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new diagnosis

midcen
Posts: 1
Joined: Mar 2014

We are in the midst of deciding what direction to go.  My husband (57) had a PSA of 4.6 with DRE showing non-smooth borders. With his biopsy 1/12 biopsies showed positive with a Gleason score of 7(3+4), 12% and 1/12 had HGPIN. The other 10 areas were B9.  The urologist encourages DaVinci surgery and discourages any CT or MRI because of cost and little help in diagnosing advancement of the PCa. We can go to Iowa City or Mayo Clinic in MN. It is very difficult to find any numbers on any of the surgeons and we are in a quandry as to what to do.  I am almost more nervous about what is in the HGPIN as I am about the actual area with PCa. Any feedback on either hospital or if we should be requesting further diagnosing would be greatly appriciated.

VascodaGama's picture
VascodaGama
Posts: 1599
Joined: Nov 2010

Midcen

Welcome to the board.

I can sense worries in your writings but the data and info you shared seems not be enough to evoke surgery the soonest. Before deciding you should firstly get second opinions from several specialists in each field of treatments, including another urologist. In fact, assuming that the diagnosis is correct, the positive DRE may rule out surgery as the proper way for treating your husband.

The PSA is low, the Gleason score (aggressivity) is intermediate and the volume of cancer is very low (1 out of 12 needles positive to cancer with 12% involvement). High Grade PIN is just a group of irregular, atypical epithelial prostatic cells, judged as precursor of cancer. This is an important finding for those not diagnosed yet with cancer, which is not your case. Unfortunately one needle did found cancer and your husband is a member of our boat. PIN is common in patients with prostate cancer, and this carcinoma commonly forms in the prostate capsule where epithelial cells exist.
Probably the 1/12 positive needle was taken for the same region. You can check it in the pathologist report.

I believe that his doctor’s opinion regarding CT and MRI comes from the low PSA. Typical image studies do not detect cancer/deformations when the PSA is low. NCCN guidelines also recommends these tests to be done in cases with a PSA higher than 10. However, modern and sophisticated equipments manage now to detect small sized tumors (1.5 mm) using C11 as contrast agent. Some doctors go further and use these newer MRI machines with 3-tesla capability to diagnose probabilities of cancer before a biopsy is done. They call it Multi-parametric MRI. Here you got a link to the fact;
http://www.radiology.ucsf.edu/patient-care/services/prostate-exam-study

One of these tests would provide you with an answer to the bumps found at the DRE and such would give you a better diagnosis and clinical stage to decide on a treatment. In present times, even 57 young guys, typically receive advice from doctors to pursue Active Surveillance instead of a radical treatment. This is a way for dealing with an indolent cancer that may not bother a patient in his life time. Treatment would be postponed to be timed with one needs if it ever is necessary. Here is a link to AS;
http://www.cancer.gov/ncicancerbulletin/041911/page2

I would recommend you to educate yourselves on the matter before signing any agreement with any doctor. Surgery and radiation are at present the only treatments that can assure cure if the cancer is contained (totally enclosed within the gland). In existing metastases surgery is used to debulking. It would not “hurt” but it would only treat the wound. In such cases radiotherapy is better and proper. The radiologist would include a field to cover those possible areas where cancer usually hides/spreads (the prostate bed and lymph nodes).

Both treatments cause side effects which may become nasty and permanent. Incontinence and ED are more common in surgeries whether colitis is common in radiotherapies. You should get informed about the risks and effects researching the net. Just google “side effects of surgery and radiation for prostate cancer”. He may not father a child again.  Frown

A good book to read is A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition); which may help you understanding options between surgery and radiation.

Nutrition is an important matter in prostate cancer. Here you got a good link;
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

I suggest you to get copies of all data and pathologist report and to prepare a list of questions to expose to the doctors when looking for second opinions. Here are some ideas for your list;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

http://www.mayoclinic.org/diseases-conditions/prostate-cancer/basics/preparing-for-your-appointment/con-20029597

I would invite your husband to participate in this forum. He can discuss with us, “man to man” if he feels like.

Best wishes and luck in your journey.

VGama  Wink

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