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Need help on my dad's prognosis

Steelchuggin26
Posts: 16
Joined: Mar 2013

Hi everyone. Let me first introduce myself, my name is Brandon and I just joined the community as a result of my dad being diagnosed with prostate cancer last Tuesday. He is a 63 year old male with recent problems of frequent urination, and a blood test revealed a PSA level of 4.2 ng/ml, and he was promptly referred to a urologist. Well the urologist decided to do a biopsy with ultra sound, and he said out of the 12 samples taken, 5 were cancerous, and he said his Gleason grade was 6; 3+3. I asked the doctoat about what stage this and his Psa level correlated to, and he said clinical stage 1. He said in all likelihood, the cancer is contained to his prostate, though there is a small chance of it being outside of it. He offered dad several treatment options: watchful waiting, surgery, hormone therapy, radiation therapy via external beam or brachytherapy(radioactive seeds) . Of those options, he said surgery is the best chance for cure, followed by brachytherapy. This would lead me to believe he has a good prognosis; however, last week he bagan complaining about his testicles hurting, so I am now worried that it may have metastasized. He choose surgery and the doctor said we would know for certain if his cancer has spread or not once they perform the surgery and get a pathological stage. I am very worried that his testicular pain may be a sign of metastasizing cancer and I urged him to give the doc a call, but he refused. I am really worried right now, and I do not want to lose my feather. I have already lost my mother to squamous cell carcinoma of the base of tongue 5 years ago, and I can't bear the thought of molding my feather so soon afterward too. Based on what I have told here, what do you think my dad's prognosis is?

jakog101
Posts: 1
Joined: Mar 2013

Hi Steel...26,

In my opinion your dad is in good shape. For a 63 year old man a psa of 4. Is almost normal. I would not op for surgery at this stage. Would watch and wait. The painful testicles should be looked into but I doubt if the prostate cancer has spread. Only a thorough exam can tell for sure. Your dad should look into it. Just don't sit around.

I have been diagnosed with stage 4 cancer with a psa into the thousands. Have been responing well to the drug Eligard according to my doctor. So far  I have experience very little pain. 

Good luck to your dad.

VascodaGama's picture
VascodaGama
Posts: 1554
Joined: Nov 2010

Brandon (Steel…26)

Welcome to the board.

I am sorry for the death of your mother and now the PCa positive diagnosis of your father. According to the data you posted here, I would think that your father will live many many many years and you shouldn’t be so worried thinking in “losing” him. I am 63 years old too. I was diagnosed with PCa at the age of 50 (PSA= 22.4) and I did manage to be standing here today. Relax and try helping your dad coordinately.

The frequency in urination could be due to hyperplasia (typical in all men) or cancer or even due to other problems not related to the prostate. The testicle pain could as well be behind the urgency in urinating and your dad should check for the cause, not just accept the idea that it is related to PCa. I agree with Jakog above. I doubt if the prostate cancer has spread to the testicles. It is an unusual area for PCa spread.

I would think that the clinical stage 1 attributed by his doctor is solo based on the biopsy (ultrasound) findings. Your dad can but should not have surgery with intent in getting better diagnosis as suggested by his doctor. Cancer spread can be judged with other means less invasive and if found to exist then surgery alone would be of no use at all. Radiation treatment is better for cases of cancer spread and can be administered alone as the prime treatment without the need of previous surgery.

Image studies (CT, MRI, PET, Colour Doppler) are the preferred way to identify metastases and therefore to diagnose the clinical stage of a patient. These studies are done with newer contrast agents and higher resolution equipment that have improved detection. Surely the results could be false negative and lead to one thinking that surgery is the best shot. However, radical treatments (all forms of surgeries and radiotherapies) got risks and side effects that one should avoid to the maximum. These effects superimpose to the ones we get from previous treatments so that choosing a therapy just on the bases of getting a better diagnosis is a very wrong way of decision.

