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Just diagnosed

willie49
Posts: 7
Joined: Dec 2017

Hello,

I was just diagnosed with prostate cancer. Biopsy results indicate:
12 cores taken, 6 are positive for cancer. 
Right apex - 10% occupied
Right base - 30% occupied
Left base - 10% occupied

The report did not indicate a T score, the urologist did indicate that it was contained so based on this, I place it as a T1c
We are waiting for an appointment to see the oncologist, however, his urologist suggests he should seriously consider surgery. He is 50

PSA has risen from.4.5 to 9.7 in just over a year
.
Any advice would be greatly appreciated

Clevelandguy
Posts: 441
Joined: Jun 2015

Hi,

Any idea of what his gleason score is?  Is the tumor completely inside of the prostate?

 

Dave 3+4

willie49
Posts: 7
Joined: Dec 2017

Gleason score is 3+3=6

ASAdvocate
Posts: 115
Joined: Apr 2017

Your post used both "I" and "his", so were you diagnosed, or somebody else? 

 

In any event, having six positive cores, bilaterally, at age 50, would usually require treatment, even if the Gleason scores were all (3+3).

 

But, PCa is usually slow growing, so you/he have the time now to get educated on the treatments and their side effects. The worst mistake a patient can make is to rush into surgery or another treatment without having consulted multiple doctors offering different specialties. Don't be afraid to ask and question all that you can.

willie49
Posts: 7
Joined: Dec 2017

Thank you.  Sorry for confusion, my wife started to type the note and I took over (should have proofread).  

Urologist seemed to be concerned with the volume (i.e 30% in one core and 10% in the others) and the 6\10.  Just waiting for appointments with the radiology oncologist and the surgeon.  Scarey not knowing if there is more in there aside from what they detected.

Old Salt
Posts: 720
Joined: Aug 2014

'urologist suggests he should seriously consider surgery'.

Yes, but radiation options should also be considered. The good news is that you, or your partner (?), has time to make an informed decision, a point already made by ASAdvocate.

1005tanner
Posts: 29
Joined: Dec 2017

Take you time and consult all options . Being 50 is young for this so study and take slides to have looked at again

My psa was only 2.97 at 60 years old but biospy showed 2 cores positive 25% left apex gleason 6. still deciding on treatment

at this time or active survellance. Any advice also appreciated.

ASAdvocate
Posts: 115
Joined: Apr 2017

1005, you should create your own thread. But, with only two cores on the same side with G6, you would appear (with what we know now) to be a perfect candidate for active surveillance. Of course, more testing would be needed to confirm that.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

As I understand your Gleason is 3+3=6.

In one core, there is a 30% involvement, and in another there is 10% involvement, that is 30% and 10% of each of these cores are cancerous.

Now are there any other cores out of the twelve that were taken,  that are cancerous? and if so what is the involvement of each? 

willie49
Posts: 7
Joined: Dec 2017

Hi,

This is from the report:

Right apex - 10% occupied
Right base - 30% occupied
Left base - 10% occupied

Greatest percentage of tumor in a core = 50%

hopeful and opt...
Posts: 2224
Joined: Apr 2009

So, as I understand six of twelve cores were postive within the areas that you mentioned. Do you have the information for each of the cores that were positive and the involvement of each?

willie49
Posts: 7
Joined: Dec 2017

6\10 gleason score for each core involved, the breakdown as per my previous note for involvemen. The report didn't indicate a T score, but based on my research it would be T1c.  

