Just found out I've got Prostate Cancer

SLONG1958 said:

UPDATE
Hi to everyone
Just received the Biopsy report in the mail.You guys wanted to know the percentage if I'm looking at this right it's 4%.Can somebody please explain this,and give me some treatment oppositions.The 4% is on the picture of the prostate along with 3+3 also looks like I have one core that was borderline.The cores are not together one is in the upper left corner the other is in the lower right corner this is the borderline one.

Pathologists Analysis
Summary Diagnosis
Adenonocarcinoma involving LLB
Gleason Score 3+3=6
Tumor length/Core length 0.5mm/105mm (<1%)
Core involved 1
Core Examined 13

Coments
Immunoperoxidase stains for the prostate triple panel(p504s,p63 and cytokeratin 34be12)were
performed on LLB and RLA.The immunostains conffirm the diagnosis of adenocarcinoma in LLB.
The focus of atypical small acini in RLA shows lack of basic cells,however it is to small for a more definitive diagnosis. Control slides were performed and are satisfactory. The specimen was described and processed at Conrad Pearson Clinic, 125 Guthrie Drive, Southaven, MS 38671 and labeled as CP11-215. The specimen was received with Oncofix II fixative and is labeled with biopsy site(s) and patient's identification. All jars contain soft white cores of tissue. Each specimen is entirely submitted for sectioning and the fixative fluid is processed into cytospin slides. For a detailed description, please see the gross section. DNA testing is being performed on block LLB. The results of this DNA test will follow at a later date.</p>

Kongo said:

Early Detection
Slong,

Welcome to the forum and thanks for sharing the additional information from your biopsy pathology.

Your diagnosis seems to show a very small amount of prostate cancer with a single core apparently having an involvement of 4%, meaning that 4% of the cells in that core showed adenocarcinoma (the most common form of prostate cancer). Frankly, your pathology could just as easily have missed that small amount of cancer and come back completely negative. Also, it is not uncommon for a biopsy to have one core considered "borderline" and is generally associated with some type of inflammation such as a mild case of prostatitus or some other condition that would have no symptoms.

As others have pointed out you are in a position to choose between a wide variety of treatment options all of which would promise a high degree of success. Another option that might be appropriate given your pathology would be active surveillance although at your relatively young age I would suspect that at some point, perhaps years and years later (or maybe never) you will find yourself needing to address the cancer.

At this point you should have enough information to gain some additional insight into your condition. First, calculate your PSA density which is the ration of PSA to prostate volume. The prostate volume should have been determined via the ultrasound probe when they performed the biopsy. A very low PSA density is generally indicative of low risk cancer. If you have a previous history of PSA readings you can calculate your PSA velocity (how quickly your PSA is increasing) and PSA doubling time (which is the length of time it should take for your PSA to double in value). A low PSA velocity and a long doubling time are also indicative of low risk cancer. There are nomograms available on the web at several places that enable you to calculate these values and PSA velocity and PSA doubling times are not strict algebraic relationships but are logarithmic.

As you consider options please seek second opinions. Urologists are mostly surgeons and statistics show that over 90% of them recommend surgical treatment. Radiologists almost always recommend radiation. One of the frustrating aspects of this disease is the conflicting advice you will get from the various experts in the field. I believe it is important to seek several opinions in order to get a balanced view that will enable you to eventually reach a choice that is best for you, your lifestyle, your personal preferences, and the degree of side effects you’re willing to risk.

Each treatment will have some degree of side effects that will affect every day for the rest of your life so it is very important that you understand these potential effects and choose according to your values and expectations.

Besides surgery (open or robotic) and the many different types of radiation treatment (Proton, SBRT, IMRT, IGRT, Brachytherapy, HDR Brachtherapy, EBT, Tomography, and so forth) there are also HIFU (not available in the US), cryosurgery (freezing of the prostate), hormone therapy, as well as a few others. I would recommend reading about these from information readily available on the internet and discuss them with your doctor.

