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Posted 12/4/2014 9:19 PM (GMT 0)
well here I am.

Age 57, in Chicago... like the deer in the headlights

PSAs
5/14 4.5
8/14 3.9
10/14 6.7

Biopsy- 11/13

5/ 12 samples showed cancer (25%, 25%, 40%, 50%, 60%) all on right lobe, thus I am T2b

One perineural invasion identified on 60% core (how significant is this??)
I was all GL 6.

trying to figure all this out alone.. no family/spouse etc...

Brachytherapy (Mono only , not interested in external combo) seems like a good option ??? but with my status?? Am I low risk or low medium risk? and what about the PNI?

open to da vinci consideration....

am I allowed to ask whos the best for me? Man this sux

Thanks to all and grateful to find this site of help and support.

MS
Posted 12/4/2014 9:31 PM (GMT 0)

You are at the correct place.  Lots of really informed people here that can answer questions.  Just remember that you need to independently verify all the info exchanged here.  I always recommend the following:

1 Get an evaluation at a nationally recognized cancer center

2 Get an independent 3 party analysis on your prostate tissue

 

Best of Luck,

Hero

Posted 12/4/2014 9:37 PM (GMT 0)
Welcome to HW, sorry you need to be here.

It's a shock for sure to get that news. Takes a bit to wrap your mind around the whole thing.

That is low risk stuff and brachy would knock it out. It's a good choice. Lot of guys here have gone that route and done well. If the brachy doesn't get it all, then you've got the choice of a beam RT follow up to finish the job. I see no reason to be attacked by surgeons.

Did you talk to your doctors about AS, active surveillance? If you're low enough risk and being G6, there is a possibility that you'd be okay delaying treatment for awhile (years maybe).

Hang in there and keep us updated on your progress.

Andrew
Posted 12/4/2014 9:43 PM (GMT 0)
I'll also welcome you BenSam - and before covering more ground or giving input I'll simply state in this post that I'm also 57, work in Waukegan IL and was treated in the Chicago area with LDR Brachytherapy/Monotherapy.

Others will chime in shortly giving good advice and direction; I'll also be back to hopefully provide some help and reassurance.
Posted 12/5/2014 12:08 AM (GMT 0)
Hello Ben and welcome. Sorry you have to be here. Right away I'll recommend that you read the sticky thread that is designed for newly diagnosed patients. www.healingwell.com/community/default.aspx?f=35&m=2652250

Continuing your education, you might want to pick up Dr. Walsh's book, "Guide to Surviving Prostate Cancer" as well as Dr. Scholz' book, "Invasion of the Prostate Snatchers". You probably should also get a re-reading of your slides done by a real expert such as Dr. Bostwick of Bostwick Labs or Dr. Epstein at JHU.

I understand that you are interested in brachytherapy and, based on your stats, that should provide a good cure and minimal SE's. But, you should do your due diligence and speak with an experienced surgeon as well. If you do decide on brachy, there are members here (e.g. Yooper) who have been very successfully treated in Chicago and will be happy to give you info.

Best to you,

Jim
Posted 12/5/2014 1:31 AM (GMT 0)
Ben, welcome and sux that you are here, but in your situation you'll find this place to be amazingly helpful in more ways than one.
I'm new as well almost 4 weeks from diagnosis. I have had a very hard time dealing with this as I'm sure most here HQVE in the beginning, so know you are among people that empathize with the fog that you are probably in.

Tudpocks advice on the two books, AND the second pathology opinion are two things you definitely should do. Alan make sure you explore , at least look at and learn about, ALL options. That's something I learned here

The only other thing I can add, is that FWIW, in an email conversation today with dr Epsetin at JOhns Hopkins, who is one of the foremost experts in Prostate cancer pathology, he pointed out to me that having all the positive cores on one side as you (and I) do, is a "favorable finding" (his words),

So start educating youself, while looking for positive things to grab onto as you pull yourself out of the fog. I'm still in that process.
Posted 12/5/2014 1:55 AM (GMT 0)
BenSam,

It's a confusing time when one is first diagnosed. PC is different from a lot of other cancers in that there are choices for the patient to make, and the choices (other than Active Surveillance) are irrevocable. The thing that's different that's in your favor is that it's typically slow growing, especially likely given your current diagnosis. So breathe, and take your time with this.

It's a very good idea to get a second opinion on your biopsy slides from Bostwick or Epstein, even if you have to pay out of pocket. There are links in the sticky Jim referred you to.

I won't throw a lot at you yet, but I'll try to address a few statements you made.

