Another new guy trying to understand

tommyg1951 said:

Update on things

Dr. doesn't do "saturated biopsys" he said that he sends patients who want that to another hospital 200 miles south of my home. He said he could do up to 18 samples so I asked him to do that and we kept the appointment. Biopsy was done a week ago. I got the results today - Gleason 3+4=7, involving about 5% of tissue. Tomorrow I will be contacting the Dr. office to schedule next follow up. Follow up was suppposed to be tomorrow - but he has surgery and had to cancel my appointment. 

It seems that now there are many choices for possible treatment. My wonderful wife who went thru breast cancer over the last 18 months (currently in remission) is more worried than I am I think. But we both agree that just like so many other challenges we have faced over the last 42 years - we will get through this just like everything else - - together.

I will try to keep y'all posted on what the next steps are that the Dr. will be recommending. God bless you all for being here to help and listen. Sometimes - just knowing that I have a place to vent is the best personal therapy one could ask for.

It appears from your post that only one spot (out of 18) was cancerous? If not, please provide the biopsy details.

Tommy:

I'm guessing from your screen name that you are 65.   I'm also guessing, based on what you've said previously, that your doctor is a urologist who probably will recommend surgery for treatment. 

If so, you should take a really long pause to consider your options and ask him to tell you about other alternatives.  If he doesn't do that, he is doing you a disservice.   Discussed briefly below are some of the things he should tell you.

Bascially, your choices include surgery, radiation and active surveillance.  Surgery really is the worst choice presenting the greatest risk of side effects such as ED and incontinence.   There are several methods of radiation available -- Cyberknife (CK), IMRT and Brachytherapy.  The best of them IMO is CyberKnife which provides the most precise method of delivery w/a minimum of potential side effect.  I and other men have been treated sucessfully w/CK without any side effects whatsoever.  Active surveillance is a method of monitoring the cancer through regular PSA testing and biopsy sampling without treatment unless the cancer accelerates and grows.  Given the nature of prostate cancer, chances are that your cancer may NEVER require treatment and, if you are willing to engage in the monitoring process w/o active treatment that certainly is an option.

Hormone therapy is an ancillary treatment that you've already been made aware of.  It's only purpose is to reduce testosterone production in order to reduce the growth of the cancer.  The problem w/HT is that it can have horrific side effects.  As a result, some men have chosen castration (aka orchiectomy) as an alternative.  There is a current thread that discusses this option and several others that discuss the awful effects of HT.

I'm just raising these issues for you now so that you'll be aware of them before you speak w/your doctor again.  In fact, I suggest that you do your own research on the topics that I'm mentioned before such a meeting, so that you will be better able to discuss them w/your doctor at that time.

Good luck!

The pathology results of your biopsy is a major factor in determining the best treatment option, so you want additional assurance that the Gleason score is accurate. 

Determining Gleason scores are subjective, and there are expert prostate cancer pathologists with better facilities and skills than others. A few of the best that canc be consulted are:

Jon Oppenheimer, Tennessee  888 868-7522, David Bostwick, Virginia 800 214-6628 and Jon Epstein (John Hopkins, Maryland0 410 955-5043

You can contact your doctors office, and ask them to send the slides to one of the above before your appointment.

Source:

a primer on prostate cancer....stephen b. strum, md, facp

cat scan

"At diagnosis, the CT scan can be omitted in men presenting with a validated Gleason score of 2-7, a baseline PSA of less or equal to 15 and a clinical stage of less than or eual to T2b."

"Unfortunately , a CT scan of the pelvis and the abomen is rountinely ordered in virtually all newly diagnosed men with PC. However, it is our contention based on published literature, that this is a serious waste of healthcare dollars while exposing the patient to unneccessary radiation and inonenience."

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bone scan

The American urological Association does not recommend a bone scan for those with a Gleason under 8.

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13 samples

Quite often, when biopsied, the staple gun does not pick up enough tissue for samples...in my case this has occured, but it is generally only one or two that are missed......( are there 18 cores that are referrenced in the pathology with some showing no pathology?)

It's evening here in California.

You will be fine

Best wishes for a good outcome. Brachytherapy has many years on the run and many did well. Typically they report about one week of disconfort, in particular regarding stool discharges. You may need to change diet to solve the issues.

Best,

VG

Appears you have a very small.amount of cancer thst was found in only one core. This would likely be measured on millimeters, and not centumeters. Therefore, i would yhink you can expect excellent results with your treatment. Gleason 7 is more aggressive than the commonly diagnosed gleason 6, but is far from being the worst you can get. In fact, the 3+4 isnt even the worse of the two 7 variants. Predominantly the cancer is comprised of mostly pattern 3, with lesser pattern 4 in an already very small focus. I think with such low volume disease, brachytherapy is an excellent choice. You get to avoid the rigors of surgery, and success rates are pretty much equivalent.  There are seeds that stay in there permanently, these are low dose, and then there is the high dose. Which one will you be getti g?