Posted 4/26/2017 4:05 PM (GMT -5)
Greetings and sincere wishes for overwhelming happiness to all.
The subject telegraphs the punch line and my stats are in my signature. Skip or consume the details as you choose.
My GP noticed a PSA 4.5 during a routine physical about 1 yr ago. I got a referral to a urologist, and despite no DRE (he said he'd spare me since my uro would do it), my GP warned me to make the appointment soon. I hit the Internet, as one does, rode the controversy and elected to blow off the referral.
The Friday before Christmas in '16, fate threw a brick at my head in the form of a blocking kidney stone that forced me to a abdominal/pelvic CAT and a uro appointment. That may have saved my life. The stone was gone before my uro consult, as though it had done its job and left.
DRE was positive for enlargement and a nodule. Expressed fluid (don't understand why anyone does this for fun, but I'm not judging) was loaded with pus. Six months of antibiotics and one allergic reaction later, I was voiding easier and the sense of fullness was gone. All this time, I was symptomatic but unaware. Meanwhile, my PSA kept rising through 8 to 13.7.
My urologist's assistant, a lovable Vietnam vet, did my ultrasound gently and chatted through the whole exercise. He sized my prostate (30 grams, I believe) and the nodule had a troubling echo that the assistant ID'd as calcification. My urologist read the results differently and set up a biopsy.
My urologist did the biopsy, sans anesthetic, Bostwick did the biopsy labs. When I went in for results, the doc scribbled notes on my copy the results. All 12 cores were positive, Gleason 4 + 3, with the majority 60 to 80% cancerous. One core showed perineural invasion. There was mention of ERG and PTEN FISH tests, but both showed "diagnosis pending." My doc said that Gleason 7 is on the intermediate/high risk borderline, but 100% involvement and PI puts me at high risk. After breezing through my treatment options and giving me a couple of books, he referred me to a radiation oncologist, saying my next step is a bone scan to check for metastases.
My RO is a scientist/battlefield general. No warmth, all action, which suits me for this role. He opened with his credentials: over 10,000 PCa patients treated, < 5 % instance of complications. His radiation dosimetrist was the chief at MD Anderson, and his radiation staff were leads at UT Southwestern. Both facilities are centers of excellence in Texas; if you're going to poach expert staff, those are good places to go.
He clearly spent time studying my chart. He did a quick DRE and proceeded to talk 15 minutes mostly non-stop while I hurriedly scribbled notes. He had the completed Bostwick genetic studies that my urologist didn't, which rate me a Prostavysion 9. He told me flatly that I'm stage 2, my disease is high risk, high volume and aggressive. He scheduled stat bone scan and MRI for tomorrow. He wants a year of hormone therapy, plus brachytherapy (80-100 seeds) followed by 5.5 weeks of IMRT. He said that if the imaging comes back clean for mets, despite the PI he considers me an excellent candidate for cure.
He spoke to surgery. Given my profile, he predicts 70% likelihood of positive margins, which they'd have to mop up with radiation. He said that HT + BT + IMRT will have fewer side effects than surgery and will treat the margins along with the prostate.
During my visit, my RO called my urologist on his cell and barked at him to start me on Lupron pronto. I got in the middle of that. I agree that we need to move fast. Fear is no longer a factor in my decisions, but I have a medical team. I want my complete labs from Bostwick, his unpacking of the Prostavysion test (which my insurance won't cover--ouch) along with the blood panel ordered on 4/11. When I go in for imaging, I'm going to ask for the reports to be sent to my RO, urologist, GP and, if they'll allow it, to me (some labs will, some won't). I scheduled a urology visit for next Tuesday, after the imaging results are in but before I see my RO again.
I will follow an aggressive course, wasting no time. I am impressed by my RO and trust him with my radiation treatment, but I am in charge of my care. The choice of specific HT is not inconsequential--I'm an engineer and a writer who gets paid to be smart. A muddled mind could end my career. If my urologist lacks expertise, I may ask for a referral to a medical oncologist.
Don't misread that as coming from one who is sure of his way. I am all of two weeks from discovering I have cancer. I have so much yet to learn.
I came into this with an amazing wife, a smart and talented son and a skilled psychiatrist. I mentally checked out for a couple of days, then emerged feeling determined to win and fortunate to have caught this at stage 2. I'm more aware of and awed by the world around me and loving my family and friends more strongly than ever.
Ah, me. Brevity failed me. If you survived that implacable wall of text and have advice or comments, I welcome them. I'm grateful you're here and I will, as they say, keep you all in the light.
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55 yo, married w/son. Good overall health.
12/16: Positive DRE, PSA=4.7. WBC in EPS. Treat for prostatitis. Allergic to Streptomycin, switch to ciprofloxacin
1-3/17: Antibiotic eases voiding and reduces sensation of swelling. PSA=8.0 => 14.7
4/1/17: Positive ultrasound, biopsy scheduled
4/5/17: 12-core biopsy
4/7/17: Stopped cipro AM, severe rectal/prostate pain PM. Restarted cipro, pain resolved
4/11/17: PCa Dx by uro. Bostwick 12/12 cores G 4+3 avg 75%, left mid PI+; Prostavysion pending
4/11/17: (cont'd) Classified high risk, but 80% likely curable if no mets found. Referred to RO
4/12/17 Stopped cipro, no effects
4/25/17: RO consult. Reveals Bostwick Prostavysion 9. Recmd HT + BT + IMRT, concurs 80% curable w/o mets
4/27/17+: (next) Met scans (bone scan and MRI); consults with uro, RO, possibly add MO; start HT