TURP FOUND CANCER

I am new here and this is my first post. Just recently, on June 1st, I had TURP procedure for my urinary problems caused by BPH. Urologist sent removed prostate chips to pathologist. On my post op visit with my urologist on June 9th I was told that pathology report came back positive for prostate cancer. One of the prostate chips was Gleason 6 with 5% ADENOCARCINOMA OF PROSTATE. My prostate was fairly small around 40 gr and urologist removed 8 gr from transitional zone and bladder neck. He said transitional zone is very unusual place to find PCa. I am scheduled for office visit for 9/13 and after that will be scheduled for prostate biopsy.
I am wondering if anyone here was surprised and shocked with something like this. Still very shaken and this will be for me 3 longest months.
I appreciate any responds .
By the way, I am 51 year old.

Hi MK. Welcome to the forums, and sorry you had reason to join.
Pretty sure that most, if not all of us, were shocked at our Dx.
Your best of the bad news so far is that its Gleason 6.
Gleason 6 is very manageable on active surveillance.
Let's hope your biopsy holds no other surprises.

Can I suggest you have a read of the top thread on the forum to get yourself partially educated and up to speed on the important aspects of PCa terms and values so the members can help out as best they can.

Stay calm, it will all work out.

Thank you all for encouraging posts.
My PSA history:
6/2013 -0.98
7/2014 -1.85
10/2014 - 1.3
6/2015 - 1.01
11/2015 - 0.7 (started Finesteride in July thru November, stopped for breast enlargement. Tamsulosin increased to twice daily)
DRE normal
3/4/2016 AUR started self CIC until TURP.

Halbert,
I am wondering what prompted you to treat your cancer? Wasn't yours also G6. You are saying that mine is perfect for AS and I am considerably younger than you. I am not saying I want to get treatment for mine but your post is confusing to me.
I know I have to wait for biopsy to get more info because what I got it was incidental finding.
Thanks for your post.

MK, if you want the whole story, click on the link in my signature, to see a long thread about my journey. Note that my post-surgical pathology came in at G7, bilateral, totally about 20% of the gland.

Ultimately, I chose to treat for several reasons, including the following in no particular order:

1. I come from a long line of men who have dealt with PC and prostate issues. My dad died of spinal cancer directly related to his PC.
2. The opinion of both my diagnosing Uro and the surgeon who did the RALP both held the opinion that I would not be one of the long term AS prospects. The exact statement was, "You could do AS if you want, and a year from now we'll be having the same conversation". My post-surgical pathology certainly suggests that a follow up biopsy could easily have come back with 6/12 positive cores all at G7--which would have thrown me out of AS at that point.
3. At the time, I was reasonably fit and healthy, and felt that I was likely to breeze through the surgery with minimal issues--which proved to be true as well.

I realize 2 and 3 above are retrospective. And yet, I treated because ultimately I felt no assurance that AS was going to be a long term deal for me.

You're right: at your age, there is a double-edged razor blade you're sitting on. With a diagnosis at 52, with prostate issues already going on, you may well need aggressive treatment in your future. Once you get a standard biopsy, you'll know a LOT more. And yet, if you can wait it out, 5 or 10 years from now who can say what treatments will be standard? Maybe something we are just hearing about experiments with will be mainstream then. On the other hand, if you treat now--which I would not do based only on what you know today--you stand a non-trivial chance of having miserable side effects for the next 30 years.

Slow down, take a deep breath. You've got time to get information and make a rational decision. You don't have to decide today what you're going to do.

MK1965,

As you can see from my handle (turpt1a), my situation with regard to the prostate cancer diagnosis was very similar to yours. In my case, it was actually worse: I first received a pathology score of a Gleason 7. This led to my scheduling a date for surgery, after my urologist stated that Gleason 7 has a way of misbehaving.

I changed my mind on the surgery after the first PSA that came after I healed from the TURP. After a previous PSA score of 9.6, that PSA after the turp dropped to 1.0. This did not discourage the surgeon I had contacted from insisting on going forward with the surgery. I resisted this and did two things that I would encourage you to do:

1. get a second opinion on the pathology to make sure that the Gleason score is still 6. (In my case, I was going to proceed with AS even if the Gleason score remained a 7) I sent my original biopsy samples to Jonathan Epstein at Johns Hopkins. I specifically asked that Dr. Epstein do the pathology himself. I also had the opportunity to speak with Dr. Epstein who recommended that I "just watch it."

2. have a multi-parameter 3T MRI done to make sure that more significant cancer is not found by the MRI. The accuracy of the mp-MRI has led to a Negative predictive value of over 90%. In my case I have done 3 annual MRIs since my diagnosis in 2012. All have not found any evidence of cancer.

In addition to the annual MRI, I also have checked the PSA, first every 3 months, then lately every 6 months to make sure the PSA doesn't start to increase too quickly. Like you, I still have a big chunk of my prostate still in me, which continues to produce PSA. As long as my PSA density remains low (in my case, it is below 0.06, which is very close to what a healthy prostate's density is), I intend to continue to take Dr. Epstein's advice to "just watch it."

By the way, in my case, I had 3 negative biopsies over a period of ten years which sampled the peripheral zone. Consequently, I have relied only on the annual MRI and the semi-annual PSA to keep track of any potential prostate cancer; I have decided to only rely on MRI targeted biopsies, if the MRI showed any possible cancer. So far, I did not need to have a targeted biopsy done, and I have avoided undergoing random 12 core biopsies since my last one in 2009.

It's been 4 years since my cancer was diagnosed, and so far so good. I am satisfied that I chose AS as my response to the cancer, but I continue to be vigilant.

MK1965

I had my follow up PSA taken nearly two months after the TURP: the TURP was done on April 4 while the follow up was carried out on May 29.

MK1965,

The urologist who found my incidental cancer recommended that I undergo radiation because, in his experience, the TURP compromised the prostate body and made surgery much tougher. I then contacted one of the surgeons who has done over 5000 surgeries, and he assured me that the surgery would be no more difficult.

However, I have my doubts as to the efficacy of doing surgery on a TURP compromised prostate. This same surgeon did a DRE on me, found the prostate to be hard on one side, and sent me to do an MRI to check for EPE. The MRI was negative; I did some research and found that a DRE is unreliable after a TURP. The fact that this surgeon did not know this could happen was unsettling to me.

Finally, I did search though the literature for studies which dealt with surgery after a TURP: these studies found that surgery after a TURP is, in general, successful with few side effects.

MK1965,

I sent the original TURP chips to Epstein for a second opinion. In my case, the first pathologist graded the biopsy as Gleason 7. This was revised by Epstein to Gleason 6.

I never did undergo a followup biopsy after the TURP because I had already endured three biopsies which sampled the peripheral zone. They were all negative. I decided that I would only undergo a biopsy if it was MRI targeted. So far, over the last four years, my PSA has remained stable and the MRIs have not detected any cancer, so I have left well enough alone.

In your case, since your peripheral zone has never been biopsied, I would recommend that you do undergo a biopsy, preferably a MRI targeted one.

MK1965,

Try not to get ahead of yourself. A TRUS biopsy should be enough. Once you get the information from the biopsy, you can come back here for additional advice. In particular, if the biopsy has only a few cores (or none) containing cancer with Gleason 6, then AS is definitely what I would advise.There are several different protocols for carrying out AS, and should be doable even under crappy insurance.