Recently diagnosed

The gleason was one in 12 cores

hopeful and optimistic said:

I remember reading that

a Dr. Carter is in charge of the Active Surveillance program at Johns Hopkins. I think that I read that they also have a panel that evaluates new patients and treatment options. The pathology department there is one of the top, if not the top in the world.

Also suggest that you continue your research, read , research, research....books, go to local support groups......there are two national organizations that you can goggle for a local group near you......"us too" and "man to man"

Please keep us in the loop.

First, I want to thank everyone on this site for their support and information, it has really hepled me understand and loose my fear. The latest from my doctor:

The one core out og 12 that came back positive is 10% of the total core volume. Up until then, the other biopsies (4 in the past 5 years) all came back negative.

PSA is 23.88

I do have a lot of benign tissue with atrophy

Also have a fair amount of inflamation

last DRE revealed that there is some calcification as well, but there do not appear to be any "lumps" that would indicate tumor.

Bone scan came back perfect as well as the abdominal MRI.

I have had 5 DRE's since first being diagnosed and all the doctors agree that it is highly likely a good part of the high PSA is the result of inflamation due to infection. My doctor took the time to sit down with me and my wife and explain that the gleason score of 6 (3+3)  is like golf, the lower the score the better. She explained thet there are other lower scores, but that in her 20+ years she has never seen one. So she has me on antibiotics twice a day for 4 weeks and then a PSA  and DRE within 5 days of finishing the mediation. She explained that if my PSA drops at all then that is a good sign and it it gets below 10 that is really good news, and they will determine if more antibiotics are needed. A doctor from each of the disciplines discussed Surgery, beam radiation, and seeds as courses of action. So all said and done, my doctor advised to wait and see if the antibiotics have an impact, and then decide on a treatment option. She also advised taht is my PSA dropped really low dow below 4, that I could be in a monitoring mode with DRE every 60 days, biopsy at least 2 time a year.

So I think that my doctor is giving me good advice and I trust her. Glad to have access to such great care. I do value any thoughts and information from those who have been down the road, bad and good.

Thanks All

Jacquet

PS: sorry for the double posting, not quite got the hang of it yet

VascodaGama said:

Diagnosis of Low risk cancer

Jacquet

Your diagnosis so far refers to a low risk type of cancer. Gleason pattern of 3 (Gs 6) and only one out of twelve needles positive, and negative image studies. AS would be recommended by most of the doctors weren’t there a high PSA.

Your doctor is recommending well for you to wait and check for the results from the anti-inflammatory protocol. In any case the high PSA could be due to other factors not just due to inflammation or cancer. Sex on the night before drawing blood or riding a bike or even hard stool could cause the PSA to spike from 18 to 23.

The revelation of existing calcification at the prostate should be confirmed in the biopsy samples. In fact the biopsy should have been done including and aiming at those spots felt in the DRE.

Should your treatment to control inflammation not drive the PSA down, you could wait for the results of still another periodical biopsy aiming at other inner areas of the prostate, and get more specific types of image studies with better contrast agents and higher image resolutions.

Any radical approach (prostatectomy or radiation) can arm you and deprive you of quality of living. Low aggressive cancers may never bother or be prejudice to normal living. One may well die from other causes.

Can you share more details of the pathologist report?

 

Take your time and do things coordinately. Cancer does not spread overnight.

Wishing you luck in your journey.

VGama 

VGama,

Without typing a bunch of information in:

2 came back with Acute Inflamation no malignancy,

2 came back with atrophy no malignancy,

1 came back positive with a core %10,

7 were normal

Jacquet

VascodaGama said:

Molecular Profiling

Jacket

Thanks for sharing the details.

Is there any other info regarding the type of cancerous cells? Have they identified only adenocarcinoma?

The typical prostate cancer is formed at the outer layers of the prostate which makes it critical to check for hard “bumps”.
Not to worry you but, I have read cases where atrophy was connected to cancer that produces low levels of PSA notwithstanding of being aggressive.
Atrophy could indicate a breakdown of tissues, involving cellular apoptosis. This is considered in some cases as a cause of low supply of androgens to cells metabolism. In other words, your prostatic cells could have the characteristics and behave as “self-sufficient”, producing its own androgens to survive.

This apotheosis in your diagnosis with high PSA could well lead to think that the main cause is the acute inflammation; however, since you have been diagnosed with the bandit, now you will have to be vigilant and follow your status with constant periodical test, but any future biopsy would be done only to check for cancer volume (positive cancer found in other areas of the prostate) or to look for higher aggressivity (worse Gleason patterns). I think that such biopsy would be required if you are “set” to follow AS (no radical treatment). Otherwise, I would recommend you to request for other means of testing the progress.

