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Posted 8/3/2015 6:37 AM (GMT -5)
My husband recently had a prostate biopsy with the following results:

Age 64
PSA June 2014--4.2
PSA June 2015--4.6
Twelve core needle biopsy
2 core positive
G6--1%
G8--32%
SE Indiana

We have no history or experience with prostate cancer. We have naturally researched and read much since we were give the results over the phone. So much to comprehend and sort what is pertinent to our situation. Will be visiting the Urologist in two days for follow up consultation. What questions should we ask and what should be expect.

Post Edited (TERIDEEH) : 8/3/2015 8:36:27 AM (GMT-6)

Posted 8/3/2015 7:17 AM (GMT -5)
Hello TERIDEEH and welcome. Interesting results in one G6 and on G8. The first thing I would suggest would be to try and slow down, and be ready to put your learning caps on. Also, I would strongly urge you to get a 2nd read of his slides from one of the acknowledged experts in doing so - labs such as Bostwick and Epstein (see below links) are two of the very best and a 2nd opinion is a good thing to do. Reading of biopsy slides can be a bit subjective, and it's obviously paramount to know exactly what you're dealing with.

There will be many more dropping in and welcoming you - you've come to a great place of knowledge, experience and support. Hang in there - we're here for you guys!

Best,
Yoop

pathology.jhu.edu/department/services/consults/urologic.cfm

/www.bostwicklaboratories.com/services/laboratory-services/second-opinions.aspx
Posted 8/3/2015 8:14 AM (GMT -5)
Hello.
I hope you have obtained a copy of biopsy report for your own records.
What size is the prostate?
Surgery or some type of radiation is called for with a Gleason 8.
You might ask the urologist how many surgeries he has performed. What are the rates of urinary incontinence. Is an MRI needed. Would surgery be via DaVinci robot.

After a biopsy, treatment is delayed for weeks or months so you have time to research the topic. The majority of patients live a long time. Good luck.
Posted 8/3/2015 8:33 AM (GMT -5)
Thank you for your suggestions. Is the DaVinci robot also called a laparoscopic surgery? I have already had a question about that. I have heard from a friends experience that MD Anderson Cancer Center in Houston Texas does NOT recommend laparoscopic surgery on cancer patients as it can leave cancer cells due to the cutting and removal of an organ.

Post Edited (TERIDEEH) : 8/3/2015 7:54:54 AM (GMT-6)

Posted 8/3/2015 8:57 AM (GMT -5)
Terideeh: Sorry you need to be here but you are in a good place. I will second ayooper's reccommdation for a second read on the biopsy. Talk to people who have been through this, it really helps at two levels. It gives you valuable Intel and it is quite comforting. Use the search window on this board and read the sticky notes above.

When it's time to seek the best treatment providers, let people on this board know where you live. Chances are they can point you in the direction of some of the best In the business.

I wish you the best and keep us posted.
Posted 8/3/2015 8:58 AM (GMT -5)
Hello Terideeh,

Welcome to the forum. Sorry you find yourself here but glad you found us. Hope we can help.

Prostate cancer is usually a slow-growing problem and there is almost always time to educate oneself and make an informed, unrushed decision. There are a number of treatment options that are similar in terms of disease control but differ in terms of the side-effects of treatment. Your husband will want to talk to doctors who are specialists in a number of different sorts of treatment before he commits.

Yooper's advice about a second reading of your husband's biopsy slides is sensible. The labs that specialize in prostate cancer will sometimes see things that the local pathologist has missed and even if they simply agree with the previous reading you can have more confidence in it. I speak from experience in saying that a prostate biopsy is a somewhat literal pain in the a** and it makes sense to squeeze all the information out of it that you can.

I do have a couple of questions that will help us suggest the sort of treatment specialists your husband should put on his dance card. Could you give us a bit more information about the Gleason 8 result? There are several kinds of Gleason 8 results and they can make a difference in terms of treatment selection. Gleason scores are written as the sum of two numbers. Mine is Gleason 9(4+5) which means that the pathologist saw mostly Grade 4 cells but did see a few of the more-aggressive Grade 5 cells. A Gleason 8 score (such as your husband's) is usually Gleason 8(4+4) but can also be Gleason 8(3+5).
Posted 8/3/2015 9:04 AM (GMT -5)
MD Anderson is a LEADER in robotic surgery...

www.mdanderson.org/patient-and-cancer-information/cancer-information/cancer-topics/cancer-treatment/surgery/robotic-surgery/index.html

Don't believe everything you find on the internet..Pick up a copy of Dr. Pat Walsh's book, "Surviving Prostate Cancer" and learn the FACTS regarding prostate cancer...

And yes, get a second opinion on those biopsy slides as your husbands treatment will depend on accurate information. The G-8 means high-risk which means aggressive treatment.
Posted 8/3/2015 9:20 AM (GMT -5)

You said...
Thank you for your suggestions. Is the DaVinci robot also called a laparoscopic surgery? I have already had a question about that. I have heard from a friends experience that MD Anderson Cancer Center in Houston Texas does NOT recommend laparoscopic surgery on cancer patients as it can leave cancer cells due to the cutting and removal of an organ.

I wouldn't put too much credence in third hand information about what the doctors at MD Anderson might recommend. Wait until you talk to them. It is a very well respected cancer center.

