Oct 29, 2013 - 10:37 pm
My husband and I met with the urologist yesterday for results of bone scan and we left feeling pretty good, but I still had some unresolved questions. Here's his status:
Gleason score is 6. Both sides were positive. 10 cores taken, 5 from each side. All 5 cores taken from left were positive and 2 of the 5 on right were.
Bone scan clear.
Urologist says he's T1c. On the other hand, he said given my husband's high PSA level (40), that he would bet it's already out of the prostate, probably into lymph nodes. He also palpated hard areas (not lumps) on DRE . That and PSA prompted biopsy.
He did not recommend surgery because he said they'd probably find cancer in the nodes and so he'd have to have radiation anyway. Also did not recommend surgery because of his high PSA - and said side effects from radiation are less likely than after surgery. He never mentioned robotic surgery (he doesn't do it) or nerve sparing surgery. Just that surgery would likely leave him incontinent and impotent and it would be not a good treatment choice for him.
I asked about CT or MRI, particularly since he was seemed pretty convinced that cells were already outside the prostate. He emphatically said scans are not reliable for prostate cancer and there is no "good" test for soft tissue involvement. Really? This is primarily where my confusion rests.
Watchful waiting is not an option because of his high PSA level. I suggested we repeat it because labs DO make mistakes. He said he would if we really wanted to, but it wouldn't make any difference because of the biopsy results. Really? My husband's PSA went from 3 to 40 in 3 years and the Gleason is only 6 and negative bone scans. So what's up with that? He says it doesn't matter.
His recommendation is a consult with radiation oncologist who he said would likely also recommend hormone therapy. He said the rad onc would explain everything to us. He was very cavelier IMHO in his statements about side effects from all of the above. He never said if you do X, you might have Y, and if that happens we can sometimes do Z. It just felt like "you have prostate cancer. We need to treat it. I'm pretty sure it's outside the prostate already, but prostate cancer is slow growing so don't worry, you're almost 70 and won't be around long anyway. This is the treatment I recommend, now go do it". He did not say those things, but it felt like he did.
So, I'm feeling disappointed. The tx recommendations may well be appropriate, but I just don't feel like we have a complete picture of what's going on with him.