I also highly recommend that you seek a second opinion on your biopsy. Your doctor can explain how to do this. Since your treatment decision is going to be based on the pathology of your biopsy, it is vital that you have confidence in the results. It is not uncommon for different pathologists to score your cancer cells differently and a different Gleason score or level of involvement can radically change your treatment choices although given your very low risk results I would be surprised if there was a change with a second opinion but it’s better to be safe than sorry in this regard.

In my own case, I chose CyberKnife radiation treatment with a diagnosis similar to yours (PSA 4.3, Gleason 3+4=6, 1 of 12 cores postive with 15% involvement, negative DRE, no symptoms, no history of PCa in the family). I was diagnosed a year ago this month at age 59. I made my decision after consulting with six specialists which included surgeons, radiologists, and oncologists that specialize in prostate cancer. I also consulted with Loma Linda Medical Center about the proton treatment lewino mentioned. I also read about a dozen books about prostate cancer and dozens of studies about the various treatment methods. I had my treatment in June 2010 (5 radiation sessions, one every other day) and have had no side effects and the results appear to indicate that my cancer has been successfully treated.

But please do not make a decision based on what someone else has done. Each cancer patient is different and each of us has different needs, expectations, and risk tolerance. Educate yourself and be an informed partner with your medical team.

Best of luck in your journey,

K

SLONG1958 said:

2nd Opinion on biopsy
Hi to everyone and thanks for all the support.I need to know other places I can send my biopsy slides to for 2nd opinion.I live near Memphis is there any close there and is there any Top notch Cancer Centers close.We've got the best in ST JUDE for children but I don't know of any for adults.How many of you went to a Cancer Center instead of a regular urologist office.I've been going to The Conrad/Pearson Group in Memphis.They seem to be good people and what I've learned they do alot with Prostate Cancer.I wake up at night with all sorts of questions.I've got a lawn company so I'm starting to work alot now it keeps my mind clear, but at night when I'm in bed is another question.The thing is I just don't know what to do.I'm married and my wife is great and she has been a big help.There is no PC at all in my family my Dad will turn 89 in April his dad was 86 before he passed my Mom was 84 before she passed last year her Mom was in her mid 80s.

mrspjd said:

PCa Biopsy 2nd Opinion - Lab Info
There are only a few labs nationally that are recommended for reviewing your PCa biopsy slides for the purpose of obtaining a 2nd opinion. These labs are well-respected and known for their expertise in reading nothing other than prostate biopsy lab slides--unlike most local labs that read all biopsy samples for every kind of cancer, etc. You only want to send your slides to one of the top rated labs for the 2nd opinion report.

Here is a link to another recent thread where specific info was provided about several of the labs that specialize in analyzing PCa biopsy slides:

http://csn.cancer.org/node/212732

Hope it all works out.

SLONG1958 said:

Quality of Life
Hi to everyone
Just one question for the guys that have had the Robotic Surgery.Just thinking ahead I haven't made a decision yet.I'm self employed I cut grass and I'll be on a mower for 5 or more hours a day will that be a problem.Its going on 2 weeks now I guess I need to go and talk to my Doctor and see what he has to say.I'm going to call what Family doctor today and get all my PSA Tests for the past 4 years.

SLONG1958 said:

Quality of Life
Hi everyone and thanks for helping me.I must be stupid or something but everyone is saying do whats right for me.I'm 53 and I stay busy all the time if I'm not cutting grass I'm working around the house or on my 72 Nova project I'm doing something all the time.My wife and my children want me to get it removed and she understands about the impotency.She said she wants me to live a long life like my Dad and his Dad.I'm more worried about the leaking,is it alot or just a few drops which I do now.Somebody on here wanted to know what my psa levels have been.In 2008 1st psa test 3.1 09 and 10 didn't get one till 1/11 which was 4.9.I can't believe I did't get a blood test in those 2 years.I started going to the Chiropractor for neck and lower back and I told him of my PC diagnose and he said he thinks he can help me with getting adjusted along with vitamins and Alkaline water plus some kind of vitamin especially for the Prostate.He want me to do this for about 2 or 3 month and then get me PSA level checked again.What do you guys think of this.

Again thanks.

