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Posted 1/9/2007 7:48 PM (GMT 0)
My dad was diagnosed with PC on 12/22.  I probably shouldn't be posting here because after reading a few threads realize that I have no true information or understanding at this point of all the terms that are being used!  I just found out 1/7 about this diagnosis, since my dad didn't want to "ruin" Christmas or Christmas Break(I have 3 children 7, 5 and 4).  So it's all new to me.  I have been researching as much as possible and need to call my parents to get some information so I can be better informed while doing this research.  I do know that originally my dad's PSA levels(please forgive me in advance if I incorrectly use these terms!) came back in the normal areas for my dad's age, which is 74.  But a biopsy was also done and that is where the diagnosis came from.  I know my mom told me several numbers, but quite honestly, I can't remember.  I can just remember hearing the word "cancer". 

I'm realizing that due to my father's age, some treatments may not be an option.  He is a very healthy, active 74yr old that Thanks to my mom eats very healthy.  I guess it just feels better to type this out, even though I'm not real sure how you all can give me any advice without more information.  We are going next Wed on the 17th for a bone-scan, I beleive and my parents and my brother and I will be there at this time.  I just want to be able to ask the right questions.

Thanks!

LoveMyDad

 

Posted 1/9/2007 9:29 PM (GMT 0)
Hi LoveMyDad,

Sorry you have to be here but this is a great place to get information and there are no dumb questions. Some here are far more knowledgable than I and I am sure they can advise you. I can only relate my own experience.

I am 72 and none of the options was closed to me due to age. I chose the "open" surgery where the doc gets to see what is going on first hand. I chose this becasue I wanted him to have the best chance to get rid of the caner as fast as possible. I have had a very good recovery and very little pain.

Your dad has to make his own decision on treatment and whatever path he takes will be the right one for him.

Good luck and stick around here.....

Jim
Posted 1/9/2007 9:32 PM (GMT 0)
hi lovemydad!

it all is very confusing at first diagnosis.

What you need to check out are:

PSA: blood test that checks for Prostate Specific Antigens. If that is high or has jumped then a biopsy is indicated. I assume that they were high or of some concern to do a biopsy. It is a simple blood test that tests PSA levels. But has some informative factor upon treatment, prognosis, etc.

Biopsy: That is where they go into the prostate for a better indication of whether the PSA test indicates cancer. They generally take 10-12 needle samples (very small) from all over the prostate to see if there is any cancer tissue. On the biopsy, you should ask how many needle cores were taken and how many were positive, and, of those cores that were positive, what percentage of cancer did they show?

The other thing that is important is called a "Gleason score". Ask your dad's doctor what the gleason score is of any postive needle samples. Each postive needle sample should get its own gleason score. 5-6 is generally the lowest growing/spreading cancer, with 9/10 score being a rapidly growing cancer.

Welcome to the forum, best wishes, and please keep us updated on your progress.

Tanya
Posted 1/9/2007 9:37 PM (GMT 0)
Dear LoveMyDad,

I am very sorry to hear of your father's diagnosis. You should know that, when caught early, PC is one of the most curable cancers. Even if it is not caught early or even if it has spread outside of the prostate, there are a lot of treatment options to either kill much of the cancer or stop/slow its advance. Keep up your spirits and hope.

First of all don't feel overwhelmed about all the information that people in this chat room seem to know. I barely knew what the prostate gland did prior to my September 2006 diagnosis. You will learn what you need to know quickly. There are lots of good resources out there. Locating this website (the best that I have found) will be a big help to you.

There are a lot of numbers and information about PC but I would say that the critical ones to ask your dad about are his PSA, his Gleason Score (two numbers such as 3+3), and his clinical stage (for example T2a or T2b is a pretty common one.) With these three factors, you can go to something called the Partin Table (find it on the internet) and find the odds of your dad's cancer being contained in the prostate or having escaped further out which may alter your best treatment option. The other critical factor in deciding upon the type of treatment will be your dad's age and health.

I would suggest that you start with some basic research on the internet on the fundamentals of the prostate anatomy, prostate cancer, PSA, Gleason score, stages, and treatment options. I am at work right now and don't have the exact names of the web sites that I used when I was diagnosed last September. If I recall correctly, some of the best were Wikipedia, American Cancer Society, and Prostate Cancer Foundation. There are hundreds of others that are just as good.

