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Posted 12/21/2018 7:20 AM (GMT -5)
Gleason 7.

What can I expect next?

I won't see the doctor for 2 weeks as he is taking Christmas vacation.
Posted 12/21/2018 7:25 AM (GMT -5)
Howdy,

Good to meet you. I am in that club, my stats are in my sig below. G7 is "on the cusp". Good luck. smile
Posted 12/21/2018 7:56 AM (GMT -5)
Mentor that is a drag. I had the same diagnosis early this year. I recommend your read everything you can. There is a lot of good information out there. I liked Mark Scholtz, The Key to Prostate Cancer https://www.amazon.com/Key-Prostate-Cancer-Experts-Explain/dp/0999065211 It was not as dry as Dr. Walsh who wrote the bible on the subject https://www.amazon.com/Patrick-Walshs-Surviving-Prostate-Cancer/dp/1455504181 Also you can do a lot with the bioposy including sending it off to John Hopkins for a second opioion and having a couple of genetic tests to determine how agressive your PC is. Try not to worry, take your time and consult with both radiation oncologists and PC UR surgeons.I consulted with MD Anderson and UNM Cancer followed their protocols. but I was treated locally. Here a good review of places to consult with https://health.usnews.com/best-hospitals/rankings/cancer You will be fine.

69 yrs., 44 3D-CRT/IMRT Radiation delivered via 3D-CRT in 1.8 Gy minimum dose fractions to a total of 79.2 Gy., 10.5.18. PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone <.7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI w/ contrast 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 94 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.
Posted 12/21/2018 8:22 AM (GMT -5)
Things you can do - the second opinion and the reading as suggested for sure!
The experts in your care won't be here however - they'll be the ones with many years of medical education and some number of years of experience. What you can do is engage the best ones possible. That can make all the difference in your outcomes. Go deeper than picking a leading institution. Pick the individual doctors.
Another primary determinant of your outcome is doing what you can to live in a way that supports your immune system's battle against the cancer - whatever works for you in regular exercise, healthy diet, time in nature, time with friends.

Best to you, Mentor - many great people here to be supportive.

Wilderness
Posted 12/21/2018 8:51 AM (GMT -5)
Mentor, as suggested, educate yourself. Be your own advocate. The more you know, the better decisions you will make. First thing, read the Newly diagnosed with PC on this forums main page. There is a link there also for Johns Hopkins for sending your biopsy results for a second opinion. Dr. Epstein is regarded as the gold standard on reading PC biopsies. Whatever path you choose, surgery or radiation, you will find plenty of support on this forum. Choose the best facility, and the most experienced doctors. Be sure you are comfortable with them and their bedside manner. The more comfortable you are, the more secure you will feel.
There is plenty of experience on here and you’ll hear from many others soon. Ask all the questions you want. We have all been where younare right now.
For now, try to enjoy the holiday’s. Best wishes.
Posted 12/21/2018 10:29 AM (GMT -5)
Which way with the GS 7? 3+4 or 4+3
Also how many cores out of how many taken and what % of each core was PC
How about the DRE? Did the Doc feel anything abnormal.

Sorry you have to be dealing with this but you are in the right place to get the info and support you will need.

Even the unfavorable GS 7 ( 4+3 ) is very treatable and has the potential for good long term survival.

Do your home work. Don't let any one person sway your decision making other than you THE one person.

Roger
Posted 12/21/2018 11:04 AM (GMT -5)
Come on man...you know the drill..you've been lurking(not that there is any thing wrong wit that} provide us a signature...so we can help you with your question...regards...the bad cop...
Posted 12/21/2018 11:06 AM (GMT -5)
Mentor,

Welcome to our club--not the best christmas present, is it?

Well, the good news is--with a G7 (assuming it's confirmed), "cure" is in your vocabulary. Yep. G7 is listed as "intermediate risk", which means that treatment is likely in your future--but there are numerous available treatments that will all work.

So, what to do?

First, as others have suggested, ask to have your slides sent to Johns Hopkins for second read. This is really important.

