Additional Diagnosis Information

If the biopsy is correct , it means you probably have an indolent case of prostate cancer along with a whole bunch of other 55 year old men who are actually luckier than you , cause they they don't know it. Reminds me what my grandmother once said. " if you look hard enough for a negative, you will probably find it…. " " I paints what I see" Gahan Wilson.

It's tough when a doctor you trust tells you he recommends surgery.

I started trusting my doctor after the BIG consultation and he recommended against surgery. surgeons believe in cutting. in your case I would be looking at BT and AS but AS would never work for me so really just BT

you're going to be alright whatever you do...

ed

GeetarMan said:
"That's why I'm getting a 2nd and maybe 3rd opinion. Major surgery just seems ridiculous at this point. I have read quite a bit about over treatment of this disease. It's tough when a doctor you trust tells you he recommends surgery.

Ugh. Thanks logo. You are right, it would be better if I didn't know."

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Which brings to mind this gem:

"Yet ah! why should they know their fate?
Since sorrow never comes too late,
And happiness too swiftly flies.
Thought would destroy their paradise.
No more; where ignorance is bliss,
'Tis folly to be wise."

PhilC

Hi,

Glad to see you are going to visit with Dr Tollefson. You will be very impressed by him.

Your case does look very favorable in terms of your outlook.

You can see what Dr Tollefson has to say. I would also seek to consult with a radiation oncologist while you're there and you'll have a much more complete picture of both sides of treatment options -- unless they all concur that AS is all that you need at this time.

When is your appointment?

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.
Firm erections now briefly happening in early mornings, 2 years post-op.

Thanks all. My appointment is Thursday AM.

Honestly I feel a little sheepish even being here with what appears to be a "mild case" after reading all of the heartbreak stories.

But, I also see that sometimes what seems like a mild case turns into something worse. So we shall see.

I'll report back after my consult on Thursday.

I suppose no matter what, what I am posting may be helpful to others that follow.

Peace.

Before you make a final decision, make sure you get a second opinion on the biopsy from a highly respected prostate pathologist like Epstein at Johns Hopkins. I would also advise you get your prostate imaged with a multi-parametric 3T MRI to be more certain that there is not more significant cancer lurking in the prostate. Also useful is a PCA3 urine test. If it is below 25, the chances of a higher Gleason score tumor are  lower.

Finally, if these precautionary steps still leave you with a low volume Gleason 6, then Active Surveillance is definitely worth using. As you can see from my numbers below, I did all of the above, and these steps gave me the confidence to use AS instead of more aggressive treatment.

By the way, the first surgeon I consulted strongly recommended surgery. When I went to a second urologist, he agreed with the first. When I continued to resist this advice my family accused me of "shopping around" for an opinion that would agree with what I wanted.

 

turpT1a said...
Before you make a final decision, make sure you get a second opinion on the biopsy from a highly respected prostate pathologist like Epstein at Johns Hopkins. I would also advise you get your prostate imaged with a multi-parametric 3T MRI to be more certain that there is not more significant cancer lurking in the prostate. Also useful is a PCA3 urine test. If it is below 25, the chances of a higher Gleason score tumor are lower.
Finally, if these precautionary steps still leave you with a low volume Gleason 6, then Active Surveillance is definitely worth using. As you can see from my numbers below, I did all of the above, and these steps gave me the confidence to use AS instead of more aggressive treatment.

By the way, the first surgeon I consulted strongly recommended surgery. When I went to a second urologist, he agreed with the first. When I continued to resist this advice my family accused me of "shopping around" for an opinion that would agree with what I wanted.

If his situation at Mayo is like mine was, he will automatically have a second opinion from the Mayo pathology lab. When I went there for my second opinion, they would not give me an appointment in urology until I provided them with the original slides from my biopsy.

I think this was because Mayo will probably not offer an opinion based on some other lab's "eyes and ears" and would want to examine the slides for themselves.

So hopefully he will be providing Mayo with his original slides so they can make their own clinical analysis.

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 painlessly removed morning after surgery.
Catheter painlessly out in 7 days. No incontinence, occasional minor dripping. 100% continent after 3 weeks.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Brief, firm erections on occasion, still hoping for more improvement.

Post Edited (HighlanderCFH) : 3/4/2014 10:15:16 PM (GMT-7)

ditto on the sheepish. Sheep have a bad rap, they happily give of themselves, all they have, and are as cute as a bugs ear, whilst doing, exactly that….

F8 said...
It's tough when a doctor you trust tells you he recommends surgery.

I started trusting my doctor after the BIG consultation and he recommended against surgery. surgeons believe in cutting. in your case I would be looking at BT and AS but AS would never work for me so really just BT

you're going to be alright whatever you do...

ed

My DH has the same experience as you. His URO did not recommend surgery. He recommended AS or BT. Like you my hubby couldn't do AS and went with BT.