Enlarged prostate/positive for cancer

Explore your options
Yoadrienne,

It would be helpful to know the other stats. Your husband appears to have time on his side for now (for Gleason 6) so all of his options need to be explored. I had Gleason 6, T1c, Psa 13, 2/12 cores @10% diagnosis last March (age 62). My prostate was also pushing up behind the bladder. My insurance would only cover brachytherapy, DaVinci robotic surgery or radiation /seeds (40 treatments) none with which I felt comfortable. The surgeon had "only" 250 procedures for experience so I wasnot comfortable with him. Active surveillance was my first choice until I decided what to do. At Gleason 6, I was told by 3 urologists and 3 radio oncologists (RO) that I had time however the psychological aspects might play a greater role than the cancer itself. Also, every DR. preferred his/her own specialty except for one urologist who helped me look at all options including a change in diet. After 4 months of research and prayer, I opted for Cyberknife (CK)receiving a self-pay discount since my Colorado HMO would not cover it. There are several on this site who have had each of the options. I had an MRI and CT scan which showed the unusual location of my bladder. The RO for CK was able to work around it with the VSI robot. You will find a lot of support and guidance for most procedures on this site to assist you in the decision that only you and your husband can make. Best wishes to the two of you.

Active Surveilance for delayed treatment
As a man who has been on active surveillance for the last three years, I believe that if possible this is the best treatment option that is available, depending on a persons stats, since 70 percent of these cancers are indolent, meaning not likely to spread, and generally if monitored, a person can have the same active treatment later on as a person would initially choose.

There are guidelines that are optimal for a person to in an active surveillance program.

Please get back to us with answers to specifics

How many cores were taken

How many were positive

What was the percent involvement and gleason of each core positive

What is the size of the prostate

What is the PSA,

What is the history of the PSA; what are the data points

What did the digital rectal exam show

Note: Did you have a second opinion from an independent pathologist on the pathology.

hopeful and optimistic said:

OK
In my layman's opinion, I believe that your husband is an excellent candidate for "Active Surveillance with Delayed Treatment if necessary".

His gleason is 3+3=6, which is not an aggressive cancer.

He has less than 3 cores that are positive with no more than .50 involvement.

Although his PSA is currently high; the relationship to the prostate size is low, less than ,0.15 guideline.

As of late, his PSA rose significantly probably due to factors other than the prostate cancer.

Does your husband have trouble urinating, or other physical factors due to the size of the prostate?

You did not mention the dates of the other PSA's since the rate of increase over time is important to know.

When you say "2 uropathologists reviewed needle biopsy" is this an outside world qualified independent pathogist or from inside the organization? It is very, very, very important to have an independent second opinion so you are not over or under treated.

more information
Just relooked at your post...need to know what percent of the core that is 3+3=6 is cancerous.....this information is found on the biopsy report...(the percent that you gave is based on 1 of 14 cores. It's good that you have only one core that is cancerous, but other information is required.... a different percent.

Also please answer what the DRE determined?

dockbouy said:

Enlarged prostate/positive for cancer
On the report under "Clinical Information", the following information is found:
DRE: Non-Suspicious
PROSTATE SIZE: 168CC
PREVIOUS BIOPSY: Negative (approx. 5 yrs. ago)
LAST TOTAL PSA: 10.45
CLINICAL INFO: (790.93)Elevated prostate specific antigen (PSA)

Also under "Diagnostic Information" is as follows:
F: Right Apex-FINAL DIAGNOSIS: Small focus of moderately differentiated adenocarcinoma, Gleason Score 3=3=6, measuring 2mm(10% of tissue).

L: Right Apex Lat-FINAL DIAGNOSIS: Small focus of atypical glands, suspicious
for adenocarcinoma.

NOTE: Anti-cytokeratin(CK903)and p63 do not reveal the presence of basal cells. Anto-racemase(P504S)is positive within suspect epithelial cells. These data support the malignant diagnosis.

As far as the lab results go, the results were confirmed by 2 uropathologists at the same lab, and checked again at Vanderbilt. My husband faxed his biopsy report to the Radiotherapy Clinics of Georgia (where they do the "ProstRcision procedure), in order to get another opinion. However, I believe that we need to be directed to an independent lab where they are not promoting their "wares". Any thoughts or direction on this? We live in TN and are new to the area from MI. Kind of lost...

Enlarged Prostate
dockbouy,

I think Hopeful has given you some great advice. Most men your husband's age harbor some amount of indolent prostate cancer. It's most likely never going to pose a threat to his life. My feelings are that any treatment poses much more risk to decreasing quality of life than the active surveillance.

Your husband's prostate is not just enlarged. It's enormous. It's like three times what an "enlarged" prostate is. The location of the prostate in the pelvic skeleton region means that the surround bone leaves the prostate no place to expand to and it is getting pressed against the surrounding skeletal structure. I am sure this is causing some sort of urinary discomfort such as having to get up frequently throughout the night, never being to fully empty his bladder, weak stream, and so forth. This is because the surrounding tissue is being forced up against the urethra which passes through the center of the prostate and it is squeezing it.

