Nervous Introduction

Hi there,

I want to say hello and wish you well going forward.  There are so many great guys on this forum that give just excellent advice.  I'm sure you will be finding this out soon enough.  My advice is definitely focus on reading / researching info from highly credible sources and avoid the not so credible ones.  One source that I have found that I go back to a lot is the Prostrate Cancer Patient Guide put out by pcf.org (link below).  It's a great source of info with a lot of good detailed content.  Hang in there my friend.  Like you, I was in the exact same boat in Oct and fast forward to today, and I am post treatment (radical prostatectomy) and doing well with a very good outlook....this after clocking a PSA of 32.  I was told I would start to feel much better after getting my team of docs in place and learning more about my specific staging along with the treatment plan.  They were right.  I am very thankful for the guys out here that I would occasionally consult with.  They are the best.   

https://www.pcf.org/guide/prostate-cancer-patient-guide/

Take Care.....Joe - Indy

First of all, until you receive your biopsy results, there really is no informaton to base any decisions on.  In the interim, as suggested above, read all you can about prostate cancer and treatments.

As far as your prostate size, 23 CC is pretty darn small.  Mine is over 80 cc with accompanying BPH issues.

Don't fret over the biopsy.  If the urologist is skilled, it should be nearly pain free.  I have had 3 and none caused any discomfort.  I found my 2 hour MRI to be much more stressful.

Good luck going forward.

Keep reading.  The definitive test for PC is a biopsy.  Imaging and an elevated PSA do not always equal PC.  However, they do raise suspicion and should be addressed.  For now, good luck on your journey.

Like you I am a young 53 year old in good shape. I got my first PSA every and it was 17. I went and got a biopsy. Yep, positive for prostate cancer both sides. 12 out of 12 samples positive. Most 6 on Gleason but 1 was a 3+4 so they tagged me as a 7. I went crazy reading everything about prostate cancer and treatement. I got a bone scan (negative), Tesela MRI (cancer containted). Then had to decide on treatment path. I have chosen Proton Therapy vs surgery. If I went the surgery route I was going to lose sexual function for sure so I went Proton. I just had my markers placed and Space Orr gel inserted this week. Start treatment end of this month. 

If you maintain a healthy weight, eat right, and the cancer is contained, you will live a long life. It scares the hell out of you which is understandable. Just another problem to deal with and you will get through it. 

Welcome... not that you wanted to join but welcome.  A lot of good advice and suggestions here and in the other posts  ACS site has great information as does the Prostate Cancer Foundation.  In your hopefully extensive research you will also come across sites such as the Urology Association which are written for doctors but which still are useful reading.  The good news is there is a ton of information out there and you have lots of time to get smart.  The bad news is you are not a doctor and compiling it is hard.  Lots of information.  Lots of informed opinions online.  I think what is most important is to find a physician you trust and who you can work with.  I live near a univesity medical center which has a ranked urology program.  The department chair does all the prostate and bladder cancer cases himself.  And he is probably the best doctor I have been treated by over the years.  If you don't have that level of support consider finding it.  I would also suggest that if you can, find a couple of friends, collegues, new friends,who have gone through prostate cancer... they are out there.  Everything will be a new experience and it helps to have someone to bounce questions off of so you don't worry.  This feels a little differently than I expected.  How do I best deal wtih this.   

Good luck.  It sucks.  but it won't be the end of the world or of life as you know it and to a certain extent it hopefully restores some of ones faint in the goodness of friends and the skill of the medical profession. 

Hellostone,

Your PSA vector suggests that your biopsy will have some positive cores, but at this point, that is only a statistical liklihood.   My brother in the last year has followed a path very similiar to what you describe:  His first-ever PSA a year ago was 10.5, and a year later, just over 11.  His uro did an MRI guided 12-core biopsy, and every core was negative.  Not even any PIN cells.  And, his gland is normal in grams -- not enlarged.  His doc said that he was "shocked," as was I.   So, one never knows.  

You actually know very little at this point. It is after the biopsy that determinative data will be in hand: the Gleason score, and the volumne of involvement, as well as a few other findings, like whether perineural involvment was seen, etc.   Only after the biopsy will meaningful choices begin.

I suggest an excellent book for nubies:  Dr Peter Scardino's Prostate Book.   He is former Director of Surgery at Sloan Kettering CC in NYC, and is still a surgeon there today, regarded as one of the best in the world.   He presents ALL diagnoses, how to interpret them, and treatment choices.  He is NOT biased toward surgery, and discusses the pros and cons of all modalities: surgery, Active Survellance, and all forms of Radiation Therapy.   He then discusses all strategies for relapsed disease as well (Hormonal Therapy, Chemo).  The book is a regular stock item at Barnes and Noble and Amazon.

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Hellostone said:

Thanks Gforce -- and a biopsy question

Gforce, I really appreciate your post, given how similar our age & PSA numbers are!  That's great that you mostly scored at G6 even if the conclusion was G7 for that one bad core.  Here's hoping that the PT goes well for you!!  And thank you again for your calming words!

For myself, I met with my uro this morning and was told that a MRI-guided fusion biospy would not be possible for 3 months or so due to lack of hospital room availability, both locally and regionally.  (I would've thought that Boston would have plenty of capacity for this given the many great hospitals around here...)  But the uro said that he could do the biopsy in his office next week, without the software mapping of the MRI slides, but with his knowledge of where the suspect lesion is.  He assured me that he would not "miss" the lesion spotted by the MRI, since my prostate is small and the lesion is good sized (1 cm square); he said it would have been less of a sure thing if the lesion was smaller and my prostate bigger., but mine would be more of a slam dunk (those were not his words but it was clearly his implication).  He indicated he thought I could wait 3 months for fully guided biopsy if I wanted to, but I had no interest in that long a delay, so we booked his biopsy next week.  

I'm wondering if that choice and rationale sounds sensible to you all?  Or if the software-guided fusion biopsy is worth waiting for??

Prostate cancer is so slow growing that you can feel pretty confident in waiting to make decisions. One study found that there was no difference in outcomes after waiting 6 months to make a decision on a treatment plan. My biopsy was done in the Dr. office. I was nervous regarding the pain as I had never been poked in that area before. After numbing the prostate, it was no big deal. Even afterwards just a little sore that day, but next day all was fine. I was diagnossed in July 2019 and wanted to wait till after all holidays to start treatment. My Dr. suggested Lupron as a preventative measure until treatment. I started Lupron in October 2019. The only real side effect for me are the hot flashes. The Lupron lowered my PSA to 2.7 as the cancer cells die for lack of testostorone. I am looking forward to being on the other side come March this year. I have a great summer ahead of me on the water with friends. Life is good! Tough times come and go but tough people stay around for ever. 

L1917

DaVinci surgery is today very common, undoubtedly the norm for R.P.s.  The best hospital in the DC area is Johns Hopkins, actually one of the best in the world.    You should have a pretty easy time finding an excellent surgeon in the area.

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