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Newly detected prostate cancer - course of treatment - comments

psanikhindi
Posts: 7
Joined: Nov 2012

Hello everyone,

I am from Pune (India), aged 66. Have been facing urine retention related problems for the past 2 - 3 years, and had been following "wait and watch" approach as per my doctor's suggestion.

A couple of months ago, problems increased beyond my tolerance level. I went to a much better doctor, who told that my symptoms indicated BPH. In Oct 2012, I underwent TURP (Trans Urethral Resection of the Prostate) based on my doctor's recommendation. Prior to the surgery, my PSA score was pretty low (1.2) and therefore the doctor did not suspect cancer.

After TURP, parts of the removed prostate were sent for pathology tests (histology). The results showed prostate cancer. The PSA score was 1.2, Gleason score was 3+2 (5). Doctor suggested that this was a pretty early stage detection, and yet another surgery (Radical Prostatectomy). This is scheduled for 11/20/2012 - another 2 weeks from now.

The doctor said it prima facie looks like a very early stage of prostate cancer and that surgery would completely cure me. However he suggested that I undergo Bone Scan and MRI tests to verify if at all the cancer has spread to adjoining areas.

These tests (bone scan and MRI) are done, and I have results as follows:

Bone scan Impression:
"No scan evidence of skeletal metastasis."

MRI Impression:
"Ill defined area of altered signal intensity affecting the outer gland bilaterally more prominent on the right side. No definite evidence of local extra prostatic, disease extention is noted. A suspicious lesion in S3 vertebral body is seen."

I need to now take these to the doctor for his comments. I suspect post surgery there might be radiation suggested by the doctor too, but that's just my guess.

Would like to know anyone who has had a similar condition and if they could share their comments, it would help. Thanks.

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

Psanikhindi,

Welcome to this forum and sorry to read of your problem.

A Gleason 5 at age 66 is not a serious cancer and I hope you check with other doctors before allowing them to remove your prostate. The potential side effects from this surgery far outweigh the risks of prostate cancer in your case. There are several posts in this forum from men who suffer varying degrees of incontinence and impotency as a result of radical prostatectomy and in your case it does not appear to be needed.

In the United States most men diagnosed with your pathology would be placed on a protocol known as Active Surveillance where the PSA scores are watched and additional biopsies are taken every few years or so to monitor progress.

Statistics show that 60% of men in the United States have indolent prostate cancer by the time they reach the age of 60. 70% at age 70, 80% at age 80 and so on. Indolent prostate cancer, like BPH, happens frequently as men age. A Gleason score of 5 is very, very low risk and I would not be worried about it.

Hopefully the TURP has alleviated your urinary symptoms. Please don't rush into surgery.

Best of luck to you.

hopeful and opt...
Posts: 1282
Joined: Apr 2009

I was diagnosed with a low volume, low grade cancer as you have been almost four years ago. I was 66 at that time. You probably have an indolent cancer, that is not likely to spread. Surgery can have major side effects, such as impotence and ED. Success of surgery is age related, the older you are the greater the side effects. There is a difference between robotic surgeons....until a doctor does at least 250 or 300 he or she is practicing on you, and the surgeries are less sucessful.

Please click my name to see what I have been doing and tibits of information that I have come across.

I strongly suggest that you cancel the date for surgery on the 20, and take some time to do research. We will help you, and give you direction.

Aditionally if you still want to do an active treatment, as a lay peerson who has studied this, there are better treatment types available for you

psanikhindi
Posts: 7
Joined: Nov 2012

To begin with, thanks for your reply!

I will surely talk to my doctor about the necessity of surgery at this point.

I will also do more research and go through the information that you have managed to gather.

Can you tell me if you have any idea about the mention of "a suspicious lesion in the S3 vertebral body" as mentioned in my MRI report?

Thanks!

hopeful and opt...
Posts: 1282
Joined: Apr 2009

The American Urological Association does not recommend a bone scan for those with a psa less tnan 10 or a gleason score less than 8.

