Noobie here...would like some feel for where I am headed

coonhound · January 2013

Got my 3rd biopsy results today..the 2 preceding transrectal procedures came back as "NEG" but PSA kept increasing over the past 4 years..6---16---21(9/2012), in that period. Last Bx was a template biopsy done to hit the anterior lobes with 5/20 biopsies +, mostly 3 + 3, (1) was 3+4 and (1) 4+3 Gleasons. Last tranrectal was only 8 weeks ago so I guess I have a clean post. lobe/ localized anterior. Don't know about any perineural invasion since I have 2 weeks to wait 'til my Urologist discusses "treatment Rx options".

I'm 63, pretty good health except for DVT( shot rt. lower leg veins from infectious myofasciitis 12 years ago)/PE history on Coumadin and Grave's last year, now post I 131/hypothyroid and on Synthroid.

Anyone with a similar scenario who would like to share where they were pointed therapeutically ? Tried to read quite a bit of the Web on this subject and seemed like opinions weren't consistent...total radP results equal brachyRx results in some, different in other studies....

Will read with much interest obviously what you folks who have gone further down this road than I have say...Thanks.

Craig

.

VascodaGama · January 2013

Advantages and disadvantages

Craig

You do well in being apprehensive of your past medical problems and the treatment of PCa. The diagnosis of your cancer location/findings you posted above refer to the anterior lobe (other typical areas/posterior were negative), which seems to have a high chance for a curative approach with surgery (contained case). Radiotherapy is also a choice but at those areas the probabilities affecting side effects at the urinary track and bladder, and the muscled leading to erections, are similar to those typical of prostatectomies.

In other words, both treatments got their advantages and disadvantages.

NCBI published an article about the increased risks and problematic associations of thromboembolic diseases and the prostate cancer. They comment that DVT and thromboembolism are common complications after prostatectomy. This is a statement not good to those contemplating surgery as their treatment of choice.

However, in my case, much discussion were done before committing to RP due to hereditary problems (from my mother’s side) with blood and veins complications, but I and the physicians decided to go through. Special care and attention was done before and during the prostatectomy.

They took care for the need of any transfusion keeping my own blood (400cc taken three weeks before RP), and I was kept with sort of massage equipment in my lower legs the whole night after surgery. My physicians were worried but nothing happen (apparently) since then (RP in 2000).

The above article refers to a study published in the Lancet Oncology, where they found that:

“…….For men on endocrine therapy, risks for DVT (SIR 2·48, 95% CI 2·25–2·73) and pulmonary embolism (1·95, 1·81–2·15) were increased, although this was not the case for arterial embolism (1·00, 0·82–1·20). Similar patterns were seen for men who received curative treatment (DVT: 1·73, 1·47–2·01; pulmonary embolism: 2·03, 1·79–2·30; arterial embolism: 0·95, 0·69–1·27) and men who were on surveillance (DVT: 1·27, 1·08–1·47; pulmonary embolism: 1·57, 1·38–1·78; arterial embolism: 1·08, 0·87–1·33). Increased risks for thromboembolic disease were maintained when patients were stratified by age and tumour stage.”

Their terminology for “curative treatment” includes surgery and radiotherapy but none is confirmative of the numbers in each treatment. It also seems that the data refers to patients indiscriminately of the risks for thromboembolic disease being due to the treatments themselves. They say that “…a selection was bias towards healthy men for radiotherapy and prostatectomy”.

Here is the full article that may be of interest to you;

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861771/

I think that you should get second opinions on the conflicts of a repeated DVT in your other health problem context. You need to consult specialists on both sides of the problem; surgeons and radiologists.

You need to be aware of the side effects from radicals. Many are not acceptable at our young age of 63 (my age too). It seems that vitamin K can reversed deficiencies and corrected abnormal coagulation in patients treated for thromboembolic diseases (DVT and PE).

Diet and physical fitness are important components of health and PCa treatments.

Wishing you luck in your journey.

Best.

VGama

coonhound · January 2013

VascodaGama said:
Advantages and disadvantages
Craig

You do well in being apprehensive of your past medical problems and the treatment of PCa. The diagnosis of your cancer location/findings you posted above refer to the anterior lobe (other typical areas/posterior were negative), which seems to have a high chance for a curative approach with surgery (contained case). Radiotherapy is also a choice but at those areas the probabilities affecting side effects at the urinary track and bladder, and the muscled leading to erections, are similar to those typical of prostatectomies.

