Slow Growth? NOT Always.... Don't wait too long, here is why

Kongo said:

Justin
Justin, I'm sorry that you're experiencing these troublesome symptoms and you are smart to be doing your own research in addition to seeking the advice of your doctor and a urologist.

I am sure the doctors told you that prostate cancer in a man as young as yourself is so rare as to be virtually unheard of. On the other hand, despite how rare such a condition might be in a man your age, given your family history it is probably medically possible to have prostate cancer but I truly believe another culprit is at work here.

Symptoms such as you describe can be caused by a number of different conditions. BPH (benign prostate hyperplasia) can manifest itself in men as young as 30 and is a condition where the prostate enlarges through the growth of benign tissue (not cancerous) in the prostate. Eventually the enlargement can reach a point where it begins to squeeze the urethra (the tube that goes from your bladder to the penis to allow urine to pass) which happens to go through the center of the prostate. This squeezing causes exactly the symptoms you describe which include dribbling, a weaker flow, hesitancy in voiding (start and stop urine flow), and in extreme cases the urethra is pinched so tightly that urine cannot pass at all. Men who suffer from BPH (often referred to as an "enlarged prostate") are also more likely to contract urinary infections which can also cause the symptoms you describe.

While Flomax is often prescribed for BPH it does not always work and Flomax has its own set of side effects that can affect erectile potency, volume of ejaculate, and other things as well. Flomax is all about trying to keep the urethra open and does nothing to shrink the size of the prostate which is most likely the culprit of your symptoms. A drug called Avodart can shrink the prostate but it has side effects too that you should be well informed about before taking the drug. There are physical procedures such as a TURP or TUNA which actually remove benign prostate cells that have become enlarged that is very effective in long term treatment. You might want to look at the Wikipedia entry for BPH to learn about these processes.

Your urologist can determine whether or not your prostate is enlarged through a digital examination or by using an ultrasound probe.

You are smart to be seeing a urologist for this. Since the Flomax treatment isn't working for you should be prepared to discuss Avodart or the physical procedures to remove excess prostate cells. Many researchers believe that although BPH is not cancerous, if it is untreated and inflammation within the prostate occurs, prostate cancer has a better chance of developing. Another condition you should discuss with your urologist is prostatitis which can cause your symptoms as well and there are a number of antibiotics that can be administered to treat this condition.

Keep in mind that many things can cause your PSA score to elevate that have nothing to do with prostate cancer. Having sex within 48 hours of a PSA blood test can elevate your PSA reading by as much as 2 points. A urinary tract infection, BPH, prostatitus, certain over the counter medications, bicycle riding, and even a hard stool shortly before your blood draw can cause a false high reading.

Knowledge is power for these conditions and please continue to do your research so that you can be an informed and knowledgeable patient when you meet with your urologist.

Best of luck to you.

K

inspirejustin said:

evaluation
Hi there guys, I just wanted to give a quick update. I saw the urologist today, he suggests "chronic prostitis" another 2 months of antibiotics and continue with flowmax. Will have another psa test done in two months to see if it decreases and hopefully this fixes my symptoms/problems with urinating and this uncomfortable feeling! Let me know your thoughts, thanks!

tarhoosier said:

Waiting?
I followed this thread and waited until someone brought up an obvious point. Kongo has now done so. Regardless of psa, the Gleason grade and score is the greatest factor in our disease. All treatments are determined from that point. A biopsy result of G9 (as mine was) would almost certainly indicate high risk for spread. That is the whole point of G score, to identify the risk. And the utility of G score has been proven millions of times over. Psa may be uncertain for diagnosis but expert G score pathology is never uncertain.
I suggest that surgery for G9 cancer is the first step in a series of treatments. Gleason 9 has shown us the way this may progress. Surgeons may occasionally go to surgery with isolated G9 biopsy samples, but even in these cases long term durable remission by surgery alone is uncommon. My point is that for Gleason 9, as for me, the die was cast before biopsy, before diagnosis, before repeat psa.
The better(?) part of my thinking is that it absolves guilt and remorse about the eventual diagnosis. As much as I would like to think that the cerebral level was in control, our futures are determined at the micro-cellular level,

Klemon said:

I totally agree! My husband
I totally agree! My husband had three years of rising PSA, two negative biopsies, negative DREs, negavite pelvic MRI and finally in 2010 1 positive core at 3+3=6. They tried to convince us we had all the time in the worldto wait around and watch.
We got a second opinion and saturation biopsy at Mayo and what do ya know, cores at 6 and 7 and 8 throughout the entire prostate..earned him an early surgery date with extended pelvic lymph node dissection.. final gleason score 7 with all negative nodes and confined. Had we waited per the standard urologists, and other doctors, we'd still be watching and waiting. instead, surgery was a breeze, life is great, no lasting side effects and PSA undetactable at 3 and 6 months. Fingers crossed. To cut is to cure my friends. (my husband -who is a surgeon himself- this is his motto)- you only get one bite at the apple before your options become limited.

mrspjd said:

Well Said, Kongo
In the case of PJD, after his 2nd opinion biopsy report from a respected path lab confirmed PNI (perineural invasion) and showed a higher risk Gleason of 3+4=7 than the G6 from the original local lab, he set about to more accurately stage the PCa before making any tx decision. Four different pre-treatment diagnostic tests later including, but not limited to, an endorectal MRI w/Spectoscopy, the PCa was re-staged downward to high volume T3 locally advanced (outside the capsule to the rt SV). No evidence of spread to lymph nodes or distal mets. We had multiple consults with every PCa tx modality specialist, including top surgeons and radiologists.

While PJD was a candidate for surgery with no pre-existing health issues to compromise that option, he elected not to have RP. In his case, RP (cut) mostly likely would not equate with cure (perhaps "abate" is a better choice of word) and, a tx plan including adjuvant RT would likely have been required following a primary tx choice of RP. Therefore, rather than risk the common side effects of RP, incontinence for one, and potentially compound that with adj RT, he did his research and elected a different tx plan, not RP, that he felt had the best chance for successful outcome. As you may know, that primary tx plan included a multi-modality tx approach of ADT, HDR-B, & IMRT.

All treatments have been completed to date and PJD is doing well with no side effects from the txs. While we are not naive about this insidious disease and the courses it can take after tx, we know that he made the right tx decision for his stage of PCa.

We continue to enjoy and celebrate life each day with an active and healthy lifestyle. Wishing everyone the same.

mrs pjd

Kongo said:

Klemon
I believe that your savvy decision to seek a second opinion of the biopsy was an important step in getting the information you and your husband needed to make an informed decision about appropriate treatment choices and I'm very happy for you both that he has had such a quick and full recovery. I question, however your statement "to cut is to cure" particularly within the context of this thread that highlights a very advanced cancer stage as evidenced by a Gleason score of 9.

While each treatment choice is a personal decision, I believe that there are highly divergent opinions among urologists and oncologists as to whether or not surgery, when there is strong evidence that the cancer has spread beyond the prostate, is an effective course of treatment. In the case of the original poster, cutting does not appear to have produced a cure and considering that almost a third of men undergoing RP eventually see a recurrece of their cancer your assertion that cutting equates to a cure seems a bit overstated, to say the least.

My personal opinion is that each of us with prostate cancer have unique circumstances and suggesting that just because a particular treatment worked for one man is a reason that it will work with the same results on another is presumptuous.

K