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Posted 9/21/2007 12:38 AM (GMT 0)
I have been reading posts on many forums for days as I have tried to get a handle on what is ahead for me. This board obviously has many caring people that provide a valuable service to those like me who are a little overwhelmed with this PCa thing, so I decided that I should start asking the experts for advice. Well here goes.   As you can see from my signature profile, I have gone from a 1st ever PSA of 4.6 less than a year ago to a PSA of 13.8 in July. I had a positive biopsy with 1 of 12 cores showing 1% with a gleason of 3+3=6. The PSA number really concerns me, but my urologist doesn't seem that concerned about the number. The current plan is to do another biopsy on October 10th, but I am starting to wonder what value another biopsy will have. When my urolgist and I discussed another biopsy as a next step, the thought of "watchful waiting" was sounding pretty good to me. He said we could do another biopsy, and make decisions based on the results. Now that I read in Dr. Walsh's book that I am in the 1% of the population of all men age 50-59 that have a PSA of 10 or higher, I am feeling that I am not going to have the luxury of waiting.   I have many questions, but I will limit it to 2-3 for now. Should I have another biopsy, or forget that and move on to the treatment stage? Would there be a value in getting the biopsy slides read by someone else instead of having another biopsy?   Last question for now. Does anyone know of a DaVinci surgeon in the Atlanta area or in the southeast that has done many of these procedures and is recognized as a leader in this field?   Thanks for all of your help. Walter   Age 58 10/06 - 1st PSA ever - 4.6 11/06 - PSA retake - 5.3 12/06 - Biopsy, 12 cores - negative 7/07 - PSA - 9.0 7/07 - PSA - 13.8 (after 10 days antibiotics) 8/07 - Biopsy, 12 cores, 1 positive @1%; Gleason 3+3=6 9/17/07 - Bone scan - negative 9/18/07 - CT scan - negative   Post edited to correct format on this thread..due to extensive length on link below... : ) Post Edited By Moderator (bluebird) : 9/23/2007 7:13:01 PM (GMT-6)
Posted 9/21/2007 1:32 AM (GMT 0)
nono  Walter

Welcome to the party no one wants to be at!  You are a young man with a very treatable cancer.  Watchful waiting is a treatment, IMHO, reserved for the 80 year old patient.  You have many years ahead and you need to BEAT this monster.  You have CANCER, if you get the right treatment you WILL HAVE HAD CANCER!  Reading Dr. Walsh's book was a very good start, now you need to decide on a treatment, and find the best Dr. to treat you. 

I looked at all the options, even went to the Cancer treatment centers of America (which I DON'T recommend), and even the radialogist said surgery is the best option for me. I got it out, and I can always have radiation if my PSA goes up. Remember you only get ONE chance to get it right. To have your PSA double in less than a year is NOT a good sign, and waiting will only make it worse.  Your Gleeson is low, that is a big Plus.

Knowing what I know now, I would MOVE FAST!  WHAT will you gain by waiting?  This is the question you must answer.  Don't assume the DeVinci procedure is the best option for surgery.  My surgeon has done over 3000 open procedures, his comment was he can feel, and see things a machine may miss.  I had very little discomfort, and NO pain at all.  Mr. cath was the thing I hated.  Keep your eye on the goal.  Dr. Scardino's book is also a good read.

Good luck, email me if necessary.

Posted 9/21/2007 1:36 AM (GMT 0)

Hey triker, maybe your uro wants to do a 'free and total' psa.  I lack the knowledge, or experience to be of any assistance.  As others will say, welcome to the place nobody wants to be, but better here than not.  Hang in here and do your research and you will make the correct decision.

Best,

Bill

I'm a radiation guy, so I can't help with the surgery stuff.

Posted 9/21/2007 2:35 AM (GMT 0)
Hey Triker,

Once a biopsy shows cancer there isn't much use in another biopsy unless its for some other kind of test. Perhaps have it read by another pathologist if you aren't sure about the current one.

As soon as I got that message from my doc, I wanted it out. So one month to the day after the diagnosis I had open surgery. Now if it comes back I can still do radiation if needed. I believe in keeping as many options open as possible. I chose open surgery instead of robotic because I had lots of confidence in the surgeon. He did a masterful job. I was continent the day after the catheter came out and am conquering ED with the help of drugs. I had very little pain after the surgery and was up and walking the day after. I went back to work teaching school 3 weeks after the surgery.

