Still trying to decide treament

All,

I posted back on Aug 12, 2013 when I was diagnosed with prostate cancer. I'm 58 years old a little overweight but in otherwise good condition. Had a older brother who had prostate cancer when he was 49. He had it removed 10 years ago and is doing fine. My PSA has been anywhere from 3.3 in 2009 to 4.6 in 2010 to 4.2 in 2012. A biopsy was done in 2010 and was ok. This year PSA  went from 4.0 in Jan. to 8.29 in July. Biopsy then done and showed 1 of 12 cores malignant with 20% cancer of one core involved. Gleason score of 3+3=6 T1C. Small rough spot felt on DRE. No change of rough spot in 4 years. No urinary problems at all. I'm torn between treatment & A.O. I've almost talked myself into A.O. with trigger to do something if PSA goes over 10 or another biopsy or DRE down the road show something. I've talked to my family doc and only one urologist. Family doc seems to think I'm safe in this decision. Urologist is leaning more to treatment sooner than later. I am planning on talking to another Urologist & radiation people at Huntsman Cancer Institute in Salt Lake City, Ut. on Jan 3,2014. I would like to to take a few more months ...Jan...Feb... to make a decision. I've read so much stuff my head is spinning. Am I crazy or taking a big risk by waiting this long?

Any comments would be appreciated.

Thanks!

Steve Hall

Your docs will advise you.

If I were in your shoes I'd only be concerned about that doubling PSA in 6 months (if I read correctly). I'd probably make my decision on treatment or AS quickly and then proceed with either properly.

One thing is for sure, you seem to have all and any options available to you. Both a blessing and curse of course because ultimately you need to make that decision.

Did you get a second reading on the slides?

If I had your stats I would choose AS, but that's just me. I'm not sure if everyone is suited for that.

However, I do have three suggestions while you're deciding: 1) take your time. Time is on your side and you should use it. I do NOT think you are crazy by waiting until January.

2) Get a second read on your biopsy slides from either Bostwick or Epstein. Perhaps your numbers are slightly different and that could point you one way or the other.

3) Consider talking to an oncologist that doesn't have a vested interest in either surgery (like a urologist) or radiation (like an RO). Ideally, find one that works specifically with prostate cancer or is familiar with AS.

Steve, you're not crazy at all. But would re-emphasize the advice to get another reading on your biopsy slides (e.g. from Epstein or Bostwick), take your time, try a round of antibiotics to see what happens and...if you choose AS....find a doc who is experienced with AS patients and remember that the key word is "active".

Best of luck,

Jim

Welcome back Steve.
I also don't understand why you didn't take a round of antibiotics to see if it is something else.
Relax and take some time to research and find out what is causing the jump in your PSA.

Bill from Florida

Good for you, Hallsb...AS (AO) is the one choice that has 0 side effects. It was my first choice as well.

Steve,

The PSA would be my main concern (because biopsies often miss significant tumors) but if you do AS the PSA will be followed every few months anyway. You could also try antibiotics and then re-check it. Make sure you abstain from sex, bike riding, etc. prior to the PSA. If it goes up significantly again I'd want another biopsy - perhaps a saturation biopsy.

Also you could get an endorectal MRI, which would give you another data point.

In any event, an expert 2nd opinion on the biopsy is highly advisable.

hallsb1 said...
All,

I posted back on Aug 12, 2013 when I was diagnosed with prostate cancer. I'm 58 years old a little overweight but in otherwise good condition. Had a older brother who had prostate cancer when he was 49. He had it removed 10 years ago and is doing fine. My PSA has been anywhere from 3.3 in 2009 to 4.6 in 2010 to 4.2 in 2012. A biopsy was done in 2010 and was ok. This year PSA went from 4.0 in Jan. to 8.29 in July. Biopsy then done and showed 1 of 12 cores malignant with 20% cancer of one core involved. Gleason score of 3+3=6 T1C. Small rough spot felt on DRE. No change of rough spot in 4 years. No urinary problems at all. I'm torn between treatment & A.O. I've almost talked myself into A.O. with trigger to do something if PSA goes over 10 or another biopsy or DRE down the road show something. I've talked to my family doc and only one urologist. Family doc seems to think I'm safe in this decision. Urologist is leaning more to treatment sooner than later. I am planning on talking to another Urologist & radiation people at Huntsman Cancer Institute in Salt Lake City, Ut. on Jan 3,2014. I would like to to take a few more months ...Jan...Feb... to make a decision. I've read so much stuff my head is spinning. Am I crazy or taking a big risk by waiting this long?

Any comments would be appreciated.

Thanks!

Steve Hall

Hi Steve,

As others have noted, a biopsy is just an educated guess on the true nature of things inside the prostate. A standard 12-core biopsy only samples about 1/1,000 of the prostate, so it is easy for other tumors to be missed.

I usually am not all that thrilled about just watching and hoping that nothing bad happens. PC research has not yet developed a test that can show who truly is safe for AS and who is not a good candidate.

So, the best advice I can give you is to consider having another PSA test in the near future. Then follow it up with a saturation biopsy (usually 30-40 cores) to give yourself the best chance of knowing you only have the one G6 spot to worry about.

I would recommend this also because your most recent PSA is rather high. This could be caused by a prostate infection. But, if not, this means it has doubled in just a few months.

Try for that new PSA test & saturation biopsy and then consider AS if nothing else is shown.

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.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
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, 9/9/13 PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.