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Wife of New Club Member

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Posted 3/12/2015 8:55 PM (GMT 0)
Hi Everyone,

I've posted a couple of times as a concerned spouse, but thought I would post a new thread here as the wife of a newly official member of the club.

Here is the path as far as I understand it, so your take on things and our plan would be great. The collective wisdom here is awesome.

Age 57; Health excellent (weight, exercise, etc.)
PSA 5.27; %fPSA 14.4
8/20 cores %
Gleason: 3+4
Clinical State: T1c
Pathologic Stage: T2c
-There was a lot of variation regarding % involvement within each core: 5% 5% 10% 50% 50% 60% 80% 90%
-All of the cores except 1 were Gleason 6 (3 + 3).
-There was a note saying: The Gleason grade 4 component involves approximately 5% of the tumor.

The total volume of the prostate is small: 19.5

Right now we have requested a second read with Dr. Epstein.

Sooooo... we have a scheduled appointment for a day-long clinic at John's Hopkins on April 3rd. Right now my partner is considering RALP or Brachy. Both Dr. Alluf and Dr. Song will be there, and we are told that they're generally scheduling out about 3-4 weeks (so early May).

Any thoughts? Is this putting things off too long? Should we have more consults? Do they seem like good choices?

Pretty tough day here. Thanks to everyone for the collected wisdom.

Best,

pjr (real name is Mary)
Posted 3/12/2015 9:21 PM (GMT 0)
Sorry to hear about that report.

You'll be in good hands at JH. Glad you get to see both doctors. I wouldn't think about other consults until you've talked to those two. You may or may not need to after that.

PC is a slow growing cancer so the timing is nothing to worry about - very normal in fact. You're looking at two good options. Personally I'd be leaning towards Brachy - less recovery time, fewer SEs and just as good a outcome.

The thing that will drive you nuts is that both are good options and you're likely in that curative zone.

and this is likely a big shock to your system. Take some time to adjust to the news - this is as much a mental game as a physical one.

Hang in there and keep us updated on your progress,
Andrew
Posted 3/13/2015 2:15 AM (GMT 0)
Hi Mary,

Welcome- and I'm sorry to hear the biopsy results. They put him in the category called "favorable intermediate risk." (I don't know what you mean by "pathologic stage T2c" -- pathologic staging is only done after a prostatectomy, so I assume he is stage T1c).

With his favorable intermediate risk, he is a good candidate for surgery, LDR brachy, HDR brachy, and SBRT. You have to talk to experts in each of those - I don't know if Johns Hopkins has experts in SBRT or those brachytherapies. All of them, in expert hands, should cure his cancer. Johns Hopkins is (rightly) famous for surgery, so it behooves you to get other opinions. You have time to get those opinions, so please don't feel pressured to decide immediately.
Posted 3/13/2015 3:45 AM (GMT 0)
Hi Mary and sorry you need to be here. But please try to take some solace from your husband's favorable diagnosis. (If you can call any sort of cancer a favorable diagnosis...)

Glad to see you already have your slides out to Epstein, which is textbook. I would recommend you continue to investigate all different types of treatment. Since your husband is likely to be cured by ANY treatment, learn about their SE profiles (both physical and psychological) and which you think you can best deal with. Everyone is different there. And there's a world of difference between everyday Uro and ROs those that have PC expertise--both in their skill level and their breadth of knowledge. In my mind, no reason you shouldn't have the best!

Good luck!
Posted 3/13/2015 8:14 AM (GMT 0)
Mary,

Sorry to hear about the full membership. In going to Hopkins you have chosen one of the best over-all programs available anywhere. Your husband's cancer is curable via a number of treatment options. Make sure he has thought about, and is ready to talk about, the importance to him of avoiding various side effects such as ED or impotence when he meets that panel of doctors at Hopkins.
Posted 3/13/2015 4:20 PM (GMT 0)
Thanks so much, everyone, for the helpful suggestions.

Learning, learning.... I think we're lucky to be within a half-day's drive to Johns Hopkins. I'm thinking that Sloan Kettering might be good to look into to maybe get one more take on radiation options (it's about 4-5 hours away). Maybe this is overkill...

In terms of "pathologic stage," I don't know what this means either. The urologist seemed to imply that it was because cores on both sides were involved?

So the path says: "Clinical State: T1c" and "Pathologic Stage: T2c" I'm not sure what to think.

I'm worried about the % positive in many of the cores, but the uro seemed to think that the fact that only 5% of one core was 3+4 it was a good thing (with the rest being 3+3). Any thoughts on this?

Finally, I don't know if it's of relevance or not, but all of the biopsies wrote "no perinueral invasion seen." Is this generally good news, you think, or just pretty routine?

Learning so much.... Thanks everyone.

Warmly,

Mary
Posted 3/13/2015 4:45 PM (GMT 0)
Mary, frankly, JH has such a good reputation that I wouldn't spend much effort into look at alternatives right now.

no perinueral invasion is good news. You've got a good URO there, I don't see a reason to argue with him.

You'll get a lot of answers at your next JH appointment. It's easy for us to say 'don't worry,' but you and your husband are in good hands, relax a little. It won't be fun, and normal will change but soon you'll have the PC thing beat.

Andrew
Posted 3/13/2015 4:51 PM (GMT 0)
If you have not read Dr. Walsh's book "Surviving Prostate Cancer" now would be a good time to do so..Dr. Walsh works at J-H......
Posted 3/13/2015 5:30 PM (GMT 0)
You can't do much better than JH for surgery.

I would schedule an appointment at MSKCC with Dr. Zelefsky to talk about brachy - he certainly is one of a handful of leaders in that.

Are you near DC? If so, you might want to discuss SBRT with Sean Collins at Georgetown.

- Allen
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