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Oncas' second opinion...

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Prostate Cancer
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Posted 2/21/2009 3:48 PM (GMT -5)
Sought 2nd opinion from what turned out to be a much more savvy and informative urologist this week. Suggested that my numbers were of deep concern and when prodded offered that my odds of cure were less than 50%.(not a surprise). Suggested that my cancer was uncommonly aggressive and would start with open, wide on both sides, non nerve sparing surgery as soon as possible probably followed by some sort of radiation protocol after some continence returned if indicated by detectable PSA. After checking in to set up an appt for surgery the following day I found that the earliest date available was 5 weeks from now.
I have two issues where I'm sorely needing advice.

!. Given my profile and this guy's initial advice should I wait this long or continue my search and listen to my gut feeling that time is critical and even perhaps seek input from an oncological direction. It's just so hard to trust the vendor with an issue this critical.

2. Anyone experiencing blood in semen 4 weeks after biopsy or am I perhaps looking at evidence of more extracapsular advancement.

Thanks for any advice ...

Oncas

PSA 11/11/08 8.04 (previous PSA was 2.5 11/11/05 )
Biopsy 01/23/09
DX 1/28/09 12 cores positive 9 cores 4+3=7 2 cores 3+4=7 1 core 4+4=8
9 cores suggest perineural invasion
Scans 1/26/09
Bone/Pelvic/Abdominal All clear

Post edited to add a subject line ~ TC-LasVegas

Post Edited By Moderator (TC-LasVegas) : 2/28/2009 1:42:24 PM (GMT-7)

Posted 2/21/2009 3:53 PM (GMT -5)
Oncas,

I know the wait is nerve wracking. I do know that you need some healing between the biopsy and the surgery and I am pretty certain that Drs. like to wait more than a month, in my case we waited 3 months.

I would talk to my Dr. and express my concern about the wait and see what he said.

Is the blood still bright red or is it a dull brownish color, it seems like I am remembering it took a couple of months for me but the bright red stuff didn't last for more than a couple of weeks.

Scott
Posted 2/21/2009 4:22 PM (GMT -5)
Oncas:

It is also my understanding that certain recovery time from trauma of biopsy is required before surgery.

Also same as Scott, blood in semen for a couple of weeks - then dark brown- about two months before normal color again.

Stay strong and I wish you all the best.

Posted 2/21/2009 4:23 PM (GMT -5)
Oncas,
My PC was also aggressive but my doctor wanted to wait 6 weeks before he will do the surgery. As far as the blood, mine was more like brown than red. That is normal for a while.
Posted 2/21/2009 5:21 PM (GMT -5)
Greetings, Oncas. My doc said wait 6 weeks after biopsy before surgery.  Had biopsy on Dec 17 and surgery on Feb 4.  My semen was bloody right up until surgery.  Since then no semen - bloody or otherwise!  David

Posted 2/21/2009 5:36 PM (GMT -5)
Due to agressive nature of my PC, my dr. wanted to do a surgery 6 weeks after 3rd biopsy, but due to logistics of hospital schedule, ended up being 8 weeks. Worked for me.
Posted 2/21/2009 6:11 PM (GMT -5)

Oncas:

One way to slow down the PCa and also give you a little piece of mind is to start on Casodex and get a Lupron shot ASAP.  That will do a few things, if you decide to go ahead with surgery it will begin to shrink the tumor in the prostate immediately.  It will also give you the peace of mind knowing that the probability is very high that there will be no progression in the cancer over the waiting period.  It would also buy you some time and give you the opportunity to actually look at other options if you want.

The downside to the protocol is it makes the prostate and nerves "sticky" during the surgery so it takes a little more time on the table.

I had this done and a few others have also, I felt much better about the wait.

David 

Posted 2/28/2009 8:54 AM (GMT -5)
Oncas - For me, it took a while for it to sink in about the seriousness of my condition. The first doctor said don't wait more than 2 months, the second doctor was not in as big a rush, and the 3rd guy said, "If you were a family member of mine, I'd clear my schedule and do you in the next 2 or 3 weeks." We picked him, and he did, but still, by the time I hit the table it was about 55 days from the date of my biopsy.

If I had gone to the 3rd guy first, I get the distinct impression that he would not have waited any time because of the biopsy. I know your rectal wall gets penetrated during the biopsy, but they are needle sized holes, and recovery should be pretty quick. And who cares about the recovery of the prostate? If you choose surgery they are going to cut it out anyway.

I also get the impression that my guy shuffled surgeries around based on the seriousness of the case. Obviously different doctors run their practices different ways. I can only report on my experience.

Good luck,
kcragman
Posted 2/28/2009 9:43 AM (GMT -5)
I would take the surgical opening that you have been offered, need to get that thing out of you.

The blood after the biopsy is still normal I would say.

David in SC
Posted 2/28/2009 12:32 PM (GMT -5)
Oncas,
With gleason 8 and the number of positive cores you are in the high risk catagory. I would at least get a 2nd opinion from a prostate oncologist before I did anything. Why would you want surgery if you have to follow it up with radiation anyway. This indicates that your doctor feels that surgery will most likely not result in a cure, so why incur the side affects of surgery. An oncologist will give you a much more unbiased opinion. It is extremely important to have your PC staged as accurately as possible before you decide on a treatment option. There a a number of tests availabe to determine if the PC has spread, you need to know this before you choose a surgical option that may not be effective.
JohnT
JohnT
Posted 2/28/2009 1:11 PM (GMT -5)
Your decisions are tough Oncas my stats were much worse so it made my decision to skip surgery more automatic (after I knew what level I was really at). If you wish to buy some time while you still consider everything and/or seek other opinions or testings, you can take casodex alone also, as an option to keep it at bay during such time. Casodex side effects will probably be alot easier for you to handle compared to Lupron/Zoladex and others, also costs alot less, generic in Canada has been researched by OhioState/Andrew and is under $150 now vs. USA brand name at $600 (per month or so).
Best to you on whatever path you choose to take on this.
Posted 2/28/2009 10:56 PM (GMT -5)
Look I think you should just take the date the surgeon gave you and be happy with that, UNLESS you can get an oncologist to see you before that. I had second biopsy on 08/14/08, went on pre-planned trip to Nothern California two days later to forget about possibility of prostate cancer for awhile. First biopsy on 03/15/08, results indicated "suggestive of cancer but not diagnostic", urologist said repeat biopsy in 4 months, vacation already bought and paid for before this biopsy. I went on vacation, had blood in semen a couple times during sex during vacation, not a whole lot. Came back from vacation only to find out prostate CA in 2/12 cores, 5% one core, 25% other core, gleason score of 3+3= 6. My local urologist doesn't do robotic, went to see robotic surgeon in larger town, he agreed to do robotic surgery on 09/11/08, 3 days shy of 1 month. I am only a layman but I don't think 2 more weeks would have much of a difference. I am just paranoid about cancer, my father died in his late 50's from colon cancer, my mother from breast cancer in her mid sixties. I just couldn't live with cancer diagnosis, had to get it out due to family history. Radiation therapy can cure prostate cancer, but if it ever comes back surgery is not an option for MOST urologists, maybe someday it maybe but not today. I did not want to take chemical castration drugs for the third tier treatment for this disease, just take a big breath and go with the surgeon, that's what I did.................
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