Second, start studying and paying attention. Learn all you can.

Third, get a spiral notebook, a pen, and a big 'accordion' folder: Take it to all appointments. Get copies of ALL the paper (and it will add up). The notebook is to write down what the docs tell you. And for your questions, as you think of them. It makes a difference.

What happens next?

Well, your doc will likely send you for a full body CT scan and a full body bone scan. They probably won't find any surprises....but the baseline is also important.

After that, you'll need to start researching your options. Remember, Urologists are surgeons, and they recommend surgery--and frequently bad mouth radiation. For true and good info about the radiation options, you need to talk to one or more radiation experts.

Somebody sent you a link to the US news list of best cancer hospitals. That's a good place to go for experts. Find one close to you and go for consultations (at least) there.

Last, relax. It's not a death sentence. The 2 week wait--even though it feels forever, isn't a big deal with PC. It can take several weeks--or several months--to make your decision. And, it is YOUR decision--not ours, not your doctor's, or your wife's, or your cousins. Yours.
Posted 12/21/2018 12:06 PM (GMT -5)
What to expect? Multiple doctor visits. In addition to your urologist/surgeon, you should visit with a radiation oncologist. You can also expect some scans (bone scan, CT scan) to see if the cancer has spread to other parts of your body. You can also expect to live a long time.
Posted 12/21/2018 12:59 PM (GMT -5)
Mentor - I just lived your bad dream back in Aug/Sept, a few months after retirement, and can tell you that you are forever changed by the news. The only answer that helps is "no cancer" although never suspecting cancer is much better and where you were before you were sent to the urologist. This forum is excellent for finding lots of advise and prior experience by posting and searching the forum. The recommendation for reading a book like Walsh or other publications is mandatory to understand the basics and options. I actually got a book from the urologist, "100 Questions & Answers about Prostate Cancer" which is pretty factual and not very opinionated so it was a good starting point.

"What can I expect next?" - You will read these forums, publications, etc until you are confused and depressed for your meeting with the urologist. Make up a list of questions for your meeting and take spouse with you if applicable. Expect to have surgery and/or radiation treatment brought up in your meeting. At this point, you want to make sure you have good doctors working on your problem as others have advised so you then do more research and get second opinions, visit a radiation oncologist, etc. As others have said, fill in some of your specific information in your profile signature or include in your next posting. Otherwise, you will get a lot of repeat questions and not very helpful comments.

In my case, I had an Prostate MRI first as a result of the my initial urologist meeting due to increasing PSA and family history. The questionable MRI results mandated the prostate biopsy which was guided by the MRI. Once the Gleason 7 is determined (and can be verified by JH as others have suggested), the 3+4 and 4+3 designation becomes a little more important as the latter is actually worse. Once the extent of the cancer is confirmed from the MRI and biopsy and is typically higher than G6, doing something is probably required so the CT and Bone scans are done next to check for any obvious organ or bone spread since that materially affects the treatment options.

Good luck with this and enjoy your holiday as best as you can. I can tell you that you will feel a lot better in a few months when you and your doctors finally make some decisions.
Posted 12/21/2018 1:10 PM (GMT -5)
Pick your treatment method and get it done.

You can expect anxiety, worry, confusion, lots of doctor's appointments, and plenty of people telling you what to do. Talk to a surgeon, an RO, get second opinions on the biopsy.

Andrew
Posted 12/21/2018 1:44 PM (GMT -5)
As Andrew suggests above, line up your medical team, better educate yourself, become MUCH more detail oriented than your first post here would suggest, enjoy the Holidays, and get cracking.......

.....but I suspect you knew all that already.

Good luck!
Posted 12/21/2018 9:11 PM (GMT -5)
Mentor - As the others have said, with G7 it is worth the effort to have a second opinion on those slides from Dr. Epstein at Johns Hopkins. He (or his lab) is the top opinion, as all he does is read prostate cancer slides. His word is gold.