Generally the two kinds of prostate surgery one sees these days are "open" surgery and "robotic" surgery. Comparisons seem to show a slight edge for robotic surgery (better results) but the difference is small enough to be totally overwhelmed by the experience of the surgeon. A very-experienced open surgeon will get better results than a run-of-the-mill robotic surgeon, and vice versa.
Posted 8/3/2015 9:38 AM (GMT -5)
Sometimes the wrong question is asked. Laparoscopic surgery can be done in multiple ways, and if you ask the question with the correct words in the wrong context, no telling what you'll hear.

DaVinci is robotic laparoscopic surgery, but I don't know anyone who has ever referred to it that way. It is just "DaVinci" or "robotic" in conversation. I can believe that if you asked a surgeon about doing laparoscopic prostate removal, you might get a bad answer, as he would think you meant without the robot.

MD Anderson is a leader in DaVinci surgery.
Posted 8/3/2015 9:39 AM (GMT -5)
Will post more after Thursday's consult with Urologist. We now know to ask for second opinion on labs and to obtain a copy of the biopsy result. And that DaVinci robot surgery is not a concern. We live in SE Indiana...center of Indianapolis, Cincinnati, and Louisville.

Thanks for all of your suggestions and support.
Posted 8/3/2015 11:09 AM (GMT -5)

PeterDisAbelard. said...

You said...
Thank you for your suggestions. Is the DaVinci robot also called a laparoscopic surgery? I have already had a question about that. I have heard from a friends experience that MD Anderson Cancer Center in Houston Texas does NOT recommend laparoscopic surgery on cancer patients as it can leave cancer cells due to the cutting and removal of an organ.

I wouldn't put too much credence in third hand information about what the doctors at MD Anderson might recommend. Wait until you talk to them. It is a very well respected cancer center.

Generally the two kinds of prostate surgery one sees these days are "open" surgery and "robotic" surgery. Comparisons seem to show a slight edge for robotic surgery (better results) but the difference is small enough to be totally overwhelmed by the experience of the surgeon. A very-experienced open surgeon will get better results than a run-of-the-mill robotic surgeon, and vice versa.

h

I would agree if anyone said that Robotic or DaVinci or Laprosopic surgery is not good and worse than open surgery, I think that I would probably run the other way and that's coming from a guy who had a bad experience with my DaVinci surgery, but I would do it all again the same if I had too. Wish you all the best of luck, and second opinions on everything is great advice. All the best.
Posted 8/3/2015 11:20 AM (GMT -5)
Welcome to HW, sorry you need to be talking to us.

Hope you've had a chance to check out the sticky thread at the top of the forum for new comers. Lots of great info there.

The biggest problem is that you'll get overwhelmed with information. Take your time to sort through it and make an informed decision. G8 is on the aggressive side, but you've got time to not rush the decision (don't wait months) and get second opinions on things.

and see more than just a surgeon. Talk to the radiation oncologists as well.

Hang in there and keep us updated on your progress,
Andrew
Posted 8/3/2015 6:26 PM (GMT -5)
I live in rural southeastern Illinois so I understand the challenges of being in this region. I do know several men who had PC treatment in Indianapolis, with excellent results. One of the top robotic surgeons in the country is in Nashville, TN at Vanderbilt (Dr. Smith).

I guess what I'm saying is that while you certainly want to get treated at a major center (if you actually need treatment), there are great practitioners all over, even in the midwest.
Posted 8/3/2015 7:32 PM (GMT -5)
A very useful technique for you would be to start using the SEARCH capability of this Forum. Many of the questions that you have may very well have been addressed by others who may no longer be active on this Forum yet had insights that are still very useful. I spent hours doing just that before I ever got around to making decisions that would effect myself and my family. You are now hooked in to a group of people on this Forum who want to help you navigate what may seem to be a scary road ahead. But we're here for you! Best wishes!
Posted 8/3/2015 7:40 PM (GMT -5)
Hi Terideeh - After an MRI and a biopsy, it was confirmed on 7/13 that my husband has PCa. I know all too well that gut-wrenching feeling of falling into a deep, dark hole and not having a clue of what to do next. All I can tell you is that you are in amazing and caring hands on this forum. You can ask absolutely ANYTHING and you will get honest answers. First hand experiences are shared with total candor. The immense amount of accurate and qualified information available here from moderators and members still astonishes me.

Because we are so new on this journey, there is not much I can add to the advice you've been given already. But I strongly second the suggestion that you pursue getting a second opinion on the pathology slides. We used Johns Hopkins. Just so you know, we had to download forms and releases from their website to get the process started. (The link that Yooper gave you should take you to the right place on the JH website.) The forms were well-organized and explained the whole process, step by step. (We thought we could just ask our urologist to send them to JH and found out that the process has to be initiated by the patient. Not sure if it is that way everywhere though.) The cost for the second opinion was $250, but you might be able to get insurance to cover that. The doctor who read the slides at JH, Jon Epstein, had a phone consult with my husband who said he was very down to earth and easy to understand.

We also purchased the book that Fairwind suggested - "Surviving Prostate Cancer" by Dr Walsh. It's about $14 on Amazon, but you might be able to find it in a local bookstore for around $20. That book and this forum have been our best sources of information. Hands down.

I'm so very sorry about your husband's diagnosis. It is devastating news to get. But know that you truly have friends here who will help you in any way they can.

Suz
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