Well, darn it...

This was my first post, on Saturday:

"I'm sitting here reading the posts...and just feeling like a darned sissy. But. No diagnosis yet. 8 core biopsy done on Thursday. Prostate harder than normal, whatever that means. Had a check-up a couple weeks ago to talk about urinary issues. Weak flow, odd pain/pleasure sensation when the flow finally started, a little leakage if I waited to long. Family doc did a prostate exam, said it felt too firm. Sent me to a urologist who did a DRE and also pronounced the darned thing to be harder than normal. And, immediately scheduled me for the biopsy. My blood work was done between the visit to the family doc and the visit to the urologist. My first ever PSA came back at 19. During the biopsy, the uro said that he didn't see anything really abnormal in the prostate...again, whatever that means. His sense is that the news isn't going to be particularly good...and my instincts are telling me the same thing.

Second opinion if the first one sucks? Is there a real difference between a 12 core and an 8 core? I want to ask intelligent questions...but I just don't know what those are.

I am 63, and actually pretty freaked right now."

Now it's Tuesday morning in Tacoma, and my provider allows access to records and such. Me, being the curious type, peeked. I haven't talked to my URO yet, but from looking a other people's profiles it seems like maybe I hooked me a pretty good sized fish.

From the biopsy I had on the 4th, these are the results:

"A) RIGHT PROSTATE NEEDLE CORE BIOPSIES: INVASIVE ADENOCARCINOMA, ACINAR
TYPE.
1. GLEASON SCORE: 3+4=7.
2. NUMBER OF TISSUE CORES INVOLVED WITH TUMOR: FIVE OF FIVE.
3. PERCENT OF TISSUE INVOLVED WITH TUMOR: 80%.
4. PERINEURAL SPACE INVASION: POSITIVE.
5. VASCULAR INVASION: NOT IDENTIFIED.

B) LEFT PROSTATE NEEDLE CORE BIOPSIES: INVASIVE ADENOCARCINOMA, ACINAR
TYPE.
1. GLEASON SCORE: 3+4=7.
2. NUMBER OF CORES INVOLVED WITH TUMOR: FOUR OF FOUR.
3. PERCENT OF TISSUE INVOLVED WITH TUMOR: 100%.
4. PERINEURAL SPACE INVASION: POSITIVE.
5. VASCULAR INVASION: NOT IDENTIFIED."

I expect I'll be getting a call from the doc pretty quick now, and Honey1 (her) and Honey2 (me), will be sitting down for a chat. Somehow, having all of the cores involved with 80% involvement on the right and 100% on the left, doesn't leave me feeling totally optimistic, but hey, I'm the new guy on the block.

Talk to you soon.

Jim

First suggestion, get a recorder, ask the doc if you can use it, and record the conversations. You are about to step into the twilight zone, and you'll miss about half of what is said.
Latest phones often have recorders built in - try it first in a room environment.

Back to the big question, yup, sounds like you are one of us now. Let's wait till you talk to the doc before saying much, as he needs to explain things. But, do go to our "useful list" thread (the second thread at the top of the list, almost to the bottom of the posts in that thread, there is a link to it, I'll copy it and paste it here shortly). Have a read of that first.

Link added:

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

Jim,
The biopsy indicates a large volume intermediate risk cancer. Your high PSA puts you into the high risk category and you should treat your status aggressively.
The next steps would be to have your biopsy slides confirmed by an expert pathologist like Epstien at Hopkins of Bostwick Labs. your Uro can help you in getting your slides sent there.
I would also strongly recommend a PAP test as this is the best indicator of systemic disease and also a multiparametric MRI to see if there is seminal vesicle invasion or extra capsular extension. With this information you can then set up a treatment plan.
Good luck.
JohnT

Dahoney,
Welcome to our club, sounds like you are going to be a card carrying member of HW.
Sorry you had to join us. My PSA was 18.5 and Gleason 3+4=7 a year ago and
Now it is Zero, undetectable. Hopefully you can follow me into the Zero club this year.
Stay with us and keep us informed about your visit with the uro.

