Just Got Biopsy Results

Your case is pretty typical here WJS.

Your results are very similiar to what mine were n 2015 when I was diagnosed as Stage 1, except that you show a larger volumn of involvement than I did. My biopsy showed only one core, and it at 5%. All other cores were negative for any disease.

I went strainghtaway and had surgical removal the next month, at age 58.  But the pathology report after removal came back with a lot more cancer than the biopsy showed -- significant Stage II disease.  Biopsies routinely underestimate the extent of disease, but virtually never overestimate it.

At the age of 68 you are approaching the upper age recommendation for surgery against non-metastatic diesease. Most guys would likely suggest that radiation (RT) is more reasonable in your case, and certainly a lot easier.  I say this as a "surgery guy" myself.

max

A Gleason 6 does not metasize outside the prostate, however when a large amount of Gleason 6 is found, a more significant cancer that can metasize can be found. This may be true in your case.

July 2017 Interview with Dr. Klotz https://www.urotoday.com/video-lectures/advanced-prostate-cancer/video/mediaitem/778-embedded-media2017-06-02-13-54-01.html?utm_source=newsletter_4652&utm_medium=email&utm_campaign=uroalerts-prostate-cancer-weekly

Since determining Gleason scores are subjective, I would seek a second opinion on the pathology by a world class pathologist. Johns Hopktins is a great place for second opinion.

I would also ask for a 3 T multiparametric MRI. This type MRI may show extracapsular extension, and is valuable in making a treatment decision.

If in fact the second pathology opinion confirms extensive Gleason 6, I would ask the radiation oncologist about SBRT.  SBRT is more convenient with only 4 or 5 treatments versus 40 for IMRT with similar outcome and side effects.

Here is a study about SBRT.

https://prostatecancerinfolink.net/2016/01/06/nine-year-outcomes-after-treatment-with-sbrt/

Surgery of all active treatments has the most severe side effects that happen more frequently than other active treatments, ie radiation.

WJS said:

Max, Old Salt, and Hopeful,

Max, Old Salt, and Hopeful, thank you all for your input! It's great to have a support group like this to turn to when things like this happen.  I will look into the 3T MRI and the SBRT, among other options.

By the way Max, just a few months ago I had a routine colonoscopy done, and they found a large flat polyp that they could not completely remove during the procedure.  The biopsy of the removed portion came back as high level precancerous out to the margins of the specimen, so my doctor recommended that I have the rest of the polyp removed.  Being naive, it sounded llike a simple process to me.  I found out very quickly it was not simple.  It meant having a sizeable portion of my large colon cut out (with the side benefit of taking out the attached appendix along with it).  A few weeks later, I had the surgery with no complications other than quite severe wandering shoulder and neck pain for several days, apparently a side effect of the gas they used to inflate the abdominal area during the surgery.  The biopsy of the removed colon section and lymph nodes revealed that I did indeed have stage 1 colon cancer.  So you were right, these biopsies many times understimate the extent of the disease.  Luckily, the cancer was completely contained in the removed colon section, and no lymph nodes were affected, so no further action was necessary other than increased frequency of future colonoscopies.

I wonder if having this surgery to my abdominal area would have any effect on the ability to do robotic prostrate surgery now?  It left a 6" vertical scar in the middle of my belly, right across my belly button. 

WJS,

You will have to ask the surgeon if DaVinci is still possible for you. 

The main DaVinci incision is vertical, just above the navel. Mine is about 2 or 3 inches long.  I had had laproscopic removal of the gall bladder a few years before my DaVinci. The gall bladder is removed actually through the navel, and the side holes were virtually indentical to the side access holes required for the DaVinci, but the DaVinci went well.  Within a year after DaVinci my incision herniated; the hernia surgeon said most likely because the area was weakened from so much cutting and stretching.  He installed a large mesh almost as large as a wash cloth, so now I have had 3 lapro surguries in that exact area (DaVinci is a robotic form of laproscopic surgery).

