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newly diagnosed

tadow
Posts: 4
Joined: Dec 2012

Hello everyone,
I am a 75 yr. old african american male who was recently diagnosed with prostate cancer. I am very active and healthy with only hyperlipidemia in my medical history. I was told that my cancer was localized to the prostate and a Gleason score of 7. I had 2 biopsy cores that was a 3+4 and 2 that were 3+4. I am not choosing active surveilence, my doctor recommended either radiation or cryotherapy. I am so confused as to which to choose. Any feedback will be well appreciated. I am wondering the best route to go, the side effects if anyone experienced either method and the likelihood of reoccurance. I also heard that with radiation, cancer can spread to nearby tissues. Please advise

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

tadow,

Welcome to the forum and I am sorry to read of your recent diagnosis. You are in good company, actually. Studies have shown that about 75% of men in their 70s have prostate cancer and I am sure you are aware that African-American men have higher incidences of prostate cancer in the United States and other Western countries.

It would be helpful to know more about the background of your diagnosis such as your PSA history, whether or not you suffer from BPH, if there is a history of prostate cancer in your family, the staging the doctor assigned your biopsy, the presence of PNI, or any other physical symptoms.

Certainly radiation or cryotherapy are two ways to treat localized prostate cancer but these choices offer vastly different potential impact on your quality of life. Men who undergo cryotherapy stand at much higher risk of post procedure impotence and ED as well as urinary incontinence than men who have radiation. You should also be aware that there are many different types of radiation that may effectively treat your cancer.

You have one doctor's opinion. I would urge you to seek out other opinions before making a decision.

Best of luck to you.

K

hopeful and opt...
Posts: 1292
Joined: Apr 2009

Please provide more information so we can better help you.

How many cores were taken in your biopsy?

How many of the cores are positive?

What is the Gleason of each core that is positive?....…..It looks like there is a typo in your original post….

What is the involvement of each core that is positive, that is what the percent that is cancerous ?

What does the digital rectal exam show (the finger wave?)

It is very important for you to do research at this time. Books, internet, face to face support groups.
Many of us here at this site have made life style changes, since we as a group are more likely to die of heart disease than prostate cancer………heart healthy is prostate healthy.

tadow
Posts: 4
Joined: Dec 2012

Hello I am a 75 yr old African American male with newly diagnosed Prostate Cancer. I have no history of BPH and this is not known to run in the family. Therefore I have not monitored my PSA levels because they were within normal limits every year until this year when it was elevated and the urologist noticed a couple hard nodules during a DRE. They were biopsied and results were 4 positive cores out of 14. My gleason score is 7, and state TP2c. My PSA has since went down to 4.6 and then 4.5 which I was told was WNL. I only have hyperlipidemia in my medical history. I am very active, drive and otherwise healthy. I am confused and unsure as to which tx method to choose and am very stressed out. Please offer any advice on these 2 treatment options and its efficacy and reoccurance rate. I have heard that radiation can cause cancers in surrounding tissues which scares me and also that cryotherapy is fairly new. Please Please advise

hopeful and opt...
Posts: 1292
Joined: Apr 2009

3+4=7, or are two 3+4=7 and two 4+3=7, please clarify.

What is the percent of each core that is positive. This information in on the report about the biopsy that the pathologist wrote. It is important for you to have a copy of this report in your possession.

In order to determine the best treatment decision the above primary information is needed.

What does the initials "WNL" mean?

I personnally have never heard of radiation treatment for prostate cancer causing cancer in healthy cells.

As you, when we are diagnosed we all are stressed with all kinds of negative emotions and fears. It is compounded, since we are also put in the position of being asked to choose from several treatments, all with degrees of negative side effects. These feeling generally last for two or three months. There are strategies to cope with this. Associate with positive upbeat people. For me gaining knowledge about prostate cancer and treatment decisions has helped

dwhite1031
Posts: 26
Joined: Jul 2012

You have come to a very special place, where everyone here is always helpful based on their own experiences & is supportive of each other! I have been here since my diagnosis back on July 13, 2012.

One thing I learned based on my ongoing journey is to educate yourself about PCa as much as possible! Also, second opinions are a must as far as I'm concerned. While my local Urologist is top notch, he encouraged me to get a second opinion. You'll undoubtably hear well meaning people tell you about "old so & so" who had PCa & is did this or that, & so on & so forth. Every person is different & your PCa situation & journey is different from mine & other men's.

