HealingWell
Search Close Search
☰

joining the club

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 4/19/2018 2:44 AM (GMT 0)
Just diagnosed via biopsy, MRI T3 showed right paramedian peripheral zone apex showed ;nodule with extra capsular extension bulging on capsule. Rated PIRADS 5. Second lesion left peripheral zone, posterior lateral mid gland rated PIRADS3. Seminal, nodes and bones all appear clear.

PSA has been rising over several years, recently up tick to 9.15 from 7.89 6 months ago, before 7.06. . Three prior biopsy were negative.

Recent biopsy showed cancer, right medial gleason score 6, 1.9 % involved, tumor 1 mm, core 51mm

2nd spot right lateral core, gleason 6, involved 2.1 %, tumor 1mm core 48 mm and last

right paramedian apex, gleason 6, less than 1% involved, core 45mm no perineurial invasion ..none
identified.
Left side showed benign tissue
Relatively good news, my worry is the extra capsular extension any thoughts I am 71, in good health no symptoms leaning towards surgery just be done with it. Thoughts thanks I am just out of the panic mode
Posted 4/19/2018 3:32 AM (GMT 0)
Hello Slick7,

Welcome to the forum. Sorry to hear of the diagnosis but as you said, if you've got to get PCa, Gleason 6 is certainly what you hope for. You will have a ton of options to choose from in your case. I'm sure more guys with more experience in the lower risk category will chime in soon with some recommendations for you.

- Bill
Posted 4/19/2018 4:08 AM (GMT 0)
Welcome to HW, sorry you need to be here.

G6 is the good news. You have all your options on the table and you have plenty of time to decide what to do. Don't let anyone rush you into a decision (even yourself). Slow down, learn about your options, and get a few opinions from other docs. Surgery would work, but so would radiation - actually with the possibility of being extra capsular, radiation might be a better choice as the beam can be targeted to cover a wider area. RT is also less traumatic to the body. RT comes in a number of forms SBRT, Brachy (HDR and LDR), and IMRT.

In your place, I'd get a referral to a good RO and check out your options.

Andrew
Posted 4/19/2018 7:11 AM (GMT 0)
In my case, MRI was more accurate than later biopsy to point out that something significant was going on. I hope it is different for you, they are not 100% accurate yet and they require expert interpretation. You should ask your doctors about how much evident is the extracapsular extension. If it is clear and extensive enough, maybe surgery is not your best option because you would need adjuvant radiation anyway, specially if you are upgraded in the pathological report. In this respect, ask if your PIRADS 5 rate is just because of the capsule bulging, nodule extension, or there is restricted diffusion, low DC. The latter usually indicates a higher grade. We understand how you feel now but be sure you will have many bright days after treatment.
Posted 4/19/2018 9:25 AM (GMT 0)
Welcome and I echo the comment about slowing down. We have similar numbers and it took me 5 months of study to make an informed decision. Recommend you weigh the stress of the procedures, the likely side effects, and the cure rates before making a decision. I wish you well. Denis
Posted 4/19/2018 12:27 PM (GMT 0)
Slick,
You asked and I'll get to the point. I'm a surgery guy and most likely had the best outcome that you could ask for. So did my younger brother. However under your current data points surgery would absolutely be the very last consideration in my decision tree.
Good Luck
Hero
Posted 4/19/2018 1:01 PM (GMT 0)
If your worry is the extension and possible escape, surgery would not be warranted as it might not get all the cancer. Surgery is often not "just done with it".

In your very low risk case with so little G6 surgery would also be over-treatment. One of the radiation therapies would be much better for both cancer control and minimal side effects compared to surgery. You could treat in as little as 5 SBRT radiation fractions or one High Dose Rate Brachytherapy procedure. No hospitalization, no catheter for a week or more, etc. Also AS is very viable for you.

Take your time and explore the options that you haven't yet learned about.
Posted 4/19/2018 9:13 PM (GMT 0)
Thanks for all tour thoughts and info, still processing maybe no quite out of the panic mode Best
Posted 4/19/2018 9:31 PM (GMT 0)
Sorry about your diagnosis and the panic mode is very understandable. That said, I'm sure you already realize you may not make your best decision in panic mode. The good news is that with a G6 diagnosis, you have plenty of time to make a decision on what to do so you can investigate all of your options: surgery, several radiation options and active surveillance. Don't be afraid to take a few months doing this--PCa is pretty slow growing.

