HealingWell
Search Close Search
☰

Newly diagnosed w Prostate Cancer

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 4/10/2014 2:50 PM (GMT 0)
60 yr white one positive core Gleason 3+4= 7 PSA 16 (2 negative biopsies over the last 4 years w rising PSA). Had CT and bone scan yesterday don't have results yet. I live in Houston TX so I have access to virtually every treatment option. I want to consider all of my options. Thanks for any help
Posted 4/10/2014 2:55 PM (GMT 0)
in case you have not already done this, start here:

www.healingwell.com/community/default.aspx?f=35&m=2652250

Sounds like you know about various treatment options availability already and that's half the battle.

Good luck and let us know how the scans come out.

LupronJim
Posted 4/10/2014 3:29 PM (GMT 0)
Dennis,

Welcome to the forum. Sorry you find yourself here but glad you found us.

Do you know the percentage of your positive core that was involved with the cancer? One of the things you will find in the thread that Jim recommended is the best labs to send your biopsy samples to for a second opinion. This is always a good idea but particularly if you have a single, low-volume positive core. That doesn't give the pathologist a lot of cancerous tissue to look at and a second set of expert eyes is particularly helpful.
Posted 4/10/2014 3:58 PM (GMT 0)
Dennis,
Your one core of G7 does not explain your psa of 16. The biopsy report should indicate the size of your prostate in cc. Multiply that by .066 and you get the psa that is generated by benign prostate tissue. Subtracting this from total psa gives you the psa generated by the cancer. For example if your prostate is large at 40cc your benign psa is 2.6 and the cancer generated psa is 13.4; this does not correlate to a small G7 cancer. You must identify the source of all psa is order to get an accurate assessment of your status before even choosing a treatment option. This is the basic of staging PC, which most doctors don't do very well.
Based on your psa I would conclude that you either have an infection present, or a much higher volume of cancer than is indicated by your biopsy, most likely in the transition zone or anterior. It could also indicate systemic disease in the lymph nodes.
In your case I would recommend a multi parametric MRI before you go any further.
JohnT
Posted 4/10/2014 4:35 PM (GMT 0)
I didnt see a total size on the report so I added the individual sections volume and came up with 17.4. Multiplied by .066 gives 1.148 so you are saying the psa generated by the cancer is actually around 15? I havent heard of the parametric MRI.
Posted 4/10/2014 4:59 PM (GMT 0)
Hi Dennis and welcome to Healing Well. Sorry you have to be here but I'm sure you will find lots of support and advice here. Here is a quick link to a simple summary of the multi parametric MRI.

www.jenkinsclinic.org/procedures/multiparametric-mri/

This is a fairly new procedure and not offered everywhere but many doctors with expertise in prostate cancer now feel this test is essential to proper staging and treatment of our disease.

Re the PSA calculation you did - your math is right but the 17.4 volume for your prostate would be quite small. Your report should absolutely indicate the total prostate size; if not, you should be able to get that info from your physician. In any case, the point is that you have a lot of "unexplained" PSA that needs to be tracked down.

BTW, I know that when you arrive at a forum such as this you don't know Adam from Eve re who knows what they are talking about. You are fortunate enough to have gotten some great insight on your thread from JohnT who, while not a physician, has studied our disease for many years and I consider him highly qualified to give you pointers about where to go in your journey for answers.

Best of luck as you proceed,

Jim
Posted 4/10/2014 8:12 PM (GMT 0)
JohnT,

Sometimes, a small amount of G6 may generate a lot of PSA.

In my case, my PSA was 9.51 before a TURP. The PSA after the TURP was 1.0. The prostate volume resected added up to 25 gms, leaving a 18 gm prostate, almost all peripheral zone.

One study calculated that the PSA leakage factor for the Transition Zone is 0.14 compared to 0.052 for peripheral zone.

Doing the calculations in my case, 18gm of peripheral zone times 0.052 accounts for almost all of the 1.0 PSA left. 25gm of TZ times 0.14 accounts for 3.5 PSA. This leaves a PSA of 5.0 to account for the cancer. However, the biopsy in my case accounted for cancer in 7 out 245 chips, and this was "small focus" according to Epstein in his second opinion. Consequently, it appears that at most only 1% to 2% of the 25gms resected was cancerous, which is about 0.25 to 0.5 gms. That is a very small amount of cancer volume, all G6, to be associated with a PSA of 5.0.