BenSam said...
5/ 12 samples showed cancer (25%, 25%, 40%, 50%, 60%) all on right lobe, thus I am T2b

No. Staging is irrespective of the biopsy. It is usually based only on the DRE. Most men are clinical stage T1c - unremarkable DRE.

BenSam said...
One perineural invasion identified on 60% core (how significant is this??)

Not significant at all. It's a very common finding on biopsy that doesn't much affect the prognosis.

BenSam said...
Am I low risk or low medium risk?

Assuming your DRE was unremarkable, you are low risk. That means you qualify for Active Surveillance (on many programs) and all the radical therapies: surgery, SBRT, IMRT, LDR brachy, HDR brachy and protons. Which is the best for you depends on you, and no one can answer that for you. You have to do a frank self-assessment to figure out what's most important to you, and weigh that against the risks and benefits of each treatment. I did a lot of soul-searching, a lot of information gathering, and a lot of interviewing of doctors (6, I think). BTW - I was the same age and single at diagnosis, and maintaining potency was my most important consideration, given that all treatments are equally good at curing low risk disease.
Posted 12/5/2014 1:57 AM (GMT 0)
Welcome to the forum,BenSam. Keep reading, keep posting your questions, and keep breathing.

Tim
Posted 12/5/2014 2:00 AM (GMT 0)
Hello, and welcome to HW PC, Ben. As others have said, sorry you need to be here, but glad you found us. You have already been given some super advice, my best to you, and will continue to look for updates on your PC journey.

David
Posted 12/5/2014 4:16 AM (GMT 0)
PNI is significant as a prognostic tool{ mainly on higher GS scores} on biopsy as it can, operative word can, open a way for an escape from the prostate. Having said that, on post op pathology I had intensive pni, but prostate contained pca. Some here think it should be prognostic on post op path for spread but the "medical community" says only on biopsy. this is not to say that some respected medicos in fact do not agree with "medical community"
It has only been in the last 3-4 years that it has been even reported on biopsy even if found. Have no idea if they have always reported it on post op path. One thing to note as a newly diagnosed. Controversy is an inherent factor in much of this disease. So read, study as many books as yo can on it.
Be your own advocate. There is much technical knowledge and a whole lot of misinformation on this or any forum. There are no md's here, who are the ones who have the credentials to diagnose or prognosticate. Keep that in mind, but make those doctors make you understand what they are saying.
Posted 12/5/2014 5:07 AM (GMT 0)
BenSam: Welcome and rest assured you have come to a great place. The brethren here not only know from experience but are students of all things PC.

Brachy Thearapy monothearapy is an excellent choice with outcomes on an even keel with the most successful PC procedures. Below is an informative BT link that takes you through the entire procedure and includes charts showing long term survival rates.

Best wishes to you and please keep us up to date.
Posted 12/5/2014 4:44 PM (GMT 0)
Ben, the best remedy is Active Surveillance for those who qualify as all other treatments have various side effects.

In the Chicago are, Chicago Prostate Center and Dr.Brian Moran is the one I would recommend, plus there are others affiliated with Northwestern Univ that I am not as familiar with like Dr.Catalona who I have heard speak.

A friend who does not post here but does on the Inspire.com site under username CEricWin is in same situation, no family in area. He is active in the Chicago suppport group that meets monthly on second Tuesday as I recall at Weiss Hospital 6 PM.

It is headed byDr. Bhalani, a urologist. I attended the July meeting when I was in the area to visit my daughter.

So you can join Inspire.com and friend Eric to get the particualrs and make a local friend who is also dealing with PCa alone.

LupronJim
Posted 12/6/2014 6:11 PM (GMT 0)
Chicago/Midwest PCa Support Group

This was just posted on Inspire.com

This Tuesday, December 9, our monthly PCa Support Group is meeting at Weiss Hospital in Chicago.

This group is open to all, and is moderated by Dr. Bhalani, a very competent urologist. The group is small, so you can get a lot of individual attention, and there is usually a handout of the very latest in PCa treatments and meds.

We meet at 6:00 P.M. in the 8th floor conference room. Just take the "A" bank of elevators near the hospital's main entrance.

Weiss Hospital is associated with the University of Chicago, and is located at 4646 Marine Driver, just off Lake Shore Drive, between Lawrence and Wilson. For those who would take public transportation, the 81 Lawrence bus stops directly in front of the hospital entrance.

I hope to see you there. If you have any question about the meeting, you can call me directly

Eric; 773-xxx-yyyy (email LupronJim to get eric's phone number that I lanked out) or email Eric through the Inspire.com site.
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