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Sorry to be a pain, but were three cores positive or were there six cores positive? There is a difference in available treatments depending on this answer.

willie49
Posts: 7
Joined: Dec 2017

No trouble.  6 cores were positive of the 12.  Breakdown is what I listed from the report.  I had to ask.to for clarification as it seemed confusing.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Determining Gleason scores are subjective; there is a difference among the skills of pathologists and available facilities, so I recommend that you receive a second opinion of the pathology from a world class organization that specializes in prostate cancer. Johns Hopkins is one of these organizations. The results of your pathology is the primary source to determine treatment. If your insurance does not cover the cost of the second opinion, it will be approximately $250 out of pocket. Simply call your doctors office and ask that the slides be sent to Johns Hopkins

Basically even with with a low 3+3=6 when there is an abundant amount of cancer located, you would not be a candidate for Active Surveillance (monitoring), unless you are an older man where the critieria is relaxed,  since there is a good chance that a 3+4=7 can be found.......so consider a second opinion by an expert organization that you can trust, and you will know where you stand.    .

Swingshiftworker
Posts: 1013
Joined: Mar 2010

The following is a duplicate of one that I have posted in various threads on this forum to give men newly diagnosed w/lower risk prostate cancer (Gleason 6 or 7) an overview of the treatment options available to them.

 

Anyone newly diagnosed with prostate cancer rated Gleason 6 (and usually Gleason 7) has all treatment options available to him and, since this cncer is considered "low risk", he has time to decide which choice is best for him.  So, the first thing a new prostate cancer patient should do is to do research on the available options before he actually has to make the decision regarding which treatment to choose.

The following is my response to other men who asked for similiar advice about the treatment choices avilable to them.  It's a summary of the available treatment options and my personal opinion on the matter.   You can, of course, ignore my opinion about which treatment choice I think is best.  The overview of the choices is still otherwise valid.

 . . .  People here know me as an outspoken advocate for CK and against surgery of any kind.  I was treated w/CK 6 years ago (Gleason 6 and PSA less than 10).  You can troll the forum for my many comments on this point.  Here are the highlights of the treatment options that you need to consider:

1)  CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer.  Accuracy at the sub-mm level  in 360 degrees and can also account for organ/body movement on the fly during treatment.  Nothing is better.  Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding.  Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

 2) IMRT is the most common form of external radiation now used.  Available everythere.  Much better accuracy than before but no where near as good as CK.  So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding.  Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed.  I think some treatment protocols have been reduce to only 20 but I'm not sure.  Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

 3) BT (brachytherapy).  There are 2 types: high dose rate (HDR) and low dose rate (LDR).  HDR involves the temporary placement of rradioactive seeds in the prostate.  CK was modeled on HDR BT.  LDR involves the permanent placement of radioactive seens in the prostate.  1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children.  The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive.  Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body.  Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc.   Both HDR and LDR require a precise plan for the placement of the seeds which is done manually.  If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects.  An overnight stay in the hospital is required for both.  A catheter is inserted in your urethra so that you can pee.  You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

 4) Surgery -- robotic or open.   Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation.  Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function).  Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body  due to the remove of the prostate which sits between the interior end of the penis and the bladder.  Doctors almost NEVER tell prospective PCa surgical patients about this.  A urologist actually had the to nerve to tell me it didn't even happen when I asked about it.   Don't trust any urologist/surgeon who tells you otherwise.  Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer.  Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

 4) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer.  You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer.  Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it. 

 I personally could not live w/the need to constantly monitor the cancer in my body.  Like most other men, I just wanted it delt with.  Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted.  I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected.  Other men on this forum have reported similiar results.

 So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment.  The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

 Good luck!

fullmoon50's picture
fullmoon50
Posts: 40
Joined: Dec 2017

My husband’s doctor neglected to tell him about a PSA of 9 in summer 2016. A recent routine test indicates his PSA is now over 30. The only information so far is that he has cancer. I will accompany him to urologist on Wednesday December 20. I’m trying to not get too anxious before we have more info. However, I did read that a man presenting with a >20 PSA is more likrly to have advanced cancer. Can anyone comment to that?

Mostly what I’m seeking is advice on what questions to be asking at the urologist appointment. What information is most important at this time? My spouse is 65 with chronic hypertension and Type 2 diabetes. Thank you in advance.

hopeful and opt...
Posts: 2224
Joined: Apr 2009

Please start a new thread so we concentrate on answering your questions. Additionally this will not infringe on the current thread.

