hallsb1 said...
Hi all,
Never thought I'd be talking about prostate cancer. Up to 5 years ago (2008) I hadn't seen a doctor since 1986. PSA has been in the 4's in 2008,09,10. Went up to 6.5 in Jan 2011 had a biopsy. Negative. PSA 4.4 in 2012 PSA 8.29 July 2013. Biopsy done Cancer in one of twelve cores. Gleason score of 3+3=6 T2A with small rough area on Apex of prostate. All above sounds like low risk with the x factor of my having a brother who had PC when he was 49. He had Prostate removed and is doing fine. My head is swimming as to what to do. I dread the idea of catheters,incontinence and impotence. I'm leaning toward watchful waiting for time being. Does that seem reasonable?
AS is one possible route you can take. You had just one positive core, probably with low involvement (you didn't mention the percentage), your estimated Gleason score is G6. Those are the qualifications they generally use to justify AS.
But the only thing that troubles me is that your PSA is over 8. It doubled in one year's time and that suggests that something is going on. Remember that a prostate biopsy only samples about
1/1,000th of the prostate. It is very easy for the biopsy needle to miss any other tumor(s) that might be present.
Around 20-28% of clinical Gleason scores end up being upgraded following post-op pathology, which is able to examine the entire prostate.
So going with AS, while very justified in many cases, sometimes is a roll of the dice. You would certainly want to stay right on top of our PSA to see any changes that might take place. But, then again, your PSA has already doubled in one year and that could raise some red flags.
If you opted for some form of treatment, surgery is probably not your only option. Radiation might be just as curative, although there are still potential side effects involved there as with surgery.
As they say with PC, "You have ONE chance to get this right." So you might want to discuss your situation with highly competent & experienced uro/surgeons and radiation oncologists. Also talking to an oncologist might be good.
In this way you can learn the pros & cons of AS, surgery, radiation, etc., and then make an informed decision based on what you have learned.
Wishing you the very best!
Chuck
Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1. PSA tests now annual.
Semi-firm erections now happening 14 months post-op & VERY slowly getting a bit stronger.
Post Edited (HighlanderCFH) : 8/28/2013 12:52:02 AM (GMT-6)