Here is some more information on two critical measures of prostate cancer:

PSA: Prostate Specific Antigen. A blood test meauring the level of this antigen which is produced by the prostate gland. A level above 4 normally means that further testing should be done (although that threshold level may be higher than 4 if you are older - I am not sure.) Basically a rising PSA score higher than 4 may indicate that you have cancer. This is frequently the first indication of a problem which then leads you to have a biopsy.

Gleason Score: They do a biopsy on the prostate gland removing several cylindrical cores of prostate tissue with a thin needle. The tissue is examined by a pathologist. If the tissue is cancerous it is assigned a "Gleason" rating of 1 to 5. 1 is the least abnormal and 5 is the most abnormal which means the most aggressive cancer. They add the scores of the two most common cells together to make a Gleason Score. The first number is the one that is the most common pattern and the second number is the one that is the second most common. For this reason a 3+4=7 Gleason is less serious than a 4+3=7 Gleason. The most common Gleason Scores are 6, 7, and 8. Lower scores are usually not detected because there is too little cancer to increase the PSA. Higher scores indicate a more aggressive cancer and are less common due to the prevalence of PSA testing catching cancer earlier.

Treatment options: Most common are surgery, radiation, hormone, chemo (if the cancer is already outside the prostate), and watchful waiting. Other less common treatment options include freezing, high energy, etc. I don't know much about them. If you decide to pursue one of these, you may be able to find others on this web site who has used that treatment option. 

Because of my age (49) I pretty quickly focused in on the surgery. Do not rule that out for your dad. However, at his age, he will likely want to also look closely at radiation and other options. Since I don't know as much about them, I will let others give you some information on those.

Good luck.

Ben
Posted 1/9/2007 11:25 PM (GMT 0)
LoveMyDad,

We are all shocked when we first hear the words, "Prostate Cancer". It is generally stated that 50% of the men over 70 have prostate cancer. The point is that many may have it and not know it. In general prostate cancer is slow growing. As already mentioned the Gleason score that is given by the pathologist that analyzes the biopsy samples indicates the agressiveness of the cancer. The most common Gleason scores are 5 to 6. If your dad's Gleason is in this range then there is time to research and learn before making a decision. You mentioned that your dad's PSA was in the normal range for his age so you should find out why the biopsy. It could be a rapid change in his PSA or the urologist felt something in the DRE(Digital Rectal Exam).

I know of no treatments that would not be available for your dad due to his age as long as his general health is good. The reason that men decide not to have certain treatments at an older age is to avoid the complications from those treatments when it is more likely that they will die from something else the the prostate cancer. Knowledgable medical professional will tell you that more men die with prostate cancer then by it. In looking at surgery versus radiation the statistics are that at the 10 year mark after treatment the reoccurance rate is about the same for both. Once you get beyond the 10 years then surgery has a lower reoccurance rate. I was 56 when I was diagnosed and general expect that based upon my health and family history that I could expect to live into my 80's therefore I chose surgery. If I had been your dad's age my decision would have been radiation. There are also those in the medical community that believe that older men's prostate cancer responds better to radiation then younger men.

You should know that protate cancer is curable, not just treatable. You should also know that there is a large variation in the skills and knowledge of urologists and doctors concerning prostate cancer. It is highly recommended that once you have your dad's urologist's opinion on treatment that you get a second opinion. Today surgery for prostate cancer has come a long way. The relatively new robotic assisted laproscopic radical prostatectomy is becoming the standard although it is not for everyone. The advantage for men like your dad's is the faster recovery time and less pain. I personally would recommend that you seek out a university based urologic center or one of the premium medical centers. While all treatment providers are biased toward what they do it is less so at these centers. They have plenty of patients and do not need to sell you on their treatment specialty.

Take heart that your dad will be fine. Stay with us through the journey. Ask any question as none are unimportant. Do your research and visit the web sites already mentioned. One that has not been mentioned here is www.yananow.net. When you enter this site click on Mentor Experiences. These are the stories provided by men that have been diagnosed with PCa and they are categorized by type of treatment. Just a caution. Some of the stories can be graphic and disappointing.

Good luck!

Tamu
Posted 1/10/2007 12:11 AM (GMT 0)

Hi,

Tamu gave sage advice. May I add that if your dad is considered a good candidate for surgery, another benefit of the robotic surgery is much less blood loss and generally less traumatic to one's innards.  I think that this method opens up the surgical option, which I feel is the most likely curative, to older men.

Secondly, when I was diagnosed, I was terrified, but wanted to know as much as I could find out about this to give me as much hope as possible.