Once you learn for sure whether you have G3+4 or G4+3, come on back and start your research here at HW. There is a lot to learn, and you can do it very quickly here. The standards of care are very different for G3+4 and G4+3, but both are curable.

Whatever you do, do not let any doctor rush you into a commitment for treatment. Either version of G7 is still a disease that gives you the luxury of time. There have been research studies done that proved that the ultimate outcome (cure or not) is the same for G7 patients who rushed into treatment and for those who took a few months to decide.

Learn all you can about the various treatments for your particular pathology. You didn't state your age, but unless there are other specific decision drivers in your case, you can choose from surgery or several varieties of radiation therapy. You should learn about all the applicable treatments and their side effects. In most cases, all of the mainstream primary therapies have about the same cure rate, but they have different side effect profiles. Learn about the side effects, and try to discern which set you could most easily live with. If all goes well, you will be living with them for many years.

Another "claim" to de-bunk is that you should choose your treatment so that you have the best backup plan in case of primary treatment failure. Why, I ask? Since most primary treatments (surgery and radiation) now have cure rates up in the 90+% range, why is a backup plan so important? Also, don't let the surgeons scare you with the claim that "If you have surgery and it fails you can have radiation after, but if you have radiation and it fails, you can't have surgery after." First, remember my note about cure rates. Over 90% and you're making life-altering decisions based upon backup plans? Not me.

And, finally (sorry I'm so wordy), when considering radiation therapies, be sure that you learn about each of them from a radiation oncologist who actually provides that treatment. Nobody will tell you how good a treatment is if they cannot offer it. It would be like sending all their potential business to the competition.

Hang in there. After the initial shock, things settle down. As I often counsel new folks on another medical board, there is a lot of emotional turmoil in the beginning. For most people, though, things settle down dramatically once they have formulated their game plan. Then things settle down and all you have to do is work the plan.

Your first assignment, grasshopper, is to learn all you can handle about your own situation, and about the treatments appropriate to that situation. Then you can start learning how to decide what is best for you. (Yes, YOU get to decide, not the doctors.)
Posted 12/21/2018 9:28 PM (GMT -5)
Hey mentor...see how that works...its called one hand clapping...I do it all the time...you got what you needed...they still don't know what happened...they feel good...you feel good...I feel good... hey what are brothers for...its the season to be jolly...whoooo!!!...
Posted 12/22/2018 12:51 AM (GMT -5)
Paxton, beg pardon, but the backup plans are for the other 10 percent. When it is YOU who was not one of the 90+% then the backup plan becomes very important.
Posted 12/22/2018 6:14 AM (GMT -5)
Rob, very true. However, one of the biggest irritants that many of us have are the urologists who make the statement, "if radiation fails, you can't have surgery afterwards". Which is pretty much true, as far as it goes. However, it is the implication buried in the statement (which is a sales pitch for surgery): That if primary radiation fails there are no further options. Which is adamantly NOT TRUE.
Posted 12/22/2018 6:36 AM (GMT -5)
You have gotten lots of advice from the guys so far. My wish for you is to take a breath and become a student of this disease. You need to make a decision but it needs to be informed, so study, ask questions, share your fears and work hard at it and the right answer will emerge. I also have G7 and would be will to share my journey if you want to talk about it. Send me a PM and I will share my phone number. Hang in there! Denis
Posted 12/22/2018 7:17 AM (GMT -5)
Sorry about the news. Your Uro needs to share more info - if you are on the new health record systems - you may find the rest of the biopsy report there. As others have said , read it , understand it and share it with us so we can help you.
G7 is a great place to be - depending on which lens you are looking from.
Please add a signature with your PSA history and other information (DRE) other symptoms If any. You may want to look at getting a mpMRI scan - that gives more info (and it’s not 100% accurate) on how much PC you have and if it is contained in the capsule. That will also help you in the treatment decision.
You are in a new normal. You have heard the worst. It only gets better from here. It did for me.
Posted 12/22/2018 11:21 AM (GMT -5)
Ahh the signature...missed that...it will be interesting...as I find that any thing(one?) with a 59 or the name Jack... in the tag name...arguably...never have one....souvenirs anyone??...Wicked....
Posted 12/22/2018 1:15 PM (GMT -5)

RobLee said...
Paxton, beg pardon, but the backup plans are for the other 10 percent. When it is YOU who was not one of the 90+% then the backup plan becomes very important.

