Leaning to RP due to Dad's History
I'm 64. At 61my PSA jumped from 2.5 to 6. After MRI and a fusion biopsy was diagnosed with 3 core samples being cancer. Gleason score 6. Went into AS. Had another biopsy in late 2022, tumors have gained in size but still Grade 6. My father passed at 72 from Prostate cancer. Had high PSA at his physical when 70, it had already spread to his bones. I am in AS program at Johns Hopkins. At my last appt. the Dr. told me I could stay in AS or choose RP. My next appt is late August. Given my dad's history, I'm leaning heavily towards RP at Hopkins. Any experiences, guidance you can share is appreciated.
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I was on AS at Hopkins with Gleason 6. I had a 2nd biopsy with 2 cores at high volumes but, still Gleason 6. The AS doctor was apprehensive to keep me on AS but, surgeon seemed like it would be OK to continue AS. A few months later, my PSA creeped up a little more and I decided to go ahead with RP. Surgery wasn't that bad, was walking that evening, discharged next day. Never took any Oxy, just Tylenol the first couple days. Once catheter was out, I was pretty much continent from the start. In the following months I would only leak if I had too many drinks. Now it's not an issue at all. Was sexually active within weeks. Overall, I faired well, no complaints.
Pathology on my prostate when removed was 3+4 (Tertiary 5).
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Can you post your full biopsy results and PSA history? The devil is in the details.
With steady progression, sounds like you will eventually have to do something anyway, but if you are Favorable Intermediate risk, something like brachytherapy could give you your best shot at a low effort, low side effects cure.
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Hi, I'm in central PA too, just outside of Lancaster. Below are my latest biopsy results. Recent PSA on 9/18/22 was 6.1 and 6.3 on 3/12/23.
Study Result
Impression
IMPRESSION:
1. Focal suspicious abnormality, dominant nodules described above.
2. Overall PI-RADS = 4/5
Follow-Up Score (PRECISE) for this lesion = Definitive radiologic stage progression 5/5 (increased restricted diffusion, increased size of the anterior fibromuscular stroma lesion with bulging of the capsule).
Images and interpretation personally reviewed by: Dzmitry Haviazheu, MD
Images and interpretation personally reviewed by: Ihab Kamel, MD
Narrative
EXAM: MRI PROSTATE W/WO CONTRAST WITH 3D
INDICATION: prostate cancer
PSA 4.3 ng/mL 4/22, 6.04 ng/mL 7/21, 4.81 ng/mL 6/21, 3.7 ng/mL 3/20.
Prior biopsy: 3+3 of right mid prostate
COMPARISON: Prostate MRI 8/25/2021
Imaging at 3 Tesla.
HEMORRHAGE:
No areas of high T1 signal to suggest hemorrhage.
PROSTATE VOLUME:
Prostate measures: 4.2 x 4.4 x 4.0 cm (AP x TV x CC), volume 38 cc.
Prostate volume calculated in DynaCAD Prostate Boundary segmentation: 41 cc
PERIPHERAL ZONE:
Patchy areas of T2 hypointensity throughout the peripheral zone, likely due to prostatitis. More focal abnormal signal on T2-weighted images, ADC maps, or DCE in the peripheral zone, as follows:
Lesion #1:
- Side: midline
- Level: midgland
- Zone: anterior fibromuscular stroma
- Location: anterior
- Diagram - sector: AS
- Size: 1.4 x 1.1 cm cm on ADC map, previously 1.2 x 0.9 cm on ADC map when remeasured for consistency
- Relation to capsule: abuts more than 1 cm or bulges capsule with bulging
- ADC: B values lower # 50, higher # 800. Average ADC value 606, standard deviation 83, range 478-826
- Representative image(s): 4-14, 6-11, 5-13 (see key images)
- DCAD label: 1
Assessment categories for this lesion:
- T2 = 4/5
- DWI-ADC = 5/5
- DCE = (+)
- PI-RADS for this lesion = 4/5
- Follow-Up Score (PRECISE) for this lesion = Definitive radiologic stage progression. 5/5 (increased restricted diffusion, increased size)
Lesion #2:
- Side: right
- Level: midgland
- Zone: peripheral zone
- Location: anterior
- Diagram - sector: PZa
- Size: 0.7 cm on DWI imaging
- Relation to capsule: abuts less than 1 cm of capsule
- ADC: B values lower # 50, higher # 800. Average ADC value 971, standard deviation 116, range 837-1120
- Representative image(s): 7-18, 6-18 (see key images)
- DCAD label: 2
Assessment categories for this lesion:
- T2 = 3/5
- DWI-ADC = 3/5
- DCE = (+)
- PI-RADS for this lesion = 4/5
- Follow-Up Score (PRECISE) for this lesion = not previously present ADC signal.