I hope that you consult with some other urologists who can talk to your husband about options to reduce the size of his prostate. The swelling is caused by BPH, benign fibrous tissue that tends to grow inward in the prostate. A procedure known as a TURP can be effective in addressing this.

I suspect that your husband's PSA is the result of the BPH. In the cramped quarter his prostate is literally squeezing the PSA out of the prostate cells and a higher rate than normal.

In my lay opinion, I very much believe your main problem here is BPH and a runaway prostate not prostate cancer that is going to cause a future problem.

Best of luck to you both.

K

Yo Adrienne!
Well, you've certainly gotten an earful here and I hope you and your husband are taking stock.

Fortunately, April is still a ways off and you have time to think about everything everyone has told you before allowing your husband to submit himself to the knife.

If you browse the threads, you'll find that I am an outspoken opponent of the surgical removal of the prostate as a method of treating prostate cancer. There are just too many risks associated with it and there are alternate treatments available with the same level of success but without the risks associated with surgery.

If you want to know what the risks of surgery are, please read the following article with describes them in clear detail:

http://www.hifurx.com/prostate-cancer/prostate-cancer-after-effects

As for alternate treatments, you're already aware of active surveillance which would certainly be suitable for your husband at his age and with his early stage and low grade cancer. However, if you and your husband can't live with the idea of "doing nothing," then I suggest you investigate CyberKnife and Proton Beam Therapy as alternate methods of treating the cancer.

CyberKnife (CK) is currently the MOST accurate and precise method of treating prostate cancer and is able to attack the cancer within margins far smaller than possible with surgery. CK is so precise that it tracks for body and organ movement during treatment. This precision is also responsible for minimizing collateral tissue damage (common with other forms of radiation treatment, including "seeds") and thereby reducing common side effects such as ED and incontinence (which are both very common w/surgery).

Proton Beam Therapy (PBT) is also a good alternative but it is older technology than CK and has certain limitations which IMHO make it a less attractive treatment method now. Some of the differences include the need for more treatments (28-40 vs only 4-5 for CK), fewer treatment sites than CK and the need to be seated in a body cast to restrict movement and the insertion of a water filled balloon in the rectum during each treatment (not required for CK).

I and several other men here have been treated w/CK with no significant side effects and appropriate drops in their PSA levels (below 1 for most) which indicates successful treatment.

I strongly suggest that you investigate these treatments BEFORE your husbands' scheduled surgery.

BTW, I also think Kong's remarks are noteworthy. Your husband may have cancer but the size of his prostate is ENORMOUS at 168cc and that problem should probably be addressed before any action is taken to "treat" the cancer.

Good luck!

hopeful and optimistic said:

MRI with a spectroscopy
Is appropriate to make sure that there is no extra capular extension; show where the cancer is located, one lope or two...at teaching hoapitals there are MRI machines with tesla 1.5 or with more definition 3.0 tesla magnets.....The MRI is covered b medicare, however the spectrorsopy is consider investigation, for some reason and is not covered...the spectroscopy provides better definition........please feel to click my name to see what I have been doing.

A bone scan is not recommended for those with less than a gleason 8.

Cyberknife, although a very precise, execellent treatment is invasive, radiating(frying) the tissue, and I personally would not do this or any other invsasive treatment such as surgery, etc. unless I really had to. Remember 70% of the cancers for those with low risk are indolent, and will require no invasive tretment.

Fried Prostate?
While we agree on most things, Ira, I think your choice of words here is misleading. CyberKnife doesn't "fry" anything and neither does any other type of radiation when administered properly. Technically, frying is cooking food in oil or fat. That's not at all what is happening here. The ionizing radiation alters the DNA in the prostate cancer cells causing them to be unable to conduct mitosis. There is sometimes some irritation caused by the ionizing energy but the term "frying" conjurs up bacon sizzling in the pan which is not what happens at all.

In rare cases, radiation can cause scaring which causes problems. The scaring is caused by ionizing radiation which damages adjacent cells and nerves that eventually die. It's not like scaring which occurs after a scalpel makes a cut. CyberKnife, and IMRT for that matter, very accurately deliver the radiation which minimizes the possibility that these issues occur but everyone reacts differently.

I know your opinion that radiation is invasive. I disagree on this as well although I would concede that fiducial placement is invasive because it is physically putting something into the prostate. For that matter, biopsies are invasive and, as you know, are frequently a regular part of active surveillance. Given my previously expressed opinions on biopsies I would rather have the radiation than repeated pokings into potentially cancerous sites with a needle gun, but overall I think active surveillance, particularly in the case germane to this particular post, is appropriate given what we know now. I do think a TURP is in order and that would have to be considered invasive.

I think it's important that we be as precise as possible when describing treatments and their effects and medical terminology is rich enough to do this without frying things.

Best,

K