Diagnosed x2 weeks ago...request opinions

Dennie,

Welcome to the board. The Gleason 8 is not good news but the biopsy found cancer at the same area that could mean a solid tumor. This also could be the area felt by the urologist during the DRE. In any case, the bump increases the risk for extraprostatic extensions which you need to consider seriously in your decisions. The PSA of 3.37 ng/ml is high for 64 years old. I wonder if you have BPH in the mixture. Do you have any symptom related to urination issues or erectile disfunctioning?
The doubling time close to 9 months is also short and places you in the risky group of aggressive case. They consider PSA-DT above 14 months as midterm. Best is over 24 months. Let's hope for true positive images so that you can plan your next step.

Solid tumors are easier for treating with directional radiation that would cover the tissues close and around the bump. If the case is contained then surgery could provide you with peace of mind dissecting the whole tumor. I recommend you to research on treatments side effects so that you can better chose what you like. Mean while you can plan in obtaining additional information regarding bone health (DEXA scan) and cardiovascular health. These are all important issues in the event of a major therapy and continuous care if needed.

Survivors in this forum will try helping you to understand the facts. Let us know the exam results and your doubts.

Best wishes and luck.

VGama

Hi,

Sounds like to me that you need to wait just a bit longer to get the test results of your scans to see if the PC has escaped the Prostate.  If its totally contained, then surgery could do the trick or if it has escaped then maybe radiation is a better bet.

Dave 3+4 

Dennie,

The timing of your post is rather fortuitous, because I too have been recently diagnosed, with some downright scary numbers (super-high PSA of 69, rapid PSA doubling time of 2-3 months, and a Gleason score of 9), which are inarguably a bit worse than your own numbers, and because of that, I'm perhaps a bit ahead of you in terms of the raections and follow-up visits and treatment decisions. That said, there are innumerable people here on the ACS Forum that are far more qualified and have far more expertise than me. However, those folks notwithstanding, I believe that some of what I can share with you may in-fact be helpful, and maybe even encouraging to some degree.

So, here we go . . .

Firstly, the fact that you've caught your PSA this early, and the fact that the number of positive cores was minimal, are two "great" things in my view. I would strongly suspect that the low/lower PSA reading in your case, and the fact that you have distinct nodularity, makes it highly unlikely that the cancer has spread to any significant extent. In other words, it would appear to be "localized" which will become a critical factor in your treatment options (and decisions) moving forward, and I hope that others will agree with me on that point.

Secondly, its great that your urologist has ordered some immediate diagnostic imaging (MRI, CT and bone scans), but I would caution you on how useful these tests may prove to be. I too had a CT Scan and a bone scan, and I can now tell you without hesitation that at least in my case, they were essentially 'pointless' exrecises. I say this because my own CT and bone scans both came back "negative", which I falsely assumed meant "good news", but I was subsequently informed by my urologist that both tests produce far too many "false negative" results to allow for any confidence in terms of a definitively "negative" diagnosis. Worded somewhat differently, you could have a negative CT scan and a negative bone scan, and still have low-grade 'positive' spread of the disease to other organs, tissues, and/or bone. Accordingly, I would strongly suggest (as others here have suggested to me), that you run (not walk) to get a high-resolution 3T-MRI with/without contrast (not the standard, low-resolution, 2T-MRI), as soon as practical. Given my own experience in this regard, and given your own insurance particulars, I suspect that you might meet with some resistance in getting your physician(s) to order one, because the test is rather expensive (and insurance companies often don't like to authorize them), but also, because your PSA numbers are not yet (and hopefully never will be!),super-elevated, which seems to lead some urologists/oncologists to hold-off or postpone such imaging. However, I would suggest that you strongly-forcibly "insist" on this 3T high-resolution imaging, because the results will be invaluable in identifying all sorts of critical information that is absent from your equation at this early stage, such as the 'accurate' size and weight of the prostate, size, location and characteristics of the nodule, whether there is any involvement outside the prostate gland itself, like the seminal vesicles, pelvis, bladder, etc.

And thirdly, I would encourage you to try and avoid the natural over-reacting that we often do over your initial Gleason scores, particularly the "highest" Gleason score (GS-8 in your case). The initial pathology report from my one and only prostate biopsy rated a single one of the 5 'positive' (out of 12 total) cores as Gleason 5+4=9. However, I have subsequently consulted with another (unrelated) oncology group, who requested to receive and review those initial pathology slides, and that secondary oncology group's pathologist's report "down-graded" my Gleason of 5+4=9 to 4+4=8, which may seem on its face as an insignificant change, but is apparentll a 'huge' difference in the opinion of most oncologists. Moreover, there are a number of reports and articles (including peer-reviewed scientific journal articles), to indicate that after physically observing and removing the prostate of various patients, surgeons occasionally down-grade the patient's Gleason score from its higher initial value.

Lastly, the reported volume of your prostate (58 cc) is perhaps a teenie bit large (depending on your own body size and weight), but its hardly abnormal for your age (64). It is my understanding that minor swelling can occur from a variety of things unrelated to cancer (e.g., BPH, biopsy trauma, etc.). By comparison, I am now 66 years of age, and the most recent and accurate assessment of my own prostate's volume was determined (by 3T-MRI), to be 50 cc, which I'm told is quite typical for a man my age.

So, maybe call your doc . . . make sure the MRI that he ordered is in-fact a 3T-MRI version (not the standard variety 2T type), and then, I suspect you'll both be in a far better position to make the best decisions for you regarding future treatments, moving forward.

Good luck!