Recently Diagnosed and am a bit confused

Kongo said:

Sorry
AussiePup

Sorry to hear of your diagnosis but welcome to the forum. There are many men here who have gone through similar circumstances and I'm sure you will get much support and advice based on their experiences.

As you know, your diagnosis is troubling because it indicates a higher risk cancer which has cells that are much less differentiated that a Gleason 3+3, for example. Assuming you have been having regular physicals where PSA testing was done, you should have a good history of your PSA scores. If you put them into the Sloan Kettering nomograms then you can calculate your PSA density, your PSA velocity, and PSA doubling time. All of these help give you some perspective on the aggressiveness of your cancer.

If I were you I would be heartened to know that only one core came back positive which may be an indication that the cancer tumor in your prostate is relatively contained. (Of course, it could also mean that they just missed any cancer in the other core samples).

Your doctor is right to have a sense of urgency about this and he is being smart to have you consult with a radiologist as well as his specialty. As Larry pointed out and your doctor alluded to, surgery following radiation for salvage therapy is more difficult but not impossible.

Your doctor may have discussed with you that there are differing opinions about whether surgery on a Gleason 8 cancer is prudent or not, your age notwithstanding. Gleason 8 cancers have a much higher probability that some of the cancer has moved outside your prostate even though the bone scan showed negative results. Removing the prostate after the cancer has spread will not slow the progression of cancer outside the gland. (Prostate cancer inside the prostate isn't fatal...but the relatively small percentage of men who DO die from prostate cancer succumb to the damage to their organs outside the prostate). On the other hand, if there is good evidence that the cancer is still contained, there have been some recent studies published that show excellent results in long term absence of recurrence following surgery. You should also consider that if indeed tha cancer is contained in the prostate, then several forms of radiation may also be appropriate.

One particular form of radiation that is frequently used with your stage of prostate cancer that is apparently contained within the gland is HDR brachytherapy where temporary radioactive wires are inserted into the prostate for a short period of time. This is frequently done in conjunction with a limited course of hormone therapy. When you meet with the radiologists, I would include HDR (High Dose Rate) brachytherapy on the list of possible treatment options to discuss.

Despite the fact that your pathologist apparently specializes in prostates, I would strongly encourage you to seek a second opinion from one of the major medical schools such as Johns Hopkins. The initial diagnosis in your case is so important and so much rides on it that i would go the extra mile on this.

You shouldn't feel guilty about leading a healthy lifestyle and coming down with prostate cancer. I'm not sure what a "mostly vegetarian" is but I would encourage you to read The China Study in addition to the standard issue prostate cancer books. I would also consider eliminating dairy if that is part of what you eat because of its strong association with the IGF factors and cassein which accelerate cancer growth.

Best of luck to you.

Kongo said:

HDR Brachytherapy
Martin,

While brachytherapy (permanent seeds) is generally considered a solution for low to medium risk patient, HDR brachytherapy is another story altogether with a much higher dose rate very precisely administered. Brachytherapy and HDR brachy should not be confused with each other.

Check it out at: http://www.prostate-cancer.org/education/localdis/demanes_HDR.html

Good luck.

K

Swingshiftworker said:

Gleason 8 and Stage T1c?
I know it's possible, but I don't think I've ever heard of anyone w/a Gleason 8 (high grade cancer) also being diagnosed as Stage T1c (early stage cancer undetectable by DRE or imaging).

This apparent inconsistency suggests the need for a 2nd opinion on the biopsy. Dr. Jonathan Epstein at Johns Hopkins, who is one of the experts in the field, did a 2nd opinion for me and I highly recommend him. His contact information is available here: http://pathology.jhu.edu/department/services/consults/urologic.cfm.

If you really have a Gleason 8, surgery is usually suggested (but not absolutely mandated) as long as the cancer has not migrated beyond the prostate capsule. There are other radiological alternatives, as other have already suggested.

While your slides are out for reanalysis, take the time to investigate your options before submitting your body to the knife. The negative consequences of surgery are quite draconian and various forms of radiation treatment may still be the better choice.

BTW, don't let the suggestion that surgery after radiation is contraindicated deter you from choosing radiation over surgery as the primary treatment. If surgery fails you'll have no choice but to opt for radiation and/or chemo later, which are the same follow-up choices if the initial radiation treatment fails.

Good luck!

mrspjd said:

HDR-B
Hi Martin,

Welcome to the PCa forum. A bit about our PCa journey: After multiple consults with skilled and experienced docs in all tx modalities, my husband, PJD, chose HDR-B as his primary treatment in combination with ADT (Androgen Deprivation Therapy aka hormones) and IMRT. He is doing very well with good results todate, enjoying golfing, skiing, working, exercising, etc. In all the confusion & fear of a cancer diagnosis, there is, afterall, for many, a good life after PCa!

Briefly, PJD was dx’d with PCa in Feb 2010 @ age 67. He was otherwise healthy, fit, and active, with no major pre-existing health issues. He had a history of low PSA’s. PSA @ dx was 2.8. Nodule found on DRE lead to a twelve core biopsy resulting in 9 cores positive with many of the nine cores @ 70-100% positive. Local pathology lab reported Gleason 3+3=6, stage T2 with PNI. PJD sent his biopsy lab slides out to a well known and respected PCa pathology lab, Johns-Hopkins, for a 2nd opinion reading. The J-H’s report downgraded (worse) the Gleason to 3+4=7, confirmed PNI (PeriNeural Invasion), and lead us to seek further diagnostic testing in order to determine the correct staging. We felt that establishing the correct pre-tx staging was critical in order to evaluate which tx would offer the best chance of successful outcome with the least side effects since no two cases of PCa are the same. Staging was ultimately determined to be intermediate/high risk T3 locally advanced PCa with ECE (extra-capsular extension).

If you wish to read a few of my recent summary postings relating to our PCa experience and HDR-B, they can be found in the following threads:
http://csn.cancer.org/node/193113 (May 2010 & March 2011 posts)
http://csn.cancer.org/node/215851 (April 9 & 14 posts)

To read more about a topic of interest or previous posts made by a particular user/board member, you may wish to take advantage of the search box feature located on the upper right side of the PCa forum home page. Just enter a topic, key word(s) or user’s name.

Once you have all the facts and educate yourself about your options, you will be able to make a tx choice that will be right for you. Wishing you all the very best.

mrs pjd

PS: Next to Springer Spaniels, Aussie Shepherds are great! Rescue dogs of course.

finbar said:

Prostate Confused
I had a very similar report on my p cancer. That was 3 years ago at age 82.
With the help of both patients and doctors, I looked into all the treatments
available and and soon came to the very solid decision to get rid of the cancer
once and for all. Once I settled on the Davinci robotics, the next step was
to find a surgeon with a great deal of experience having at least a 1,000 operations
a year. Not only saving as much of the nerve bundles as is possible but making
re-connections to the bladder is vital to a good outcome. I was most fortunate to
now have a near zero PSA that has been checked every six months. Should you wish
further info, I can emailed at alb212@gmail.com

cooksey23 said:

PCa
Found out when I was 48 years old that I had prostate cancer. Gleason 8 (4&4). Did the Davinci. Clean since June 2007. Other problems with CLL. Radiation and 4 rounds of chemo. Your life has changed but, always make the best of it. No matter what the side effects. Like for me, once in your life you have to think about you.

God Bless

Willie Teague
cooksey23@cox.net