There are lots of options for treatment. You are doing research and taking control of your future. Thats a big hurdle. Now be patient, study, ask questions and make a decision.

Good luck and please stay with us...

Jim
Posted 9/21/2007 3:09 AM (GMT 0)
Triker, My Gleason was higher than yours ( 3 + 4 ), but my PSA was lower although going up fairly fast. My URO was real experienced in open surgery and Cryogenics, however I opted for the da Vinci procedure. My URO scheduled an appointment with Dr. Dasari in Nashville, TN. I was operated on 9 weeks after my biopsies. If you wish go to my post and read about my results. I have tried to post my progress frequently. If you have read Dr. Walsh's book I think you are off to a good start. God Bless, Uncle Dan
Posted 9/21/2007 6:04 AM (GMT 0)

Hi triker, we're sorry that you were diagnosed with cancer.  We are really glad you came to what I believe to be a very caring forum.  There are a lot of good folks here who can help and support you.

I agree with the rest of the vets here, that once you're diagnosed with cancer, you probably have it.  However, it does not hurt to get someone else to read your sides and get a second opinion. 

In my case, I had a PSA of 1.1 in October 2006 and 4.3 in April 2007.  I was very religious about getting a PSA test every year since I was 40 (am 54 now).  My PSA's never exceeded 2.0, so I was pretty shocked at the quick rise in just a few months.  My PSA was still "borderline", but my urologist/surgeon used her intuition and decided go ahead with a biopsy.  She found cancer in two samples, <5% of each sample.  By the time this biopsy was done and the results came in (June), I had already researched my options in case I found that I had cancer.  The doctor told me she liked to do surgery for cancer likely contained in the prostate and for men as young as I, but that I should listen to what the radiologist had to say too, and make my own decision.

I later chose the da Vinci surgery and scheduled a firm date.  It made me feel I had a direction.  Then I sought opinions from other urologists I knew and trusted.  Not only did they highly respect my surgeon, but they thought that the choice of surgery would be very good for my chances at a "cure" or long-term remission.  So... I stuck with the surgery and I am very happy with the entire process.

Hang in there, and I wish you the very best in your decision making process.

Kind regards,

Barry (Idaho)

Posted 9/21/2007 11:05 AM (GMT 0)
Triker,


Welcome to HealingWell.
Your new friends here know that the information, data, and decisions seem overwhelming.

I agree with others here that you should get a second opinion.
Make an appointment with the most reputable facility you can access.
They will review your slides and your decision process.

While your low gleeson and one small positive core suggests
  that you can take some time to decide on treatment,
(and the high PSA can just be inflamation)
 -the third biopsy can't give you a lower gleeson.
Unfortunately, as others have said, 
  even a clean biopsy won't exonerate you from that one positive core.

My suggestion to move forward with your treatment choice is based on
 the idea that we don't get any younger and in most cases are healthier now.
The more robust your health, the faster you will fight back to your pre-treatment
  lifestyle.
Your numbers suggest that you can wait and get another biopsy.
I personally wouldn't wait more than 4 months as -
  -except perhaps for the 64+ core saturation biopsy -
   - any biopsy can miss a cancerous growth threatening the edge of the capsule.


There are a lot of very good treatment facilities in the Atlanta area.
If a post-treatment biopsy were to indicate capsular pentration, 
I personally might then consider travel to other locations
(e.g., M.D. Anderson, Johns Hopkins, UCLA, etc).
Even still, you may very likely find your best treatment options near home.

You could do something similar to what I did:
Usually scheduling a treatment option involves almost a two month wait.
Go ahead and schedule your treament choice
  and while waiting  in line for treatment,
   pursue your second opinion  and   continue researching your treament options.

Your pro-active attitude towards your health has undoubtedly served you well.
This fight can certainly make you feel sad - but never give in to despair!
We, your new friends here, always hold out hope for each other.
Hope for radical, quantum leap blessings & miraculous health. :-)

CCedar
ICTHUS!




