Hi. I’m new here.

So, I am 46 yo father of 4 recently diagnosed with cancer. PSAs 36 then 33. Doc says cancer is pretty big, been there for years based on biopsy. Gleason 7(3/4). Waiting for pet scan. Sick with worry. Vacillating between despair and denial. Have some good supports, but could really use a place with people in the trenches with me.

Good Morning Touchdown.

Welcome to the club you really didn’t want to join. Good news is that there a lot of men here that have walked the path you are starting and can provide knowledge and experience and, most importantly, support.

First of all, keep living life. Learn, but don’t panic. Be seriously concerned, but don’t worry. Most PCa is very treatable and many men have presented with far worse situations that are doing fine. For us to be most helpful, please tell us more about your situation. If you look at the bottom of my post you will see my signature that provides my details. For you these will be brief as you haven’t started treating. Also, where are you located? And what is your doctor status? I assume a urologist. Has he/she started to lay out the various treatment options?

My best advice to you right now is to commit to getting assessments from different specialists. No one doctor has every treatment and no one doctor can speak for other specialists. A big decision will be surgery versus radiation. They both work and they both have pros and cons. So expect at least a couple of surgical assessments and a couple of assessments by radiation oncologists. If that sounds like a lot, I was able to see three surgeons and two radiation oncologists in a four week span and it was the best thing I did.

And how are the kids and your wife doing? Please don’t let the diagnosis get in the way of a wonderful summer. While you have a serious situation, it is not an emergency situation. At this point a few months making the best decisions is just fine and will not impair your long term results.

Best Wishes and understand we are all here for you,

Jack.

Hey Touchdown,
You have definitely come to the right place! I'm sorry that you have been diagnosed with PCa, but pleased that you found us and that you will have most of your questions answered. I was diagnosed almost 3 years ago with Gleason 9 PCa and this has been my "go two" place for answers and support. There are several very knowledgeable men here and some long term survivors.
I know that it can be hard to hear men tell you to "relax" after you've been diagnosed with PCa, but down the road, you will understand why. My suggestion is to educate yourself on PCa and it's treatments. Remember, "Knowledge is Power." Another resource that I recommend is Dr. Mark Scholz. He has written several books and posted several videos on YouTube.

I wish you well,

Ron (Boomer)

Touchdown, welcome to HW. And yes that initial diagnosis can be a gut punch. I was diagnosed at the age of 59yo and I am now 75yo, So life keeps rolling along for me, although I have been stage 4 PC for 11 years, It sounds by your screen name that you might be an athlete. If so, think about engaging in physical activity to help with the despair and anxiety. My morning begins early, around 6am and I have my coffee and cereal and fruit, After that the dogs and I head out for a 35 minute walk in the woods around us. Three or four times a week I left weights for 35 minutes in my garage with a weight bench. Having been an athlete and then a runner I find that continued exercise helps me deal with stress.

Again, welcome to HW and I think you will find a great deal of knowledge among our group members.
Michael

Have a great 4th with the family. With me the glass is always half full. Don't have a pity party. You have G 7, I was G 8 and there are a lot of guys on this site that were G 9 and they've been on this forum for years. This is a great site. These guys always amaze me as to their knowledge. They are like your best friend from afar. I urge you to do your research and find a great doctor and a great hospital. My choice was MD Anderson and Dr.Brian F. Chapin. Remember, it's highly treatable. You will pass from this world someday, but it's highly improbable that PC will be the cause.

TD, welcome to the club none of us volunteered for. Yes, it's a kick in the teeth, isn't it. I can say that I ended up at G7, and I'm 91/2 years out from surgery, and my PSA is till non-detectable, and I have no significant side effects.

The other guys have made some great suggestions. I'd ask again where you are located? There are great, and near great, cancer centers everywhere, I'd suggest you get yourself to the nearest one and get a full workup there.

DO talk to the experts in Radiation Oncology about the radiation options, as well as expert surgeons about the surgical options. Cover all your bases before you make a treatment decision.