Rob - I hear you. I just ran out of steam and didn't want to try to write a book. Halbert hit the point, though, that one should not choose primary treatment assuming that there is no backup treatment for some primary treatments, as there is some form of backup treatment for probably all of them. I was just worried about those uro's who tell patients that if radiation fails, there is nowhere else to go.
Posted 12/22/2018 3:13 PM (GMT -5)
Paxton/Rob/Mentor - Surgery appealed to me to get the actual information about the cancer from the pathology and possibly be done with everything after surgery. Now that I know the answer and experienced the surgery, radiation seems like a slightly better option now but that is with the knowledge of the answer and second guessing my decision a little. The concept of salvage or adj radiation after surgery seemed to make sense at the time also.

Mentor - There is a lot of pressure (internally and externally) to make a decision when G7 and higher is involved and there is some odd satisfaction when the cancer has been removed and PSA hopefully goes to zero vs. the prostate being destroyed by invisible rays with a hopefully falling PSA at the end of the ordeal. Plenty of time for those decisions and more post reading...
Posted 12/22/2018 5:20 PM (GMT -5)
Admittedly I personally went into this knowing nothing. I had already been fighting with my Uro for a couple of years, and my wife and I were trying to get our retirement and downsizing/relocation underway. Surgery was the most expedient means to "get it over with". Those who know my story will understand the time crunch that I was under. But knowing now what I didn't know then, I feel confident that I made the right decision.

I can't even imagine how things might have gone if I had altered our plans to undergo a period of radiation. And knowing that everything that could have possibly gone wrong, did go wrong, having options available to me and knowing exactly what was going on in there was a tremendous advantage. As I've mentioned before, I am probably the poster child for untoward side effects both from surgery as well as radiation.

But now some years later, my wife is in full remission and the great white north is but a distant memory. And so far I am NED (no evidence of disease) from the PCa and my uro feels confident that throwing everything at it will probably keep me cancer free in the future. I have no way of knowing what may have come to pass if I'd had the luxury of time to further investigate treatment options early on. But it just didn't happen that way.

I know there are a number of guys here who had RP for high grade cancer followed by RT and HT as well. In most of our cases having the backup plan worked. Maybe not always, but I do believe that line of reasoning has merit.
Posted 12/23/2018 1:39 PM (GMT -5)

three 5's and a jack said...
Which way with the GS 7? 3+4 or 4+3
Also how many cores out of how many taken and what % of each core was PC
How about the DRE? Did the Doc feel anything abnormal.

Sorry you have to be dealing with this but you are in the right place to get the info and support you will need.

Even the unfavorable GS 7 ( 4+3 ) is very treatable and has the potential for good long term survival.

Do your home work. Don't let any one person sway your decision making other than you THE one person.

Roger

Both DRE's were good. Do not know if it was 4plus 3 or 3 plus 4

15 cores were taken
Posted 12/23/2018 9:16 PM (GMT -5)
elementary...my dear Watson...Shibai...without a doubt
Posted 12/24/2018 12:51 AM (GMT -5)

mentor5959 said...


Both DRE's were good. Do not know if it was 4plus 3 or 3 plus 4

15 cores were taken

64 years old with 7.5 PSA? G7. The biopsy report...do you have it mentor? (If so, post some numbers from it). If not...when You see your urologist, get a copy from him.

A week or two won’t make it any worse. Many weeks won’t make it worse. And worry won’t make it better.

As one of our wisest members here says from time to time...in your case, “They’ll be no hanging tonight”.

Hang in there guy. You’ll be OK. (And I don’t want to disappoint, but no...they’ll almost certainly be no chemo for you)
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