New to this...scared....need advice

Hello and welcome to HW,

Sorry you needed to be here, but glad you found us.

In one of your father's sample, there is a 4+4, making it a Gleason 8, which is the beginning range of an agressive prostate cancer. It is the norm to treat for the highest Gleason sample found, so he should be treated as a Gleason 8. Also, his PSA is fairly low, considering a positive diagnosis for PC. This could also be an early indicator that he is dealing with an agressive cancer.

Urologist typically will advocate surgery, as many urologists are surgeons as well. I would reccomend getting a second opinion on his biopsy sample, to confirm his standing. It would also be wise to speak to an oncologist and perhaps a radiation oncologist as well, to see if he would be suitable for other primary treatments other than surgery. He may well qualify for some form of radiation in lieu of surgery.

To help bring you up to speed on prostate cancer, I would reccomend you buy or borrow a copy of Walsh's "Surviving Prostate Cancer", its a great one-volume primer on all things prostate cancer. There is a new 3rd edition just out on the market.

Don't feel rushed or intimidated to have immediate treatment, take the time to learn what you can, both about the cancer and its treatments. I had open surgery myself, followed later by radiation, but with surgery, there is the risk of dealing with short term to long term incontienence, as well as ED issues.

Please keep us posted of your dad's journey. You will find many other adult age children here at HW that represent their father's prostate cancer journeys, so you will not be alone.

I wish you both the best, get as educated as you can, before making a final decision

david in s.c.

p.s.  there is no such thing as a stupid question when it comes to prostate cancer, so feel free to ask as many questions you have need of. there are people here well versed with every type of  treament for this cancer, as well as experiences with side effects and complications.  and never give up hope!

Thank you for information. It's such a scary time! There is no history of this in our family, so it came as quite a shock. I guess I have always heard that it is a slow growing cancer but what is the difference when they say that and then say that it is aggressive, like from the gleason grading system. We are praying that he can get it out and be on his way to more years with us. We want him around longer! :) The Thanks again!

It is a shock to hear the cancer word. Don't rush into anything. Take your time and educate yourself and explore all the treatment options that may be available, as they vary. Meet with the best surgeon and radiologist you can find. It makes a difference.

Ask any questions your have here, as the people here have varied experience and a lot of information to share.

You can read what I went through by clicking on the link in my signature.

Good luck to you and in all probability your dad will be around a long while.

Welcome to HealingWell, and I'm sorry to hear about your dad's diagnosis. Understand two things: This is very treatable, and he has time to get second opinions and consider his options.

You and David are both right. Gleason 7 is moderate, but Gleason 8 is a little more aggressive. Still very treatable, though. When they look at the sample, they give two numbers. The first is the dominant score from that sample, and the second is the secondary score from the same sample. Therefore, a 4+3=7 is more aggressive than a 3+4= 7. Out of the five core samples, three of your dad's samples are primarily 4. Again, treatable -- but it needs treatment.

Robert hit the nail on the head. Your dad's treatment options will probably be surgery or radiation. He may need to do both. He may also have more than one radiation option available to him. The choices can get confusing, and there will be choices.

I recommend he get three opinions: one from a surgeon, one from a radiation doc, and a third from a medical oncologist. They'll all have their own professional treatment biases, and that's ok, but your dad should hear all three perspectives. He should come out of that process knowing a lot about his condition. I also recommend that he not write off any treatment option until he has all the facts. He should inquire about outcomes and side effects. Both are important.

Someone should go with him, talk to these doctors with him and take notes. Even the smartest, most analytical person doesn't hear everything when they're under this kind of stress. It's easy to miss important details when you just found out you have cancer. He'll need a note-taker. He or someone should also do some homework. These threads are a great source of information, and there are some good books. Dr. Patrick Walsh's Guide to Surviving Prostate Cancer is highly recommended.

My hunch is he'll have at least two or three treatment options with similarly good outcome probabilities. The differences will be in the side effects and the time it takes to undergo treatment. From what you've posted, it sounds like the chances are very good that he'll be just fine, so try not to freak out. It'll be ok.

Good luck, hang in there, and please let us know if you have other questions. And let us know how he makes out. Remember, he has time to educate himself and get multiple opinions -- and what he's got is treatable. He'll be ok.

Best,

Jonathan

nmckinley,
First I'll take a moment to welcome you to HealingWell. We do hate to see new members, but everyone here has been down the same path.

The Gleason score is expressed as 'highest volume' + 'lower volume', so a 4+3 has more 4 than 3, and 3+4 is predominately 3, less 4. The more important number is the 4+4, which does put him in the aggressive category, and is what the doctor will treat. It looks a lot like my own scores at biopsy.