Two very good books which I heartily recommend that you get or check out of the library, and discuss with your dad are:

Peter Scardino, M.D.- The Prostate Book, and Patrick Walsh, M.D.-How to Survive Prostate Cancer. Both give similar information, yet there is non-overlapping material.  They can help with the decision making, and tell about what to expect before, during, and after all the treatments.

Your dad sounds like a young 70s kind of guy, and if it were me, I'd try for the most curative solution.  My dad is a youngish 87, and has a PSA in the 0.somethings, but if he came up with PCa (our shorthand for this condition) I'd try to see if I could get my doc to operate on him with the robot.  As you will see from the books, all the options have some downsides.

Sorry you had to come here, but we all are here to help each other. Stay tuned.

dj

 

Posted 1/10/2007 4:11 PM (GMT 0)

Thank you all very much for taking the time to respond.  All the information has been very helpful as my family starts this journey.  You all have given me some great resources. 

A little more background on my father and why the biopsy.  My father had blood in his urine early Nov. and went to his Dr at the VA hospital.  He had several tests ran and they discovered that he had a few kidney stones and that his bladder looked not quite right.  It was also noted that his prostrate was slightly enlarged.  His Dr wanted to biopsy the kidney and even though my dad's PSA score had not increased and was in the normal range, she decided to go ahead and biopsy the prostrate since it was enlarged.  She said it is very common for the prostrate to be enlarged some at his age, but better safe than sorry. 

I'm concerned that when the Dr called my dad on 12/21 and told him that the biopsy came back showing cancer that there isn't exactly a sense of urgency on her part.  My dad does not have his PSA level, his Gleason score or any of the information about how many needle cores were taken and how many were positive and what % of cancer did they show.  She scheduled a bone scan for 1/17.  The only info that she gave my father is that surgery is not an option, either radiation or hormone treatment and that he has high grade prostrate cancer.  She did not give him the actual numbers and my dad was so stunned at the news that he did not question her further at this time.  Quite honestly, I'm sure my dad had no clue what to even ask at that point.  We are better informed now and my parents are actually meeting with our family physician, who was faxed all my father's results, so he can go over everything with them and explain all the results.  I think this will help give us a better grasp on all of this.  On the 17th, we will meet with his VA Dr to go over these same results, plus the bone-scan. 

My brother is busy researching Dr's in the Orlando area and surrounding areas, as it seems extremely important to find the best Dr that is available.  My father is very healthy for his age and is very active.  Other than PC, he is in great shape.  I'm not sure why his VA Dr said surgery was out of the question, but I have a feeling it's his age.  Or maybe she feels that it has spread?  The 17th cannot come fast enough for me at this point. 

Thanks so much for all your kind and helpful words.  My next step is trying to find the right words to tell my children after we know more on the 17th.  My husband and I live 15min from my parents and they are very involved in my children's lives.  My 7yr old son and he are especially close.  I'm one for honesty, kid's always seem to be able to sense what's going on anyways!  It's just finding age-appropriate words for a 7,5 and 4yr old that will make sense and not scare them.  My sense of panic is still very high, but reading this board and doing research is helping.

LoveMyDad

Posted 1/10/2007 9:39 PM (GMT 0)
Hi LoveMyDad,

Don't panic! Even "high grade" tumors are somewhat slow-growing, but it is important to get a plan as soon as you can.

Just looking ahead, but I would not take no for an absolute answer about surgery, unless there is some reason your dad cannot undergo anesthesia. I think surgery is the most probable for a cure. If the cancer is outside of the prostate, many old school doctors don't want to operate, because they think, why subject the person to the stress and risk of surgery, "when the horse is already out of the barn." But, in possibly the Scardino book that I mentioned in the previous post, it is said that the surgery might be considered even there is extension of the cancer out of the prostate gland. The reason for this is that if the tumor grows enough, it may block the flow of urine which will be lots of trouble. The only reason, it seems to me, to keep the darn thing in is that there are some experimental treatments that involve gene therapy in which they use the prostate to attack itself. My doc is doing this in Houston.

The website, http://www.davinciprostatectomy.com/hospitals.html, gives names and locations of doctors who know how to do the robotic procedure around the country. I looked and there is a load of docs in the Orlando area that do the robot. The robot is about 5 years old and not all docs are familiar with it. I don't own stock in Intuitive Surgical, the company that makes the robots, and I'm not a surgeon, but I'm just a happy, satisfied customer. The robot is not a toy, it is not experimental, and don't let any doctor tell you different. It is becoming standard of care, not only in urology, but also in OB/GYN. The robots are going in all over, and are being used for cardiovascular, GI, and the above mentioned specialties. One has to go to a doc who has done a hundred or so of these, because there is a learning curve. This is mentioned further in my doc's department website, www.baylorurology.org (go that site and click the word that lets you open their online magazine, Pathways. There is an article about him and his partner who do the robotic technique).


