Aug 14, 2012 - 1:55 pm
Hello all. New to forum - first post.
I have had prostate cancer screening since age 40 due to a FH of prostate cancer in my father. PSA's always normal. In July 2009 during a routine PE, my PCP palpated a nodule. PSA was 2.14. Previous PSA 18 months earlier was 1.4. Was referred to a local urologist where prostate bx's returned adenoCA with Gleason 4+3. Slides sent to Dr. Epstein at JHU and revised Gleason 4+4. Bone scan and CT scan negative. Had consults with Dr. Walsh and Catalona, and also with the Proton Beam center in Indiana. Due to a large prostate (100 cc), was felt not a candidate for brachy.
Underwent RRP at JHU on 11/4/2009. No complications except for blood loss, no transfusion. Pathology Gleason 4+4. Focal ECE. Margins negative. Nodes and SV negative. No incontinence. Sexual function 50%.
All follow-up PSA's undetectable for 2 yrs and 8 months. Recent PSA in July detectable at 0.113. Local urologist said to repeat in 3 months. I repeated 2 weeks later and still elevated at 0.129.
Went to JHU to see my prostate surgeon. He felt that I probably had a local recurrence and was recommending salvage RT, preceded by a course of HT. But first he wanted to repeat my PSA at the JHU lab. On August 8 at JHU my PSA was undetectable, with a level of 0.07. Recommendation was for close observation with a repeat in 3 months, but additionally with an immediate repeat PSA performed at the other local lab in my area used by my PCP. PSA at this lab on August 13 was detectable at 0.118. I am scheduled for a phone consult with my prostate surgeon at JHU tomorrow.
Not sure what to make of all of this but fear that I might have a recurrence. According to the Trock study, salvage RT can be quite effective if tratment is begun within 2 yrs of PSA recurrence and when PSA is still low <0.5, even in patients with high Gleason scores and fast doubling times.
Have been researching for the best Rad Onc centers in the country, but not sure where to get that information. I am sure that JHU has a reputable program, but also considering UCLA as I have family there with whom I can stay. I have a consult this week with the chairman of the program at MCV in Richmond, who is supposed to be quite skilled in treating prostate cancer, Dr. Anscher.
I had a phone consult last night with Dr. Datolli, but my prostate surgeon at Hopkins does not think very highly of him, nor Snuffy Myers.
I have been quite stressed over these recent events, which is sinking me into depression. Any useful advice would be appreciated, especially in regards to the treatment centers and physicians noted above.