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Posted 7/30/2013 2:04 AM (GMT 0)
My husband, age 57 has had jumps in his PSA for the last 8 months.  Last fall  4.0 now 6.7. Biopsy showed Gleason 8.  Waiting for bone scan & Ct Scan. His doctor wants to do Da Vinci Surgery if both scans are clear.  We find out the scan results tomorrow.  Advice? Thank you
Posted 7/30/2013 2:13 AM (GMT 0)
Hi Ibanez,

Welcome to Healing Well. It is a great place for information and support. Sorry you have to deal with a diagnosis of prostate cancer.

Take things one step at a time. Based on what the scans show you will know what options are available.

Check back in with the results and we'll go from there.

Hang in there. We are all here to help.

Jerry
Posted 7/30/2013 2:17 AM (GMT 0)
Ibanez, this place is a godsend and a wealth of information, don't rush into a decision.
Posted 7/30/2013 2:42 AM (GMT 0)
I'm very sorry that you have to be here, but you'll find this community to be very helpful as you begin to go through your next steps.

A few initial thoughts...your husband's cancer is considered high risk. That's not as bad as it sounds since it's still very treatable. But it also means that you need to really consider all treatment options and get multiple opinions. Assuming your husband's doctor is a urologist, they are surgeons by training and they often recommend surgery as a primary treatment. That's not to say surgery isn't the right option for your husband, but you need to get additional perspectives.

To that end, I recommend your first stop is a medical oncologist that specializes in prostate cancer (as opposed to working with all kinds of cancer). Depending on where you live you can get recommendations from this forum.

You'll also want to get a second reading of the biopsy slides from a lab that specializes in this. Mine were read by Dr Epstein at Johns Hopkins. Reading biopsy slides is a subjective process and you want to be as sure as you can about what you're facing.

You'll get lots of other great information here, so I'll end by telling you that you're among friends and our collective goal is to give you benefit of our experience. You can do well even with news like this. All the best and please let us help you.

Michael
Posted 7/30/2013 2:48 AM (GMT 0)
Ibanez,

Welcome to the forum. So sorry you need to be here but glad you found us.

With his diagnosis of Gleason 8 cancer your husband will want to seek treatment. If his scans are clear and his cancer appears to be well contained within the prostate then DaVinci surgery can be a good option, but it is not always the best option and it is never the only option. Before he schedules the surgery he should talk to several other doctors so he will have a range of options from which to choose. He should seek out a Medical Oncologist who sees a lot of patients with prostate cancer. Your husband's cancer is probably in the high-risk category (like mine) and for men like him and like me the best treatment option is often a combination of more than one treatment. He will probably wind up with several doctors to handle the different aspects of his treatment and a medical oncologist would be a good addition to his team of doctors.

He should also talk to a radiation oncologist. There are several radiation treatments for high risk cancer that give good disease control and often offer it with fewer side effects (on average) than surgery. Look for a radiation guy who does brachytherapy.
Posted 7/30/2013 2:50 AM (GMT 0)
Hi Ibanez-

Sorry you need to be here, but I hope we can help direct you to the information you need. Please see the links in my signature below that will help you as you begin your journey.

-Gedman
Posted 7/30/2013 2:54 AM (GMT 0)
Hello and welcome to HW PC,

Glad you found us, sorry your husband will now have to deal with cancer, and you too, of course.

I agree with what both Michael and Peter wrote above. Both their posts are full of good and useful information, and should help give you a sense of direction in your husband's PC journey.

I wish you both good luck ahead, and please keep us posted.

David
Posted 7/30/2013 2:54 AM (GMT 0)
Welcome to you and your hubby Ibanez - I'm sure you'd rather not be here but trust me you've come to a great place for experience and support.

If you could share more of the biopsy results that would help us, help you.  How many cores were taken?  How many were PCa positive, what percent involvement on the positive cores, what Gleason were each?  What is his PCa stage, what were the results on PNI (perineural invasion), as well as lymph nodes involvement (N category), and any presence of distant metastasis (M category)?  All of that stuff is important as you start heading down the path of looking into what treatment options are out there - towards making a decision.

Surgery may be the best for him, but IMHO I wouldn't rush into anything at this point. . . I'm sure you're both confused, scared, angry and a whole lot more - trust me that's all part of dealing with a diagnosis of "you have cancer."  Step back, take a few breaths, and LEARN about this beast, your hubby's specific PCa statistics, and the different treatment options available.

We're here for you - so ask away!

Best to you both.

Posted 7/30/2013 6:10 AM (GMT 0)
Hi Ibanez,

The others are bestowing very good advice to you. First, this is not the end of the world. If the scans come back clear, it IS possible for a cure to be obtained.

Also, as some of the others have noted, surgery could be a good option if the scans are clear. But you should NOT jump right into the surgery realm without first consulting a very good radiation oncologist.

Together, the two of you (always best to have 2 sets of ears to absorb all the info during doctors' consultations) can learn the pros and cons of external beam radiation, radioactive seeding AND surgery.

This is the best way to go -- and the only way to map out your comfort & confidence zones regarding treatment.

Then, once you make your decision, do not look back -- go with it and be confident that everything will work out just fine.

In the meantime, we're all here to keep offering our thoughts, experiences & comments.

