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Posted 6/23/2011 2:13 PM (GMT 0)
The following was posted on another thread so I thought I would start a new one so folks can both welcome her and respond to her issues.

Tudpock (Jim)

This is wife posting.....went to Dr. Wheelers in Sarasota, FL yesterday.....remember we have had no biopsy, opted for MRI-s we will not have the results until next week, however they performed a sonogram, there was one area of concern, very small located in the front right side......the MRI procedure according to my husband was a bit painful for a few minutes then subsided and was just uncomfortable.....the doctor said from his opinion according to sonogram that there was a 33% chance it was cancer and that it was not aggressive. The thing that baffles us is that 3 other doctors prior too Dr Wheeler said my husbands prostate was very enlarged, but Dr Wheeler measured it on the sonogram and it is actually very small......since this all began my husband began drinking POM wonderful in large quantities, could that be the reason????? Its all so confusing and the internet is all over the charts with this disease.....at this point in our minds we are going to do diet modification, vitamin and herbal supplements with watchful waiting no matter what the MRI results are and monitor is PSA levels every 3 months.....Then in the future if needed we are considering the HIFU procedure, which if the cancer is only on one side they only target that area leaving most of the internals of the gland still there......I will post the MRI results when we receive them, hoping for the best.....
Age:52
May 2011
PSA: 4.7%
Free PSA: 6%

Posted 6/23/2011 2:23 PM (GMT 0)
Dear Concerned:

First of all welcome.  Most of us seem to have missed your first posting earlier this month; when I saw your second one I wanted to tell you that I'm sorry you have to be here but welcome you to HW.

First of all, I will leave the speculation on the possible prostate shrinkage due to POM to others who have stronger opinions on the subject.

With regard to the MRIS, I will suggest that IMHO this test alone is not enough to determine your future course of action.  So, please don't be surprised if Dr. Wheeler suggests a biopsy to follow up on this test.  Hopefully he will be able to do some targeting on the biopsy based on the MRIS results.  Another reason to think a biopsy is in your future is the very low level of hubby's free PSA.  Dr. Catalona would say that this indicates a 56% chance of cancer.  Finally, while it MAY be possible to manage the cancer with diet and supplements, you need to know what you're dealing with.  If, heaven forbid, a biopsy showed G8 cancer cells, I doubt many would suggest managing that w/o active treatment.

Sorry if this sounds like a downer but I wanted to provide some food for thought.

Pls. keep us up to date on your progress and ask any questions you may have.  There are lots of folks who frequent this forum with tons of knowledge in PCa and, in concert with your medical team, this can be a help to you.

Tudpock (Jim)

Posted 6/23/2011 7:20 PM (GMT 0)
Your husband is definitely on the high end of cases where watchful waiting would be recommended, but it is not out of the question.

Dietary changes are likely to be overall good even if not specific to PC. Pomegranate juice shows up neutral to slightly positive in the medical literature so it probably can't hurt. Do be very diligent in researching other supplements. Some that are highly touted have serious scientific evidence which would discourage their use.

In any case, hug each other and be together on this rather frightening journey.
Posted 6/23/2011 8:17 PM (GMT 0)
Hi concerned

First, I suggest that a diagnosis of cancer - and maybe even no cancer - without a biopsy is likely outside the reach of 2011 science. Hopefully soon, but not yet,

Second, having been treated with HIFU not once but twice, I suggest that your husband not consider hemi-ablation.
I know it's done. I suggest, however, that it is far too easy to miss - in the diagnosis process - clusters of cancer cells on any use of any current technology. And if you have clusters on one side or part of the gland, there is a very good (bad) chance there are clusters elsewhere.
Maybe some day soon the technology will be where MD's can reliably locate all relevant clusters, but I suggest that we are simply not there yet.

Good luck
Posted 6/23/2011 8:27 PM (GMT 0)
Larch,
That's good advice on the partial ablations. We are seeing some success with targeted ablations but the argument against them is that prostate cancer is typically what is called multifocal, meaning multiple lesions versus one identifiable lesion.

Given this patients age they likely will need some intervention at some point if a tumor is identified in the near future.

Tony
Posted 6/23/2011 9:54 PM (GMT 0)

larch said...
Hi concerned

Maybe some day soon the technology will be where MD's can reliably locate all relevant clusters, but I suggest that we are simply not there yet.

Good luck

A 3d saturation biopsy while not fool proof is about as close at it comes to locating PCa. With 30 to 90 needles used depending on gland size it will rarely miss much. Not all that new as I had mine over 3 years ago with 45 needles. 

http://alprostate.com/mapping.aspx

Posted 6/24/2011 12:05 AM (GMT 0)
A question for Ziggy9:  While a saturation biopsy is more likely to pick up any cancer present, don't the high number of needle penetrations make the prostate gland like Swiss cheese afterward?  It is , after all, only a small organ.

 

Posted 6/24/2011 12:22 AM (GMT 0)

Tim G said...
A question for Ziggy9: While a saturation biopsy is more likely to pick up any cancer present, don't the high number of needle penetrations make the prostate gland like Swiss cheese afterward? It is , after all, only a small organ.

The needles uses aren't that big. A grid is placed over the perineum where the needles are inserted unlike a normal biopsy through the rectum. You need to be sedated unlike standard 12 needle biopsies and one wakes up with a catheter that's removed 24 hours later. I was a little more sore than after a normal biopsy but the recovery times was still the normal 6weeks. I had my TFT 2 months to the date later. I picked that date for it was 2/22/08 that I had my first good PCa cancer news, that being I was officially eligible for the new treatment based on the saturation biopsies results. So it was to be 4/22/08 for my targeted cryosurgery which results have been nothing less than spectacular I'm realizing as time, two additional testing biopsies and acceptable Psa tests go by.
Posted 6/24/2011 3:42 AM (GMT 0)
If you husband endured the endorectal MRI, he can endure the TRUS biopsy..A biopsy is the ONLY sure way to tell..