TRANSITION ZONE:
Moderate hypertrophy with heterogeneous T2-signal.
No focal areas with suspicious morphology.
SEMINAL VESICLES: Normal, symmetric.
NEUROVASCULAR BUNDLES: Normal, symmetric.
BLADDER NECK: Normal.
MEMBRANOUS URETHRA: Trabeculated urinary bladder.
LYMPH NODES: None enlarged.
BONE MARROW: No suspicious osseos lesions.
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Hi Old Salt,
The info below from Sloan Kettering is consistent with what I have read. My dad had aggressive prostate cancer.
"Most prostate cancers are not associated with a hereditary predisposition, but prostate cancers that have spread or are more aggressive are more likely to be associated with a hereditary predisposition."
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That bulging would get my attention.
I've been going to Hershey for my stuff, but will likely move to a more major center as I see the end of AS approach. You are definitely at a good spot with JHU.
Your prostate is pretty small. Do you have any urinary issues? Retention or weak stream, etc.?
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PaBill,
Members here are not allowed to make recommendations, but can share observations and personal history. There is SOME correlation between first-degree male relatives and occurrence of PCa, but the medical history of your father is not a certain guide regarding what lies ahead for you. Curative treatment for your particulars consists essentially of either therapeutic radiation (RT), or surgical removal (RP). These have been statistically essentially equal in success for well over a decade now. I am somewhat surprised that your JH doctor did not mention RT among options, but I suspect that that was just an oversight. I had robotic RP eight years ago, and have been pleased. I have no incontinence or ED today, although full recovery of the former took a few months, and full recovery of potency took about two years. RT, for many men, has fewer side-effects, but it does have some counter-indications, which your doc will no doubt be very willing to share. My PSA was never above 4.5, and my Gleason was 6. I was told prior to surgery that I was Stage I, but the pathology study after removal showed that I was actually Stage II. I hope this two-cents helps; bless your decision.
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I’m gonna give you my two cents worth. I was diagnosed at 57 and I’m 62. I opted for radiation treatment and now it’s creeping back. I pray to God I have a second chance it looks like it is still in the prostrate even though it’s risky, I’m taking this damn thing out. Don’t think twice brother have it take it out find the best surgeon you can have this done over 3000 of them and don’t look back this forum is filled with a lot of stories and a lot of them are a scareybones and alot of good advice but you can get confused Like i did but since I have been diagnosed over the last five years, I know 4 older men that had the surgery done and all of them were back to work within 2 to 3 weeks and they’re all fine Find a surgeon make the date get it done that’s just my two cents. Don’t look into it too much you’ll get too confused like I did take care and God bless. I posted a video take a look at it it’s remarkable work they can do with the surgery now .
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Hi,
I had similar results from my robotic surgery in 2014 as reported above and still test undetectable. Still leak a drop or two if I strain too much, ED is back to about 85% of what it used to be. If you choose radiation, Cyberknife or Proton radiation have had great successes. But as others have said there are no guarantees with any type of treatment so choose your hospital facilities and doctor team wisely to get the best results. Extra diagnostics testing to make sure where the cancer is located inside of your Prostate, ie; close to the edge or deep inside can also help determine your treatment type and how much time before spring forth with a choice. I had pleural neural extension, if I would have waited much long my cancer could have escaped my Prostate and gone elsewhere, which is never a food thing. Good luck……
Dave 3+4
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Hello all... new here. I'm 44 years old dx w/ prostate cancer (PC) 3+4 in March 2023. My dad is a PC survivor. He was dx in his mid 60s. He's now in his late 70s. After careful consideration of my options, I decided to proceed w/ robotic radical prostatectomy. I am 1 month post-op. Pathology report was in my favor. No metastasis to nearby tissues. Tumor remained within prostatic capsule. Surgeon was able to perform bilateral nerve sparing surgery.
The only complication was urinary retention 1 week post surgery after initial foley was removed. New foley was reinserted and remained in place for an additional 2 weeks. No further urinary retention after foley removal. Very mild incontinence (triggered by heavy yawning), no need for pads (day or night). Erections are almost baseline. Scheduled to have first post op PSA blood work in early August.
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