Diagnosed in August 2017 - Still researching

Hello,

Working on Christmas so I'm using the time to do some more research.

I went to the doctor in 4/17 for a routine physical (age 52) which included blood work. Got a call a short time later telling me they wanted me to comeback for another blood drawl so they could repeat one of the test. A week later the doctor called to let me know my PSA was elevated (4.1) and he referred me to a urologist.

5/2017 The Urologist repeats the PSA test does a DRE (no Issue) schedules a follow-up appointment for late July because of my work schedule. I received an email from the urologist in June (while I was out of the country on business) confirming the PSA results of 4.3. We changed the July appointment from a consult to a biopsy.

7/27/17 The biopsy is performed with nothing abnormal seen on the ultrasound. Doctor estimated the prostate at 50-60 cc.

8/14/17 I stopped by the urologist for the results of the biopsy on my way to the airport for another business trip. Never even thought about prostate cancer. Given the size of my prostate I would expect my PSA score to be a bit higher than "normal." To say I was surprised is an understatement. The urologist reviewed the pathology report with me and informed me that I do have Adenocarcinoma. The good news is that it was only found in 1 of 12 cores. Path report describes it as MINUTE Adenocarcinoma. Gleason Score 6(3+3). 0.3mm, 2%. Carcinoma arises in PIN. There are 2 other areas that came back as "Suspicious" for Adenocarcinoma, one in each lobe. The pathology report also states the PSA level 4.4 ng/ml Prostate Vol: 67 cc; PSAD 0.07 Clinical Stage T1c, ICD-10: R97.20. The urologist and the pathology report both state that I'm a good candidate for Active Surveillance and I'm OK with that. My wife's immediate thought was to get the RP and yank the thing out while the cancer is still (hopefully) contained within. Her thought being that since my prostate is so large and they only took 12 cores they probably missed the other spots of cancer that may be present so why take a chance. After getting a second opinion from The Duke Cancer Center and meeting a second time with my urologist I think she is onboard with the AS approach for now. Urologist prescribed Dutasteride/Tamsulosin combination.

11/17 Was supposed to have a follow-up PSA test performed but had to skip that part of the appointment due to an event of urinary retention which resulted in me going to the emergency clinic at Charles DeGaul Airport in Paris so they could install a catheter and drain 1600 ml. Yes, that's 1.6 liters. Urologist at home performed an ultra sound and determined that even after I thought I emptied my bladder I was still holding more than 8 oz. Urologist changed meds to straight Dutasteride and added Rapaflow.

I have an MRI scheduled for 1/18/18 on a 3T machine and a follow-up with my urologist on the 19th where I'm sure they will take blood for another PSA test. The doctor at Duke told me that the MRI probably would not pick up any G6 tumors but should register any more severe tumors if there are any. He also said that I am a good candidate for AS but if the PSA rises or if the MRI finds any other tumors all bets are off and I would need to consider other treatment options. My wife is already preparing for some form of treatment in March.

My father and two of his brothers all had/have PC. Dad had RP when he was 54 and said it took almost 2 years before things were back to normal. I know 1 uncle had Brachytherapy SI when he was diagnosed in his 70's but not sure what my other uncle did for treatment. I have spoken to my brothers about this and none of them seem to have any issue with their prostate thus far.



Has anyone else had a similar diagnosis and stats?

Hi Gemson,

Sorry about your diagnosis but you found the right spot for info and support.

I was almost in exactly the same situation as you. I, too, was diagnosed in August but I had 3 positive cores, all G6. Initially, my URO said I was a good candidate for AS but he wanted to do a MRI to make sure. Unfortunately, the MRI showed several suspicious areas which were high risk for “clinically significant” cancer. At that point, my URO suggested treatment, but also suggested I get a second opinion.

I decided to see Dr. Polascik at Duke. Worst bedside manner of any doctor I have ever visited. Kept me waiting for 3 hours before I finally saw him. When he came in he misquoted my pathology report and said I had only 2 positive cores instead of 3. He refused to even review my MRI and said that I needed a new one with their Radiology department. He immediately wanted to sign me up for an AS clinical study he was leading which made me feel like that was the only reason he was recommending AS. I left there feeling angry and confused but determined never to see him again.

I ended up going back to my original URO to perform RALP on Oct 30. Turns out my initial G6 was undergraded and 30% of my prostate was actually G7 tumor. Today is the 8 week anniversary of my surgery and I’m happy with my decision.

Good luck with your decision and if you have any questions just ask.

Jeff

Gemson: Also.....read the long running thread at the beginning of the page, if you have not already, for the newly DX.

Gemson,

It looks like you're on a good path so far. The first biopsy found only a little cancer in only one core, which as others have suggested makes you an excellent candidate for AS. The MRI and continued PSA testing should provide warnings about anything immediately serious, and a follow-up biopsy later in 2018 is a must.

If nothing more serious comes up from any of these things you have a significant chance that you will never need treatment, and even if you do you will have put off side effects of treatment, perhaps for a decade or more. AS does involve a sort of looming uncertainty there in the background, but treatment involves uncertainty as well, and come to think of it isn't all of life somewhat less than a sure thing?

That's beyond bad bedside manner. That's a terrible person.

Hello Gemson,

Merry Christmas.

The MRI will help with information.

The people on this board are great. Take your time.

Thanks for all the information guys. It is nice to see so many responses from men with similar stories.

Denis,
I have read about Brachytherapy and spoke to my Urologist about it briefly. He did recommend this based on the size of my prostate. He said that if the dutasteride works well at reducing the size of my prostate it my be an option down the road.

Allen,
Thanks for the links. I will definitely read the information available there. I am also concerned with the urinary retention as I know this can lead to other serious complications. My urologist did give me some samples of personal catheters to bring with me when I travel to eliminate the need for another emergency room visit. We talked about the TURP and he suggested that since we already know that I have PC they would recommend the RP instead of the TURP. He did caution that we should continue with the AS for now and wait for the results of the MRI and to see if the dutasteride and rapaflow help before rushing into any definitive treatment. He is definitely a supporter of the Active Surveillance protocol and has mentioned at every visit that we have time to gather the needed information and see how this develops before we take direct action.

Thanks again for the input guys!

Hello Everyone,

Had my 3T MRI earlier this week and got the results yesterday. My urologist said the MRI found nothing specific that could be used for targets in the next biopsy so that sounds good to me. I continue to have issues with urinary retention but nothing that has required a catheter so I'll just keep making the frequent trips to the toilet for now. Next visit will be in March for a new PSA reading. This will be the 1st PSA test since the biopsy. My urologist said we would talk about the next biopsy at that time. I think I'll have that done in may or June but we'll wait until March to see what the PSA is and what my Urologist says.

On a side note, the Dutasteride has left me with dry orgasms so that is a bit different. just doesn't feel the same but at least i'm still able to perform.

Thanks for the support guys. I think my wife is slowly coming around to the AS protocol which helps, I'm in no hurry to face the side effects of treatment.

Gemson