Kongo said:

Welcome
Recordal,

Welcome to the forum and congratulations on treating your cancer. I hope that you quickly recover from your surgery, regain your continence and erectile function, and enjoy those grandchildren on your lap.

Without knowing details of your diagnosis it's difficult to comment on your choice other than to say that you appear to have made it based on several priorities you laid out for yourself and that is what I think every man should do as well when facing treatment options.

I would, however, like to comment on several of your statements from a different point of view. For some of the same priorities you cite, I chose a radiation therapy.

My family also urged me to "get rid of the cancer" but I came to realize that this was my decision not theirs and that their opinions were driven by a gut-wrenching inate fear of the word "cancer" rather than any informed judgement on prostate cancer. So while I agree that family influences can be a powerful impetus during the decision making process, at the end of the day -- for me at least -- that was not a determining factor.

Certainly family history plays a big role and the early death of your father and grandfather would weigh heavily on your decision. BTW, how did they treat their cancer?

There are little comparative studies about prostate cancer biochemical recurrence other than a large study that looked at men who had either RP or radiation treatment in the early 90s. Those were the days before DaVinci or the newer forms of radiation treatment such as SBRT, IMRT, Tomography, HDR brcachtherapy, or IGRT. It makes little sense to compare the EBRT of the early 90s with its broad pelvic dosage patterns to modern radiation techniques that use fractional doses, compensate for prostate movement in real time, and deliver planned dosages with sub-millimeter accuracy. In any event, at the five year point that study shows almost exactly the same BCR rate with either RP or radiation (34% vs. 35%) The ten-year rates do indeed show a higher overall failure rate for radiation (46% to 37%) but there were several factors in this study that were not normalized and again, it was a completely different method of delivery than what is commonly used today.

The good news with respect to BCR failure rates is that regardless of whether or not you had surgery or radiation treatment, the long term prognosis following recurrence remains very high and only a minority of these men actually die from prostate cancer. In fact, the number one cause of death for men who have been diagnosed with prostate cancer is heart disease.

While I considered those older studies when I made my choices, it was not a determinant factor as the technology today had moved so far beyond what was in use then both in surgical techniques and radiology. In any case, my priority was in quality of life (not quantity of life) and I too wanted to avoid the risks of incontinence and impotence.

HDR brachytherapy, a form of radiation that uses temporary radioactive wires inserted in the prostate has nearly a 90% BCR free survival rate at the 10-year point. CyberKnife (a from of SBRT and the method I used to treat my PCa) has 5-year success rates above 90% and since it is modeled on the HDR brachytherapy protocal, it is expected to have similar long term success rates.

When you say that the radiation would be long and drawn out, I assume you are referring to an IMRT regimen that typically has 40-45 treatment sessions, each one lasting a few minutes. While that is a long time to be going back to the doctor each day, it seems to me it is over at about the same time most men recover from their surgery and get back to a normal life. In my treatment, it was over in 5 sessions and wasn't drawn out at all.

With respect to fatigue, it is true that some radiation treatments have a mild degree of fatigue associated with the treatment, particularly near the end of a long treatment plan. Not every patient reacts the same way to radiation and some feel no fatigue at all. In my case, I never felt any fatigue. I think most men are pretty fatigued after the major surgery of RP as well. Fatigue from radiation passes within a week or so after treatment is complete.

The only type of radiation where your grandchildren wouldn't be able to sit on your lap is if you had either the iodine or palladium isotopes inserted in your prostate. The half-life for these isotopes is about two months and the standard rule (at least at the Mayo Clinic) is that young children should not sit on the lap for "prolonged periods" for two months after treatment. I don't know about your grandchildren but mine are pretty hard to keep still for a "prolonged" period in any event. It seems to me that two months is more of an inconvenience rather than "several months" you stated but perhaps it just seems longer when you can't hold them as you would wish. I would also think that tenderness about scar tissue from your surgery will somewhat limit how much sitting or jumping around in your lap by grandchildren.

I certainly respect your decisions and truly do hope they play out as you expect. But there are always two sides to the story about our treatment choices and I've learned to greatly discount over generalizatons about prostate cancer treatments and their effects.

Best wishes for a full and speedy recovery and I look forward to your future posts.

K