Fiance referred to urologist over psa

ANWANK said:

Operative report

Ok so obviously the biopsy results are not back yet but I did get the operative report. It says that his prostate volume is 58.8 and englarged in transitional zone. Which seems to me he would probably just have bph then? They took 12 cores. It does say his prostate health index score is 69 which I know is not good at all. But if he has bph, I would imagine that would effect this score?

Anwank,

MOST men over 50 have BPH/BEP.  The symptoms of BPH are mostly IDENTICAL to PCa.  Hence, the presence of BPH in any given man is no evidence for or against PCa.  You will know the answer within a few days however.

max

ANWANK

I am sorry for the results of the biopsy but you do understand that this diagnosis relieves you both from the anguish of probabilities in confronting this hereditary disease. A negative biopsy would always be questionable. I would like to know more details on the results but 3 cores with Gleason score 6 is good news. The next step will involve exams to locate the bandit. This is traditionally obtained with CT and Bone scans. However, I would prefer to get those images with a 3tMRI or the sophisticated PET/CT which is presently the most recommended exam in PCa diagnosis. After that, his doctor will provide a Clinical Stage with which a treatment can be planned.

In this regard, you better wait for his doctor's opinion, do some researches, get second opinions from several other specialists and discuss with the whole family before deciding on an option. In my opinion, for a man of 45 yo, Active Surveillance is the best if appropriate in his status. The quality of life is in jeopardy and he is too young to risk permanent effects from radical treatments. In any case he should think to treat if the bandit shows to be aggressive.

I agree with Old Salt's opinions above. Without a due clinical stage obtained from reliable due exams nobody should decide on a treatment. You need to advance in this journey without rushing. Move coordinately and timely but do not sleep on the matter.

Each case is unique of the holder and should not be paired with others. What works for one may not do well for another. His father and brother hereditary history should not be taken as the way to follow but simple as reference examples. While waiting, I would recommend you to get additional tests that may influence treatments. For instance; a colonoscopy to look for any asymptomatic ulcerative colitis. A DEXA scan for bone health and a full lipids account.

Here are some links to help you understanding the matters of PCa. You should prepare in advance a list of questions for the doctors you are metting;

A practical guide to prostate cancer diagnosis and management;
http://www.ccjm.org/index.php?id=105745&tx_ttnews[tt_news]=365457&cHash=b0ba623513502d3944c80bc1935e0958

Prostate Cancer Staging;
http://emedicine.medscape.com/article/2007051-overview

List of Questions;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Books;
https://csn.cancer.org/node/311252

Please note that we are not doctors. Our opinions are based on own experience and researches done along our journey as survivors.

Best wishes and luck in his journey.

VGama

Some are suggesting expensive testing, he Is young, family history, had positive biopsy not bad now. Surgery side effects are immediate and tend to get better but not always, tougher on younger men, radiation some effects during and after tend to get worse as time goes by. Doctors tend to bottom line it . Surgery it’s gone might come back years later, many men choose that. Radiation takes awhile to know the results. AS really delays the decisions and treatment as long as everything stays stable. I’m an outlier PSA 1.5 for years, at age 62 a lump  had a biopsy because my family doctor is proactive. Gleason 6 5 out of 12 cores. AS 5 years. three biopsy’s later psa still under 2.8 7 cores 6 1 core 7 4+3 1 core small 8 4+4. 20 20 hindsight should I have skipped AS, urologist says he wouldn’t have recommended surgery and is at a loss as why the quick progression. My prostate is small so no BPH. Treatment decisions haven’t changed much hormone therapy added to mix,  just happening now.

Prostate cancer is very slow growing.

Good idea to interview various treatment specialists to receive input.

There is a difference among surgeons, and successful outcome. Interview more than one.

There is an image test, 3T MRI that may indicate if there is extracapsular extension, that is if the cancer has escaped the capsule (which in this case is not likely, but still very improtant to have). This would affect treatment choice.

I am fairly new here and my diagnosis is very similiar to his.  I am still learning and taking in all the great advise the great people on this site have to offer. I had the MRI T3 last week, which is a good test to see if everything is contained. In my case it was and my last psa was 5.23 and I am 53 years old. I have been on a rollercoaster ride since I found out about the cancer, doctors in the town I live in did test and i was diagnoised having  mets to bone. Talk about scared. I went for 2nd opinion to UAMS cancer institute and had more test run and here I am.  I have decided to go with AS for the time being and hopefully I can continue this for a long time, the thoughts of surgery and the possible side effects scare me....This is just my 2 cents and not trying to change any decisions anyone has made...Like these knowledgeable people always say it is his decision and what ever it is, it will be the right one for him.

ANWANK said:

Clinical stage

Dr said it was T1C, I believe. My guy is completely against radiation. He did not even want to meet with the radiation oncologist. He says he would rather have the surgery and be done with it and doesn't want to take the chance of getting radiation, it coming back, then having to find a surgeon to do the surgery on a radiated prostate and not be able to have the nerve sparing surgery. We do have the best urologist in our city. He is the chief of urology at several hospitals here and was the first to perform the Da Vinci here. He has been doing them for 14 years in our area now. I definitely checked on that! So I feel like he is in good hands. The doctor has a great bedside manner and spent over an hour with us yesterday just talking and giving him all his options. He was very upfront about the risks with the surgery and how it would change things. He is sending my fiance to biofeedback to learn to do certain exercises for urinary control and said he would be prescribing cialis and a vacuum pump. Anything else I should know about this surgery beforehand so I can help prepare him?

Anwank it soulds like your "guy" has become well informed in a brief amount of time.  It is good that his surgeon shared all likely effects of surgery in detail beforehand.  The biofeedback is very likely kegel exercises, that will quicken urinary control post-op.

It is curious that he repudiated radiation without ever even speaking to a rad oncologist, but he is his own man, with his own reasons.  Be aware that under-estimation of Staging is fairly common, whereas over-estimating virtually never happens.

Best of luck to the both of you,

max

 My story:67 year old male; PSA 4.72 increasing over the last 3 years; Digital Rectal Exam, prostate is not swollen; father had prostate cancer elected removal (the cancer did not cause his passing); I requested a 3T MRI prior to biopsy; MRI indicated 2 lesions one a PIRAD 5 and one a PIRAD 4; biopsy confimred prostate cancer in the PIRAD 5 lesion; PIRAD 4 no cancer. Urologists recommends: Prostate removal with pelvic lymph node dissection.  I am looking at an experienced urologists who only does robotic guided prostate removal now (over 1,000 procedures).  He did offer hormone and radiation but did not think that was the best route due to tumor and it being only in the left apex of the prostate.  I feel very comfortable with this surgeon.  My wife and I decided on the removal of the prostate and lymph node dissection procedure.  On the lighter side, during our interview the surgeon did ask us did we have sex.  My wife did not say anything, I told him everytime I can catch her, but she is very fast.  Anyway go to preop March 5 and surgery on March 20.  Gleason 4+3=7.