positive biopsy today

psa presently 6.9 up from 4.2 in oct 2011, 12 samples taken, 2 positive beside each other, GS 3+4. doctor recommends keyhole surgery or brachy.

complicating decision is almost no bladder muscle due to nerve cut in a spine operation in 1975. I have used stomach muscles to pee since with help of slight bladder sphincter relieving with surgery in 1975. doctor worried because  the cut nerve affected bowel as well and perhaps has weakened pelvic floor muscle and will contribute to incontinence. on the other hand, weak bladder muscle might work to counteract incontinence!!

leaning toward the surgery.

comments??

same to you jimmie. time to begin a new journey, eh.

Hi there ayjaydee,

I'm not familiar with how the various forms of treatment will affect your special situation. Your case of PC certainly sounds curable. If you were to have surgery, you might want to ask if da Vinci robotic would be better for your situation than an open procedure.

Your next move probably should be to consult with top radiation oncologists AND uro/surgeons and learn about the various potential outcomes from all of the available treatments. Then you can make an informed decision on how to proceed.

Wishing you the best of luck!

Hi DaHoney,

As you're probably already aware, your PC is significant with all the positive cores, perineural invasion, etc. But your bone scan & CT scan were negative, which hopefully means there has been no spreading of the disease.

The Gleason 3+4 is not a horribly aggressive cancer. In fact, the grade 3 is low risk -- and this is your primary cancer, so that is very good. The grade 4, which is the secondary cancer, is mildly aggressive.

But you should have great hope of being cured. I would not wait very long to choose a treatment, however, because the high PSA number is saying that time is of the essence.

All in all, BOTH of you should be hopefully looking at cures.

Best of luck!!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.

ayjay,
Your stats are similar to mine. I don't know what keyhole surgery is. I chose brachy. Couldn't be happier.
Wish you the best, Brother.

Hi ayjaydee,

Selecting a treatment is a very personal decision. I took into consideration my age, health, and current quality of life. There are several side effects to any treatment that you must consider and be prepared to deal with. I won't recommend what you should do but I can tell you what I chose and why.

I chose the Da Vinci robotic surgery because for surgery treatment it is cutting edge. The recovery is quicker, less blood loss, pain, etc. The surgeon also has a high resolution 3D image of the surgical site so they can typically see better. Also, since the prostate, seminal vesicles are removed (and in most cases lymph nodes), post op pathology report will tell you how much the tumor has progressed, if it was confined to the prostate, and any invasion lymph nodes or seminal vesicles as well as an updated Gleason score and tumor staging. This is the only treatment that would have given me this information and I felt it important enough to know exactly what I was up against.

The other thing I considered was my backup plan or salvage therapy options in case my primary treatment failed mine being radiation should I have treatment failure.

Good luck on your decisions.

-b

ayjeydee - How old are you? If you had a bladder surgery in 1975 I'm guessing you could be in your late 60s early 70s, right?

david, I will be 68 in june. the surgery in 1975 was to remove a benign tumour in my spine. bladder/bowel function was compromised and I have been using stomach muscles to pee ever since. if pelvic floor muscle weak from that suregery, doctor worried about incontinence. on the other hand, perhaps my stomach muscles could use a little help?? lol

thanks andrew

Ayjaydee,

Welcome to the forum. Since you are of my generation you might remember Dr Henry Kissinger who was the US Secretary of State in the early 1970s. He comes to mind because one of his diplomatic innovations was his "shuttle diplomacy" where he would alternately visit the leaders of world powers in conflict carrying proposals and counter-proposals back and forth looking to broker a less confrontational relationship between them.

I think with your special issues with urinary continence resulting from your prior surgery you will probably want to do a bit of shuttle diplomacy between your doctors. You should have, at a minimum a very good surgeon and a brachytherapy expert on your medical team and possibly a medical oncologist for good measure. As you consult with each you should discuss your special issues and get their ideas on how it can be dealt with. You should also convey the impressions of the other doctors and get their reactions. Let each of them know that you are not just shopping for a treatment but are consulting them for advice and are looking to build a cooperative medical team. Plan to consult everyone at least twice so you can close the loop.

Good luck. Let us know what you decide.

yooper:

does BT stand for brachy?

Ayjay,
I wish you the best in making a decision! All the advice given is pertinent and I'm thankful for your sake that the opinions didn't resemble the Hatfield/McCoy or surgery/some form of radiation dispute. You might want to see the recommendations-for DaHoney by clicking on his name..Many of the posts might be applicable to you.
Since you asked for comments, with your intermediate low volume PCA bracky (seeds) might be an excellent choice with minimal se's of both ed and incontinence..
Good Luck
Bill

I just had the DaVinci surgery and will be returning to work a week for today. My PSA was 4.7 had been going up a little each time they
did blood work. I,m sorry you are having to go through this. Talk to
your Doctors and don't get in a rush to make up your mind what route
to take. I still leak and wear pads for bladder i get them at the dollar
store very light is on the package and they are thin and work great for
me. Good luck.

Best of luck to you whatever you decide.