It should be noted that these calculations of cancer density is based on a biopsy which dealt with the entire amount of prostate resected, and not on a 12 core needle biopsy which samples only 1/1000 of the prostate.

Let me know if my calculations above are incorrect.
Posted 4/10/2014 10:24 PM (GMT 0)
Hi dennis,

Sorry you are here, but glad you found us. Lots of good info and support to be had from the folks here.

I strongly suggest you check the links in my signature for folks newly diagnosed.

-Gedman
Posted 4/10/2014 10:36 PM (GMT 0)
If you can get an appointment with Christopher Logothetis at MD Andersen, you would probably get some very good advice. He is an oncologist, so he would not be the doc to do your primary treatment. But he is one of the smartest prostate cancer guys in the world, and right in your backyard. (Of course, there are some great surgeons and radiation oncologists at Andersen too, but for an unbiased expert opinion, Logothetis would be a good choice, if he will see you). Best wishes, Medved
Posted 4/10/2014 10:40 PM (GMT 0)
dennis, sorry you needed to join our little club, but glad you found us.

you have already been given a lot of good information, hope it helps you.

there are a lot of gleason 7 guys here's, including myself.

sometimes they act benign, which is a good with, and others will act very aggressive, like in my case, gleason 7's can be very unpredictable.

good thing, all primary treatment choices should be open to you, take your time, study well

david
Posted 4/11/2014 12:06 AM (GMT 0)
Turp,
When biopsy volume does not correlate to a high psa, the first place one should look is in the transition zone, which is very hard to biopsy. If I had to guess, Dennis has a TZ tumor that the biopsy missed. Only a MRI or CDU targeted biopsy can confirm this.
Posted 4/11/2014 3:34 AM (GMT 0)
Welcome to the forum Dennis, sorry you need to be here; you found a great place for information. These folks are amazing!
Posted 4/11/2014 3:34 AM (GMT 0)
John T,

I agree with you. However, when I tell people in the same situation to search the TZ, most of the time they continue to go with the doctor's advice and protocol, and ignore my advice.

Now, with the advances with CDU and mp-MRIs, I hope the diagnosis of cancer in such cases will not take quite so long. Fortunately, PCa, in most cases, grows slowly enough so that it didn't kill us before the doctors found it. In our cases, we both went more than ten years with the anxiety of the PSA progressing, without being able to deal with the underlying cancer.
Posted 4/11/2014 8:46 PM (GMT 0)
Cancer was found in left lateral apex RT and LT were also biopsied. What is the normal size of the prostate? I looked back on the 2 previous and couldn't find a volume on either
Posted 4/11/2014 9:08 PM (GMT 0)
"A normal, healthy prostate gland is a walnut-sized organ that weighs approximately 15 grams in young men and around 30 grams (about an ounce) in men age 50 or older. "

prostatesnatchers.blogspot.com/2012/01/prostate-size-matters.html

Jim
Posted 4/17/2014 10:37 PM (GMT 0)
Saw my Uro today bone and CT essentially neg he wants me to get an MRI to be sure. Robotic Surgery probably not feasible due to previous abd surgery so "old school" surgery which sounds completely unpleasant. Will talk with Rad Onco soon and MD Anderson for Proton therapy and Cyberknife therapy. Stage is T1C. Or do nothing.
Posted 4/17/2014 11:12 PM (GMT 0)
Welcome aboard Healing Well Dennis!
You came to the right place at the right time. Living in Houston is a definite advantage, you have some of the best facilities at your disposal.
I am originally from Dallas myself.

Take your time deciding on a treatment plan, sounds like you will have all options open to you to beat this thing.

Bill from Florida cool
Posted 4/29/2014 7:53 PM (GMT 0)
Went for consult today at St Luke's here in Houston. Met with Dr Steven Carpenter over the Cyberknife treatment center. Super nice and knowledgeable about all aspects of P CA. I need to get an MRI of the spine to r/o mets. If that comes back neg then I am a candidate for either CK or IMRT. I am also going to see another Uro who has good recommendations and who does cryo. Carpenter reommended Dr Brian Miles at Methodist if I decide to pursue surgery. He has done over 1900 Robotic RP.

_________________________________________________________________________________________
✚ New Topic ✚ Reply