Bill

Don't care much for calling you Honey, so I'll go with Jim.
Welcome, I to am a Washingtonian, living north of you. Yea, it suck uh? Not to live north of you but having PCa.
Lots of information here from very great guys and gals.
Good luck, Bertb

Welcome,

I fully agree with what JohnT wrote to you. You have a lot of PC, based on those volumes and positive cores, and it is Gleason 7 at this point. Sometimes after surgery, the Gleason can be upgraded to something higher. Any Gleason 7 needs treatment, so now is the time to do all your homework, talked to not only some good surgeons, but some good radiation oncologists, to see which primary treatment choice best suits your needs.

Don't let any of the doctors rush you into a decision, as you only get to choose once here, and it needs to be the best and most educated choice.

Good luck, and don't be afraid to ask questions, both here and with any of your doctors.

david

CT and bone scans are set for 4/16, and we get to sit down with the URO for a long visit on 4/29.  Off to Mexico then for 2 weeks 5-3 to 5-17.  Lots of time to sit on the beach, push limes down the necks of cold Pacificos and kick back.  The Honeys (Cindi and me) will need it by then.  And you all can call me Honey...everybody else does.

Thanks for the information...education starts now.

Sorry to hear your results, but as many have said you've got lots of options to win - welcome to our club.

142 posted a good link that provides great insight to robotic surgery and external radiation - but please keep in mind those topics are the focus of that link - and in fact I think the title of "The Really Useful List made by HW people for HW people" is a bit misleading and really should be clarified to state what the content is about. And based on your stats you'll want to learn a whole bunch more - as others here have suggested surgery may not be the best route in this case due to your stats probably suggesting additional treatment approaches. Caveat - keep in mind we here at HW are NOT medical professionals, but rather a band of brothers that can provide our experiences and knowledge.

I would agree with getting a 2nd read on your biopsy slides by a lab such as Bostwick or Epstein. And then along with forums such as this where you can learn from people that have and are going through what you are, do as much internet research as you can. When I was at your point in my journey I encountered the "paralysis by analysis" syndrome as I was spending several hours a day doing all of the research and reading as much as I could - but that's o.k. as it will put you in a better place in terms of deciding your choice of treatment. There are a number of great books out there as well - Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" and Strum and Scholz' "Invasion of the Prostate Snatchers" are two that I found incredibly helpful during that part of my journey.

You will also want to talk to and if possible meet with as many of the medical experts in the different treatment approaches as you can. When you do, be sure to ask for their specific outcomes post treatment (and in particular relative to your PCa statistics) - % regression free, continency (and have them define what "continent" means - to you and I it means NO issues, while others may qualify that with "only one pad per day" or "only when straining;" same goes with ED. They all have these statistics and if they say they don't or are unwilling to share that would be a cause of concern for me.

As part of my journey to learn about the various treatment options I downloaded, purchased, and copied a number of studies and reports that I would also be happy to share with you, so if you are interested shoot an e-mail my way and I'll reply right away.

We are all out here to help - my very best wishes to you in this journey.

You hooked up with a big fish. Too bad you can't throw it back.

Instead you need further imaging to see where else it might be. I believe the best scan for you right now is a bone scan. The one's JohnT is mentioning are good but moot in treatment theory if the bone scan confirms presence in the bones and it won't matter if the seminal vesicles are positive, which they likely are.. Your next steps will likely involve hormonal therapies and see if this can be shrunk for a local treatment, but if not you can still do well so staying positive is a good idea.

You look like you might be further along than I was almost 7 years ago but our numbers were close. I've been in remission over six years...so far.

The second opinion is probably reasonable on the slides but I would only expect a 100% of cores positive to not be downgraded unless everything we've been discussing about Gleason 6 disease is utterly useless. In any case, if the Gleason were to be upgraded to a higher Gleason it would not change anything on what you might need to consider at this point. HT is the likely first start, and second HT products such as Xtandi or Zytiga are reasonable. Look for a guy here, his screen name is Zufus and he had 100% of cores positive I believe ten years ago. He's got a lot more to say as well.

Tony

Note: Our signatures can't exceed ten lines. So if you were attempting to put that pathology report in your signature, you see what happened.

Hang in there. It's natural to try to cope with things, but the next phase is moving to the right treatment. It is what it is and I've been at this long enough to know a positive mindset does help.

You had a bad diagnosis but I've seen worse and I've seen lot's of guys do well. We are at a point right now in treating this disease that presents some great new tools for the advanced cases.

Again welcome to our crowd. Peace to you and again, take it easy.

Tony