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orcaman
Posts: 6
Joined: Apr 2011

My brothers:

I had a meeting with my doctor today and as you all suggested I got a report of the biopsy.

He went over all the possible treatments from watch and wait to the more radical surgeries.

For those who asked the biopsy report is as follows. Right prostate six cores taken, left prostate six cores taken.

Exam results are

A-right core biopsies
Prostatic Adenocarcinoma, Gleason's score 6 (3,3)
Tumor size is 3 mm identified in one of the multiple tissue cores. Overall estimated tumor volume is less than 10%
Perineural invasion is not identified.

B-Left core biopsies
Begign prostate with focal glandular atrophy.

That's it in a nut shell.

Again, I thank all of you for quick responses, your advice and your willingness to help me relax some. I did purchase the book that you suggested and have been devouring it.

Carl

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

I'm not in the medical field...just another prostate cancer brother....but overall it looks like you have caught your cancer very, very early! You have time to educate yourself, weigh the options and then make your decision.

Larry

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Hello Orcaman,

Let me add to the welcome you have received from several of our members in your previous thread and thanks for updating us with more information from your pathology report.

I'm curious as to why you ever ended up having a biopsy in the first place. Your PSA certainly was not high given your age and the PSA history you listed earlier suggests an exceedingly long PSA doubling time with a low PSA velocity.

Did you have any other symptoms such as a suspicious DRE, a family history, or frequent urination, or anything that would have led your doctor to suggest a biopsy?

And another curiosity...after your positive diagnosis, did your doctor send you down for blood work ups and a bone scan "just to be sure?"

Your oncologist may have told you about autopsies taken on men who died of causes other than prostate cancer showed that almost 60% of men in their sixties have evidence of prostate cancer. (50% of men in their 50s, 70% of men in their 70s and so on) In other words, indolent prostate cancer in men at this stage of their life is exceedingly common and generally poses absolutely no threat to the health of the individual.

Now that you have been presented with a cancer diagnosis I'm sure you feel that you must do something about it. Given your very, very low risk statistics you certainly have plenty of time to sort this out so I hope that you can resist any recommendations to treat this quickly. You have plenty of time to educate yourself on prostate cancer and what treatment courses may be appropriate for you given your priorities in life, your risk tolerance levels, and what kind of quality of life you expect to have after treatment. Active surveillance (watchful waiting) may well be an appropriate course of action to take and I would encourage you to seek out a prostate specialist who has experience in this for more information before deciding anything.

Men in this forum have had a wide variety of treatments and experiences in dealing with this disease so don't hesitate to ask questions.

Best of luck to you,

K

orcaman
Posts: 6
Joined: Apr 2011

I did not present any other symptoms and my primary care physician just said that there were an increasing number of men with lower psa's that have prostate cancer and just as a precaution it wouldn't hurt to the the biopsy done. I will be having some blood work and x-rays done in the near future.

I really don't understand the watchful waiting all that much. I don't understand why waiting is a good idea. The cancer isn't going to cure itself. Wouldn't it be better to just get is cured....gone?

Thanks for your responses.

Carl

hopeful and opt...
Posts: 1353
Joined: Apr 2009

All of the teatment options that "cure" can have negative side effects such as incontenence, etc.; if the cancer is indolent, , you are likely to die with the disease , not because of it....there is a good chance that you can go on with your life; but you will have to be closely monitored, in the event that there is indication that the disease is progressing...... you will be able to be treated at that point if necessary , using for the most part the same treatment option that you would choose at this point.

I have been on active surveillance for two years now....please free to click my name to see what I have been doing

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

I suspect that you have either a set of exceedingly cautious doctors or some that view you as a business development opportunity.

Despite what your physician told you about "it wouldn't hurt to have the biopsy done" there are measurable risks associated with a prostate biopsy. Besides the pain, expense, and hassle (biopsies cost about $5,000 on a national average) there is a very real risk of infection (sepsis) or other complications resulting from a transrectal biopsy. Some believe that biopsies can actually contribute to the spread of cancer as cancer cells are frequently observed to "track" along the path the needle takes into the prostate. Women with breast cancer who have biopsies stand a 50% higher chance of recurrence than those that have lumpectomies. Although a biopsy is the only way to positively confirm the presence of cancer the risks associated with such a procedure should have been thoroughly explained to you, particularly with your relative lack of symptoms to start with.

Although there are an increasing number of men who are being diagnosed with lower PSAs, that it because more men are electing to have biopsies done which frequently reveal indolent cancer cells. Studies have shown that 25% of men over 40 who have a biopsy will show prostate cancer. In the overwhelming majority of these cases, their cancer is of the indoelnt variety which will never pose a threat to their health. If you delve into the enormous about of material available on the web about prostate cancer you will quickly learn of the enormous amount of men who are considered to have been overtreated for their indolent cancers.

Regardless of what treatment course you may choose to follow, there will be some impact on your quality of life. Some treatments pose a higher threat than others but none of the treatments are risk free. Common side effects from many prostate cancer treatments include incontinence, erectile dysfunction, bowel toxicity, reduction in the size of the penis, infertility, and other risks associated with major surgery or radiation.

Also, you should know that the American Urological Society does not recommend either follow up bone scans or blood tests for the diagnosis you have received. These tests will not reveal a metastasis of your cancer as it is staged now and will only serve to increase the money that is set to flow to your doctors.

Given enought time, almost all men will eventually show cancer cells in their prostate. Studies of men who have died by other causes show that 50% of men in their 50s, 60% of men in their 60s, 70% of men in their 70s, and so forth have some amount of prostate cancer.

The more accurate term for "watchful waiting" is "active surveillance." It means that your medical team keeps a close eye on your health through regular PSA testing, biopsies every other year or so, and MRI scans when appropriate. If there is any change in your cancer characteristics then you move toward a treatment phase. Studies have shown that waiting for treatment generally poses absolutely no risk to your health of future treatment options.

There are many strains of prostate cancer. Most are very slow growing. The histology of most prostate cancer strains is about 55 years from the time it first begins until death and in most men, prostate cancer probably starts while they are in their 30s or early 40s. It is usually not detected until late 50s or early 60s. The median age for cancer detection is 65 years.

Of course, at this point a lot of this is a moot point. Like most of us on this forum, you had a biopsy at your doctor's recommendation and ended up with a diagnosis. Now you feel you have to do something about it. After all, you have CANCER!

Knowing the process of detection and diagnosis is an important step in taking charge of your disease. Many men simply do what their initial doctors recommend. I hope you now take the time to have your biopsy slides read by a pathologist that specializes in prostate cancer to confirm your diagnosis and Gleason score. I would then hope you discuss your disease with other doctors and get a second opinion on what your courses of action should be.

Education is the key to combatting this disease and at this point you appear to have plenty of time to gather information, obtain second opinions, and consider what your priorities and options are.

Best of luck as you progress.

K

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