Posted 1/13/2014 12:33 PM (GMT -5)
Hi all,
I posted a couple of weeks ago and you all gave good advices and support so I am back again. I have been researching my particulars and have found several articles that seem relevant to my case. I am 54, G6 found during TURP Dec 2013. No previous bx, no previous TRUS, annual DRE okay, but have had BPH since my late 30s. PSA doubled in in 18 months, Dec 2011 - July 2013 to 3.4 - 7.1, but doc decided to go ahead with TURP to relieve LUTS. So, he removed ~50 g of tissue 11% of which had cancer cells at 5% per chip. (9/80 chips examined had 5% cancer cells, G6). I have had the slides sent to Johns Hopkins for second reading my PSA test 14 days after surgery was 6.0. At 5 months prior to surgery it was 7.1.
Anyway, I have found a retrospective study of 114 patients whose PCa was discovered during TURP that says if you have any 2 of 5 of the following prognostic indicators, you have 47% chance of disease progression: 1) PSA at time of TURP > 10.0 (in my case we do not know for sure, we did not do PSA), 2) Post TURP PSA > 2.0 (still do not know but seems likely to me), 3) Tissue removed > 30 grams (I had 50 g removed), 4) Pre TURP Prostate size > 60 grams (doc estimated > 70 grams), and 5) Gleason score =>6. Okay, so I have at least 3 of the 5 and it seems likely to me I will confirm post TURP PSA >2.0 in March. This is a recent study and disease progression was defined as PSA doubling from post TURP baseline. Also, I found another study that related % of chips with cancer cells and >10% is a marker for possible disease progression as well.
Anyway, I am of considering prostatectomy because I am currently feeling I have a significant chance of disease progression. Yes, the doc and I are considering a biopsy and MRI (I need to heal a while) as well before we decide anything. We could not do the genomics testing as we had hoped since they "don't do TURP chips as it is not FDA approved".
So, I am looking for advice and comments on:
1. Has anyone had prostatectomy after TURP? How long did you wait? Did you talk with your surgeon about how TURP could make the surgery more difficult and less likely to have good outcomes due the scaring and fibrosis making the surgery and repairs less "clean cut" (<=== pun ).
2. I am leaning towards RALP, and I would like recommendations for the "best". I have one recommendation for Dr. Miller in Atlanta from a friend, he said he has done thousands, and I have found some in Charleston, SC and Charlotte, NC that are in the Society of Urologic Oncology, but I know there are likely some consensus top surgeons so I am soliciting your input. I live near Columbia, SC (Lexington, SC) and my preference would be someone regional.
3. Okay, so the last thing, lets say I chicken out because I cannot get convinced in my head that surgery is going to have a good chance of "success", has anyone had radiation treatment after having PCa discovered during TURP? Any complications? If you have had radiation, any recommendations for someone in my region?
Of course, PSA in a month could come back less than one, biopsy, neg, MRI neg (or positive MRI which would eliminate surgery as well) but I am feeling that it is likely I am going to want to act and that the future data we get will still be sketchy. I know many of you would consider AS, I would be glad to share with you the retrospective papers / studies that I have found and see if you still agree or maybe you could share some retrospective studies that help convince me otherwise. I am a chemical engineer, I love data!
I appreciate any comments you may have. I would like to encourage all of you in your battles and hope today is a good day for you!
Age 54
PSA Dec 2011 3.4
PSA July 2013 7.1
G6 discovered during TURP Dec 2013
9/80 chips @ 5%
PSA 14 days after surgery 6.0