I'm New Here

Sorry, how do I know if someone has replied?

Welcome to HW, sorry you need to be here.

You'll need some treatment. Surgery ins't your only option. Radiation in it's various forms could also work. UROs are surgeons and recommend surgery. Find a radiation oncologist (RO) for an opinion. HDR Brachy, SBRT are both good options that are still in the curative zone for you.

PC is generally a slow growing cancer so you have time to do your research and find the treatment that's best for you. Don't let anyone push you into a treatment. Take the time to learn. Don't wait forever, but a month or two or three isn't going to make a big difference.

Everyone should get a second opinion on the biopsy slides - it's a very common thing to do.

PSA tests can be tricky at times. Results can vary between different labs. PSA due to PC rarely drops buy you might have other things going on like a bit prostatitis or a number of other factors. At this point that doesn't matter too much because the biopsy shows you have PC.

Post treatment, PSA is a good indicator of success and progression. It's the primary way to monitor if treatment is working. If your prostate is removed, you'd expect zero PSA, so if you have PSA post-op, then there is some PC somewhere. A similar thing happens with radiation, only the PSA drops slower and never fully reaches zero.

Check out the sticky threads at the top of the forum for more info. Others will be along soon with more info.

Keep us updated on your progress,
Andrew

Welcome, sucks that you have to be here butgood that you found us. You’ll get a lot of support as well as education here. To your questions…
1. PSA going from 4.3 to 4.1 in a standard test is just noise doesn’t mean anything
2. Yes you should get a second opinion on the biopsy from Jonathan Epstein, pathologist at Johns Hopkins. Here’s a link to the instructions, although you can probably just ask your doctor to send the slides to Dr. Epstein he will know what to do. pathology.jhu.edu/department/services/secondopinion.cfm

3. Some may disagree, but with a (4+3), and that many cores, I probably wouldn’t wait that long. You’ll have plenty of time for vacations if you nip,this beast in the bud before it becomes a bigger problem. With a PSA of 4.3, I’m guessing it’s still early stage and curable
4. After treatment you will have regular PSA tests and that will tell over time if they got it all. However we currents can happen five even 10 years from now so you always need to keep an ion it.
with that said, generally speaking, this is a very slow moving and highly curable disease. Even if it’s not cured it can be treated and managed for decades. Not sure of your age, but it’s likely that you’ll probably die of something else. So stay strong

Most urologists are surgeons and that’s what they do they recommend surgery. There are many other viable options for you as well, different forms of radiation. LDR Brachytherapy, HDR break a therapy, SBRT. Make sure you see a specialist in each of these different types of radiation. Don’t take advice from someone who specializes in one thing, on a treatment that is different from his specialty
I would recommend reading the sticky at the top where the newly diagnosed patients. It has a lot of good information. I would also recommend getting this book, /www.amazon.com/gp/product/1538727471/ref=od_aui_detailpages00?ie=UTF8&psc=1

Make sure you get the fourth edition which is the most recent. Things are changing fast and prostate land. It will give you a great education on your options what do you need to think about what you need to worry about

As far as knowing when someone replies just keep an eye on this thread, I’m guessing you’ll have 20 responses within the next 24 hours, just a guess but many people will come along with their thoughts. When you come back to this thread instead of clicking on the thread title click to the right of it on the green arrow and it will take you to the po as far as knowing when someone replies just keep an eye on this thread, I’m guessing you’ll have 20 responses within the next 24 hours, just a guess but many people will come along with their thoughts. When you come back to this thread instead of clicking on the thread title click to the right of it on the green arrow and it will take you to the last post that you read and all new posts.

I used voice recognition so excuse any typos. More important good luck to you, I’m sure if you get educated you will be fine. Knowledge is power. And stick around here it will be a big help to you

I knew I wasn't doing it right. Is this better?

GS 8
No Treatment yet

Allen,

Thank you. What does this all mean:

•PSA=7.3, prostate volume=55cc, 8/17 cores G6 5-35% involvement
•SBRT 9 yr onc. results •SBRT 7 yr QOL results
•treated 10/2010 at age 57 at UCLA,PSA now: 0.1,no lasting urinary, rectal or sexual SEs

You have a big decision to make so please dont rush into surgery. With your biopsy results you should definitely get a 2nd opinion on the biopsy. Pathologists may have particular areas of expertise and others are generalist, analyzing all type of tissue with varying degrees of experience and competence. Dr Epstein is one of the best, specializing in prostate pathology.