One thing I would suggest in the meantime is to get a second opinion on your biopsy slides from Dr Epstein at Johns Hopkins. This is easy to do and it will help validate that you are a low-risk G6 diagnosis. You can find out how to do that in the newly diagnosed sticky or just google it. Good luck to you!
Posted 4/19/2018 11:57 PM (GMT 0)
Hello Slick, and welcome to our club that none of us wanted to join before we found it. I'd also add my welcome, and have a few suggestions that I haven't seen yet in your thread...

At the top of the topic list there are two 'sticky' posts, one is called "newcomers, read this first", in there is a lot of good information that will fill in a lot of the holes in your knowledge.

Second, ask your diagnosing doctor to send your biopsy slides to Johns Hopkins, "Dr. Epstein's team" for second opinion. They are the best, and with their opinion, you will truly know what you're dealing with.

Third, try to relax and slow down. You've got low volume G6, which means that you've got the lowest possible diagnostic score. You have time to spend deciding what (if anything) you want to do. Active Surveillance is a legitimate choice for you. It means that you keep getting checked regularly to see if anything is changing. If it changes, you take action then. Many men with diagnosis similar to yours have been on AS for years with no changes.

If you DO need to treat, cure is in your vocabulary. Any of the typical treatment modes will work for cancer control. The key question is, what side effects are you willing to risk having? There are advantages and disadvantages to all the treatments, and you owe it to yourself to really dig in and learn as much as you can. A key point is that you need to talk to specialists in all the treatment modes. Urologists are almost always surgeons--and they can tell you all about surgery. Don't ask them about radiation, because they don't know as much about it. For radiation information, talk to an experience radiation oncologist (or more than one, there are multiple 'flavors' of radiation therapy--and each type has it's own specialists).

Most of all, hang in there, try to get out of panic mode and in to thoughtful decision making mode. You'll be fine.
Posted 4/20/2018 12:51 AM (GMT 0)
Welcome.

I'm sorry you have to deal with it at all, but you seem to be a perfect candidate for active surveillance.

Get a second opinion from Epstein.

Take your time! You have more than a year - probably years - to make a decision.
Posted 4/20/2018 2:22 PM (GMT 0)
Like all of the preceding posts say. Slow down and take it easy. Yes you have cancer but you also have a lot of time to do what needs to be done. It is also possible that nothing needs to be done other than keep a close eye on it.

You have a number of options, that if you do treat, will leave you feeling like this was a sweet walk in the park.

Just take this time to learn everything you can about PCa AND about who you really are and what you really want for the future. You can decide which TX based upon what you want for the future as you have options.

Be well.

Roger
Posted 7/23/2018 11:08 PM (GMT 0)
I opted for surgery on June 26, overnight stay, cath for week. Pathology increased to Gleason 3-4. clear margins, nodes clear, and the extension issue was still in the capsule. Recovery from DeVinci was very easy, up the day fo the surgery, walking the second and home by noon. The arrest part was the removal fo the drain tube. The cath was a inconvenient but managed ok, out one week after surgery.
Dealing with some leakage, but its getting better every day, nerves on one side were spared so we will see what happens in the future. For those of you not expecting it, there is some shrinkage, maybe 1/2 inch or 3/4/ due to the reattachment o f the bladder. Was expecting it so not shocked. Appears I caught it at the right time, AS would not have been good, had to do some sort of treatment. Wont do a PSA test for a week or so, for next appointment in Aug. Thanks to all for the information in the forum it all helped dealing with the cancer.
Posted 7/24/2018 7:10 PM (GMT 0)
Congrats on what sounds like a very successful surgery! Let us know how the PSA test goes.
Posted 7/24/2018 11:22 PM (GMT 0)
Great news on the recovery Slick7 and not breaking the capsule

Post Edited (KC342) : 7/24/2018 5:30:11 PM (GMT-6)

Posted 7/24/2018 11:36 PM (GMT 0)
Slick, glad to hear that the cancer was still in the capsule. I was another case where the radiologist looking at the MRI thought he detected a bulge, but after the prostate was taken out, there was no EPE and margins were clean. While MRI is good in guiding a biopsy, it doesn't seem very accurate in terms of selecting a treatment.
Posted 8/2/2018 4:38 PM (GMT 0)
First PSA came in Siemens .015 follow up with MD next week, hopefully all good best to all thanks for all the support
✚ New Topic ✚ Reply