Will Doran
Posts: 207
Joined: Sep 2015

Willie,

I was diagnosed in August 2013.  My PSA was 69 when found, I had no symptoms.  It was found purely by accident, because of an internal bleed.  At the time, I was 67 years old at the time.  I had biopsy done, and my Gleason was 3 + 4 --7.  As has been stated in another reply here, I wanted the cancer gone.  My Urologist / Surgeon suggested Robotic Surgery or Radiation. He suggested surgery, because "Of my Youth, and physical condition".  I laughed at that, but he was totally serious. I was a road cyclist and out riding with the University Cycling Team practicing Drafting and such things. So, at your young age, that has to be a consideration.   I was ready to jump at the surgery right away.  However Dr. "M" would not do the surgery until I went to Radation Oncology first, and talked to the Oncologists.  Then I thought I'd do the radioactive seed thing.  However I decided to go with the surgery, instead, after I read many articles about the side effects of all the treatments available.  It was a good thing that I decided to do the surgery.  As they were working on my surgery, They discovered that my Bladder was adhered to my prostate, and they had to do other work , put an incision in my bladder, etc to get the prostate removed.  They found that using the radiation seeds would not have worked because they coudn't have gotten all the seeds where they needed to be.  Also, because of Hernia mesh from an Abdominal Hernia, my robotic surgey that was supposed to take about 3 hours ended up taking 5 1/2 hours.  Post Op Pathology showed 40% involvement of the prostate, and there was one very tiny spot in one lymph node.  That spot was so small that it hadn't shown up in my MRI's. There was no other spread of the cancer.   Thus I was listed as a Stage pT3bN1.  Because of that pathology, I had to do 38 follow up Radiation Treatments.   28 regular and 10 treatments  they called "Boost" to the Prostate Cavity.  This was done to catch any cells that might have been missed.  I was also on Lupron for two full years.  They started me on the Lupron first, to weaken any cancer cells that might have been left during the surgery. My surgery was on December 10, 2013.   I am now  four full years and 7 days past my surgery.  My PSA dropped to <0.010 with in about 2 months, and stayed there for three years.  I've been off Lupron for over a year now, and my testosterone has come back up into normal range.  They had my testosterone down to 17.  Normal Total Testosterone Level range is 250 - 1100.  I am now at a Total Testerone level of 380. Normal Free Testosterone Levels are 30.0 - 135.0.  My Free Testoaterone is now back to 41.8.  As of my last check up my PSA was at 0.147. It had come up, but the last tests showed the rate of increase has been cut in half.   My Radiation Oncologist, My Chemo Oncologist and My Urologist / Surgeon are pleased.  However they say there are still cells somewhere, and we must keep close watch on the PSA Numbers.  If we come up to around 2, the I will probably have to go back on Lupron or some other form of treatment.  My doctors keep it real.  This is and will be a constant on going fight for the rest of my life.  

So, as far as advice----->.   Read, study, read, study, and then repeat.  Make sure you understand all the options and all of the side effects of all types of treatment.  I am not a doctor and thus would never make suggestions.  Only that you should study hard.   Ask as many question as you can think of.  Ask your doctors, and also ask us here on this site.  We can share our experiences with you.  You will have to make the decisions for yourself.  That's how my doctors were with me.  So far, I'm glad I followed the path I did.  My doctors are talking types of treatment options we have, if needed, for 10+ years and beyond, as of right now.  My wife has been my biggest help, support and "Cheer Leader".  Enjoy the simple things in life.  Being together and out side.  Sunsets, Rain and thunder storms, lazy snow falls,  wild life in the yard  (for us, that's Birds, an occasional Bear, Deer, and even a Coyote), etc.  Sunny Day Drives just looking at the scenery.  All this has gotten us through this up to this point.  

Know that you are in my Thoughts and Prayers.  Best of luck and sucess with your journey.

Love, Peace and God Bless

Will

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