PSA 3.5 %fPSA 7.6 abnormal DRE Biopsy or wait?

Mark, really sorry to hear about your path results. I can't add to the already excellent advice given. Just want to say good luck, make sure you do get that second opinion on the pathology, and remember that all is not lost. I'd refer you to Todd 1963, member here and his great story of being diagnosed with a really tough path report and he's fought through it, and still posts here. He is an inspiration to all of us, and will be to you as well.

As Halbert said, take the weekend to get your head together, and start making the calls on Monday

Mark,

My PSA was 3.7. My biopsy showed a "smidgen" of cancer, which just happened to be a G9! I got in early and I'm not unhappy with the DRE and biopsy. Glad I did not wait for my PSA to be > 4.0

All the best with the decision(s).
.

Thank you to everyone that has been helping me through this so far. Today I was able to get an appointment with the head of the uro dept at Virginia Mason Seattle, Dr. Corman . My appointment is Fri 17th followed by an appointment with the oncologist/radiologist. Local Dr. called and is trying to set up xrays awaiting insurance approval. I finally feel like I am hooked up with someone who knows what they are doing and actually is getting the ball rolling. Will keep you updated . I would have not gotten this far without the help of this forum,thank you very,very much...Mark

the intial staging after biopsy is called clinical staging and the guidelines for that can be found in Walshes book or a simple google..' clinical staging of prostate cancer'. It is the only staging a patient gets unless the prostate glan is removed and subject to post-op pathology... Be advised a ct scan that shows no lymph node involvement is useless , in that, if it does notpick it up,which it won't, it does not mean it is not there...disected lymph nodes subjec to a pathologist scope will " normally pick them up...but at this point in time it is only the microscopes eye that is accepted as "definitive" proof of cancer...period. I had surgery only...am a gleason 9 and 3 mos short of 7 years have not had a BCR...holding 0.15 for a year...
I have had one treatment period and quite frankly do not expect any more in my lifetime...good luck in your journey... Ps surgery was prostate contained 29 nodes disected,neg cancer,negative margins...al negative...did have PNI{ any one who has any tumor that can be detected will have some pni...there be plenty nerve tunnels running thru a P glan..some report it other's don't...that assessment is strictly mine...prove me wrong!!

ps.ps there is still quite a bit of misunderstanding and lack of knowledge you have about this disease...you may want to follow TA's advice and put me on ignore...until then don't kill the messenger.. always refer to my signature for the caveats included...they are pretty straight forward...just to soften and smooth your perspective..

Mark,
First things first....

Meet with your docs for the next consultation. Ask them to send your slides out of second opinion from Epstein's lab at Johns Hopkins...they'll know how to do it.

Then, start asking questions about your case from those who are looking at all your information. Ask them about staging and risk factors. Ask them what they recommend for your case. With that many G9 cores, with PNI, they're probably going to want to apply the "Kitchen sink" approach: Hormone Therapy (HT) + External Beam Radiation + Brachytherapy (seed implant). Unless your prostate is super large, surgery is less often recommended in cases like yours. Bottom line is whether or not they think (or find with the bone scan) you have distant mets.

You'll get through it Mark, many others have been on your path, and done well.

Bone scan neg..Now on to Seattle. Great news!

UPDATE:
Back from Seattle and have began my treatment. Started HT.. LHRH-(Zolodex) 6/17/2016

Surgery was not going to be the best option as many have said.

Will return to Virginia Mason in about 2 months for gold markers to be set for IMRT with image guidance gold beacons.

IMRT will be done here in Walla Walla....5 days a week for 6 weeks and another Zolodex shot in there somewhere

Then after that I will have real-time dosimetery brachytherapy at Virginia Mason.

Sometime after that I will have another Zolodex shot

Artist Mark said...
UPDATE:
...
IMRT will be done here in Walla Walla....5 days a week for 6 months and another Zolodex shot in there somewhere...]

I'm guessing if you're doing IGRT by traditional dosing, you'll be doing about 44 or 45 sessions. That's 9 weeks at 5 times/week.

Be sure to keep a comfortably full bladder and an empty rectum at the time of each and every treatment. You can start practicing to see how you can do that. I found that I needed to stop drinking water about 2 hours before the treatment, and then 30-40 minutes before the treatment I'd drink about 14 ounces of water. It was pretty specific to be just right at the right time.

It's really important to do this so you minimize radiation to surrounding structures. It will give you the best chance for minimum side effects. I'm approaching 3 years after that therapy, and have none of the significant side effects that can happen.

My IMRT was 37 treatments, as I recall (I try to forget).

I envy any of you that have such great bowel control so you go in with an empty bowel each day!

Mel

Tall Allen said...


Assuming there are no mets, this is classified as "very high risk" by NCCN. That means that it will be hard, but not necessarily impossible, to cure. As halbert said, throw everything at it. By everything, I mean:
1- hormone therapy, starting 2 months before radiation
2- whole pelvic external beam radiation
3- brachytherapy boost to the prostate
4 - chemotherapy with docetaxel (Taxotere) or cabazitaxel (Jevtana)(+carboplatin worth considering)



- Allen

I asked the radiologist bout chemo and he said I wouln't be having that. Assuming that would come next if everything else fails?

Hello again. Just got back from the radiation oncologist here at home town as iwill be having my radiation done here. Markers and brachy to be done at Virginia Mason. The conversation went pretty well until we started to talk about having brachy following IMRT. She was concerned about the SE of brachy on my urinary function and stated that she would do HT + EBRT leaving out the brachy. She said she would consult with my DRs in Seattle to see why we choose the plan we did. I was all good with the plan we had from V.M. but now she has planted a bit of doubt about the original plan. Has anyone had sever urinary problems that lasted long after having all three procedures? She did say the decision came down to me and I know that, but just wanted some input. I still want the original plan. Too many cooks in the kitchen I guess but I need all 3. Thanks Mark

Post Edited (Artist Mark) : 7/1/2016 7:59:26 PM (GMT-6)

Mark, you have to make the decisions for yourself, but I think TA gives great info in his several posts for the full triple play, that includes the HDR brachytherapy boost. Especially with your numbers. I would think you'd want to throw everything you can at it to get the percentages of success as high as possible. The side effects suck, I know, but better to give it your all for 18 months so the beast doesn't come back. My two cents (and my plan of attack). Good luck. -JR

Mark, I think most of us eventually get to the point where we start new threads as new things happen. What I (and some others did) was to take a thread like this one and turn it into a 'my story' thread that we link to in our sig file, then update occasionally as new things take place. So, sort of a combined thing is common. But, there are no rules...whatever works for you.