I'd also suggest getting yourself a big folder or notebook to get copies of all your diagnostic reports, and a place to write down your questions and answers. I found it helped to take my wife to the consultations--she had questions I hadn't thought of, and she helped recall the details of what the doctors said.

With the G3+4, you do need to be treated, but you do have some time to sort out your options and get ready. Getting ready? Eat healthy, exercise-especially your core and pelvis areas. Make yourself get off of the internet for a while--and certainly get away from "Dr. Google".

When you talk to your experts, take notes, and come here with questions. We've all been there and been through it.

I remember the brain fog. I remember the denial. It took several weeks of “lurking” here before I joined. In my mind, by joining this forum, I was conceding that I had cancer.. Joining the forum made it real. Joining was an admission to myself that it wasn’t something I could deny nor avoid dealing with. It was an admission of needing help. I’d never needed this kind of support before and it scared me that I did.

I thought I knew something the people here did not know. I knew that I was different from them in that this cancer was going to kill me. “It didn’t kill you all but that doesn’t mean it won’t kill me”. I didn’t know if I could go through the treatment these gentlemen had gone through and were going through.

It’s been the best thing I could have done for myself. The kind men here calmed me when I was going crazy with fear. They kicked my butt into gear when I procrastinated treatment. They befriended me. They cared. There’s nothing you’re going through or are likely to go through that someone here hasn’t been through before.

You’re in the right place Touchdown. Tell us more about your case when you’re able.

And as one old curmudgeon who once frequented here used to like to say….. “They’ll be no hangin’ tonight”.

Thank you all for the support and helpful info. Thankfully, I am in the Duke health system which is pretty good. Right now, waiting for a pet scan. Insurance has been reviewing my situation for approval, which is bs. Hopefully Monday get prior auth and schedule scan asap. My numbers so far suggest advanced stage, ie regional. The hope is for no metastasis to bone or where ever. Even better would be local, contained and operable.

I have been reading on different radiation and surgical options. My urologist is a pretty well regarded surgeon, but he said “once they radiate, surgery is not an option”. My research says differently, but definitely that surgery first is preferred. Especially, if I understand it, as recommended by Dr Walsh in his book.

I have a call in with the leading robotic prostate surgeon in the country. Follow up with Duke oncology July 15. I was hoping to have scans done by then but it looks doubtful.

I have biopsy results, but I am to afraid to look at them again. What I recall from my brief glance is that it is Adenocarcinoma. Right side is all in and left is involved. I do know is that it is enough with my 30+ psa to warrant a pet scan and even doctors won’t speculate to interpret beyond that so i am just leaving them be right now.

My name is an old nickname btw, for my initials… TD. I do run (15-20 miles an week) and keep fit. Don’t drink. Don’t smoke. Started a vegan diet a week ago. May reincorporate some fish and limited dairy depending upon on how things pan out with petscan and my feelings about almond milk in my coffee.


I have a supportive friend here who is one month out from his own Prostatectomy. He was G7(3/4) and is currently undetectable.

Thanks again for all the supportive feedback and guidance. I’ll be back for more and with more info as my journey progresses.

TD, surgeons still say that--and they shouldn't. Go back to a thread with that exact title and read through it.

It's more or less BS. I've been hoping that would be disappearing.

Once you get the PET scan, you'll know a lot more. DO go talk to the radiation team at Duke. Even for uncomplicated cases, there is virtually no post treatment difference in outcome for radiation vs surgery as far as cancer treatment, and surgery does have a greater risk of negative side effects such as ED and incontinence.