The website from the robot company also has an animation about how the surgery is done. It is minimally traumatic, because it is laparoscopic. In addition to minimal loss of blood, a patient only has five or so little incisions in the abdomen, about half an inch long, except for the navel one which is maybe two inches. Unless your dad is not a good surgical candidate because of an anesthesia risk, I think surgery should not be ruled out just because of his age. I mean, they do hip and knee replacement operations on folks older than him.

The books gave me information such that I would not be a big fan of anything that leaves even one prostate cell in the body, because eventually it could become cancerous. I ruled out any kind of radiation as first line treatment, because it can be fatiguing to middle-aged or older people, and, although they can focus the rays pretty well these days, they still go through the body and can affect bowel elimination, something that surgery practically never does. Nevertheless, sometimes, radiation has to be done, even after surgery, to kill off any cells that may have gotten out. The radioactive seeds can cause the bowel problem and can eventually cause irreversible erectile dysfunction, something that is usually affected but can come back with the surgery. You may hear about cryotherapy, in which the majority of the gland is frozen then thawed and removed through a catheter. This leaves some tissue. High intensity ultrasound (HIFU), which some people go to Canada for because it is not approved in the States yet, "cooks" the gland and, then like cryotherapy, it is removed through a catheter. This also leaves some tissue. Hormone therapy, which is really testosterone withdrawal or negation therapy, is what they give to people that are so advanced that nothing else will help. It kills the hormone-sensitive cancer cells but can leave the hormone-insensitive cells.

I am probably putting a bit of a cart before the horse, because you don't have a lot of the details yet. But, if the doctor that you have already seen said it is a high grade tumor, then you have some time to study, but maybe not as long as the lower grades. So, this is just a start for your consideration. Don't be hesitant about getting several opinions, but ask them the hard questions about what their relapse rates are and what percentages of each kind of side effect they have had.

Keep us posted,
dj
Posted 1/12/2007 1:25 AM (GMT 0)

Hi-

  I live in the Orlando area and my dad has Advanced PC..he is only 61.5.  He is however doing very well in a Clinical Study involving Chemo and Vitamin D.  We get new results tomorrow.  I wanted to let you know that our oncologist is absolutely wonderful.  His name is Dr. Kuntas and he works at the Cancer Centers of Florida.  He is mainly in Clermont but also works in the Ocoee office on Thursdays, I believe.  We love him and I trust him completely.  The rest of the cancer center has also been a Godsend.  The Ocoee office number is 407-292-3042..they can give you the Clermont number or you can see Dr. Kuntas in Ocoee.  Please keep us posted.

Prayers and best wishes from another girl who loves her daddy-

Lisa

[email protected] if you would like more info or just to talk :)

Posted 1/13/2007 2:00 AM (GMT 0)
Dear LoveMyDad & Loved Ones,     Sending a “Warm Welcome” …to You!   I know we can “all” make your journey smoother just by being here for you!   This is a great forum !!! which you’ve joined… so stay with us.   Your first posting really lets us know that you are reaching out… and that’s what we do best! Helping Hands…are always here to help you travel this new path you’ve found yourself on. Thank you for sharing your dad’s journey with us.   This is a journey best traveled with friends. So ~ Welcome New Friend!!!   It can be overwhelming…. so stop and take a deep breath…. And then let your mind settle a little so it can truly take in everything that you need to take in.   You will be better informed after reading postings on this forum and you will amaze yourself at how fast you learn!!!!!     Any questions…. just ask… each time you post it pops back to the top and we all read it!!!!   So ~ ask away. Keep posting…. OKAY!!!     Keeping you close in thoughts and prayers. In Friendship ~ Lee & Buddy   “God Bless You”   It's a little prayer   ~   "God BlessYou" ...but it means so much each day, It means may angels guard you   and guide you on your way.
Posted 1/18/2007 8:22 PM (GMT 0)
Hi LoveMyDad... Did your dad have his scan yesterday? Please let us know when you get the results... Keep us close~ Okay... Thinking of you and wanted to let you know! Keeping you close in our thoughts and prayers... In Friendship ~ Lee & Buddy
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