Newly Diagnosed

DanTW said:

Hi RCH,

Yes, my PSAa over the past few years were between 1.2 and 1.9. And yes, a prostatic nodule prompted the biopsy (assume that's what you meant by bx).

I'm in the Sacrtamento area, and my urologist is in Roseville. He told me that his interpretation was stage 2b. Will he have more specific info than that?

Thanks...

Kongo said:

Stage T2B
Dan, welcome to the forum and I am so sorry that you and your wife are now finding yourself dealing with this diagnosis.

The definition of T2 cancers is:

T2: the tumor can be felt (palpated) on examination, but has not spread outside the prostate
T2a: the tumor is in half or less than half of one of the prostate gland's two lobes
T2b: the tumor is in more than half of one lobe, but not both
T2c: the tumor is in both lobes

Since you described your pathology report as having cancer in your right base, right mid, left mid, and left apex it would seem that you have cancer in both the right and left lobes which means your stage should have been set at T2c not T2b. It really doesn't make that much difference in your treatment choices...what it is saying is that your prostate cancer is distributed across the entire prostate gland and can be felt by the finger in a digital exam.

What is disconcerting in your post is your PSA levels. Typically with a man your age and a T2 stage the PSA levels are much higher. Not that there's that much specificity for cancer from a PSA test. Gleason 7 cancers, and yours were of the less dangerous 3+4=7 rather than the more aggressive 4+3=7 variety would typically be expected to generate a higher level of PSA and I would expect that you would be showing PSA values in the range of 8 - 15. The reason this is worrisome is that more advanced and less differentiated cancers produce less PSA yet your overall pathology doesn't give any indication that you're harboring a more advanced cancer.

So, the first thing I would ask your urologist to explain is what his opinion is about why your PSA values are so low yet you have a biopsy report that shows only a 3+4 Gleason reading on both sides of your prostate.

I have never been a member of Kaiser but have read of many men with prostate cancer who have been presented with only limited choices pertaining to prostate cancer treatments. Of course, that's how HMOs operate. I would carefully examine your policy coverage before visiting the urologist.

In California urologists are required to give you an unbiased overview of the treatment options for prostate cancer. These include surgical removal of the prostate, brachytherapy (radioactive seeds planted internal to the prostate), or external radiation. Within these broad treatment subsets are very many variations such as robotic or open surgery, different types of brachytherapy seed implants using different radioactive isotopes, and a broad array of external radiation techniques that include proton therapy, IGRT, IMRT, SBRT, tomography, and on and on. There are also treatments that involve high frequency ultrasound (not approved in the USA), or freezing the cancer. Many of these are probably not covered under your HMO policy.

One thing to keep in mind is that surgery and radiation (including brachytherapy) all have almost the same long term survival rates. They do not, however, have the same level of side effects. Be sure to grill your doctor on the impact and likelihood of unwanted side effects for each treatment he reviewed with you. Common side effects for surgery include incontinence, ED, penile atrophy, and normal hazards associated with a major surgery. Radiation has much less incidence of incontinence and ED initially, but depending upon the type of radiation you elect there can be longer term effects on both of these areas. In short, every treatment has a downside.

You will also want your doctor to talk about hormone therapy and what it can do in your situation and how long you should take it and what those side effects can be.

I would also ask him his plan to rule out metastasis to the bone marrow, seminal vesicles, and lymph nodes. There are tests that can be conducted in each of these areas. If he determines that the cancer has indeed spread beyond then you will want to know his reasoning for primary treatments to the prostate since radiating the prostate or removing it are not going to stop the growth of prostate cancer in other parts of your body.

I would take along a tape recorder and have both you and your wife attend the session.

Best of luck to you.

K