TD, glad you checked back in. With all due respect, your latest post indicates that you are making some of the same rookie mistakes that many of us make early in the process. Namely:
1. Leaning toward surgery, i.e. "getting it out". That's understandable since you have only spoken with a urologist (surgeon). Your aim should be cure with the least amount of side effects -- whatever the treatment option. That means, as others have suggested, get an appointment with a radiation oncologist ASAP so you better understand your options.
2. Early education on one side of the story. Yeah, Walsh is good but he is a surgeon and has that bias. As Prato suggested read the Dr. Scholz books or go to YouTube and view some of his videos. He will give you another perspective on treatment that is generally non-surgical.
3. Believing the sales pitch, "if you have radiation you can't have surgery later". Yeah, post-radiation surgery may be problematical but there are other options for treatment after failed radiation...you need to hear those from a RO because your surgeon is unlikely to have familiarity.
4. Having too much trust in your doctors. Dude, you say you're afraid to look back at your biopsy results. Time to hunker down and learn as much about your cancer as possible. Post those results on this site for some very knowledgeable feedback. Your docs may or may not take the time to explain all of the nuances but you need to know them.
5. Not clearly understanding every test you take or will take. I assume (?) that the pet scan is a PSMA pet scan that will specifically look for PCa outside of the prostate. Google or YouTube it (another Dr. Scholz video) and make sure you are getting the latest and the greatest.

Good luck; be your own advocate.

Jim

Well, I haven’t figured out how to make a signature, but here are the biopsy results I have:

DIAGNOSIS SUMMARY:

(A),(B)
(PROSTATE CORE NEEDLE BIOPSY)
(Left,Base),(Left,Mid)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 3 + 4). THE PROPORTION OF
GLEASON GRADE 4 COULD NOT BE ACCURATELY ASSESSED IN THIS SMALL TUMOR FOCUS.)
(6% of total biopsy length.),(1% of total biopsy length.)
(1.3mm),(.2mm)
(88305),(88305)

(C)
(PROSTATE CORE NEEDLE BIOPSY)
(Left,Apex)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 3 + 4). GLEASON GRADE 4
COMPRISES 40% OF THE TUMOR.)
(30% of total biopsy length.)
(6mm)
(88305)

(D),(E)
(PROSTATE CORE NEEDLE BIOPSY)
(Right,Base),(Right,Mid)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 3 + 4). GLEASON GRADE 4
COMPRISES 30% OF THE TUMOR.)
(100% of total biopsy length.),(93% of total biopsy length.)
(19mm),(14mm)
(88305),(88305)

(F)
(PROSTATE CORE NEEDLE BIOPSY)
(Right,Apex)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 3 + 4). GLEASON GRADE 4
COMPRISES 40% OF THE TUMOR. PERINEURAL INVASION IS PRESENT.)
(77% of total biopsy length.)
(14mm)
(Although these findings are atypical and suspicious for adenocarcinoma, there
is insufficient cytologic and/or architectural atypia to establish a
definitive diagnosis.)
(88305)

(G)
(PROSTATE CORE NEEDLE BIOPSY)
(L,Lat Base)
(BENIGN PROSTATE TISSUE. NO EVIDENCE OF MALIGNANCY.)
(Grade groups range from 1 (most favorable) to 5 (least favorable). Pierorazio
et al. BJU Int 111: 753-60, 2013. Epstein et al.EUR UROL 69: 428-35, 2016.)
(88305)

(H)
(PROSTATE CORE NEEDLE BIOPSY)
(L,Lat Mid)
(SINGLE ATYPICAL GLAND, SUSPICIOUS FOR CARCINOMA. SEE COMMENT.)
(88305)

(I)
(PROSTATE CORE NEEDLE BIOPSY)
(L,Lat Apex)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 4 + 3). GLEASON GRADE 4
COMPRISES 80% OF THE TUMOR. (GRADE GROUP 3))
(17% of total biopsy length.)
(  mm)
(88305)

(J)
(PROSTATE CORE NEEDLE BIOPSY)
(R,Lat Base)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 4 + 3). GLEASON GRADE 4
COMPRISES 60% OF THE TUMOR.)
(87% of total biopsy length.)
(14mm)
(88305)

(K)
(PROSTATE CORE NEEDLE BIOPSY)
(R,Lat Mid)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 6 (GRADES 3 + 3).)
(35% of total biopsy length.)
( mm)
(88305)

(L)
(PROSTATE CORE NEEDLE BIOPSY)
(R,Lat Apex)
(PROSTATIC ADENOCARCINOMA. GLEASON'S SCORE 7 (GRADES 3 + 4). GLEASON GRADE 4
COMPRISES 10% OF THE TUMOR.)
(82% of total biopsy length.)
(14mm)
(88305)




SPECIMEN COMMENT-:
Although these findings are atypical and
suspicious for adenocarcinoma, there is
insufficient cytologic and/or architectural atypia
to establish a definitive diagnosis.