"In patients newly diagnosed with PC, a PSA of less than or equal to 10 is associated with an abnormal bone scan in only one of 200 patients" A primer on prostate cancer ...stephen b. strum md and donna pagliano

"Since uptake of the technetium isotope also occurs at sites of arthritis or trauma to the bone, routine x-rays, ct scans or mri scans may be used to evaluate areas of uptake of the isotope based on past past trauma or arthritis, the bone scan is considered to be "negative"-----showing no evidence for metastatic disease. IF ON THE OTHER HAND, THEREIS NO EXPLANATION FOR THE ISOTOPIC UPTAKE ONANY OF THESE STUDIES, THE BONE SCAN MUST BE PRESUMED ABNORMAL AND CONSISTENT WITH PC UNTIL PROVEN OTHERWISE."

hopeful and opt...
Posts: 1282
Joined: Apr 2009

I believe that the statistic applies to all cancers, not just indolent cancers which are the majority. At any rate, I agree with the points that you made to the Original poster.

"Statistics show that 60% of men in the United States have indolent prostate cancer by the time they reach the age of 60. 70% at age 70, 80% at age 80 and so on

psanikhindi
Posts: 7
Joined: Nov 2012

To begin with, thanks for your reply!

You are right in stating that a Gleason 5 at age 66 in not a serious cancer. My doctor has indeed said the same thing, that this is extremely early stage cancer, growing very slowly and likely that the cancer itself might not create problems as of right now.

The TURP has resolved the urinary symptoms to an extent, and I am told things will become normal over time, as I heal from TURP.

I will surely talk to my doctor about the necessity of surgery at this point.

Can you tell me if you have any idea about the mention of "a suspicious lesion in the S3 vertebral body" as mentioned in my MRI report?

Thanks!

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

I could only speculate on a "suspicious lesion" in the vertebrae. It could be a flaw in the film, perhaps you sneezed or twitched at the wrong moment, perhaps it is just a shadow. It could also be a touch of arthritis which would not be unusual for a 66-year old either. It is highly unlikely that it has anything to do with your prostate cancer although more accurate imaging tests may give your medical team better insight.

By the way, your cancer has probably been "early stage" for decades. I think "low risk" is a more appropriate term. Early stage seems to me that there is a suggestion of inexorable progression which would not be warranted at this point with a Gleason 5.

If I were no understand your diagnosis properly, did the Gleason 5 score come from only looking at cells removed during the TURP procedure? Was a sextant biopsy done?

The reason I ask is that the more aggressive prostate cancer tends to grow in the outer edges of the prostate gland. The BPH which was targeted during your TURP procedure was most likely toward the center of your prostate.

If they have not done a sextant biopsy, I would have one done as soon as your doctor feels you have recovered from the TURP procedure.

Best of luck to you.

K

psanikhindi
Posts: 7
Joined: Nov 2012

The Gleason 5 score came from the cells removed during the TURP. None of my reports indicate a sextant biopsy conducted.

I did meet my doctor today morning, and asked him the reason for recommending a surgery, and following were the reasons he specified:
1) Detection of cancer in the prostate
2) Advantage of age being on my side (66)
3) Comorbid factors: Diabetes, Blood Pressure, minor heart issues, minor kidney related issues
4) Taking a safety first approach - to reduce the probability of 'missing the boat' - in case the cancer grows later when age is not on my side, surgery might not be an option at all

These are the few things I now have to consider before making a decision. At least I got to know what the doctor thinks.

I will indeed look into the biopsy thing, and post an update.

Thanks for all the help, and best wishes to you too.

PSA (coincidently those are my initials :D )

Swingshiftworker
Posts: 620
Joined: Mar 2010

From what you've said there's no evidence that there's any need for surgery and that, even if you need treatment, radiation, which provides the same probability of success (as surgery) without all of the risks, would suffice.

That said, whatever needs to be done doesn't need to be done right NOW! The effects of surgery are irreversible and you should be fully informed before you go that route. Read the following article to learn why the recommendation of surgery may not be in your best interests:

http://www.hifurx.com/prostate-cancer/prostate-cancer-after-effects/

Take the time to learn what other treatment options are available -- including active surveillance -- which will enable you to treat/control the cancer while also maintaining your quality of life.

Good luck!

psanikhindi
Posts: 7
Joined: Nov 2012

To begin with, thanks for your reply!

I will surely talk to my doctor about the necessity of surgery at this point.