In other words, both treatments got their advantages and disadvantages.

NCBI published an article about the increased risks and problematic associations of thromboembolic diseases and the prostate cancer. They comment that DVT and thromboembolism are common complications after prostatectomy. This is a statement not good to those contemplating surgery as their treatment of choice.

However, in my case, much discussion were done before committing to RP due to hereditary problems (from my mother’s side) with blood and veins complications, but I and the physicians decided to go through. Special care and attention was done before and during the prostatectomy.

They took care for the need of any transfusion keeping my own blood (400cc taken three weeks before RP), and I was kept with sort of massage equipment in my lower legs the whole night after surgery. My physicians were worried but nothing happen (apparently) since then (RP in 2000).

The above article refers to a study published in the Lancet Oncology, where they found that:

“…….For men on endocrine therapy, risks for DVT (SIR 2·48, 95% CI 2·25–2·73) and pulmonary embolism (1·95, 1·81–2·15) were increased, although this was not the case for arterial embolism (1·00, 0·82–1·20). Similar patterns were seen for men who received curative treatment (DVT: 1·73, 1·47–2·01; pulmonary embolism: 2·03, 1·79–2·30; arterial embolism: 0·95, 0·69–1·27) and men who were on surveillance (DVT: 1·27, 1·08–1·47; pulmonary embolism: 1·57, 1·38–1·78; arterial embolism: 1·08, 0·87–1·33). Increased risks for thromboembolic disease were maintained when patients were stratified by age and tumour stage.”

Their terminology for “curative treatment” includes surgery and radiotherapy but none is confirmative of the numbers in each treatment. It also seems that the data refers to patients indiscriminately of the risks for thromboembolic disease being due to the treatments themselves. They say that “…a selection was bias towards healthy men for radiotherapy and prostatectomy”.

Here is the full article that may be of interest to you;

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2861771/

I think that you should get second opinions on the conflicts of a repeated DVT in your other health problem context. You need to consult specialists on both sides of the problem; surgeons and radiologists.

You need to be aware of the side effects from radicals. Many are not acceptable at our young age of 63 (my age too). It seems that vitamin K can reversed deficiencies and corrected abnormal coagulation in patients treated for thromboembolic diseases (DVT and PE).

Diet and physical fitness are important components of health and PCa treatments.

Wishing you luck in your journey.

Best.

VGama

Thanks for the reply,

Thanks for the reply, VGamma.

My first episode of DVT/PE 4 years ago in fact made me look for some underlying Ca as a cause..it was then I noticed my first elevated PSA of 6. Pretty clear after investigation that source was rt. leg vein insufficiency with DVT formation. Didn't realize per your referenced article that patient's with endocrine problems had a higher incidence of DVT in general, plus higher with prostate surgery obviously.

I got the feeling RP had lower side effects than radiation if the surgery was done optimally...correct me if I am wrong. Cure rate seemed about the same for similar Ca stages/Gleason's.

Time to get in better shape and lose a few pounds. Am leaning toward a RP ( I'm learning the parlance !) as a "get it over and done with" choice unless my Urologist has better info. stating brachytherapy just as effective..side effects question needs to be clarified for me.

Beau2 · January 2013

PE

Welcome to the forum .... sorry you need to be here.

I also had a PE and was on blood thinners before I was diagnosed with CPa at age 63. After my prostatectomy, I did not go back on blood thinners and have not had a PE problem over the last four years. I did make serious changes to my diet, started taking lipitor(statin) and aspirin, began exercising more, and lost 25 pounds.

I have done well with the prostatectomy; howver, you should seriously look at ALL treatments. I probably would have chosen brachy; however, I had a large prostate (70 cc) and the doctor indicated that they would try to shrink the size of the prrostate with hormones. I chose not to do this and had them remove it.

I was also a guy who just wanted the darn thing taken out of me, and I must admit that I do like knowing that it is gone; however, if you can control this desire, you will probably find brachy is almost as effective as surgery for long term PCa cure and that at least in the short term, you probably will not have as many side effects.

With a Gleason 7 I assume active surveillance (AS) may not be an option; however, you may also want to discuss this option with your doctor.

laserlight · January 2013

Beau2 said:
PE

Welcome to the forum .... sorry you need to be here.

I also had a PE and was on blood thinners before I was diagnosed with CPa at age 63. After my prostatectomy, I did not go back on blood thinners and have not had a PE problem over the last four years. I did make serious changes to my diet, started taking lipitor(statin) and aspirin, began exercising more, and lost 25 pounds.

