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Just Diagnosed Today w/PCa - Help

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Posted 3/1/2013 1:45 AM (GMT 0)
Peter,
I hope I answered you question in my post to Robert. Brachytherapy will treat the bed at about 5 mm in to get minor penetrations. Any extra capsular extensions should be combined with IMRT to get a 15mm margin. Brachytherapy is good for nerve involvement and Apex tumors.
Posted 3/1/2013 2:20 AM (GMT 0)
 

TIME101,

Yes the tumor proportion (percentage) of prostate involved by tumor 15% .

We live in the Bay Area of Calif. and our Uroligst was out of Good Samaritian Hospital.

We also sought advice post RP from Stanford, as well as UCSF, both who are in our backyard. My husband had present perineural invasion, but no definate lymphatic invasion.

Ask all the questions you wish on this forum as well as to your Dr's.

A suggestion: When having tests, scans, blood tests, treatments, etc. ask for copies of everything, so you will be better equipted when visiting with your teams of Dr's if that's what your future holds.

Stay positive and know we are all here for your support.

BOOGEE

Posted 3/1/2013 1:07 PM (GMT 0)
Thanks Boogee. You see my numbers are similar to your husbands 4+3 at 13% and 3+3 at 1%. So, to you and John T, makes me wonder if any bone met will be missed (am to do bone scan this morning and CT scan March 27) if I decide to do Brachy (and maybe IMRT to John's point) to try for a cure.

I have appt. with Dr. Moul and Dr. Lee at Duke on March 19 for their opinion. I will ask why not do a parametric 3D MRI at Duke.

Thanks,

Robert 

Posted 3/1/2013 1:13 PM (GMT 0)
Irmaly,

If you see this, like you guys did, I have appointment with Dr. Moul and Dr. Lee at Duke on March 19. Guess I may tell Dr. Miller here I just want another opinion on course of treatment. I also talked to Jan at PCRI yesterday. She looked at my numbers and asked: (1) have you considered HT only - acknowleding the 4 but that it is small, and (2) why not do parametric MRI at Duke.

Obviously, as we all do, I want to go for closure of a cure. John T and Peter are encouraging that with my numbers that it is possible.

Robert

Posted 3/1/2013 2:24 PM (GMT 0)
Time, you should send your biopsy slides to Duke before your meeting with Lee/Moul if you haven't already.
Posted 3/1/2013 2:59 PM (GMT 0)
Irmaly, thanks, I did that this morning. I also asked them if they would approve a 3 Tesla or Parametric MRI.

Robert
Posted 3/1/2013 5:14 PM (GMT 0)
 

Time 101,

As far as traditional scans they often don't show mets, if they are micro sized.

We were told by our Urolo. to have RT for my husbands rising psa post surgery.

Everything I read said it (The tumor) has probably already escaped the capsule. We had traditional CT scans and MRI to abdomen and pelvis that showed nothing as they often aren't reliable.

 I took it upon myself to take my husband to Stanford for a second opinion and he was put in a trial. That's where we had the  F-18 pet scan, which showed 1 isolated micro-met to his spine.

I am not privey to the perametric MRI, so others may know more about that test.

You seem to be eager for info as I was, but stay calm and try not to compare your stats to others.

You could talk to several Dr's and often they aren't in agreement.

We also went to UCSF and Stanford and UCSF had differing opinions on what to do about my husbands met.

Do get 2nd opinions.

Good luck,

BOOGEE

Posted 3/2/2013 1:52 PM (GMT 0)
John T,

What did you mean by the underlined part?

Not quite. Brachy does a good job if the cancer is around the nerves or in the apex as these are areas that surgery often fails. If there are signs of extra capsular extension or high psa the adding is an excellent choice. Also adding IMRT for large volume tumors is also recommended. Every indication is that your tumor volume is small and there is no evidence that it is not contained, so brachy alone should be very effective.

Robert 

Posted 3/2/2013 4:05 PM (GMT 0)
Robert:

He left out a one letter and one word. I was tempted to use my awesome "Moderator" powers to fix it for him. But I didn't. I'm pretty sure he meant to say --

"If there are signs of extra capsular extension or high psa then adding IMRT is an excellent choice. "
Posted 3/2/2013 5:23 PM (GMT 0)
Thanks Peter,
When you become a Mod you indeed take on special super powers like mind reading.
JT
Posted 3/2/2013 6:03 PM (GMT 0)
Hi Robert. If you decide on surgery, Dr. Moul is the best. He is my Dr. and have been in the zero club since my open surgery.

Mika
Posted 3/2/2013 7:18 PM (GMT 0)
I meant to mention for what it's worth at this point that my biopsy path also noted:

Benign connective tissue
Benign stromal tissue

Meaning just a sample around prostate?

Robert
Posted 3/4/2013 1:39 PM (GMT 0)

I am still doing research. Entered my numbers on the updated Partin Tables. Based on my one 4+3 core, Partin shows probability of organ confined at median 60%. Not very good odds. I thought due to size (13% of core 5.5mm), chances would be better. At this point still undecided on Brachy/IMRT or surgery. However, have had some obsession to "get it out" quickly or do Brachy before it gets worse. Cataloni advises to have sugery six weeks after diagnosis. He also says HT before surgery causes scars that make nerve sparring more difficult and he doesn't recommend it.

What to do......

Robert   

Current age: 67
8/1/06 PSA 1.1
2/26/08 PSA 2.1 (exercise bike that morning)
7/30/08 PSA 1.3
9/19/09 PSA 1.5
10/28/10 PSA 2.2
5/4/11 PSA 2.3
1/10/13 PSA 6.6
1/28/13 PSA 5.3
(Was using 1mg finasteride a few years)
Dx'd 2/27/13, 2 of 12 pos., GS6 (3+3) 1.0% 0.5mm, and GS7(4+3) 13% 5.5mm
DRE neg., 39gm, 2/27/13--1-month Eilgard, then 3 mos. Lupron to lower PSA
and shrink prostate - then brachy or surgery.

 

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