Newly Diagnosed-Could use some advice re Lab findings
I have been trolling these boards recently after my first inclination I might have pCA. I must say I am impressed by the amount of unselfish, sincere help offered on these boards and the level of educated, well thought out responses offered by it's members. I hope to return the same at some point. I was hesitant to post prior to having some clinical data to report and now I have same.
I am a 64 y/o in reasonably good health. Smoked previously/ HPTN controlled with meds. My PCP has been watching my PSA over several years and suggested I see a Urologist when my level rose to 5.1 a few months ago. I had recently been experiencing some symptoms, urgency and less than ideal flow. My Urologist suggested a TURP due to my PSA velocity. The results of my TURP were as follows:
Right Medial Base: Benign
Right Medial Mid: Benign
Right Medial Apex: Adenocarcinoma, Gleason score 7 (3+4) involving approx 25% of the biopsy length
Right Lateral Base: Benign
Right Lateral Mid: High-grade prostatic intraepithelial neoplasia
Right Lateral Apex: Adenocarcinoma, Gleason score 6 (3+3) involving approx 15% of biopsy length
Left Medial Base: Adenocarcinoma, Gleason score 6 (3+3) involving approx 5% of biopsy length
Left Medial Mid: Benign
Left Medial Apex: Adenocarcinoma, Gleason score 6 (3+3) involving <5% of biopsy length
Left Lateral Base: Adenocarcinoma, Gleason score 6 (3+3) involving <5% of biopsy length
Left Lateral Mid: Benign
Left Lateral Apex: Benign
Subsequent the TURP during my follow-up with the urologist, we spent about an hour going over the TURP results and my new Dx of pCA. He placed me at an "Intermediate" risk due to the existence of the Gleason 7 ( he placed my DRE and PSA in the "low risk" catagory) and suggested an "MRI with 3D imaging" to furthur diagnose and check for possible extracapsular spread. He reviewd treatment options with me and felt I would be a good candidate for RP, however suggested I review/research all my options before deciding. He stated Both XRT and RP had a similar "cure rate" of 90-95% and mentioned RP to be the "Gold Standard". ( He's a surgeon.....) He did not try to force surgery over other tx options and offered referrals to other tx providers. He has performed "over 500" RP's and performs other DaVinci procedures on a frequent basis. ( including my wife)
About a week later I had a "MRI Prostate w/wo contrast w/ CAD and MPR"
Prostate Meas: 5.0x4.9x4.5 cm
Prostate Vol: 57.17 cc
PSA Density: 0.09
Prostate capsule intact
Lymph nodes: No suspicious or enlarged pelvic lymphadenopathy.
" There is no evidence for transcapsular extension or local regional disease"
(There is much more info in this MRI report however I am not sure what all is relevant, or not. So I have attempted to summarize. )
Subsequent the MRI, he met again with my wife and I. I had 2 pages of questions..........
He said my stage is "T1Gleason 7". If there is an error in this stage explanation, it is probably mine, as I still don't completly understand this staging system
Most of my questions were answered. He was very honest and forthcoming as far as I could tell. Again, he did not try to push me into a surgical remedy, however he did think I should make a decision within the next 3 months or so. BTW I asked if I could speak to prior patients. Another pt approx my age just happened to overhear our conversation and offered to talk to me. We spent an hour alone, in a closed room supplied by my doctor. he was 1 year post RP and he stated he would do it again. He was very frank about his experience, side effects, etc. I had all my questions answered by him. I felt I got an honest opinion.
I have scheduled an appt with another Urologist specializing in pCA here locally at the Moffit CA center this Wed. and an appt with an Oncologist at another facility this Thurs.
From my extensive reading on these boards describing pCA cases much more involved than mine, I remain cautiously optimistic. It is early on in my quest for answers, however I am currently considering either RP or CK.
I have a million questions, however at this late hour, the one that comes to mind is this: If PSA is produced only by the prostate, obviously PSA readings should be 0 post RP. How then, if RT irradiates and "kills" the entire prostate, can men have PSA readings post RT? Would that not indicate that ALL the prostate cells were not killed and those live cells could subsequently produce PSA, and furthur, become cancerous?? Another thing that stuck out to me was the prospect that recurrence after RP could be treated with radiation, however the reverse is not feasible.
I welcome any/all opinions, advice or experiences.
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