Due to “atrophy”, I would recommend you to get a testosterone test. I would also recommend you to check your bone health (dexa scan). Free PSA to get the real antigen level, and other markers to follow progress more closely; such as PAP (Alkaline Phosphatase). Also track liver enzymes ALT, AST and as well as BUN and the creatinine.

In modern monitoring of cancer doctors are recommending to get a DNA profile to more precisely identify the medicines that will work or not in your system. I would recommend you to do it if affordable to you. It will be the way to control cancer with the newer drugs, existent now or in development, that will revolutionize the way we/they treat our prostate cancer cases.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1069086/

http://www.urotoday.com/Treatment-of-mCRPC/successful-treatment-of-advanced-metastatic-prostate-cancer-following-chemotherapy-based-on-molecular-profiling-beyond-the-abstract-by-charles-e-myers-md.html?mkt_tok=3RkMMJWWfF9wsRonv6zPZKXonjHpfsX86eklULHr08Yy0EZ5VunJEUWy2YIJSdQhcOuuEwcWGog80B5XCfSUaIVG9edIBg==

 

I wish you good results from your anti-inflammatory treatment.

Best wishes.

VGama 

VGama,

Thanks for all the insight. I will definately talk about these other ideas with mu doctor when I go back for my PSA test in about 2 weeks. I'm retired military and work for the government so procedures and cost are not usually any problem. So far, the antibiotics seem to at least be maing urination a little better, could be due to reduced swelling. I also seem to have more energy lately. You mentioned the things that can make PSA go up, and I seem to remember that just a day or do before the last test I was out in the yard chopping wood to relieve some stress.

Might be why it spiked from 18 to 22/23

Jacquet

VascodaGama said:

Could be Micrometastases

Jacket

I am sorry for the outcome. The PSA should be much lower after the antibiotic treatment.

Not to stress something here but some guys have reported about their experience in treating inflammation with different medicines because some bacteria does not “clear” as expected. You could still try to get a urine culture test if you think it would give you peace of mind.

Mean while you can do your homework researching about treatments. You could get more specific image studies with higher resolution equipment (3-tesla MRI, choline contrast) to verify for any spread. Low Gleason cancer with High PSAs are usually related to micrometastases cases, to which radicals are limited. These are done with defined targets otherwise they cannot assure cure.

Yours and mine cases are different but to inform you; I also was a low Gs (2+3=5) with high PSA=22.4 and negative traditional image studies, choose prostatectomy but soon after recurrence indicated that I had micrometastases. Later I had Salvage Radiation but that did not cure me too. Specialists indicated again that I was confronting micrometastases. I now believe that what was missing in my initial diagnosis was a proper image study, but at the time (2000) they were not available. The image techniques  are now more precise in detecting small colonies of cancer. I would suggest that you explore this "field" and try to get the best diagnosis possible, and affordable to you.

You may think that I am proposing you to do nothing but such is not the case. I think you should move forwards but coordenately. Do not jump into anything without fully checking for the pros and cons on a therapy. All treatments for PCa got side effects and some may not be acceptable to you.
Typically doctors suggest their “trade” as the best approach (your present doctor   ) but typically the outcome suggest the contrary. Remmenber that she will request you, before the operation, to sign an agreement relieving her/him of any wrong doings or outcomes. You will acknowledge that you know what you are doing. Unfortunately this happens everywhere, even in the military.

Accordingly you need to read a lot and discuss about the disease, its treatments and consequences. Many guys treat indolent cancer that may not cause a problem during their life time, and many get so scary that just want to get rid of it, no matter the consequences.
Many of those become more involved with the problem of confronting the side effects than the causes of the cancer.

I think that you got enough time to educate in all type of treatments that best would fit you and your family. I also recommend you to look for modern facilities/hospitals and experienced specialists with many years on the "trade". You also should get several second opinions from specialists in each field (out of the military compound).

You will need a list of questions when confronting the doctors. Here are some ideas to prepare your own list;

http://www.cancer.org/Cancer/ProstateCancer/DetailedGuide/prostate-cancer-talking-with-doctor
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

A compendium on Prostate cancer and care;

http://prostate-cancer.org/decision-aide/where-to-start/prostate-basics/

 

I wish you luck in your journey.

VGama 

Thanks VGama,

My post got cut short. I'm not concerned that my Dr. is pushing one or the other. She is telling me taht the only option taht they offer at the military hospital is then DaVinchi. In the mean time she has scheduled me to get the MRI procedure you mentioned. It will be done at Walter Reed. She wants to make sure that if there are micro tumors.

I'll check out the links you provided.

Jacquet