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In the beginning - Confused and Scared

VegasMike
Posts: 4
Joined: Dec 2019

Hi everyone my name is Mike.

 

Please let me thank you in advance for any guidance you may be able to give me.  I would be lying to say that I am not incredibly confused and scared, but also hopeful.  Any insight you might be able to give me from the info I have listed below would be so appreciated. I have been trying to read on this sight, along with doing research online, but I seem to be as confused as when I began.

 

 

Age 52

 

PSA Sept 2017 - 1.8

PSA Sept 2018 - 2.5

PSA Sept 2019 - 3.4

 

27 years ago, my Father was diagnosed with prostate cancer at 52, the same age as me now. He died less than a year later at 53 from the disease.

 

I have been aware of and watched my PSA numbers since I was 38. My General Doctor would tell me that anything below a PSA of 4.0 was nothing to worry about, but given what had happened to my father, I was very skeptical and decided to pursue things on my own. The urologist that I have been seeing told me that my general doctor was uneducated about the PSA facts, and was glade that I took things into my own hands.

 

11/26/19 - Met with Urologist for 1st time. We talked about my prior PSA scores, my father dying from PC, and he preformed a DRE(said prostate felt normal), but wanted to do Biopsy because of the increase in PSA levels over past two years related to my current age.

12/16/19 - Biopsy performed

12/23/19 - Diagnosed with PC

1/7/20 - Scheduled for full body bone scan and pelvic CT Scan.

 

Tissue Pathology Diagnosis

A) RT APEX (Needle Core Biopsy)

- Benign Prostatic Tissue

B) RT MID (Needle Core Biopsy)

-Prostatic Adenocarinoma, Measuring up to 0.1cm

-Gleason Grade 3+3 = 6 of 10 (Grade Group 1)

-No Perineural Invasion Identified 

-See Comment

B,C,D,F - Immunohistochemistry-Prosatic

adenocarcinoma is identified (B,C,D) by the

staining pattern using Pin 4* cocktail 

(epithelial cells positive for p504s, lacking

circumscription by p63 and HMW keratin). In ‘F’

there are rare glands with similar pattern of

antigen expression. Controls Work

Dr. Scamman has reviewed C and D with

immunohistochemistry and concurs there is 

adenocarcinoma grade 3+4=7

C) RT BASE (Needle Core Biopsy)

-Prostatic Adenocarinoma, Measuring up to 0.7cm

-Gleason Grade 3+4 = 7 of 10 (Grade Group 2)

-No Perineural Invasion Identified 

-See Comment

D) RT LAT APEX (Needle Core Biopsy)

-Prostatic Adenocarinoma, Measuring up to 0.35cm

-Gleason Grade 3+4 = 7 of 10 (Grade Group 2)

-No Perineural Invasion Identified 

-See Comment

E) RT LAT MID (Needle Core Biopsy)

- Benign Prostatic Tissue

F) RT LAT BASE (Needle Core Biopsy)

-Rare atypical glands, suspicious for prostatic

adenocarcinoma 

-See Comment

Comment: The focal area of atypic measures less

than 0.1cm, and consists of only a few glands.

G) LT APEX (Needle Core Biopsy)

- Benign Prostatic Tissue

H) LT MID (Needle Core Biopsy)

- Benign Prostatic Tissue

I) LT BASE(Needle Core Biopsy)

- Benign Prostatic Tissue

J) LT LAT APEX (Needle Core Biopsy)

- Benign Prostatic Tissue

K) LT LAT MID (Needle Core Biopsy)

- Benign Prostatic Tissue

-See Comment

Comment: Immunohistochemistry-No prostatic

adenocarcinoma is identified by the staining pattern

using the PIN 4* cocktail (small glands negative for p504S,

with circumscription by p63 and HMW keratin).

Controls Work

L) LT LAT BASE (Needle Core Biopsy)

 

- Benign Prostatic Tissue

Clevelandguy
Posts: 590
Joined: Jun 2015

Hi Mike,

Sounds like with the 3+3 and 3+4 the bone and CT scan will give you a clearer path on treating your Pca. Most people either go with one of the various forms of radiation(seeds or external beam) or surgery. Both treatment methods have their benefits and side effects you will lean about in the near future.  The American Cancer Society has a lot of very good info on the various types of treatments for Pca along with a lot of other internet sites. A 3+4 is less aggressive than a 4+3 since the first number is the most abundant type of cells in the sample and the second number is the lesser amount of cells in the sample.  When you get the results of your scans the cancer patients on this board can help you understand them and what it might mean in your future.  A lot of experienced cancer survivors here to help and support.

Dave 3+4

5 yrs. out and still kicken........

VascodaGama's picture
VascodaGama
Posts: 3234
Joined: Nov 2010

Mike,

Welcome to the board. As Dave above writes, you need more information to decipher your PCa status. The results of the image studies will guide your doctor to attribute a clinical stage from which a due treatment will be decided. I understand your confusion and fears. It is typical in all of us diagnosed in the beginning as we are confronted with the unknown. You will do good too once you reach a practical decision on what to do next.

I agree with the urologist' comment. The PSA of 2018 (2.5 ng/ml) was already an alarming situation in view of you having a PCa case in the family. Apart from that, a normal PSA at the age of 50 without symptoms is not 4.0 but 2.3. It seems that the GP was following old principles and guidelines. However, how much better is the urologist in comparison with the GP. This is some thing you need to discover along the diagnosis process.