I hope you have the support of a strong & loving family & friends as you make this journey. For me personally, the support of my spouse & family along with our faith has been so very important.

tadow
Posts: 4
Joined: Dec 2012

To answer some of the earlier questions i have 2 cores that were gleason 3+4 with one being 65% of the tissue and the other 20% of tissue. The other 2 core bipopsies wer 4+3 with one 60% and the other 70%. so 4 cores were positive out of the 7. Can someone explain these results. Also, it says at bottom of report clinical stage T1c and PSA 4.68. Please advise on radiation or cryotherapy.....so confused on which is best treatment and the possibility of long term side effects. Thankyou

hopeful and opt...
Posts: 1292
Joined: Apr 2009

One has to look at the results of the biopsy , and thr Gleason scores, etc to start determining treatment; the PSA and other tests of this nature are indicators only and not critical for a treatment decision

In reading the Gleason score, there is more of the first number that is shown, so if there is a score of 3+4=7, there are more less aggressive cancer rated a 3 than more aggressive cancer rated a 4; if the score is 4+3=7 there is more aggressive cancer in that core that is rated a 4 in aggressiveness. So a 4+3=7 is more aggressive than a 3+4=7. In determining treatment, the most aggressive cancer that is found in the prostate is used to make a decision. So in your case you have to base any further diagnosis and treatment on a Gleason of 4+3 =7.
As far as involvement, the numbers that are reported in your case of 65 percent , 70 percent and 60 percent indicate a greater involvement, and since your cancer has been classified as an aggressive one, my layman’s opinion is that other tests are needed to determine whether or not the cancer has escaped the prostate.

Basically if the cancer has escaped the prostate, hormone treatment is most appropriate, and other therapies ssuch as CryoTherapy is not. As a layman, I think that certain radiation therapys along with hormone therapy can be appropriate if the cancer has escaped the prostate.

By the way, treatment is also dependent on what yo believe your life expectency to be.

More about an excellent diagnostic test :

MRI

There is an MRI scan for prostate cancer that is done with a special coil in the rectum. This are certain major hospitals that have a Tesla magnet. There is a 1.5 Tesla magnet, the effective resolution is limited to tumors 0.5cc or larger. There is also a 3 Tesla machine which may have a bit finer resolution.

The most effective MRI for the prostate is called a MRSI (MRI/MRS) and includes the ability to identify cancer metabolites using spectographic analysis.....Basically using the spectoscopy with the MRI provides more accurate results, both the MRI and the spectroscopy are done at the same time.

The MRI is generally covered by insurance, however the spectroscopy is considered investigational and is not covered by medicare which I use.

The test indicates if there is any nodule involvement, if there is involvement in one or two lopes , wll show size of prostate, any evidence of extracapular extension, will stage your disease.

hunter49
Posts: 200
Joined: Oct 2011

Welcome to the party. Sorry to hear you got the beast. Given you have a 7 and there is a a good chance there is more and even posible a upgrade to a 4+3 than reveled by the biopsy I would look to do radiation. I would definately get a second opinion on the slides from Hopkins or another well respected facility. Radiation and surgery have similar 10 year non-reoccurnce results. That puts you in your mid 80's before you should have to think about it again. You may do a combo of hormone and radiation therapy as well.

VascodaGama's picture
VascodaGama
Posts: 1528
Joined: Nov 2010

Tadow

Your case is typical as intermediate for high risk of metastases. The grade 4 is of concern as it is the main pattern found in the biopsy.

I think that you should look for an aggressive way of tackling the “bandit” with intent at cure. A combi of Brackytherapy plus IMRT or Hormonal plus radiation got higher rates of success.
In any case, you should get additional testing to try to pinpoint the location of the cancer. Within radiotherapy you can avail of several other types for delivering radiation but IMRT can provide with a wider range of attack. Your present status described in your post does not refer to localized extensions but the positive DRE could mean that cancer has perforated the capsule and probably travelled to nearby lymph nodes.
For these cases doctors recommend irradiation of the whole gland plus the traditional spots where cancer usually hides (lymph nodes and prostate bed tissues including localized nerves). In such scenario cryotherapy has poor rates of success.

I think you are much stressed and that you need to discuss with specialists in all the fields of treatment. You just have to be cautious because doctors are usually biased to their trade or follow the institution norms where they work. Medical oncologists seem to be the best to consult when on “distress”.
It is also advisable of getting second opinions in everything. One must be sure that it is not under or over diagnosed.

You should get educated about the disease and about the ways to treat it, particularly with regards to the side effects. All treatments got risks and side effects and none of them can assure total eradication of the cancer. There is lots of guessing and one must be prepared in case things go wrong.

Radiation can cause additional cancers as you commented before. This is classified in the group of “Long Term Effects”, however its occurrence is rare and mostly reported to happen at the 20 years mark. Such would mean a matter of concern when you turn 95.
In any case you need to treat your present condition and should choose the therapy that most assures you success. Otherwise just choose a palliative way for controlling the disease such as hormonal therapy. Many 75 years old guys prefer not to adventure with a radical treatment. It is advisable to consider other health problems or future concerns because we are not young forever. Some value more quality than quantity of life.

Here are links that may help you understand your situation;
Questions to the doctors;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor
A compendium on Prostate cancer and care;
http://www.lef.org/protocols/cancer/prostate_cancer_01.htm

Bokks;
A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which may help you understanding options
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs on diagnosis and treatments for systemic cases. This famous is himself a survivor of a challenging case on his 13 year of survival, where he battled the bandit with IMRT and ADT (hormonal).

I hope you get peace of mind.

Wishing you a wonderful season.
VGama

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