Before you start thinking about treatment choices, you must know FOR SURE what you are dealing with..Gleason 6 PC is one thing. Gleason 8,9 or 10 is a COMPLETELY different animal..

I would not be betting my life on Pomegranate Juice....JMHO....
Posted 6/24/2011 8:39 PM (GMT 0)
Thank you everyone for all the replies, it is very overwhelming at this point and we are just at the beginning of our journey, next week after we get the MRI-s results things will take a different path I am sure.....and yes husbands PSA indicates 56% cancer......the 33% was based upon the ultrasound and the doc's opinion..... also the doc said he wouldn't do a biopsy unless we demanded it....he is ANTI biopsy, actually he is publishing a book about why he does not like doing them....
Wish everyone a great weekend and thanks again for the wonderful welcome!
Posted 6/25/2011 4:45 AM (GMT 0)
Reconsider the doctor.

No cancer is definitevly diagnosed without a pathology of a biopsy, a lumpectomy, an excision, a blood study, etc. Why does this doctor think his style is different? Good for him that he is writing a book, isn't everyone? Are you willing to bet your life on him? Will he indemnify you and your family if his opinion isn't quite right and you die before you should???

I suggest that you need to definitively confirm whether you have cancer and then determine as best you can what grade and extent it is. A biopsy does that in most all cases except for the transition zone cancers, which are uncommon. Then you use a color doppler test.

Stick with the basics that are proven. Find out what your situation is and treat it with proven methods.
Posted 6/25/2011 5:54 AM (GMT 0)
Concerned, another welcome to the forum.

A biopsy is certainly the norm, but your doc may have good reason for not recommending it ~ I'd be interested to know what his thinking is. [Edit: A Google search has just thrown up Dangers of Prostate Biopsies so I have probably just answered my own question!]

As another who is trying diet modification and supplements, I think it an excellent idea for someone on active surveillance. But if PSA is moving up I would also advise conventional treatment ~ it's good that you have a Plan B in place.

Opinions here are divided on whether POM, wonderful or not, is effective against PCa. I take the view that it may work for some, and the best way to find out is test it. It may indeed be responsible for the big apparent reduction in prostate size, or it may something else entirely. You mentioned POM wonderful in "large quantities" ~ how much is that?
Posted 6/25/2011 11:31 AM (GMT 0)
It was my husbands choice to not have a biopsy at this point so we searched for other methods of detection......The first urologist he went to in May after the free psa test was done, he was very quick to simply say biopsy, then cut it out and gave no other information as to various treatments so we began our own search.......We are new to this and have a little time in on our side so we are trying to get as educated as possible before any major decisions are made.....and yes JNF, we all want to write a book!!
Piano: large qty of Pom juice.....about 16 oz a day plus one Pom pill.....also he is taking prostate health vitamins from GNC...it's all we can do at this point until we know for sure what kind of monster we are dealing with...I am very glad to have found this forum, you all are a wealth of information and it's coming from people who know first hand about this. MRI-s results should be in by wednesday......Thanks again everyone:)
Posted 6/25/2011 6:14 PM (GMT 0)
I'd recommend he get a biopsy. It takes like 15 minutes and for the majority here it's uncomfortable but afterward you fell fine. I went golfing the day after two of mine.

I'd feel safe guessing that all your pom juice and "prostate vitamins" are doing is producing more expensive urine., There have been many promising foods and supplements which have been proved in a rare case aids aggressive Pca to no effect at all for most. I see one a day vitamins for men finally has taken off the stickers containing lycopene for prostate health because it's another supplement now proved noneffective. Normally upon dx here it's not unusual to find some men drastically changing their diet hoping it will be miraculous. But seriously a few months change of diet will not make up for a lifetime eating less healthy.

Rejoin the world of medical science, have him get a biopsy.
Posted 6/28/2011 7:11 PM (GMT 0)
There is only ONE widely accepted way to diagnose Prostate Cancer (PCa) and that is by Prostate tissue samples being examined under the microscope and they are usually acquired by Biopsy. Although Imaging can aid in locating suspicious areas to Biopsy, they cannot replace the need for, or the results obtained by, Biopsy. Until a Biopsy is done they cannot even identify Image lesions as PCa, with certainty. The imaging you are having done is much more valuable after a PCa diagnosis is confirmed, rather than for diagnosis itself, except as previously described in aiding same and, sometimes, helping to determine the extent of disease.

Whether you and he decide to have one done or not, is certainly his prerogative, but, it should be a conscious and INFORMED decision based upon best practice guidelines, in my opinion. Although I consider myself a well informed layman regarding PCa, I am NOT a Physician. Good luck! - [email protected] (aka) az4peaks
Posted 6/28/2011 7:17 PM (GMT 0)
Concerned,
AZ is correct. There is no other means of detection. There are means of suspicion but they are not valuable unless the cancer is confirmed through drawing tissue in a biopsy and examined under a microscope. You can draw conclusions in other ways but it is a very risky business if all signs point to prostate cancer and there is no biopsy...

Tony
Posted 6/29/2011 9:00 AM (GMT 0)
I have had four biopsies, including a 30 sample biopsy, and an endorectal mri (all negative), and I would say that the mri was easily the worst of all experiences. The mri only finds fairly large malignancies. It is too crude to get all clinically significant malignancies. You need the biopsy.
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