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Met with doctor following biopsy showing Gleason 7

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Posted 3/8/2015 2:19 PM (GMT 0)
Met with doctor following biopsy on Thursday. Going for bone scan and MRI next Friday. My doctor is a Urogynecologist. He referred me to another doctor who is a urologist and was his university professor to read the scans when they're done. The more I think about this the more I get nervous. Is this standard practice or does he expect the worst by referring me to someone more experienced?

He was also discussing debulking and we don't even know for sure that it's spread yet. Why would he do that. Just preparing me for the worst? He said he wants to take an aggressive approach.
Posted 3/8/2015 3:31 PM (GMT 0)
Welcome to HW, sorry you need to be here.

Kind a shock to the system isn't it?

I can understand your doctor wanting to be aggressive. That's not a good PSA number. Don't want to scare you more than you likely are, but that's a high PSA number and would lead most doctors to worry if the the PC has spread.

Getting a second opinion on the biopsy report is normal and we always recommend doing that. Reading the results can be a bit subjective so it's best to get a couple of pairs of eyes to check that out.

The problem is that you don't know if it's spread yet and even the bone scan might not be conclusive.

De-bulking just reduces the tumor load and often helps to keep new mets from appearing (at least that is one theory). You should consider it - maybe a little radiation treatment.

I would think you need to be somewhat aggressive in your treatment plan and likely will want to do a couple of treatment modes at the same time (RT with HT, or something). What you really need to do right now is start learning all you can about this thing. Check out the sticky threads at the top of the forum.

Hang in there, you've got a lot of options and every hope for a good out coming,
Andrew
Posted 3/8/2015 6:53 PM (GMT 0)
I agree with Andrew.

It's premature to talk about debulking - let's see what the scans show.

- Allen
Posted 3/8/2015 7:43 PM (GMT 0)
Always good to get the scans done but even they don't always tell the whole picture. Best wishes to you.
Posted 3/8/2015 7:48 PM (GMT 0)
Hello, As 'Shop said, welcome and sorry that you need to be here. This is an excellent bunch of compassionate cancer survivors who will give you a healthy range of opinions and a great deal of first hand knowledge.

Receiving the biopsy results with the news that you have prostate cancer is a shock. There is a very human and natural desire to jump to a conclusion for treatment. Please set this desire aside for a bit and take the time to educate yourself on the options. An excellent way to start this journey is to purchase the third edition of Dr. Patrick Walsh's book _Guide to Surviving Prostate Cancer_ . Further, understand that you are in charge of selecting your treatment. Please be aware that there are some treatments that claim to be minimally invasive and offer bold promises for cure (high intensity ultrasound etc), you want the best that modern medicine can offer, not an unproven 'miracle' cure. Dr. Walsh's book is the best source for information currently and will help you evaluate the options and help you select the best one for YOU. Please also be aware that age and general health are important factors in your choice.

Even though it feels wrong, taking some time to evaluate the options is the right thing to do. Even if you choose surgery as I did, your surgeon will want to wait 8 weeks or so after the biopsy before surgery. This time allows the inflammation from the biopsy to subside and will make for a better surgery. If you do choose surgery, it is critical to choose a surgeon that has done several hundred of these operations. This is a complex surgery and you want someone who has mastered this procedure. Please stay open to the possibility of traveling to a large city if you do not have an experienced doctor and the necessary equipment for treatment in the area close to your home. Please also take the time to understand if there is a history of prostate cancer in your family as this can influence the aggressiveness of your treatment choice.

If you do not already use meditation or some other self calming practice, now is a good time to start. There is an older book that will teach you called _The Relaxation Response_ by Dr. Benson. This book and Dr. Walsh's book are available from Amazon.com and most book stores.

Please stay in touch with the excellent group of cancer survivors here.

With Very Best Regards, Pat

Diagnosed at age 55, very strong family history of aggressive prostate cancer (Dad, Grandfather, Younger Brother, Great Uncles all with early onset and young age at death, except younger Brother who is doing well due to early diagnosis and treatment with LP surgery) T1C, Gleason 6 (3+3) biopsy, RALP surgery 12-2014, Gleason 3+3 bilateral, PNI inside capsule, negative EPE, one positive margin, awaiting first PSA post op.
Posted 3/9/2015 7:20 PM (GMT 0)
Waiting for scans is very hard, I remember that as one of the worst times. Your PSA is high but there are some other features that might not be so bad in your case. I think that you need more information about your particular case.

For example, did they tell you whether they can feel anything unusual on your prostate? A uro should be able to tell if they can feel a hard spot or a lump of any type. That tells you the clinical stage and something about likelihood of spread. Also, if the tumor is only on one side of the prostate that could mean that it is not that big. So those are the positives or potential positives. You have a lot of cores with mostly grade 3 which put out the most PSA but are not that aggressive, another potential plus.

As far as "debulking" I remember seeing studies from Mayo that seemed to find that there was a benefit to surgery even in cases when the tumor was out of the prostate, even with some lymph node involvement.

Wishing you the best.

Tom

Posted 3/10/2015 6:26 AM (GMT 0)
Goatts, disregard my last post. I posted before I read this thread. Btw, welcome to the forum and I wish you good results from you scans.
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