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Husbands new diagnosis

arizonadolphin
Posts: 2
Joined: Aug 2016

My husband is 50 his history is as follows

PSA Was 2.2 in May 2015

              3.8 in Nov 2015

              5.4 in May 2016  free PSA 3.8%

positive DRE in May 2016

Biopsy August 2016 results:

T2b Gleason 7 Left perineural invasion present, 6 of 12 cores were 70 to 95% adenocarcinoma 4+3and 3+4

MRI Scan scheduled for 6 Sept

What i am wondering is if it has spread past the capsule than we should look at radiation vs surgery?  Urologist also stated that after prostate removal surgery his gleason score will likely be upgraded to 8 in his opinion.  Due to his young age and all the side effects  i am reading about just want to hear some of your opionion based on your circumstances.

thanks to you all and fight on!!

CowboyBob
Posts: 31
Joined: Oct 2013

But I am sorry for your husbands diagnosis.  You will need the imaging study to make any reasonable decisions regarding treatment. I  am sure others more knowledgable than I will provide further guidence; but, I would caution you to not jump to any conclusions without considering all the alternatives. Your post mentions surgery like that is the only option. You need to get the MRI and also consult with a radiation oncologist. For a 50 year old man, the side effects of prostatectomy may have a significant impact on quality iof his life (and yours),

hopeful and opt...
Posts: 2224
Joined: Apr 2009

I am sorry for your husbands diagnosis. It is good that you are involved, and are doing research on his behalf. Prostate cancer is considered a couples disease, so this is appropriate.

 
Keep on researching, read books, Internet research and attend a local support group(s). There is an organization called USTOO.com that sponsors local support groups. You may wish to go to their site to find support group(s) in your area.
 
Ask questions here, also talk about your concerns.....we will answer to the best of our abilities.
 
 
An MRI can show if there is extracapsular extension, and is an excellent test to have. Be aware that there is a difference between MRI machines. There is one that has better magnet, a 3.0 Tesla,t that will provide better definition than the others.....a 3T-MRI. You may ask the doc to confirm that this will be the machine in use for the MRI.
 
The American Urological Association recommends a bone scan for men who are diagnosed with a Gleason 8 and above. Since your husbands cancer is fairly extensive, a bone scan may be appropriate in addition to the MRI. ask your doc.
 
There are different treatment modalities. The side effects of each active treatment can be considerable and cumulative, if more than one is used....so for example, if the cancer is outside the prostate, hormone treatment only,  or a combination of hormone and radiation may be appropriate, but having surgery in addition may simply add additional side effects such as erectile dysfunction and incontinence. At this point you want to have the best diagnostic tests so you can have input in  determining  what needs to be done.
VascodaGama's picture
VascodaGama
Posts: 2987
Joined: Nov 2010

 

Arizon,

 

The urologist's opinion that the Gleason score will increase, turns the case with higher risks for existing extracapsular extensions, which could be related to the positive DRE. That would also increase the staging to T3, most probably an indication that surgery alone would only treat the wound not treat the whole case. If confirmed, Radiation as prime therapy would become a better choice.

 

In fact, due to the young age of your husband, I would only decide after exploring all best methods in diagnosis to get a "proper" clinical staging of his PCa status. Traditional CT and MRI may not detect cancer, providing false negatives. Better techniques (as commented by Hopeful above) are now available with newer contrast agents (choline based) or still better with PSMA radio-tracers using PET scans. These types may not be covered by insurances but they are available free of charge in trials, or at some locations paid out of our pockets. Please read past threads on the matter for details.

 

I would also advice you to investigate on the side effects from treatments to PCa. His and yours quality of life are at jeopardy.

 

We all freak out at beginning and will accept anything thrown to us because we want it out of our body but this is not the way to confront a cancer problem. PCa is in fact a slow growing type of cancer providing the patient with time to educate on the matter and decide. Do not sleep on the problem but do things coordinately and timely. Please get second opinions from various specialists.

 

Here are links that may be helpful for you;
http://www.cancerresearchuk.org/about-cancer/type/prostate-cancer/treatment/the-stages-of-prostate-cancer
https://csn.cancer.org/node/304131
https://csn.cancer.org/node/304417

 

Best wishes and luck,

 

Welcome to the board.

 

VGama

Old Salt
Posts: 720
Joined: Aug 2014

As mentioned above, more info is needed to advise, but IMHO radiation (there are several 'flavors') should be considered as well. This is something that most urologists fail to mention.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3274
Joined: May 2012

Arizona,

Your husband is unusually young to have this disease.  Occasionally men in their 40s have it also, but the average age at diagnosis in the US is around 67.

His data suggest to me (like everyone else here, I am a layman -- not a person with medical training) significant, possibly somewhat aggressive involvement.  For one, his PSA doubling rate (also called a 'vector'; the length of time it takes for his PSA rate to double) is short.  His Gleason of 7, which the doctor suspects might actually be an 8, is worrisom. His volume is high (the percentage of the cores that was cancerous).   And perineural involvement: this means that the biopsy show that cancer has exited the gland along nerve fibers that run through the gland.

As most stated, what he needs short-term is a 3.0 MRI and/or Artemis MRI.

There are protocols that suggest whether a PCa patient will be best served by radiation or surgery.  Very generally, disease that has exicted the gland recommends radaition, not surgery.  In fairness to himself he must visit with a radiation oncologist -- one with significant PCa experience.

I had surgical removal myself, but my tests came back quite different from his. If I had only the data in hand that your currently have, I would definitely go the radiation route.

max

 

MEtoAZ
Posts: 37
Joined: Feb 2016

Sorry to hear about your husband's diagnosis.  Prostate cancer is not generally a fast growing desease but with these scores you will need to do something and active survellience does not seem like a good idea.  Many mentions of seeing oncologists which is certianly a good idea.  With the information provided, surgery alone may not suffice and having both surgery and radiation, which is an option, can also add to the complications you can experience.  Are you in AZ?  I am in AZ and was diagnosed in January of this year at age 52.  I had only 2 cores positive, one was 3+3 and 3+4 with two additional  cores were abnormal but not yet cancerous and had possibility of perineural invasion on left side.  I opted for Cyberknife after hearing about it from this forum and doing extensive research on the various options.  Each specialist you see will recommend what they know so ultimately, you two will need to educate yourselves to make what is the best decision for you.  It is easy to just "trust the doctor" and the doctors generally are doing what they believe is in your best interest but just realize, "your best interest" is usually tightly tied into what they do for a living.

ob66
Posts: 225
Joined: Apr 2010

Seven years ago my numbers were close to your husbands and my 7 turned to an 8 post surgery (biopsy). Was stage 3b, and was treated over the course of a year with robotic surgery, AUS 800, radiation (37 treatments) and 2 years of lupron.

Now that is excessive in going in but each decision was step wise. My PSA rose slightly within 10 months after surgery, thus the radiation. The AUS was placed as after 10 months physical therapy had significantly reduced my incontinence, but not completely.

So we kicked it in the pants (literally) hard, and my ultrasensitive PSAs have been below 0.02 until about a year ago when it went up to 0.03. This has been seven years and I can't tell you how happy I am we went "all in".

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