2 different path reports

Hi Worried wife,

I'm concerned about having a PSA of 6.8, even with the Gleason of 6, and then do nothing.

I had a PSA of 4.3 and a Gleason of 3 + 3 = 6. After my diagnosis following biopsy, I visited with 4 more trusted health care professionals from completely different offices. Each one advised me to do something (some kind of treatment) within 6 months. I know that no one really knows for sure, but I think that was good advice. Maybe since these folks knew me personally, they wanted me to find a curative action.

Active surveillance is done by folks in your husband's PSA range, but it is not a curative path. If your husband is not concerned too much about a cure and believes that his cancer won't spread or hurt his health during his life span, AS may be appropriate for him.

I was a member of prostate cancer site called "yananow" (your are not alone now) at
www.yananow.net . I really like this site for obtaining information and comfort.

You may wish to go to yananow and press on the returning visitor link. Look at the "Experiences" link. You'll be able to compare long term results of those who have signed up for this site. There are those who chose AS who are still doing well and folks who chose all the other basic treatments. Some folks don't do well on any of the treatments or paths and it is sad to see. In general, though, there is a lot of good news on the site.

I wish you and hubby the best in your decision-making. We all know this is a very big decision and it is yours alone.

We all have opinions, but our purpose here is to provide support regardless of what you decide to do. Not to promote a particular path.

Kind regards,

Barry

Ang, I've been reading your thread for a while now and have decided to chime in.

I too am a wife, and in February 2008, was on the same journey as you are now on.

My husband was 57 at diagnosis with a PSA of 6.4. The biopsy done in February 2008 confirmed PCa in the left side of his prostate with 2 out of 10 cores positive with a Gleason of 3+3 and 34. Because his PSA was under 10, no bone scan was done but he did have a CT scan which showed nothing. At the consultation with the urologist, we were presented with 3 treatment options: surgery, radiation and AS. AS was ruled out due to husband's age (too young). Husband did not want radiation so that left only surgery. He met the robot on March 16, 2008 and we received the surgical path report about 7 days later. The report kept his Gleason at 3+4 but upgraded his stage to IIIa due to extraprostectic extension. Everything else was clean - no positive margins, seminal vesicles, bladder neck involvement, etc. Since upstaging after surgery is quite common, our surgeon was not concerned. However, his words to me when he told me of the findings of the path report were "looks like we got to it just in time." If we had chosen AS, it's quite possible that the very small EPE could have turned into a major problem.

I'm not telling you this scare you. Surgery is a big deal and the decision to remove the prostate is one that should be made carefully by considering all the pros and cons. Fortunately, my husband is doing well two years later (see my signature) but every so often still "squirts" urine and ED is still a work in progress for him.

Due to the findings of the surgical path report, my husband had his PSA checked every 3 months for the first two years to keep an eye on things. In March, he graduated to every 6 months.

I wish you and your husband all the best, and hope you will keep us posted. Sounds like you and he are doing "all the right things" now in an effort to gain as much information and knowledge as you can before making a decision.

Thanks to everyone for the feedback. My husband has really decided against AS mainly because the doctor felt he was too young and he is great physical shape. My husband is very active (still plays inline hockey once a week), he recently had a stress echo which he did better than his last score from his test 2 years ago. My husband also doesn't think he wants to go down the road of biospy procedures every 6 months of so.

Barry, the doctor also said he wasn't too comfortable with AS due to the PSA but said if that is what he wanted to do he would support it. Like I said above my husband is going to do that as he wants to go for cure.

Chris, Epstein did my husband's path report after the first local lab called it suspicious. We are very grateful for them sending it to Epstein for a second opinion as the first uro was going to go by the first path report. I also read about the Hopkins on how they do the gleason scores.

Almost forgot. Penn Presby is offering a pre-op class on 20 Apr, where they go over the robotic procedure. I don't know if you have to be scheduled for surgery, but you might want to check to see if you could attend the class. Again, my wife and I felt very comfortable with Dr. Lee, who's done about over 2000 of these procedures - their web site says 2000, his nurse said 2200, he said 2300 (in any event, experienced).

Bill

I'm scheduled for 19 May. They offered 29 Apr to me, but my son's graduation from Rider Univ. is 14 May and I wanted to attend that without any issues. If you'd like a consult with Dr. Lee, keep in mind it took me a couple of weeks to get onto his schedule. I too had considered Johns Hopkins since my wife's cardiologist from Jefferson said that whenever a patient wants to go outside the area, that's where he recommends. ChrisR might know better, but it was my understanding that they are still investigating robotic surgery, whereas Penn Presby has been doing it for a while. Had I chosen open surgery, I felt comfortable that JH or Dr. Malkowicz at Penn would have both been good.

Bill

Dr. Lee indicated that for his robotic procedures, it normally takes anywhere from 75 min to 2 hours, depending on what must be done.

Bill