Finally after multiple biopsy cancer is found, should i be happy?

My psa has now gone from the mid 2s in 2007 to 10.14 last month, I think I have had around 7-biopsys including a saturated biopsy where they took 30cores (all neg,) They took 16 cores last wed. 10/2/13 1-core positive gleason score of 6, t,1 and when asked what stage Dr. Han (John Hopkins) said stage 1. are those pathology report results good? I am guessing the cancer has been growing for a while since my psa has been going up for 6 years. Dr. Han said its a small cancer can I really believe that to be true? Any opinions would be appreciated. Thank you for any post I have gotten over the last couple of years while going thru the process (John T.) ect.

John Routzahn

John,
Not to minimize your cancer, but what Dr Han found is very common in men your age, about 50% were found to have some prostate cancer when autopsies were done on men dying from other causes. With the number of biopsies you had it is not unusual to find small cancers that would have never been discovered in one's lifetime other than having a biopsy.
To confirm the DX of "very low risk" cancer you have a couple of options. What was the size of your prostate? A psa density less than 1.5 is confirmation of a low risk DX. You can also send your slides to Bostwick Labs to have an advanced test like Polaris to confirm. The last option is a multiparmetric MRI or CDU.
If Dr Han's DX is confirmed then you have to treat the biology of the cancer found and not the possibilities of having something else. If psa density matches, a second reading of the pathology slides match and if imaging can't find anything else then you have very low risk PC. If it walks and quacks like a duck its a duck.
The recommended treatment for very low risk PC is careful monitoring and treatment if signs of progression are identified in the future.
You will have to weigh the probability of quality of life side effects from any treatment against the probability of having the cancer progress to a point beyond a cure. These risks have been quantified to some extent among a universe of men. QOL issues from treatment are around 50%. The risk of progression beyond cure from very low risk PC is not zero, but very low at about 1%. The risk of progression that would have to be treated in the future is about 30% with a 99% cure rate for delayed treatment. (which happens to be similar to immediate treatment).
If your current DX is confirmed (it is always wise to get 2nd opinions) then you will certainly not die from your condition and you have many options available to explore and a long timeframe in which to explore them. The only area of concern is your high psa and if this can be explained by your prostate size (psa density) or if the biopsy picked up a TZ tumor, which produces high psa, you should be confident in your DX. Your doctor should be able to account for all the psa using prostate size and a tumor volume calculator.
JT

Hi John,

In your thread's Subject line, you wrote:  "Finally after multiple biopsy cancer is found, should i be happy?"

My brief response here is just addressing this question...

Almost without exception, after receiving a diagnosis of cancer (as you just have) most men have expressed fear, anxiety, a "wall of shock" (nice descriptive phrase from member "142"), and even (according to some of their doctors) "hysteria."  So, it wouldn't be surprising that you should feel some of those emotions.

But I gotta say, doing a math estimate, you've probably had about 100 biopsy samples pulled out, and only one was able to find any cells that resembled what they today call "prostate cancer," and it was the lowest possible grading of PC that exists today...well, there are probably a whole lot of guys who would say that any fear or anxiety you might feel at first should quickly wash away.  Extending what JohnT mentioned (that 50% of men 50 yrs old have what you've got, or more), you've simply got a case of what many would call "natural aging."  When you get older, you gotta monitor your health more closely, and you can now add this to the list...

best wishes...

 

Should I be happy?

No. I would never be happy about any cancer dx, however minimal it is.

But you can be happy its only 1 core and only a Gleason 6 and can be happy that AS might be appropriate for you.

With your saturation type biopsies, at least you can have the comfort that probably found all the cancer
there is, and there isn't much based on what was found. So that is good news.

David