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Just received results of biopsy

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Posted 4/26/2017 6:09 PM (GMT 0)
Ok all, I just came back from Urologist, and received results of my biopsy. He hadn't signed off on them yet so I cannot post the results. I can tell you this...my initial PSA was 7, the biopsy showed that every region of my prostate had cancer, I believe that was 11 of 12. My Gleason Score was 7. I am having a bone scan and CT on Tuesday to see if it has spread, although he believes 95% sure that it is localized.
He gave me 3 options:
1. Radiation seeds
2. Radiation seeds and external radiation
3. Removal of Prostate at Cleveland Clinic via robotic surgery
He said, "if it were me, I would have your prostate removed"......

Again, I am 64 yrs. old, in excellent health, very active......

Would most of you agree on having it removed?
Posted 4/26/2017 6:18 PM (GMT 0)
I'm so sorry that you find yourself in this situation. It must have been a shock to hear have much cancer they've found. However, it's still very treatable, so don't despair, you'll be fine.

It's very hard to give advice, it's such a personal choice. Me personally, I would not let them cut out my prostate, but you should weigh your options an dmake your own decision.

I think the urologist left another option off the table and that is HDR brachytherapy. No permanenet seeds and only two treatments, one week apart. Get second opinions and start talking to an Radiation Oncologist in your quest for the best treatment for you. It's not easy but we'll be here if you need us. All the best,

Hans
Posted 4/26/2017 7:34 PM (GMT 0)
It's definitely a personal choice as searchinla has mentioned. You have time to do the research, develop a strong opinion, and plan your own course of action.
Was the biopsy done at the Cleveland Clinic? It is a great treatment center for any of the options you have available to you.
Read the sticky thread about being newly diagnosed and that will provide with additional insight.
Hang in there, it's very treatable.
All the best.
Posted 4/26/2017 7:41 PM (GMT 0)
95% is localized...which is not the same as contained in the prostate...just so you know...you need treatment...follow your Uro's lead...or hang here for a bit and make an arguably more learned decision...based on the forums input.....which is what I would do...I stopped making suggestions on specifics of treatment... is it a 4+3 or a 3+4 gl 7
Posted 4/26/2017 7:42 PM (GMT 0)
UROs are surgeons, surgeons recommend surgery.

Find an RO and at least discuss your options with one. While surgery will work, the other treatments will too.

You should investigate each one before deciding.

Personally I went with IMRT because I needed to avoid surgery. It's been five years, SEs have not been much and I am happy with my choice.

Andrew
Posted 4/26/2017 7:46 PM (GMT 0)
You have other options. Are you in Cleveland?

First, have your biopsy slides sent for a second opinion by Epstein's lab at Johns Hopkins. It is important to have it confirmed.

Using your biopsy report, fill out the following nomogram that will give you a better handle on whether surgery is likely to be successful for you:

/www.mskcc.org/nomograms/prostate/pre-op

Good non-surgical options include:

• SBRT (5 external beam treatments). Kevin Stephans at CC can do this.
• Seeds with external beam radiation. Gregory Merrick at Wheeling Hospital would be a good choice.
• High dose rate brachytherapy - Alvaro Martinez in Detroit would be a good choice.
• Seeds alone - Jay Ciezki at CC is an advocate for this, but with your high volume, and especially if your Gleason score was 4+3 rather than 3+4, it may not be enough.
Posted 4/26/2017 7:49 PM (GMT 0)
I am considering a second opinion from Cancer Treatment Centers in Chicago. I have begun the process of them collecting my medical records, etc. Any opinions on CTA?
Posted 4/26/2017 7:53 PM (GMT 0)
Sorry about your diagnosis, but hope we can be of help to you. Pretty much everyone here has an opinion on treatment, but it is a very personal thing and everyone is different. Fortunately, PCa is very slow growing so you have time to talk to different doctors and get their opinions. In general, most doctors can only speak about their own specialities...uros can give you good info about surgery and radiation oncologists about radiation. And when it comes to radiation, there are different types so you'll need to talk to more than one specialist. With a G7 diagnosis, the chances of a cure are very good and all the treatment options have pretty much the same chance of curing you.

Can I presume you're in Cleveland? If so, hopefully some of the Ohio-based guys here can give recommendation on doctors that you can meet with.