I have done well with the prostatectomy; howver, you should seriously look at ALL treatments. I probably would have chosen brachy; however, I had a large prostate (70 cc) and the doctor indicated that they would try to shrink the size of the prrostate with hormones. I chose not to do this and had them remove it.

I was also a guy who just wanted the darn thing taken out of me, and I must admit that I do like knowing that it is gone; however, if you can control this desire, you will probably find brachy is almost as effective as surgery for long term PCa cure and that at least in the short term, you probably will not have as many side effects.

With a Gleason 7 I assume active surveillance (AS) may not be an option; however, you may also want to discuss this option with your doctor.

Craig

Sorry you have to be here. At this point in time I would recomend researching all of the treatment options. A second opinion is always good. A decision like this is very difficult and information is needed. My final gleason score was a 7.

I opted for surgery, but if you can treat in a different way then look into it. The one thing to keep in mind is the side effects of the treatments. All of these methods have side effects that will vary from person to person.

I work with the urologist and the oncologist that specializes in prostate cancer, along with my normal doctor.

Try and set your self up with the best possible support network. All of this will help down the road.

Good Luck, this is a good site to be on for information, it has helped me

Kurt

coonhound · January 2013

laserlight said:
Craig
Sorry you have to be here. At this point in time I would recomend researching all of the treatment options. A second opinion is always good. A decision like this is very difficult and information is needed. My final gleason score was a 7.

I opted for surgery, but if you can treat in a different way then look into it. The one thing to keep in mind is the side effects of the treatments. All of these methods have side effects that will vary from person to person.

I work with the urologist and the oncologist that specializes in prostate cancer, along with my normal doctor.

Try and set your self up with the best possible support network. All of this will help down the road.

Good Luck, this is a good site to be on for information, it has helped me

Kurt

Really appreciate everyone's feedback thus far..good information. Re: PE...had gone w/o Coumadin for 4 years after 1st episode only to throw a pretty good load to both lungs this past September..apparently I tolerate large PE's thanks to a good cardiopulmonary status ! Pretty sure I don't won't to throw the dice again though but may opt for weight loss, exercise and full dose ASA in the future..

I am, as I await my Urology consultation, trying to research what are, if I understand my Gleason score and relatively localized PCa (hopefully my bone scan/CT of abdomen will be clean..am I right in thinking this will be done before treatment considered??) my 2 options..surgery vs. radiation ("seeds"). Seems like most so far here and friends of mine have opted for surgery if a choice..the one poster above ( can't see your name writing this, sorry) mentioned maybe preferring brachytherapy but didn't want to delay waiting for hormone therapy to shrink his prostate. What made you prefer possibly radiation over surgery?...you mentioned the "wanting to be rid of it" factor.

With my one core being 4+3, I was left out of the "active surveillance" category per my MD, particularly with PSA bouncing from 16 to 21 in a month this past October.

Again, my heartfelt thanks to you all,

Craig

Samsungtech1 · January 2013

coonhound said:
Really appreciate everyone's feedback thus far..good information. Re: PE...had gone w/o Coumadin for 4 years after 1st episode only to throw a pretty good load to both lungs this past September..apparently I tolerate large PE's thanks to a good cardiopulmonary status ! Pretty sure I don't won't to throw the dice again though but may opt for weight loss, exercise and full dose ASA in the future..

I am, as I await my Urology consultation, trying to research what are, if I understand my Gleason score and relatively localized PCa (hopefully my bone scan/CT of abdomen will be clean..am I right in thinking this will be done before treatment considered??) my 2 options..surgery vs. radiation ("seeds"). Seems like most so far here and friends of mine have opted for surgery if a choice..the one poster above ( can't see your name writing this, sorry) mentioned maybe preferring brachytherapy but didn't want to delay waiting for hormone therapy to shrink his prostate. What made you prefer possibly radiation over surgery?...you mentioned the "wanting to be rid of it" factor.

With my one core being 4+3, I was left out of the "active surveillance" category per my MD, particularly with PSA bouncing from 16 to 21 in a month this past October.

Again, my heartfelt thanks to you all,

Craig

Choices

Your biopsy results do not seem that bad. At 63 you should have many. Years of sex left. You have RP the two things you need to. Understand is: your penis. Will definetly get shorter. Depending on size of prostate is how much you will lose when they re-attach everything. I had nothing to lose so I went for a grand slam.