The link you have sent has a lot of good information and is helpful.

What are the potential chances of the cancer spreading to areas beyond the prostate if I choose "wait and watch" (active surveillance as it is called?)

Can you tell me if you have any idea about the mention of "a suspicious lesion in the S3 vertebral body" as mentioned in my MRI report?

Thanks!

Old-timer's picture
Old-timer
Posts: 109
Joined: Apr 2011

I agree with Kongo and the others. Based on the information you have given, your "cancer" poses little or no threat to you. Keep watch on it, but tell the surgeon to go away. He can come again another day should that become necessary. That is possible but not likely. I seldom make recommendations regarding prostate cancer treatments; but your case is different. I advise you to cancel that appointment.

Jerry

Beau2
Posts: 228
Joined: Sep 2010

Hello Nikhindi,

I wonder why your doctor has recommended treating a Gleason 5? Is it common practice in India to treat a Gleason 5? Is there something I am missing in your diagnosis?

You asked if anyone had a similar condition, and if they did you asked if they would share their comments. My first biopsy came back, "Atypia" (less than a Gleason 6) and my doctor recommended that we wait a while and do another biopsy. On the second biopsy Gleason 6 was found and we sent the biopsy slides out for a second opinion. The second examination of the slides confirmed the Gleason 6.

I ended up treating my Gleason 6 cancer by having it removed (DaVinci robot). I did not have any urinary problems and minor ED. Indeed one of the benefits of removing my large (70cc) prostate was an improvement in my pre-surgery urinary problems. I no longer need to urinate several times at night and I can void in about 1/10 the time it took pre-surgery.

I would recommend you consider AS (continue "wait and watch") if indeed your Gleason score is 5 or 6.

If your doctor insists on removing a Gleason 5 prostate, I would recommend you consider looking for another doctor and getting a second opinion. I understand there are excellent medical schools and doctors in Pune and that the Medical establishments in Mumbai are not far away.

Good luck and best wishes.

psanikhindi
Posts: 7
Joined: Nov 2012

I'll actually ask the doctor why he is recommending treating a Gleason 5 with a surgery. I, with my limited information, believed it's part of the procedure. Surgery is more or less recommended in India once prostate cancer is detected - however I don't have enough data to substantiate whether surgery is common practice at Gleason 5 as well.

My diagnosis - some information not stated earlier - I have Type 2 diabetes for the last 15 odd years, and that might add to complexities in surgeries done later in my life (in terms of healing?).

As per the doctor, he gave me options between Radical Prostatectomy (RP) and DaVinci robot. In Pune, the surgeon doing DaVinci robot might not be as experienced as recommended by standards, and my doctor is a world famous one (and largely experienced) when it comes to RP.

I will surely get more opinions - thanks for that input everyone!

Would appreciate your inputs on the "suspicious lesion in the S3 verterbral body" in my MRI report.

Thanks for the reply and wishes.

Good luck and best wishes to you too.

Beau2
Posts: 228
Joined: Sep 2010

I'm probably not the best at answering this question. I think it is possible the MRI examined your prostate and your backbone. Apparently, they might have seen something (a suspicious lesion) on the S3 vertebrae. I recommend you ask your doctor what the statement means and what you should do (ie. Further imaging?).

Also, it appears there are doctors treating prostate cancer with radiation in Mumbai (I googled Mumbai prostate radiation) .

psanikhindi
Posts: 7
Joined: Nov 2012

The S3 vertebrae thing, according to the doctor, is not an indication of cancer, the doctor mentioned there are various other reasons why it can show up. To double check, he had recommended a bone scan and it came out negative, so the doctor has stated that the cancer has not spread anywhere outside the prostate gland.

Thanks! Best wishes.

PSA

Beau2
Posts: 228
Joined: Sep 2010

I am pleased to hear that the scan reveals the cancer has not spread, and that the doctor does not feel the lesion is cancerous.

I had a similar situation a couple of years ago ... after my prostate surgery. I had a heart scan and they found a spot on my lung. It is a small spot and we have been observing it for two and one half years. It has not grown in that time period

I think that sometimes it is a good idea to not go looking for problems ... there is no telling what you may find.

Good luck and best wishes.

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