Gleason score 6 is for low aggressive cancers. The PSA of 4 is just at the limit of what it is said to be normal. The 5 out of 12 cores positive to cancer may indicate high volume tumour which may be “visible” in the ultrasound and most probably by a 3-tesla MRI machine. I wonder if the doctor found any positive DRE spot.

I recommend you and your dad to get educated on the illness and treatments, and to get second opinions from several specialists in each area of treatment.
Even aggressive prostate cancer does not spread overnight. Your dad has time to check about the problematic side effects, the consequences in his life style and business. Do not let the case to get loose but firstly research about the problem.

Here is a link explaining about Staging from the National Cancer Institute;
http://www.cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional/page5

Here is a compendium on matters of PCa;
http://prostate-cancer.org/decision-aide/where-to-start/prostate-basics/

 

Here are some ideas to prepare your own list of questions to expose to the doctors while going around;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Book on radical treatments;
A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (
third edition); which may help you understanding options between surgery and radiation.

Physical fitness programs and proper nutrition are important when dealing with prostate cancer. UCSF got a publication on Nutrition & Prostate Cancer, which copy I highly recommend your dad to get.

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

 

Wishing you peace of mind and luck to your dad's journey.

 

VGama  Wink

Steelchuggin26
Posts: 16
Joined: Mar 2013

Thank you for your kind words and links to other sites for further information. Just thought I would add Ina couple more things about my dad's recent health history. Back on February 21 2012, he had 2 inguinal hernias and one hernia under his navel repaired Ina laparoscopic procedure. He also had a colonoscopy done for a routine check, and it came back clear of anything, this was done dec 19 2011. He has been having some issues with constipation over the last couple of years, and I read an article that said constipation could be a complication of prostate cancer that is advancing or has spread. Now I am extremely worried, and I have asked dad to go have another consult with his doctor about this, but he doesn't want to and just told me that we will know whether or not it has spread outside the prostate when they do his prostatectomy on April 23. The more I read and think about it, the more I believe his cancer is far more advanced than the clinical diagnosis of stage one.  The mayor clinic website said that early stage prostate cancer typically does not produce symptoms, and based on that, his frequent urination and constipation issues lead me to believe his cancer may well be quite advanced and I am scared sick. I really wish he would cave in and go for some imaging tests to be a little ore certain if his cancer has indeed spread or not. This whole process has me on pins and needles right now, and I just don't want to even have to think about losing my father so soon.

hopeful and opt...
Posts: 1317
Joined: Apr 2009

There is an MRI scan for prostate cancer that is very effective in indicating if there is any nodule involvement, if there is involvement in one or two lobes, will show size of prostate, any evidence of extracapular extension, will stage the disease. An MRI with the 3.0 Tesla magnet, is the gold standard. There are certain major hospitals that have MRI machines with a 3.0 Tesla magnet.

In my layman’s opinion it is advisable to have such a test before any surgery or another active treatment. If the cancer is outside the prostate surgery may not be the best decision for treatment.

……………………………….

You did not mention the amount of involvement (the percent cancer) in each of the cores with the Gleason 3+3=6. Although this Gleason score is not an aggressive one, there can be extensive amount of cancer if the involvement is great in each of the cores. Please let us know.

By the way determining a Gleason Score is subjective and requires expertise by a world class Pathologist to determine the score and involvement. The slides can be sent to one of these labs. Two such labs are David Bostwick, Virginia (800) 214-6628 and Francisco Civantos, FL. (305) 325-5587.

;………………….

Based on what you reported, I doubt if your Fathers GI problems have anything to do with PCA. If there is concern he can speak with a GI doc. It may be as simple as exercise and a better diet. By the way many of us at this site have changed our diets. Basically heart healthy is prostate healthy. I for one have become a vegetarian.  There is a DVD that you can view, can get it on net flicks or library. It is Forks over Knives.

Brandon since family members are more susceptible to PCa than the general population, the guidelines are that your screening starts at age 40. Also good idea to have a PSA as a baseline test at age 35.

Additionally it is important for you to eat heart healthy and exercise regularly.