So far you’ve been wise enough by requesting the periodical PSA and doing researches on your own. Doctors do not single out a patient among the many they see everyday to look for differences. Urologists also follow the standard guidelines of their institutions (AUA) and recommend accordingly. The Bone scan and CT make part of those guidelines, recommending following the biopsy process with an image study. The purposes are to identify bone and lymph nodes involvement. The CT will look for abnormal structures in the urinary tract too, but it cannot distinguish between cancerous tumors and noncancerous enlargements. A PET scan would be better if one takes into consideration your dad's story, but most probably you will be diagnosed with an early-stage PCA all contained within the prostate.

The pathologist's report indicates 3 positive cores out of 12, with one still unclear. It says Gleason score 7 (3+4) intermediate risk case with a small percentage of cancer involvement, all positive cores set in the right lobe, locating the largest cancerous tissue (0.7 cm) at the base (region under the bladder close to the seminal vesicles). Your urologist also identified a negative DRE which adding to the biopsy data is indicative of cT1c stage. The missing clarification is the size of the prostate gland that together with the PSA could lead to a better evaluation on the risks for spread. In fact the missing piece of information relates to the involvement of the seminal vesicles which is a known route for extraprostatic extensions.
The CT is not reliable in detections within the prostate as it is limited to sizes of 1cm and the biopsy footsteps (inflammatory residues) will be still present three weeks post procedure.

I usually recommend to newbies confronting the situation as cool as possible. Family members should be involved in this difficult moment of decisions. One shouldn't rush without a second opinion from other specialists. PCa doesn't spread overnight and allows time to the patient to educate himself on the matters related to the cancer, diagnosis and treatments. I was diagnosed at the age of 50 and it took me 2.5 months of investigations, tests and exams, done with my wife, till reaching to a decision.

I would like to know what made you feel confused as described in your above post. I also wonder if you ever had or have any symptom (urination issues, etc) or other health complications that could interfere with a particular choice of treatment. Can you provide details on the PCa case of your father? What was his Gleason score? What kind of treatment has he done and why do you think that cancer is behind his death?

I recommend you to find out about; bone health (osteopenia), testosterone levels (fatigue), ED issues, obesity, liver and kidney markers, etc, while waiting for your urologist's opinion. Our young age leads to think that we are healthy till something strike us and we realize otherwise. You may want also preparing a list of question for your next meeting.

Here are some links as reading materials that may help you to understand things;

https://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/talking-with-doctor.html

http://www.cancer.org/cancer/prostate-cancer/detection-diagnosis-staging/staging.html

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

https://www.lifeextension.com/Protocols/Cancer/Prostate-Cancer-Prevention

Be positive and advance coordinately and timely.

Best wishes and luck in this journey.

VGama

 

Tech70
Posts: 64
Joined: Nov 2017

Based on my experience, I would suggest a couple of things.  First, I would have the biopsy slides reviewed by another pathologist, and I would strongly suggest Johns Hopkins.  They are the gold standard.  I almost went off Acitive Surveillence after a 3+4 gleason on one of my Bx samples.  Send it to JH and they reclassified the sample as 3+3.  Also, you might want to consider genomic testing of the positive samples to determine how aggessvie the PCa might be.  I had Oncotype DX testing of my samples which showed my PCa was probably no life threatening.

VegasMike
Posts: 4
Joined: Dec 2019

I appreciate everyone giving me your initial thoughts on my situation.  I am slammed at work the next two days, so I will update this thread with more info when I come up for air.

Thank You Very Much. It is great to know there is somewhere like this to come for support and info!!!

VegasMike
Posts: 4
Joined: Dec 2019

Hi All,

 

Wanted to drop by and give a update to my situation.

I have gotten my results back from my Bone Scan and Pelvic Cat Scan, and scheduled teatment.

My prostate came back with measurements of 4.8x3.2cm in transverse and AP diameters.

There was no mass or adenopathy.

No sclerotic osseous metastic disease.

I have since learned that these fancy words mean that it seems to be contained to my prostate and has not spread.

My urologist/surgeon told me that he can not be absoultely sure it has not completley isolated to the prostate until after it is removed and the pathology tests come back, but he seems to think it has not.

I have schelued robotic surgery for March 28 and I am looking forward to getting this out of me, and see where I go from there.

I am optomistic at this point, and have much less stressed since I know it has not spread to my bones.

Thanks for your time,

 

Mike

Josephg
Posts: 229
Joined: Jan 2013

Hi Mike,

That is good news, in that the PCa has not likely spread beyong the prostate gland itself.  As your surgeon advised you, a much more definitive assessment will be made, once the prostrate gland is removed and dissected in the lab.

I wish you the best of outcomes on your upcoming surgery.

Joe

PhillyMark
Posts: 3
Joined: Jan 2020

I am new to all of this and I understand I might be jumping the gun but recent test results have me very anxious so please bear with me. 

I am 57 and had my first PSA in 11/17. The result was 3.8. My MD said it was fine and no follow up.

Around 11/19 I started to have frequent urination at night. I got another PSA which was 6.8. 

Last week I met with urologist who did repeat PSA which was 5.2. A Free PSA was 12%. I am waiting for results of PSA3 but I think I know the answer because of all other causes of frequent urination have been ruled out. I keep reading that this is a symptom of advanced disease. 

I know this is all premature but I am really freaked out by all of this. 

Gforce
Posts: 21
Joined: Jan 2020

No way. Your PSA is so low that they have caught it. Your biopsey is next. 

I am 54 now and got my first PSA last June. I was up every night at least once. Mine came back at 17. It wss stage 2 all contained to prostate. Now I am doing Proton Therapy. 

 

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