Unless your biopsy results are downgraded, radiation and perhaps some period of hormone therapy may be your best shot. With Gleason 8 in the right base, I'm surprised your urologist didn't ask for a mp-MRI to determine the probability of SVI. Your Gleason 8, amount of cancer, and location all increase the odds that surgery is not likely to be the only treatment you will need. It's possible, but the odds are not good. Talk with a radiation oncologist who specializes in HDR Brachytherapy and one who specializes in SBRT.

As for waiting until September, that does not seem prudent to me, unless Dr Epstein downgrades your pathology. You have high risk cancer. You need to take some time to chose your treatment wisely, but with a sense of urgency.

I agree with John T. You've gotten a lot of great advice. I can think of one thing to add: you'll be seeing a lot of medical people in the coming months for scans, tests, and other kinds of visits. Don't rely strictly on your memory. Instead, take notes that you can review later. If you can, take a spouse or someone else who can add an extra pair of ears. It's amazing how much more my Registered Nurse wife heard than I did during my various visits to the doc, cystoscopies, scans, x-rays, and so forth. I then reviewed what we'd been told with her and wrote it into a journal, which I still have today. You might consider something like that to avoid information overload and to look back at ten years down the line.

I wish you all the best. We've all been down the same road, and though it's a winding road and sometimes full of potholes, I truly hope you end up at the destination we all hope for: clear of cancer, feeling good, with many quality years of life still to live.

No matter what you encounter, there are guys here on HW who can draw back the curtain and remove the mystery aspect of treatment. Stay with us. Good luck.

hrpufnstuf said...
As for waiting until September, that does not seem prudent to me, unless Dr Epstein downgrades your pathology. You have high risk cancer. You need to take some time to chose your treatment wisely, but with a sense of urgency.

^^^^this

I agee with your doctor. I don't agree with him that it has to come out (radiation may be a better choice for you...you'll have to decide that) but rather, I DO agree with his opinion that in cases like yours...waiting is NOT meant to mean for vacations. It's meant to mean to give you time to investigate what kind of treatment is best for you.


If you order the book that Pratoman suggested....you'll find Dr. Walsh is also in agreement with your physician on this one. It's already been an month and a half. Not that that necessarily makes a difference or is bad at this point....but the cancer you have needs to be a priority.

And yes....PSA's can fluctuate.


Good luck.

I'll add my welcome as well. This is a not-so-exclusive club, and we're fundamentally here to help you sort out the options--which is different from telling you what to do (although sometimes it feels the same).

The big thing, as others have told you, is to seek out other treatment options besides surgery. Surgery CAN be curative in G8, but it frequently is not. With a G8, given the possibility that the little buggers could have escaped the gland and be laying in wait in the pelvic bed, radiation may well be in your future, whether you have surgery or not. So, that is why the strong emphasis on seeking our radiation experts to look at your case.

Beyond that, hang in there. Get your slides sent off to Johns Hopkins for a second read. Then, armed with that second opinion, go find the best place, and best team you can find. A good place to start, if you don't have any other ideas, is one of the major research/cancer hospitals. They are all over, and are usually (but not always) affiliated with major medical schools and universities. If you google "NCCN centers of excellence", you'll get a map that shows the big cancer centers across the US. They are always good places to start your journey.

RobLee said...

hrpufnstuf said...
With Gleason 8 in the right base, I'm surprised your urologist didn't ask for a mp-MRI to determine the probability of SVI. Your Gleason 8, amount of cancer, and location all increase the odds that surgery is not likely to be the only treatment you will need. It's possible, but the odds are not good. Talk with a radiation oncologist who specializes in HDR Brachytherapy and one who specializes in SBRT.

If I may ask - and forgive me hrpufnstuf if this is not appropriate, but I had G8 at the right base which was found by an MRI, but the MRI did not indicate anything about SVI. Also I was told that I was not eligible for SBRT or Cyberknife, which I think are the same.

Roblee, link response below to your question regarding cancer found in the base.

/onlinelibrary.wiley.com/doi/pdf/10.1111/j.1442-2042.2010.02513.x

I would add a word of caution to my reply to RobLee (and to the OP) regarding SVI.

It may well be that the proximity of the tumor to the SV may be of primary importance rather than just being located in the base. In my case my tumor was located very near the SV, so I was advised to have the mp-MRI. I read a lot about SVI during that time and saw often that cancer found in the base (particularly high grade cancer) was often viewed with suspicion for EPE. Again, it may have been only for tumors located very near the SV. I do not want to alarm the OP without good cause. Only a doctor can advise him properly.

See article linked. It appears HDR Brachytherapy is an option for extending radiation to SV.

RobLee said regarding SVI:

As it turns out, according to the article, Brachy would have also been a poor choice.

radonc.ucla.edu/prostate-cancer-brachytherapy