 


Posted 9/22/2007 1:46 AM (GMT 0)
I want to thank everyone for your support and for all of the responses to my first post. I am mentally moving myself towards no additional biopsies, and just having the prostate removed. I was able to find Dr. Scott Miller (anyone heard of him?) in the Atlanta area that does Da Vinci surgery. According to his office, he has done more than a 1000 operations. I made an appointment with him for a consultation on October 5th. I am hoping that shortly after that appointment, I will make a final decision on "how to get the sucker out". I do like my URO, and he has done hundreds of open surgeries, so I may still decide to go that route. If you had asked me a week ago, I would have told you that I was going to have seeds and radiation done at Radiotherapy Clinics of Georgia, so everything I post is subject to change.

Thanks again for being there. As others have stated, I think that once I get beyond the treatment decision point, I will be more at peace with things.
Posted 9/22/2007 11:11 PM (GMT 0)
Hi Walter,
If you have a positive sample then have it checked by another pathologist. Just have the existing slides sent to be examined. You might want to consider sending to Johns Hopkins as that pathologist there is considered the best. But that stated, waiting to take another biopsy is bad advice. Wait for another biopsy? And what? Find out it's spreading? You would be better served by another doctors opinion than a second biopsy. The rate your PSA is climbing indicates possibly more invasion that a 1% core sample.

Tony
Posted 9/23/2007 1:54 AM (GMT 0)

Hi Triker

I can appreciate your delimma, especially when your biopsy indicates that you may well be in a very early stage of PCa, but the high PSA seems to be a contradiction somehow which needs to be explained.  One of the constant concerns I have about biopsies is that the uroligist very often only take 12 or fewer core samples.  In your case, especially, it is important to take enough samples to hopefully better determine your stage of cancer.  I believe that the minimum recommended number of biopsy samples is 20 (my biopsy was 29 taken by a top urologist at a major hospital).  From what I have read, it is possible to miss cancer in the prostate if too few samples are taken.  While it seems unreasonable to have to subject yourself to a 3rd biopsy in a relatively short period of time, you may want to do this and have your urologist take more samples to hopefully give you more definitive results this time.  There is no question that you need to get a 2nd opinion of you last biopsy and Johns Hopkins is considered one of the best for doing this. There is also no question that you should also get a free PSA test and I am surprised that this was not already done unless you failed to mention it.  In my case, I had a free PSA of 27 with a PCa risk of about 18%--unfortunately I feel into the 18% group.  The lower the free PSA, the greater the risk.  It appears that you have adequate time to make an informed treatment decision once you are satisfied with your last biopsy or a 3rd biopsy if you so elect. Good luck to you.

Dave


Posted 9/24/2007 1:27 AM (GMT 0)
Hi   ~ Walter and Loved Ones ,                   W elcome to…                                         ~ HealingWell ~                                                                         and                                     A    “ Special ”    Warm Welcome   to   You !   Knowledge gives us POWER….   POWER takes away the fear.     v       bluebird ~   Moderator for Prostate Cancer Forum http://i206.photobucket.com/albums/bb179/mamabluebird1955/mamabluebirdWelcome.jpg   Click here for… Prostate Cancer Resources, Helpful Hints , and Topic Thread Links This link is also located at the top of the HealingWell’s Prostate Forum where topics (threads) are viewed   ;)
Posted 9/24/2007 1:36 AM (GMT 0)
    Hi   ~ Walter,       We know ~ we can “all” make “Your Journey” smoother just by being here for you!   This is truly a great forum!!! ~ You have joined!  You are now part our forum family ~ a group of wonderful individuals who are so willing to share...   It helps “all of us” ~ to help you ~ if we know where you are on your path. So ~ Please stay with us and take our hand when you need it!   Keep posting.... OKAY!!       KNOWLEDGE     IS     POWER   ...   and   POWER conquers   fear   YOU MAKE THE DECISIONS… YOU HAVE OPTIONS… ~ and ~ Your decision will be the right decision for you!!!     Thank you for the wonderful signature…this helps all of us to know where you are on your journey.  This path is best traveled with friends.   The stepping-stones ahead will be smoother if you stay close to all of us.   http://i206.photobucket.com/albums/bb179/mamabluebird1955/Stepping-StonestoHealingWell.jpg   Keeping you close in thoughts and prayers as you move forward... In Friendship ~ Lee & Buddy
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