Biopsy results are in, joining the PC fight

Just a quick update, we will be going to Little Rock tomorrow to meet w/ another urologist. Fingers crossed we can get more information and will have more confidence in this physician. I'm halfway through Dr. Walsh's book and the more I know the less I know if that makes sense. Hopefully, we can get all the puzzle pieces put together tomorrow and come up w/ a plan. I have 4 handwritten pages of questions so far. At least this time we're going in prepared and know what we're dealing with. Miki

Breathe. Keep reading. Keep asking questions. You have time, really. You have time. My husband was diagnosed in August--we spent time on second opinions, researching, had tests, had more tests, came up with a plan, went on a transatlantic cruise we had scheduled (!) and then started treatment in late December!
We BELIEVED the folks on this thread and others AND the Walsh, Scardino and Myers books. We believed we had time. We believed we had to be our own advocates. We believed doctors might steer us in the direction of their own expertise. And that the choice was ours, not theirs.

Our world changed when we found a medical oncologist with the perspective and smarts to put it all together, including all the doctors and tests. We are following her plan.

Breathe. You are going to have your husband around for years and years and years. He will see your son married. He will know his grandchildren. You caught this early and you have time.

 

ARangel14 said...
... but main concern now after rereading path report is the PNI and the risk that the cancer is outside of the prostate. From what I am reading it is usually always an indicator that the cancer is not contained.

No, PNI is not "...usually always an indicator that the cancer is not contained."

A Yooper's comments are solid, however, and in general PNI presence nearly doubles the likelihood (the statistical probability) of T3 disease (tumors that have broken through the capsule).   This does not, however, mean "usually always."  The literature is, in fact, a bit inconsistent on the affect of PNI, and in some cases it's unclear whether it was PNI, or the generally higher grade cancers (which your husband does not have) which have led to recurrence.

Here's a simple-to-read description of PNI considerations:  http://advancedprostatecancer.net/?p=3750

We met w/ the urologist in Little Rock yesterday. Much more experienced than the one we fired and sat for 45 minutes going over all reports, questions we had, and options. He broke down every single option available and described in detail why he did or did not think a certain option would be the best treatment. His recommendation is the DaVinci but was not opposed to radiation which he did say would carry a few more risks in my husbands case which would not make him the "best" candidate but still stating it is an option and asked if he wanted to meet w/ the team at that clinic. (Past history of colitis being the main concern and would have to also involve a GI team to run through some tests, again stating that did not rule out radiation). After talking to him and asking all the questions hubby still believes that surgery is best option for him, he just can't live w/ the prostate staying in, and wants the peace of mind that it's out. (Supporting him in this decision as I would support him in any decision he makes). Our urologist has performed over 2000 DaVinci surgeries and gave percentages of complications specific to his patients which all fell into the under 2% range (infection, blood transfusions, and incontinence after 6 months). He believes that husbands cancer is aggressive and is mimicking a less aggressive cancer based on the fact of it all being on biopsy all to one side, PNI, and that low testosterone can lower PSA. He also said in his experience that aggressive cancer can throw low PSA numbers (which echos everything in Dr.Walsh's book that I've read). In his opinion he said we could probably double initial PSA and that would be more realistic although that was just his opinion. He is still optimistic that cancer is contained but will be removing lymph nodes as a precaution (this may only be on left side, I can't remember). We are waiting on clinic to call to tel us date of surgery. He clinically staged him at T1c which we know can change w/ pathological staging. Will keep you guys informed! Please don't tell me we are making the wrong decision in choosing the surgery because hubby is determined it is what he wants so now I need a lot of support as we start on this journey!

Well you sound 100% better than you did just days ago. So much more informed and the doctor sounds perfect.

It was a great relief when I decided on my treatment plan. From that point forward it was straight ahead and no second thoughts.

I re-posted a great thread about preparing for your treatment plan. It is called "Really useful tips". I just bumped it to the front page. I found it 1 week before my surgery and it was very helpful to me.

Bill from Florida

Some times the hardest part of treatment is decided what to do. Sounds like you've made a good informed decision - that's the important part.

Surgery won't be fun, but you'll both get through it just fine.

Hang in there and keep us updated on your progress,
Andrew

Surgery will be Dec. 3. Wish it were sooner but again, when you live in a small state and you're using the best in your state I guess you have to wait. Anyone else have to wait a while before they got scheduled for surgery? Anyway, it's been very helpful reading some other posts of what to expect after surgery, at least that gives us more time to prepare!