Let us know the results of your scan (although it's very likely to be clean with your diagnosis) and details of your biopsy when you have them. Also ask for your biopsy slides to be sent to Johns Hopkins for a second opinion (the newly diagnosed sticky explains how to do that). That's very important since you do want to confirm that you're a Gleason 7.

Good luck to you!
Posted 4/26/2017 7:58 PM (GMT 0)
Thank you all so much...I am seriously considering Cancer Treatment Centers of America
Posted 4/26/2017 8:11 PM (GMT 0)
Enrico - I have not been to CTCA, but I am in the Chicago area and several members of my support group have gone there. They speak very highly of the center, in all manners (treatment, support, patient relations, just about everything). If your treatment includes low dose rate brachytherapy, Dr. Moran at CTCA is highly regarded.

They also have other consultants/advisors to help PCa patients. I have met their dieticians, their genetic counselor and their sex therapist when they came to our group meetings for presentations. All-in-all, a very credible clinic, if your chosen treatment is available there. (Mine was not.)
Posted 4/26/2017 9:46 PM (GMT 0)
Enrico - are you in Chicago or Cleveland or somewhere in between?
Posted 4/26/2017 10:06 PM (GMT 0)
Enrico,
Hello I have been to CTCA in Zion, IL (Chicago) eight time during 2014 and 2015 about every three months.
They all treat you very well. If you fly they pick you up at the airport in a stretch limo. If you go try to stay at Guest quarters North, 100 yards from the hospital and they own that hotel. My onc was Pesick a really smart guy from Boston. Every test result you get in one hour. Computers on 4th floor to login and get results before you see the onc team. I have recommended them to a bunch of cancer folks and they all were very satisfied. Your insurance might send you to another of their facilities for some crazy reason. I thought I would be going to Atlanta or Philly closer but I got sent to Chicago. I dont go anymore because I was paying for my wife's flights and then when I went on medicare I had to pay for both flights, got to know the southwest folks pretty well. One great facility
Posted 4/26/2017 10:33 PM (GMT 0)
I actually live in Canton, Ohio
Posted 4/26/2017 10:40 PM (GMT 0)
So Chicago is quite a distance, but Wheeling WV or Cleveland would be better for you.
Posted 4/26/2017 10:43 PM (GMT 0)
11 of 12 cores positive and he's recommending surgery? sounds right considering he's a surgeon. sorry man but I was 12 of 12 positive, G7, and i'm in my 7th year of remission so don't despair!

ed
Posted 4/26/2017 10:50 PM (GMT 0)
I was at the Cleveland Clinic Jan. 19th for a heart procedure. I can't say enough great things about the hospital. They're ranked 8th in the nation for cancer. (I looked it up).

Personally I lean toward the great hospitals which the Cleveland Clinic is one.

As was stated talk to an RO.