Short answer: The urology surgeon will have to look at you and answer that question himself.

max

WJS said:

Max, Old Salt, and Hopeful,

Max, Old Salt, and Hopeful, thank you all for your input! It's great to have a support group like this to turn to when things like this happen.  I will look into the 3T MRI and the SBRT, among other options.

By the way Max, just a few months ago I had a routine colonoscopy done, and they found a large flat polyp that they could not completely remove during the procedure.  The biopsy of the removed portion came back as high level precancerous out to the margins of the specimen, so my doctor recommended that I have the rest of the polyp removed.  Being naive, it sounded llike a simple process to me.  I found out very quickly it was not simple.  It meant having a sizeable portion of my large colon cut out (with the side benefit of taking out the attached appendix along with it).  A few weeks later, I had the surgery with no complications other than quite severe wandering shoulder and neck pain for several days, apparently a side effect of the gas they used to inflate the abdominal area during the surgery.  The biopsy of the removed colon section and lymph nodes revealed that I did indeed have stage 1 colon cancer.  So you were right, these biopsies many times understimate the extent of the disease.  Luckily, the cancer was completely contained in the removed colon section, and no lymph nodes were affected, so no further action was necessary other than increased frequency of future colonoscopies.

I wonder if having this surgery to my abdominal area would have any effect on the ability to do robotic prostrate surgery now?  It left a 6" vertical scar in the middle of my belly, right across my belly button. 

WJS:

We share a similar disease history, but in a reverse sequence and with a differing treatment plan.  I'll briefly outline mine and then provide some thoughts.

My first ever PSA test in March 2009 was 17.  An immediate biopsy revealed 10 out of 12 cores positive, with the highest Gleason score measuring 4+3.  After three consults I elected to have a radical prostatectomy with the use of the DaVinci robot in June 2009.  I was 57 years old.

The surgical outcome was a success, except for permanent impotence.  I did not need chemo nor radiation.  My PSA has remained not detectable since.

This May I was diagnosed with Stage II rectal cancer during a colonoscopy that I requested.  I endured 25 sessions of neoadjuvant chemo/radiation in July/August.  Last week I had a portion of my rectum removed and I am now living temporarily with an ileostomy.  The reversal of my ileostomy will occur after I complete 12 weeks of mop-up chemo.

What I have learned from the detection and treatment of these two separate and unrelated cancers:

1) Early detection is critical to all subsequent activities and their success.  We must listen to our bodies and take advantage of the current medical technology.  Both of my cancers were detected by chance but early enough to allow the medical community greater flexibility in treatment options.

2) Getting a second and third opinion is not only a good practice, you should make it an absolute.  My urologists were all over the map.  My gastro surgeon was myopic.

3) In my situation, colorectal cancer dwarfed my prostate cancer in terms of treatment and post surgery effects.  Because my PCa was contained I only had to recover from surgical pain and then resume a normal life, yet impotent.  Not so with this CRC.  This one has kicked me to curb several times and I still have three months of chemo and another surgery before I return to the normal flow of intestinal discharge.  I entered the ring weighing 145.  Today I weigh 132 and I fear continued weight loss.

4) All cancers, their treatment and the outcomes vary.  Consequently, I recommend that comparisons between them be avoided.  Each should be approached as a unique issue.

OK, enough of that.  I guess what I am trying to say is that between the two cancers, and considering your current situation, I would allocate 55% of your resources against the CRC and 45% of your resources against the PCa.

As you know, cancer sucks.  For those of us who have developed multiple cancers, it sucks even more.  Hang tough.  I wish you luck in the decision making process and a successful outcome.

Jim 

OP:  I do not agree that the side effects of surgery vs radiation are about the same.  Here is the my sticky on the topic that I post whenever a newbie is considering the choices to consider when deciding upon a treatment.  Although this post reflects my bias, it does present the most common choices that you need to consider when you make your decision.  Do your own reseach and make the choice that is best for you.

The following is a duplicate of one that I have posted in various threads on this forum to give men newly diagnosed w/lower risk prostate cancer (Gleason 6 or 7) an overview of the treatment options available to them.