I think you should really think about your choices. If I had your tests I would definetly go with cyberknife, or something similar. Your cancer does not seem that agressive. Do not trust a urologist. They really want the operation. Please get a second opinion from John Hopkins or somewhere else. Sorry to say but Urologist always say RP. You need more info before you do anything

Mike

Beau2 · January 2013

Large Prostate

Craig,

it was not the possibility of a time delay that stopped me from choosing Hormone Therapy followed by Brachy as my primary PCa treatment choice. It was the fact that I could not get assurance that the HT would shrink the prostate small enough to allow the Bachy. I was told that if the HT did not shrink the prostate enough I could then go to surgery. At that point I deciided to move ahead and just get the thing removed ... I just wanted the cancer out of me ... a gut reaction.

In hind site (going on four years removed), and having learned some on a couple of these PCa forums, I have concluded that for my low risk PCa it may have been best to first consider active surveliance (AS). Radical treatment (surgery or radition) could then follow if AS failed. From what I have read, not all Brachy doctors will treat large prostates; however, there are guys who have had HT followed by Brachy who have had wonderful results. As I said in my earlier post, the numbers I was lookking at when I made my decision indicated that brachy was almost as good as surgery in addressing the cancer , and that at least in the short term, had fewer bad side effects. Because I was with a HMO (Kaiser) my only options were surgery and brachy. Hopefully, your insurance will allow you to access to some of the newer radiation treeatments.

I hope this clarifies my earlier post. If you a researching treatment options you may want to get your hands on Dr. Patrick Walsh's book, "Guide to Surviving Prostate Cancer". Although Walsh is a surgeon, and recommends surgery, he does give a pretty good decription of the disease and treatment options. Not a bad place to start your research.

You've got plenty of time to do your research and make a decision and you should not feel rushed to just get it out.

Best wishes and good luck!

hopeful and optimistic · January 2013

Beau2 said:
Large Prostate
Craig,

it was not the possibility of a time delay that stopped me from choosing Hormone Therapy followed by Brachy as my primary PCa treatment choice. It was the fact that I could not get assurance that the HT would shrink the prostate small enough to allow the Bachy. I was told that if the HT did not shrink the prostate enough I could then go to surgery. At that point I deciided to move ahead and just get the thing removed ... I just wanted the cancer out of me ... a gut reaction.

In hind site (going on four years removed), and having learned some on a couple of these PCa forums, I have concluded that for my low risk PCa it may have been best to first consider active surveliance (AS). Radical treatment (surgery or radition) could then follow if AS failed. From what I have read, not all Brachy doctors will treat large prostates; however, there are guys who have had HT followed by Brachy who have had wonderful results. As I said in my earlier post, the numbers I was lookking at when I made my decision indicated that brachy was almost as good as surgery in addressing the cancer , and that at least in the short term, had fewer bad side effects. Because I was with a HMO (Kaiser) my only options were surgery and brachy. Hopefully, your insurance will allow you to access to some of the newer radiation treeatments.

I hope this clarifies my earlier post. If you a researching treatment options you may want to get your hands on Dr. Patrick Walsh's book, "Guide to Surviving Prostate Cancer". Although Walsh is a surgeon, and recommends surgery, he does give a pretty good decription of the disease and treatment options. Not a bad place to start your research.

You've got plenty of time to do your research and make a decision and you should not feel rushed to just get it out.

Best wishes and good luck!

Hi Craig,

I just posted some information germaine to you in a recent thread....... http://csn.cancer.org/node/252414

You definitely need a second opinion by a world class pathologist on your biopsy slides so that you are treated correctly. Determining a Gleason is subjective.

In determining treatment one needs to look at the most aggressive Gleason Score. A Gleason Score of 4+3=7 is aggressive. It is very possible that the cancer has escaped the capsule....You need to have additional diagnostic tests to get a better idea of what is happening, and if it has excaped.(these tests are specified in the posts in the other thread, that I referenced above.

So if the cancer has escaped, localized treatment such as surgery is not appropriate since you still might require other treatments such as hormone and some forms of radiation. You will be subject to possible side effects of surgery plus the side effects of other treatments. This risk is cummulative.

YOur cancer is manageable, but you have to be smart, and make some "right" decisons now.

PS. Please let us know the involvement, that is what percent of the core is cancerous in the cores that are positive. Also suggest that you call the doctors office and get a copy of your biopsy results sent to you.

Noobie here...would like some feel for where I am headed

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