Prostate cancer progression

My urologist office called and will take care of sending the slides. I have to fill out two forms they will mail me and will be billed $25 to Fedex the slides.

One thing I can say is they are prompt and thank goodness for the "patient portal" makes it less stressful

Glen AKA Billpilgram and the swan

Good luck,Swan. I can agree about the low T. My T is much higher than yours when I’m not on ADT. Roughly in the 300 ng/dL range. But on ADT, I’m undetectable. So, as long as you can avoid ADT, you should be good.

TS: Brachy was my choice in 2014 and I am here to tell you I have had next to no SEs. Lost sauce and that is all that remains! Had procedure in the morning, CT next morning, and doing long walks on my second day. Lots of walking tempered the few early and very manageable discomforts. My most recent PSA was <.1 where it has been for the past 2 years.

I don't post very often but like to help out potential Brachy Brothers with what I still feel is the best treatment going!

Now I wait to hear if the doctor in Manhattan will see me on the 29th-I doubt it with the virus still so active but I have to get the second opinion on the slides anyway and that may take extra time due to the pandemic.
I've had some symptoms on another UTI with blood in the urine a couple of times in the morning and urgency (the urgency went away) and hard time getting a flow which is ongoing.
I used to get UTI's like clockwork until I had a full 30 days on Cipro and was UTI free for about a year. I suppose it could return. It was E coli which I guess is common but maybe it was another pathogen. I do not want to deal with going to drop off a sample (they may not even be open) because if it is an UTI it will run it's course.
Naturally I begin to think the worse and it's really the cancer so I hope it clears soon.

I have a huge prostate so urgency and low flow is a fact of life (Flomax and Cialis help a lot)

I pray the pandemic leaves us soon

Happy Easter

Glen

That is a possibility but since this Dr Deutch is the doctor I will seek treatment under (he is the chief radiological oncologist) and I've only met him once over a year ago, I'd like his take on a DRE (not fond of the exam but a second doctor feeling the prostate can only be good)
My doctor said it felt normal to him about 6 months ago. I asked how does he know what feels normal or not and he explained that there is a certain "art" to it along with actually palpating an actual mass-in other words, he does so many that it is easy to detect what feels normal or not.
I'm awaiting the second opinion on the slides so that may take extra time with the pandemic.

I might add I really do not want to give up my testosterone injections just yet. if it comes down to me getting radiation, I feel then would be a good time to allow my natural low level of testosterone to emerge. I run only into the 50's with a normal being something like 330-1000
Being off TRT is a real hell for me and I do not want to stop but if it helps the body and radiation fight off the cancer then I'll stop it.

Glen

I don't think a radiation oncologist is the person to give you a DRE. Not their specialty. A urologist feels prostates all the time so they have a trained finger. By comparison other doctors are amateurs in the art of the DRE.

oh, to add, my brother did have rounds of chemo and radiation but toward the end he said enough was enough. they had just come out with Optivo and it was supposed to add 3 to 6 months but was extremely expensive. We even offered to help pay thinking the cost to be in the thousands but it was more like $80K or more and we just did not have that much.

I saw him a few days before he died and he was lucid and his pain was controlled. A few days later I got the dreaded call and got there in time to see the last rites preformed and was able to rub his feet and talk to him telling him I loved him, he did well as a dad and grand dad and we were okay with him leaving us.
I respect his choice

Glen

Thank you for understanding.
This is indeed potentially life threatening and I do not take it lightly. In order for me to continue on TRT is risky and I am very aware of this. I just want to stay on it as long as possible and if and when I am to begin radiation, I will stop. My hope is I get an "all clear" after treatment and then will face those risk's anew.

If it were a matter of body building or just general better health, I'd have stopped long ago but it is a matter of sanity. Last time I was down to 56 T level I screamed at my wife over some dumb thing-I mean screamed like a banshee! or mad man. I am fearful of crossing the street, making decisions and am at a constant state of panic and irritability. I'm not even mentioning ED to the max.
With testosterone at normal levels I am a calm easy going social and gentle fella-My wife would say a "Teddy bear" I do not want to be Mr Hyde

Thanks again, I hope I am getting my point across.

Glen

Glen - You might try calling Decipher (or Oncotype) and see if you can talk with someone about your results. I called to get my supplemental GRID report and the person gave me a name of someone who could explain it. However, to get the actual report, I had to have my urologist get it for me which took a couple of weeks and I never called back. May take some sweet talking to get through to some PhD or doctor on staff at either company but there are people that know the limitations of the testing.

On the other hand, a different sample at a different time can provide different results, just like biopsies do. PCa is anything but uniform and predictable. The mental part is as bad as the disease at times.

theswan said...
Lot of time on my hands so my thoughts started to dwell on Genomic testing
A year and a half ago Oncotype had me at "very low risk cancer " now Decipher genomic test shows high risk. I suppose cancer can change over a year and half but still Gleason score of 6 it is confusing.

Wonder how accurate they are?

Glen

Glen, perhaps I can shed a bit of light on a couple of concepts. First, the notion that all (and only) high-grade (Gleason) lesions are high risk for metastases has been dispelled by genomic testing. This was shown in a seminal 2016 study of Decipher results broken down by Gleason score and by pathological staging:

Decipher correlation patterns post prostatectomy: initial experience from 2 342 prospective patients (2016, Full Text)

Looking at the results there for G6 men who, after surgery, were confirmed as having prostate-confined cancer (pT2), 74% of the men had Decipher results that were low-risk for metastases; 26% were intermediate risk; and 10% were high-risk. For the G6 men who had cancer that grew through the prostate capsule, the high-risk percentage went up to 16%. If you look at Table 2, you will see that for each and every combination of Gleason score and path staging, there are men who are low, intermediate, and high risk (although the size of each group does vary in the directions you would assume).

(At the other end of G scores, my Decipher result on my RP tissue was, encouragingly, low-risk for mets even though I was G9 (4+5) on my final path report.)

As Mumbo mentioned, the G score reported from a biopsy is only as accurate as the highest-grade lesion that was sampled by any biopsy core. That is one reason many men have their G score upgraded after surgery. The biopsy samples a tiny amount of prostate tissue -- it can come back negative even when cancer is present, and it can underestimate the grade of the worst lesion(s) present somewhere in the prostate. As we know, G6 lesions cannot metastasize; however, higher-grade lesions can arise ex novo elsewhere, and it's thought that G6 lesions can progress -- in other words, when the cancer cells divide, a cell of a higher G grade can arise resulting in a lesion clone with grades >6, which can metastasize.

Just as a biopsy can miss higher-grade lesions, a genomics test relies on the company testing a tissue sample with the worse score. The Decipher test, for example, is run on different cancer samples and the higher (worse) score is reported to you. On another Forum, one fellow got a low-risk Decipher result on his biopsy sample. After his surgery, tissue was again submitted for the Decipher test and came back high risk! Nothing changed in the guy's cancer in the time interval -- rather the biopsy sample evidently missed a worse lesion. The Decipher Biopsy report itself states that the Decipher Biopsy risk category will match the Decipher RP risk category (only) 70% of the time. That, unfortunately, is the nature of sampling and testing.

Hope that helps,

Djin

Thanks Djin

Yes this helps and I am thinking more of undergoing treatment.
I still hope to hold off while the pandemic is still hot.
I have a lot to consider be it my mental state, risks of radiation during the pandemic and just normal being scared stiff of surgery and advanced cancer and all that goes with that

Low Testosterone will magnify my mental issue's so yes a lot of fears

Glen

Thanks again

Glen