You have some time to get busy understanding PCa. I would start with one of what I consider the two best books out there, either Dr. Patrick Walsh's third edition "Surviving Prostate Cancer", or Dr. Peter Scardino's second edition "Prostate Book".

As to diagnosis, I would suggest (and his insurance company may insist) that he have a second opinion visit with another surgeon, and a consultation with a Radiation Oncologist who specializes in PCa. He may also want a second opinion of the biopsy slides. Bostwick Labs is a respected lab for PCa-related pathology & tests.

There will be more tests, primarily a CT scan and Bone scan, both of which you will likely be told are a waste of time and money by others, but it will give him a baseline, and hopefully rule out any current metastasis. The doctors will insist.

The next few days and weeks will be full of tests and near panic, but the panic is not of any value, so don't. Take the time that is needed to understand the biopsy report (get a printed copy), and get some additional opinions.

Also have a look at this thread:

Prostate Cancer: The Really Useful List made by HW people for HW people.
https://www.healingwell.com/community/default.aspx?f=35&m=1717641

And, as he goes to visit doctors, have him take someone along to take notes, or better, if the doctor permits, take a recorder and tape the conversations. After time, you will be amazed what was said but missed or simply misinterpreted.

All that said, I see that 7 replies have been posted while I'm writing this one, so I may be repeating the others as well.

Again, welcome.

One more thing: You don't say where you're located, but you want doctors with a lot of experience handling this. Prostate surgery is difficult surgery, and you'll want someone who has done hundreds of them -- not 10 or 20. Ditto radiation docs.

If you live near a nationally known center of excellence, find out who the best docs are and see them. Again, this is treatable, but you need somebody very good.

Hang in there...

The percentages refer to the amount of each core sample (from the needle core biopsy) that was cancerous. So if a sample is 5 percent, then 95 percent of that sample was healthy tissue.

Again, they give two scores to any tissue that is cancerous, and many positive samples contain more than one grade of cancer. The first of the two numbers is the grade that's more prevalent in the sample, so a 4+3=7 is more aggressive than a 3+4=7.

You're asking good questions, and there are a lot of knowledgeable and supportive people here. Hang in there.

Hello, nmckinley ~ welcome to our forum and I am so sorry for your Dad's diagnosis.  There are several daughters, wives, and partners posting in the forum.  Believe me, feel free to ask any questions you may have.  The folks here are so nice and helpful!   It is scary if no other family member has had PCa.  All the recommendations will guide you.  The important thing is to understand this disease.  Knowledge is power.  What I did was to print up anything that I thought would help my husband.  This was reassuring to him.

When making a decision, it is important to address the issues of side effects (SE).  Each man may react differently to the same treatment.  My husband wanted the cancer removed, and for him the DaVinci surgery was the right choice.   His hospital made the arrangements for him to meet with another surgeon, an oncologist and a radiation oncologist.  Using a team approach was helpful for him even though he wasn't pleased with some of the SE of his surgery.  In exploring options, please remind him that PCa is treatable.

Yes, taking notes are important, but also be sure to write down any questions you or your father may have.  Your father is fortunate to have you as a support system.   Wishing him the very best in his journey.

Many blessings,

Aimzee 

What are some of the best questions to ask? And are most all of you in favor of him seeing a med oncologist, and a radiologist, as well as his urologist/surgeon that he is seeing now? I felt this HUGE rush yesterday and now, listening to all of you is letting me take some time to look around. My mom will be going with him to doctors appointments and me or my sister will go to as many as we can.

nmckinley

Nothing to add to all that has already been said.

This may help

HUGS to you, your Dad and to all who will be making this journey with him.

Bud & MsBud

We will beat this crap!

nmckinley said...
Why would a 4+4 be borderline less favorable treatment?

Good!  Glad to hear Bostwick did your initial reading.

Regarding your question re-posted above...it's not that it's borderline less favorable, it's that it's borderline that surgery would be the best treatment approach.

Surgery is a good approach for locally contained PC cases, but unfortunately it is impossible to tell if it is contained or not.  The best tool we have is to use past history of cases (prediction tables) with similar characteristics to see how frequently those cases were contained or not.  With a positive DRE and 4+4, your father's case will have a lower likelihood of being contained than the most typical (low risk) cases which are very common.  Surgery is ONLY successful as a monotherapy if it is contained.  With lower likelihood, many men opt for other treatment modes...increasingly a combination of HT to shrink his enlarged prostate, combined with one or two modes of radiation.

Does that explanation help?

will they only know if it is contained or not when they actually go in or will the routine scans show that?