Best of luck.
Posted 4/27/2017 12:34 AM (GMT 0)
personal decision for sure .....but I vote for the radiation-bracky therapy...........less SE`s.......please explore ALL .....David
Posted 4/27/2017 3:14 AM (GMT 0)
Enrico,
I'm also a new-by and in a much different risk category; however, we did just recently spend more than two hours discussing treatment at Cleveland Clinic (CCF) with Dr. Rahul Tendulcar a RO. Can't say enough possitive things about our meeting. Extremely informative. Dr. Stephans is less involved in PC and we were referred to Dr. Tendulcar instead who's 75% PC and 25% other cancers. I don't think you would less served by speaking with Dr. Tendulcar. My wife and I were very impressed. I was given a number of recent studies regarding treating prostate cancer with both radiation and surgery at our visit. One recent study involving SBRT in the International Journal of Radiation Oncology was titled "Dose-Escalated SBRT for Patients With Intermediate and High Risk Prostate Cancer: Initial Dosimetry Analysis and Patient Outcomes". Possibly like your case? It was jointly published by both the Taussig Cancer Institute and the Glickman Urological Institute. Possibly you could request a joint consult with both a Surgeon and RO present to review your case. CCF is so close to Canton and it provides some of the best treatment you can find anywhere. With Stephans, Tendulcar, and Ciezki on the radiation side and Klein and Berglund on the Urology side why travel.
Posted 4/27/2017 5:15 AM (GMT 0)
Get some scans to really tell if the cancer has spread outside of the prostate. We just met with a 3rd Uro. today. We were feeling so good after meeting with the RO yesterday who actually said my husband was a better candidate for surgery because we didn't have a lot of opposing opinions. It seems that my husbands age, his really good health and contained but aggressive tumor makes him a good candidate who should have a great recovery w/o long lasting SEs. So maybe you fall in that same category.
But today the URO is really interested in seeing the 2nd opinion on the biopsy. He said it isn't totally out side of the realm of possibility that his cancer is downgraded because there is so little found in the biopsy. He said based on the data he is good for surgery but if the biopsy is downgraded then he wants to chat again. This guy has over 2000 surgeries so he obviously has experience.
Once again a dr has asked me if I work in the medical field because I had so much info so thank you Healingwell.com forum posters. However, we agreed that people that post often have a bias based on their experience alone. Always remember that many patients go off and have whichever treatment and are never to be heard from again. They are getting back to putting their lives back together. Get all of the information that you can and make the best decision for you. In the beginning it was totally overwhelming but as we got more tests and consulted with more drs things are starting to gel for us. Best of luck
Posted 4/27/2017 6:02 AM (GMT 0)
just diagnosed gleason 7 with one core out of 14 positive. any one know of surgeons in Florida with experience and low residuals here. Had biopsies done at univ of Miami with Dr Punnen. Will send slides to Hopkins for another reading. Thinking of total removal of prostate. thanks for your feed back.
Posted 4/27/2017 2:50 PM (GMT 0)
Taking the time to travel and discuss your case with several doctors not only provides the education but the ultimate 'peace of mind' you'll enjoy when you finally make this very personal treatment decision.

Up4thefight's last paragraph nails it!

All the best to you.
Posted 4/27/2017 3:22 PM (GMT 0)
I don't have personal experience with CCTA in Chicago. I do have a number of friends who have been treated at Cleveland Clinic and all did great.

I doubt that CCTA in Chicago would be worth the drive when you are so close to Cleveland Clinic. Certainly, if you want HDR (High Dose Rate) brachytherapy then Dr. Martinez in Detroit is tops. I used HDR and have done wonderfully. I did not have to travel to have it done, I live in Atlanta.

The doctor in Chicago that specializes in permanent seed brachytherapy, Dr. Brian Moran, is not at CTCA. He has his own practice, The Chicago Prostate Cancer Center. If you are going to Chicago I would suggest seeing him. But the reputation of the much closer doctor in Wheeling (Merrick) would draw me there instead.
Posted 4/27/2017 3:34 PM (GMT 0)
To weigh in further on treatment options.

You appear to me to be an excellent candidate for both SBRT external beam radiation and either permanent seed or HDR brachytherapy. These are all better than surgery, especially if any of the cancer is at or beyond the surgical margins as the radiation covers a larger area than the surgeon can cut. The radiation treatments also present significantly less severe side effects than surgery. For you surgery will not be better for cancer control but will be much more invasive and injurious physically.

Regarding external beam radiation, SBRT can be done in 5 or 6 procedures (fractions) versus 35-40 for IMRT/IGRT. Much more convenient for you and less expensive. I was just with a friend over the weekend that had SBRT and he is doing great.

Regarding brachytherapy, the HDR is a bit more precise and conformal than permanent seeds and does not leave the radiation in permanently. Both are very effective in your situation. I had both to choose from here in Atlanta and I chose the HDR.

I suggest you look for the treatment that gives the least amount of side effects and is most convenient for you in terms of time and travel. You are in a great area and I don't see any advantage to going to Chicago to a clinic that has nowhere near the reputation of either Martinez in Detroit, Cleveland Clinic, or Merrick in Wheeling.
Posted 4/27/2017 3:45 PM (GMT 0)
Take your time and be at peace with your decision. I would get second opinions on the slides and treatment. You only have one shot at this. You can read what I went through by clicking on the link in my signature. It's quite a shock to most (I know it was for me) to get "the news", but you are going to be ok.
Posted 4/27/2017 3:47 PM (GMT 0)
So Enrico...is it a 4+3 which means there is more grade 4 or a 3+4 wich means more grade 3 than 4...both are considered gl7 the later is lower risk than the former...ask your doctor
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