VascodaGama's picture
VascodaGama
Posts: 1554
Joined: Nov 2010

Brandon

Your worries are not allowing you to judge the facts properly. Your mind is just tricking you to see everything negatively.

I am glad to know that you are researching at the Mayo Clinic. This is a reliable hospital where one can trust their physicians and researchers on PCa. Your comment in regards to “… early stage prostate cancer typically does not produce symptoms…” is correct, and most probably such is happening with your father. The frequent urination and constipation issues can be due to to other facts. Please notice that the colonoscopy was negative (“…clear of anything…”) so that his constipation may be due to unbalanced diet. Changing foods may change his symptoms. You can inquire about his colonoscopy doctor’s recommendation back in Dec 2011.
The testicle pain/sensation may be a neuropathy cause of the hernia treatment too.

It seems that your dad decided on surgery, scheduled for April 23. I do not know what made him to choose that treatment or if it is the best way to his case or if the hospital & physicians are experienced, but surgery is a very valid option to “handle” prostate cancer and his positiveness in the treatment is a great step forward for the success. He is a “man of all seasons” at his rightful reasoning. Your “paper” is to comfort him with positive thoughts. You can disagree and advice him but do not be anxious when talking to him. Try helping in the preparations for what has been decided.
You need to “create” your own confidence. PCa patients do not usually die at surgeries. Your father will live many years and he is very fortunate for having you.

 

Best wishes for a successful outcome.

VGama  Wink

Steelchuggin26
Posts: 16
Joined: Mar 2013

Hello, and thanks once again for your help. In regards to the amount of cancer suspected, the doctor said in the 5 positive cores, they were each 30-40% cancerous. Is this co sidered to be an extensive amount? Also on the ultrasound biopsy, the doctor noted that the prostate did have some enlargement, but did not elaborate on whether or not it was a result of the cancer, or that it just happened to be enlarged at the same time his cancer was discovered. He also made no mention of feeling the mass or seeing a visible mass on the ultrasound.

hopeful and opt...
Posts: 1317
Joined: Apr 2009

First is advisable to have a copy of all records available. The doctors will release a copy to your Father. You can ask for the notes that he made of the office visit and his findings as well as the biopsy report, etc.

Actually the amount of involvement in each core is not that great, however there were 5 cores of PCa found. Generally to be placed in a low low risk for prostate cancer and to be in an active surveillance program, it is recommended that one have less than 2 cores with a Gleason 3+3=6, less than 50 percent involvement in each with a PSA of less than 10.

With the numbers that your father has an Active Surveillance protocol might be recommended for those with about 10 years or less life expectency.

Prostate cancer is very slow growing.

I still suggest that he have an MRI with a Tesla 3.0 diagnostic test to confirm that the cancer has not left the prostate. (By the way it is somewhat unlikely that it has, but in my opinion you need to checkP

P.S. The biopsy machines generally in use are two dimensional and are used to target where the random cores go in the prostate. They are not able to determine suspecious lesions. On the cutting edge, there are MRI guided biopsies that have this capability. Basically an MRI is done where suspecious lesions are targeted, and a sample is taken of these targets. using either the same MRI machine or a state of the art biopsy machine that is three dimensional.

VascodaGama's picture
VascodaGama
Posts: 1554
Joined: Nov 2010

Brandon

It is impossible to determine the extension of the cancer in a simple biopsy. 40% in each core in 5 positive cores out of 12 is just 20 % in total but the volume can be reasoned when analysing the location of the positive needles. Dispersed locations could be related to several spot colonies of tumours whether closed positive cores could be from only one large tumour.

The pathologist report usually describes their findings indicating the location of the cores. Such can judge for possible extra capsular extensions, particularly if the patient has been diagnosed with positive DRE. Your dad’s doctor did not feel any “bump” and the ultrasound could not identify anything.  This is already a step forward to think that the cancer is contained.
For more concrete analyses a better “picture” of the prostate and its surroundings is required. Your dad could get an image study done with a Tesla 3.0 MRI suggested by Hopeful. The procedure can still be made and it would not jeopardy the schedule of the treatment.

The best to you both.

VG

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