Hey Guys, another newbie

My husband is 72 and has been healthy.

In the spring he had his first PSA after difficulty urinating and a bumpy prostate on exam.

His PSA in April was 25.61.

He had 12-15 biopsy punches and they were all normal.

His PSA in 7.69 in September after being prescribed finasteride. And up to 9 right before the MRI five weeks ago,

He had the MRI, with gadolinium and an endorectal coil, done and there was a tumor visualized.

From the MRI report: "There is a 1.5 x 0.6 x 1.5 cm T2 hypointense nodule in the
right mid gland and apex. There is bulging of the right prostatic contour with apparent nodular
foci, likely representing extracapsular extension that abuts the neurovascular bundle. There is associated increased perfusion and restricted diffusion. The seminal vesicles are unremarkable.

PROSTATE VOLUME : (6.6 x 3.2 x 4.6 )/2 = 48 cubic cm

BLADDER: Normal.
RECTUM: Unremarkable.
LYMPH NODES: No pelvic lymphadenopathy.

IMPRESSION:
1.5 cm mass in the peripheral zone of the right mid gland and apex
with likely extracapsular extension, which abuts the right
neurovascular bundle."

I missed the last urology appointment because I was recovering from knee surgery. They scheduled a high tech biopsy, I think with MRI guidance. Not sure how that works, but a younger urologist is doing this test.

Husband is a physician and is being treated at a big ivy covered teaching hospital in the North East. We trust the pathologists and physicians.

We've been happy together for thirty nine years. I'm not sleeping at night and worried sick about him. He was OK until he read the MRI report, he's not happy that the presumed cancer seems to have grown out of the capsule. He's still working in a specialty that allows for a lot of sitting around. His first impulse was that he'd have to retire. I support whatever he wants to do, but he's a bit of a workaholic, and is always busy.

So what next, Guys? I realize that Gleason scores and treatment plans are coming. I want that sucker outta there, but I've read that surgery isn't "done" after age 70. And any treatment plan is his choice.

He needs time to recover from either surgery or radiation. I'd also like to know what to expect if we get a bad Gleason as well as growth out of the prostate and possible mets. And what kind of life, or not, are we are facing?

Second biopsy is this coming Friday.

As far as experts in the area, we've got that one. This is one of the top hospitals in the country, our internist put us in touch with great docs.

If we needed to go to Hopkins, we're OK with that, too. My husband went to medical school there somewhere when dinosaurs roamed the earth.

I'm very impressed with Pratoman's advice and have little to add. Just deal with it as it comes. Anticipating buys you nothing but stress.

Please post again when you get the new biopsy results.

Jane, welcome from another newbie wife. Take a deep breath, this is always a huge shock and sometimes being in the medical field makes it more difficult. When you are able to read the reports and understand them from the start you always see the worst case scenario. I am an NP and still remember the day my nurse nonchalantly handed me my husbands bone scan report right as I walked out of a patients room. I immediately threw up, but then had to continue seeing patients for the rest of the day.
He will feel calmer when he has a diagnosis and a definite treatment plan. That's how we roll. You too will feel better when there is a plan all depends on the outcome of the biopsy and testing. He is lucky to have you for 39 years and you will have many more to come. We are hitting 34 years next week. We still are on shaking ground but trying to move forward with our lives. Hang in there, and know you can come here for support.
Dawn

(LOL@"bigger thumbs". Perhaps Sissy Hankshaw (Even Cowgirls Get the Blues) became a surgeon)

Jane, lol at worry, I'm telling you I have you beat. I've calmed considerably since I got here, but that could change at the drop of a hat,

I think you hit the nail on the head. Uncertainty is one f the worst aspects of this disease, or I am sure, any Cancer for that matter.
Tests up the wazoo , interminable waits , days seem like years. Something I'll never get used to, and I imagine most people here just learn to live with.

So as you know, it may be hard, but you and your husband are not alone.

Sounds like the procedure went well.

Good news.

Good to have lots of stuff going on - best to be able to focus on something other than waiting for test results.

Keep us updated,
Andrew

The urologist who did the test called my husband on Christmas morning with results. He was in an airport on the way to a family vaca with a child pulling on his leg. Great guy.

Gleason score 3-3, 7 positives out of 15 guided biopsy punches. Three were doubles, I assume, for research purposes.

We will talk to our regular urologist soon, and hopefully sit before the committee for a treatment plan or watchful waiting which I would not like.

While so sorry to hear positive confirmation that you husband has cancer, the fact that it is all G6 makes it very treatable. In fact, pretty much any treatment should work.

Good luck to the two of you going forward and let us know how we can help.

While doing my biopsy, both the younger doctor (primary doing it) and the veteran uro he called in said they saw nothing abnormal about my prostate. Both even said the size (small) was good. I've had nothing but compliments on DRE's, as well..... 😉

The R.O. said they did see the abnormality on the MRI with the stuff injected into my veins to seek out the cancer.

Michael T, thanks for your suggestions, I really do appreciate them.

I've asked my husband if he'd be interested in sending his slides to Hopkins, and he is not. As I said, he went to medical school at Hopkins. He's being treated at a Harvard teaching hospital, where he also trained, and was on staff. The pathologists there are pretty good.

Docs get prostate cancer, too!

My feeling after talking to our internist yesterday is, that even if the pathologists are off by a little in the Gleason scoring, it's not going to change the treatment plan much. The big concern is the initial PSA. I also remembered that months ago when we spoke to the original urologist about the high PSA, we agreed that even if it were elevated from an infection, it would not change the value too too much. It is still a concern.

It's interesting, I read all the books, and forum postings, about prostate cancer. My husband reads the journal peer review papers. They put me to sleep.

It sounds like a good decision to me. I found my radiation treatments not that difficult to put up with. The primary side effect for most guys is fatigue. In my case it mostly showed up in the evening when I sat down with my wife to watch our favorite who-done-it TV shows. I was lucky to see the crime, much less stay awake for the big reveal at the end. My wife would usually have to wake me up after the show to tell me who the culprit was and how he was caught.

The side effects of the hormones are more bothersome. Men tend to have hot flashes, and lose muscle mass, bone density and mental focus. Vigorous exercise helps with most of this.

sounds like a reasonable plan. The RT is more of an endurance test but he'll get through it. Some of us had fatigue towards the end but not all get that. Walking seems to be the best for that one.

I worked through almost all of my RT treatment. Towards the end I took a few days off, but that was about it. Only a few people at my office knew that was having daily treatments.

Hang in there,
Andrew