SPECIMEN COMMENT-:
Grade groups range from 1 (most favorable) to 5
(least favorable). Pierorazio et al. BJU Int 111:
753-60, 2013. Epstein et al.EUR UROL 69: 428-35,
2016.


GROSS DEscriptION-:
Received
Pieces: 1
Measurement: 21 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 1
Measurement: 22 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 1
Measurement: 21 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 1
Measurement: 22 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 2
Measurement: 2 to 18 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 2
Measurement: 11 to 17 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 2
Measurement: 13 to 15 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 1
Measurement: 16 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 3
Measurement: 1 to 23 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 1
Measurement: 18 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 2
Measurement: 3 to 17 mm
Description: Tan-white
Ink:


CPT CODES-:
88305

GROSS DEscriptION-:
Received
Pieces: 2
Measurement: 8 to 18 mm
Description: Tan-white
Ink:


CPT CODES-:
88305



CORE MAPPING:
location                #Pcs   Length(mm)   Gross Desc    Gleason %Invl TumLth
(A):Left,Base              1   21 mm        Tan-white     3+4=7     6%    1.3
(B):Left,Mid               1   22 mm        Tan-white     3+4=7     1%     .2
(C):Left,Apex              1   21 mm        Tan-white     3+4=7    30%      6
(D):Right,Base             1   22 mm        Tan-white     3+4=7   100%     19
(E):Right,Mid              2   2 to 18 mm   Tan-white     3+4=7    93%     14
(F):Right,Apex             2   11 to 17 mm  Tan-white     3+4=7    77%     14
(G):L,Lat Base             2   13 to 15 mm  Tan-white     n/a      n/a    n/a
(H):L,Lat Mid              1   16 mm        Tan-white     n/a      n/a    n/a
(I):L,Lat Apex             3   1 to 23 mm   Tan-white     4+3=7    17%    n/a
(J):R,Lat Base             1   18 mm        Tan-white     4+3=7    87%     14
(K):R,Lat Mid              2   3 to 17 mm   Tan-white     3+3=6    35%    n/a
(L):R,Lat Apex             2   8 to 18 mm   Tan-white     3+4=7    82%     14

TD, As you weigh the different treatment options you may wish to look at the nomogram data on the Memorial Sloan Kettering site for PCa. It was developed from thousands of data points of guys who had surgery. Your ‘numbers’ plugged into that nomogram suggests that surgery alone has less than a 50% chance of curing your cancer as a single treatment. Most guys find much better odds of a cure from multi modal treatment plan rather than surgery as a mono-therapy. In most cases a short treatment using ADT drugs is used to immediately stop the cancer from spreading and significantly weakening it make it easier for radiation to finish the job. Typically this treatment offers the best rate of success with the least objectionable side effects.

Even the very best imaging systems cannot guarantee the cancer has not escaped the prostate capsule. Neither can a pathology report guarantee “they got it all”. The good news is that the Duke Medical Center is one of the very best. I would encourage you to explore all your options and choose the best option for you and your family. I know having my wife present for the consults I had was a good choice for us. She’s a nurse by training, a better listener than myself and an excellent judge of people. Best wishes, keep posting and asking questions…Terry

TD - Don’t worry too much about treatment type until you get the results of the PSMA PET scan which “must” be done IMHO based on the biopsy and should get approved. The scan should fill in the missing pieces of the puzzle and guide the Duke treatment recommendations.

At this point, you know you have a significant case of PCa but the extent of the PCa is unknown. Yes, you have to have treatment, that part is over. Exactly what and where is to be determined. This is the part of PCa diagnosis that sucks, it just takes time to fully define the problem and the doctors should want all the information possible before suggesting the best treatment option(s) for you.

More waiting but that is the way it goes. Hang in there, one more event to go. If there are multiple options, then you can listen to the arguments.