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 7/30/2013 10:23 AM (GMT 0)
Ibanez, another wife here and welcome to our little corner of the world.

My husband was diagnosed a Gleason 7 and was 58 years old at diagnosis. Had Da Vinci surgery, and is doing fine since then.

Hopefully, you have or will have a copy of the biopsy pathology report which will provide a few more details other than your husband's Gleason score. Important information is how many samples (cores) were taken, and how many of those tested positive. Also important is where those positive cores were located and the percentage of cancer found in each core. If the cancer was found close to the edge of the prostate gland, there's a chance of what is called extraprostectic extension (EPE) which, simply put, means that the cancer may have broken through the prostate and has started to invade the surrounding tissue (called the prostate capsule). If your husband has surgery, he will get a definitive surgical pathology report which will detail the findings of the surgeon.

While bone scans are frequently done at diagnosis, they are often unnecessary when the PSA is under 20. CT scans are commonly done at diagnosis as well. So don't worry too much about your husband having to have these tests.

You're getting great advice from the guys here. Come back and ask any questions you want to, and know that we are here to help you and your husband get through this.
Posted 7/30/2013 11:29 AM (GMT 0)
Hello, Ibanez and welcome to HW. Sorry you have to be here but this is a great place full of good advice and support.

You have already been given excellent advice on this thread, i.e. get an expert reading of the slides, seek the advice of a medical oncologist who specializes in PCa and consult with an experienced RO as well. There are multiple treatment options for your husband and you/he should not jump to surgery or anything else without considerable thought and review of the alternatives.

Good luck.

Jim

P. S. And...check out this excellent thread for newly diagnosed folks www.healingwell.com/community/default.aspx?f=35&m=2652250
Posted 7/30/2013 12:21 PM (GMT 0)
Ibanez,  You've come to the right place and have recieved some great advice.  I would read as much as you can about the various treatments available for your husband.  Surgery is certainly an option, but there are other avenues, and, in my opinion you should look at them all.  A consult with a radiation AND a medical oncologist would certainly seem prudent.  There is a good thread on this site with reference materials for the newly diagnosed.  PLEASE read through and equip yourself with knowledge.  You are in the worst part right now, trying to figure out what to do.  Knowledge brings comfort and confidence, at least for me it did.  My email is in my profile, feel free to ask any questions you may have.  best of luck to you and your hubby!

Mike

Posted 7/30/2013 5:47 PM (GMT 0)
Ibanez,
Welcome aboard, I am also sorry you needed to find us. Coming here is a good start on this journey that you both are now on. Prostate Cancer is a very slow growing cancer. Your husband will need to take some action but you have some time to learn all your options. I had Da Vinci surgery and it was great for me. You both just need to find out if it is your best choice.
Take a deep breath, you are not alone any more. Any question you have you can ask here.
Good luck to you both!

Bill from Florida cool
Posted 7/31/2013 12:49 AM (GMT 0)

Ibanez said...
His doctor wants to do Da Vinci Surgery if both scans are clear. We find out the scan results tomorrow. Advice?


Welcome Ibanez.

First I would echo what others are saying: Take your time (one can't / shouldn't have surgery for at least 6-8 weeks after biopsy) to talk to multiple doctors and consider all the treatment options (including both robotic and open surgery, external beam radiation, and LDR and HDR brachytherapy) .

If you are inclined towards surgery, seek out the best surgeons, which may mean traveling. Of course I don't know who your husband's doctor is but, just generally speaking, it is highly likely that you can do substantially better than whoever it happened to be who diagnosed him.

As Patrick Walsh, the father of nerve-sparing prostatectomy, wrote in his book Guide To Surviving Prostate Cancer (which, btw, is HIGHLY RECOMMENDED reading for you ASAP), "Radical Prostatectomy is a tricky operation, one of the most difficult in medicine".

To improve his chance of a good outcome your husband will want to find a surgeon who is both highly-experienced (1000+ surgeries) and highly-talented as evidenced by their personal outcome statistics -- in particular positive surgical margin (PSM) rates which are the likelihood of them failing to get all the cancer out.

PSM rates for patients with cancer that has not spread beyond the prostate in the hands of a good surgeon are 6%-8% but for the same patients in the hands of the very best surgeons they are below 2%.
Posted 7/31/2013 8:54 PM (GMT 0)
I'm a new member, too, unfortunately. My surgery had been scheduled for Monday, July 29, but last week they confirmed the cancer had spread to at least one lymph node, so the surgery was canceled and I started Bicalutamide last week. Shots (probably Lupron) will start next week. In two months radiation will begin and go on for another two months. Hormone therapy may continue for several years.

At 48, my PSA was 4.2, but I didn't follow up. Who takes an umbrella when the chance of rain is less than 1%? At 50 my PSA was 21, MRI targeted biopsy with 18 cores confirmed 3 lesions with cancer, Gleason score 8. Fortunately all scans showed it wasn't in my bones. I'm being treated at NIH and part of several studies and hope to enroll in more.

I want to be optimistic, but it's difficult. I'm an Eeyore, and many of the members here are older without lymph node involvement. But I don't want to spend any time being miserable. It serves no purpose. I'd like to hear some uplifting stories.

Keith

Post Edited (ksargent) : 7/31/2013 3:02:08 PM (GMT-6)

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