It matured or third scan found it

In October I applied to join the UCLA Active Surveillance program with Dr Marks. I was feeling kind of relieved because three months earlier in July Dr Bahn took an 8 core biopsy that was completely negative including from my left anterior peripheral and transition G6 tumor that he could see using CDUS. The small G6 had been dxed in March with a mri-guided biopsy. My PSA had come down from 24.3 in August (not long after the Bahn biopsy) to 19.9 following one course of Bactrim and one course of Levoquin. In addition, my Prolaris score came in at -0.5 and my PCA3 was 5 -- both low risk for aggressive cancer. So I was feeling relatively chipper.

To get started in the UCLA AS, protocol is to have a baseline mpMRI and a fusion biopsy particularly surrounding the dxed tumor area. These were conducted in mid/late December. The new MRI highlighted the left anterior tumor now estimated at 13 mm. The biopsy was more painful than my past three combined, and I nearly passed out from cramping afterwards. Five of twelve cores were taken around the tumor, and two of the five came back at 4+3 with 75% involvement and 60% G4. No PNI present. Possible capsular involvement due to abutment anteriorly.

I'm waiting for a second opinion on the biopsy from Epstein, and last week had bone and ct scans at UCLA. To add to the stress, after the bone scan the radiologist asked if I have pain in my cervical spine. I said nothing extraordinary, but she had me do more scans regardless. She wasn't available after the scans so I'm stewing in my stress until a followup consultation with Dr Marks this Friday to discuss options for treatment.

Right now, I'm leaning towards SBRT with ADT to hit this hard. The high PSA has bothered me all along, and makes me concerned about micromets in the prostate. The high PSA is causing me to pretty well rule out focal laser ablation even recognizing that it might very well treat one tumor.

After my review with Dr Marks at UCLA I may head for a second consultation with Dr Turner at POS in Marina del Rey before deciding on treatment. While unsure how this will play out, I feel confident I'm working with top doctors.

Jim, I would say that even though it was only for a few months, AS worked as designed for you. Things were found that needed to be found, and in what appears to be in a timely manner. The next steps are hard, and we're here to watch your back as you start down the path.

Jim, sorry to hear that AS didn't last very long for you. But the good news, as others have noted, is you are on top of it. Keeping fingers tightly crossed for a good outcome, whichever way this goes.

Jim,
I'm sorry to hear that. I thought you were going to be one of the lucky ones. As you know your case is very similar to my journey.
Mine ended well as I know tht your's will. There is a very good chance of a total cure.
JT

I'm also sorry that AS didn't last longer, but as has been pointed out, it did ferret out the bad players in your prostate. All of the doctor's you are talking about are excellent. I agree with Allen's comment that the docs at Prostate Oncology Specialists don't know the specifics about radiation specialities that the ROs do. That said, I found my initial consult with Dr Lam to be extremely valuable in providing overall perspective--nothing to do in lieu of the ROs, but I think it can be complementary to the RO info. (With the possible drawback that you'll be spending all of your time meeting with docs and you'd probably like to be actually doing something now.)

Good luck to you!

Hi all, thanks for the words of encouragement. I'm disappointed at how short my surveillance chapter turned out to be, of course. With my high psa, I felt like it was just a matter of time until a significant problem was found. I was hoping for maybe a three year delay, and that a good immunological treatment option would be available by then. I recall my original urologist saying, a year ago, that oh you've got it significantly, it just hasn't been found yet.

My big kick-off consultation with Dr Marks is this Friday to review the Epstein second opinion, and look at my ct and bone scans. I'm already planning to follow up with two of the UCLA experts in radiation treatments for SBRT and HDR brachy, which I am pretty sure will be among the recommended options for me. Also, I'll see if seeds + IMRT may be high on the recommended treatment list. If so, then I'm not sure who I'd contact to discuss. I saw two surgeons last Spring, and removal is not completely off the table but it's a low preference right now.

I don't know how to evaluate the tumor abutting the capsule and how that affects treatment options, so that's what the experts will need to advise me.

Finally, even if there is no escape identified, I thought I'll probably meet later on with Drs Turner or Lam again (saw them in May) to get a second opinion on benefits of ADT in my case.

Thanks again all, I can feel the warmth and concern. I hope others on this site know I feel the same for them.

Jim

Post Edited (JimBear) : 1/17/2016 9:55:56 PM (GMT-7)

Allen

Thanks for the personal observations and suggestions for my consults. It helps me be better prepared, and less nervous.

My twins both graduated from UCLA, so maybe I'm getting some additional payback now, although this is not how I envisioned my return on their tuition.

Also, only in LA, during my last UCLA office visit Phil Jackson came in. His visit was short so hopefully it was a good news checkup. No time to ask him what he thought of the Lakers' or Knicks' chances this season.

Jim

Post Edited (JimBear) : 1/17/2016 8:26:10 PM (GMT-7)

Jim,

Your post confirms my own worries. All my testing and data thereof, says there's something somewhere in the prostate that's bad (=>G7). I hate that you have landed so quick on the other side. Thank God you found the demon that was hiding in the shadows. Now, its time to take some action to put this to rest again.

As the member's say, so many options with very good results are available. Because of your post, I will need to follow-up at my next PSA/Doctor visit and ask about the CDUS scan. You are the second post that has use this scanning method to find the hidden cancer. Thank you for sharing, good luck in your decision.
______________________________________________________________________________
OCTOBER 2015
Age: 59
PSA: 3.0 elevated to 3.5 in (6) months
3T-MRI: (1) lesion identified
Fusion Biopsy Results: Lesion cores benign, additional (12) cores = (1) positive, cancer <5%
Pathology Summary: Grade 1 (GS6:3+3), 2nd pathology verification
Clinical Stage: T1c

Genetic DNA Profile: Above average risk for Aggressive PC (deCode Genetics)
Existing Cancer DNA Profile: DNA risk unknown (Oncotype DX test cannot be performed, <1mm)
High Grade Biological Score: 27% aggressive risk (Mi-Prostate Score)
Other Health Conditions: Diabetes Type II (DX 2000), on meds & insulin

PC Treatment: "Active Surveillance"
Risk: Undetected Cancer Progression
Risk Likelihood: LOW

My Story: https://www.healingwell.com/community/default.aspx?f=35&m=3528051

Post Edited (NewDay) : 1/18/2016 6:04:01 AM (GMT-7)