
Nov 2008 - PSA 3.75 - no symptoms & Biopsy clear
July 2008 - PSA 4.00 - no symptoms
Sept 2012 -PSA 6.40 - no symptoms except maybe tired more
April 2013 - PSA 6.94 - no symptoms
Biopsy Cancer found in cores
T2C, Gleason 4+3=7
CT and Bone clear
May 2013 Cancer Dr & new pathology
2TA Gleason 5+3=8,
- no symptoms


Treatment suggested:
HT 1yr, 23 days of EBRT, then LDB seeds ( radiactive for 6 mths) with a recovery 6 mths after that.
Projected by Jan 2015
Cancer-free, 66% recovery of ED & Ur with no bowel issues
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Posted 5/30/2013 5:07 PM (GMT 0)
Hi,

The new pathology's Gleason score indicates a very aggressive form of PC, especially since the dominant cell type is of Gleason grade 5. At the other end of the spectrum, his PSA is not horribly high, which "might" suggest that it could still be confined to the prostate and that a cure is possible.

What kind of doctor is involved? I'm wondering since you mentioned a cancer doctor. Was it a urologist who performed the biopsy?

One question I have is whether the doctors have also mentioned surgery as a treatment option? You should probably investigate this possibility by talking with a highly experienced urologist who is also a surgeon.

If the cancer is still organ confined, an "instant" cure might be possible through an open or robotic prostatectomy instead of almost two years of treatment and recovery.

Perhaps there is a reason why surgery is not recommended. But, if you ARE a candidate for surgery, learning about it would be to your benefit.

Learn the pros and cons of ALL possible forms of treatment and then you can make your final decision based on what makes you feel most comfortable and confident.

Good luck!!
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.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 5/30/2013 8:00 PM (GMT 0)
Welcome.
I assume you will be getting care from the Canadian Health system.
You should know how many cores had cancer and what per cent of cancer was in each core.
You should obtain a copy of the pathology report from the biopsy.
You should know the prostate size.
(Many patients encounter more side effects than they expect.)
Good luck with the decision and your future health.
Posted 5/30/2013 8:10 PM (GMT 0)
location of the tumor. Important if it is the apex or at the margin.
Posted 5/31/2013 12:08 AM (GMT 0)
location of tumor(s), number of cores positive, percentage of cancer in each core, perineural invlovment, any extracapsular extensions? Size of prostate?

I had all of this info from the biopsy/path report, except the coup de grace, as seen on the color doppler ultra sound, showing extracapsular extensions.

Tumors in the apex and base or margins, greater chance escape of the mutant cells. An analogy given as I stared at the tendrils, the prostate is not like an orange with a thick protective peel, but similar to a peeled orange, not that hard for escape, anyway, I have a similar treatment plan, it's a long haul
Posted 5/31/2013 3:01 AM (GMT 0)
Thank you - this is fantasic information and thank you for the straight up info.

HighlanderCF -
Thank you for your frankness! Biopsy taken by urologist radiologist. Read by local hospital first GS 4+3=7, and then re-read by cancer clinic pathologist GS 5+3=8.
Our Radiologist Onogoloist started off with discussing an open or robotic prostatectomy but said that even though the scans are all clear, that due to the primary GS has some 4 & 5's in it, they have to assume their could be cancer is surrounding tissues. That even if we did the prostatectomy they would more than likely have to do ERBT anyway. That HT, ERBT & LDB would have better SE for ED etc... plus a better chance to get any tiny cancers cells not visable yet.
We are a young family so cure is #1 but also wish for good ED results


robertC
Yes, it is with the Canadian Health system.
I will ask for this info and i will have records later this week. To-day I did find out the primary tumour is 28cc. Some feedback said that is normal some said middle of the road from normal to enlarged. He is no symptons at all.

Thank you to John and Roy for explaining about tumor location - great help

Thank you for the frankness - trying to understand it all while trying to make a decision and deal with emotions and family is a lot. This is helping us move along at a good pace.

My next question I want to ask is " how aggressive? how concerned should we be?? but a though one to ask.
We have the pre-injections HT tablets to start asap but waiting a week for some time together. Is it aggressive enough that we are crazy to be even delaying a week etc..... When Dr says it is aggressive and we go aggressive treatment... it comes across as he will be fine once treated. It dosen't really say how much of a fight we are in or his odds etc.
Not sure I am making myself clear

Thanks everyone - fantasic info
Posted 5/31/2013 5:14 AM (GMT 0)
Hi canuk77,

It would be great if the first biopsy report (Gleason 4+3) turns out to be more accurate than the second one at 5+3. A Gleason grade of 4 is aggressive, but not nearly as aggressive as a 5.

Without being certain which might be more accurate (I would imagine the second one is), I would not waste much time getting started with whatever treatment he decides on.

You are wise for looking into all available forms of treatment. As a layman, and a (hopefully former!) patient, I often lean toward surgery because removal of the prostate "could" eliminate all of the cancer all at once. If there are any remaining cancer cells, salvage radiation could follow up on it to hopefully finish off any remaining cancer cells -- if they are still confined to the general area of the prostate bed.

Even if cancer is found in the tissue customarily removed with the prostate (extraprostatic soft tissue, seminal vesicles, etc), the surgery can still possibly give a cure. And younger patients generally recover more fully (in terms of ED) than older guys.

You should, if possible, consult with both radiation oncologists AND urologist/surgeons to get their opinions and learn the pros and cons of ALL available forms of treatment.

I'm not sure (others here can tell you), but I think that there can be ED problems even with radiation. So you should ask about that.

Naturally, you should try to do this in the immediate future so that whatever treatment is ultimately chosen can be started.

Sure am wishing you the very best!
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.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Posted 5/31/2013 11:42 PM (GMT 0)
Talked with RO On to-day armed with all your suggestions for questions. I have updated stats now and records are in the mail too. Feels like we are moving forward now

Thanks everyone
Awesome support
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