Biopsy confirmed malignant in all 12 samples; 2 sem. vessels negative

Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
Seminal vessels were OK in one sample each.

So Uro. is planning for full-body bone scan, CT scan, Lupron,
Radiation.
My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
yesterday from procedure done last week.

Any thoughts on this course of action? Age: 59.5.

Tim, Easton, PA

Tim wrote:
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.

Just one: You DID study, consider, and consult specialists in brachy and
surgery, didn't you? Not that I recommend one over the other, but all
major options should be thoroughly and objectively compared.

I.P.

On November 16, Tim wrote:
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.
>
Welcome to the club no none wants to join.

My recommendation is to study, learn, and take charge of treatment.

An excellent starting point is the website of the authoritative Prostate
Cancer Research Institute at:

http://prostate-cancer.org/index.html

Go the section entitled "Newly Diagnosed."

Regards,

Steve J

"Empowerment: taking responsibility for and authority over one's own
outcomes based on education and knowledge of the consequences and
contingencies involved in one's own decisions. This focus provides the
uplifting energy that can sustain in the face of crisis."
--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled
"The Empowered Patient's Guide."


> Tim, Easton, PA
>
>

Tim, sorry to hear this news and if you're like me, the few weeks after
this diagnosis is quite unsettling to say the least. Like others
said, welcome to the club that no man ever wanted to join.

The course of action usually takes two paths: those that trust their
doctors and go on with their recommended treatment, and one that do a
lot of research and doing consultations trying to decide which way to
go. My supervisor ( a few years younger than me took this route 6
months ago. He had his RP within just a couple of weeks of diagnosis.
I am falling in the second category and still trying to decide since
late August.

60 y.o., G7(4+3), 1/12 samples, PSA 6.7
No TX yet.

Tim wrote:
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.
>
> Tim, Easton, PA

Tim wrote:
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.

Too young.

Don't like the numbers.

Yes. Get all the scans. MRI with the butt-plug. Prostascint too if
they offer it. Get all the tests scheduled and done. Sooner is better
than later.

I'll tell you what the Rad-doc at Inova told me, "Most likely the Bone
Scan and CT scan won't show a thing." They ask for it because in some
unfortunate cases, the cancer has metastasized and grown large enough
to show up on these tests. If it does show up, they won't subject you
to surgery or seeding. There's no point as neither will help.

While you're getting the tests, read 2 or 3 books, I read the "Dummies
book", Walsh, and a book on radiation treatment. Learn as much as you
can.

Whatever you come away with from the books and the docs, realize,
internalize these points:

1) The goal is to cure the cancer, or at least beat it into submission.

2) The side effects will be worse than you anticipate going in. The
treatments aren't bad, it's the ongoing effects over the months and
years.

3) If you beat the cancer, which most do, you can rise above the side
effects.

Talk to both a surgeon and a radiation oncologist. Both will want
"their" pathologist to see the biopsy slides. Ask them lots of
questions.

Neither can give you a guarentee of a cure. They can't promise that
you'll be continent or able to have erections after the treatment.

They should be able to give you an estimate though, ie 80% have
undetectable PSA's at 10 years, 60% of patients like you are continent
within 2 years and 70% can achieve erections with pills or injections.


That's not a guarentee but it is an indication.

Good luck to you.

-kh

"Tim" <timeastonpa@yahoo.com> wrote in message
news:1163695829.600509.43220@e3g2000cwe.googlegrou ps.com...
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.

I concur, but I'm not a doctor. As I recall, you are not in the best of
physical, especially cardiovascular, shape. And, you're old enough that you
are not pushed into surgery. I think shrinking the cancer and zapping it
with radiation is the better way to go in your case.



--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05,
2/06, 6/06
PSA .07 .05 .06 .09 .08 .132 .145
Casodex added daily 07/06
PSA <0.04
Non Illegitimi Carborundum

Tim wrote:
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.
>
> Tim, Easton, PA

Hi Tim...Prostate Canncer diagnosis and treatment is more of an art
form than an exact science. As others have said, this is a time to
collect information and learn about the disease. Given the stats
you've shared, you would want to move as rapidly as possible, but
without sacrificing on the information or learning aspects. The two
key questions to try and answer are 1) is your PCa systemic and 2) how
aggresive is the PCa. Answers to those questions will guide you in
your treatment selection process

To try and get a handle on the systemic / localized nature of the
disease, you can simply run several different nomograms. The Partin
Tables are a starting point, but there are a number of other nomograms
that use different input (google "narayan" or "bluestein" and "prostate
cancer" for example). An inexpensive, simple, blood test that may also
shed some light on this issue is the PAP (prostatic acid phosphatase)
test.

To probe the aggresiveness of your PCa you could
1) have your biopsy slides reread by a PCa pathology expert. It is
relatively difficult for a pathologist to grade PCa. There's not one
big solid tumor to examine; rather PCa is typically a diffuse,
multifocal tumor. It becomes even more difficult when all you have to
examine are small biopsy fragments. That's one of the reasons that
an expert PCa pathologist (there are roughly a dozen or so around the
US, see the website Steve J recommended for a listing) should examine
PCa biopsy slides. Because many people don't have their Gleason Score
determined by one of these experts, there is a documented
"under-grading" of Gleason scores from PCa biopsy specimens (to be
accurate, I should say that there is both over- and under-grading, but,
on average, there is more under-grading). Said differently, the GS
from the pathologic specimen obtained after RP frequently comes in
higher than the GS determined from the biopsy specimen. This means
that sometimes people pick an inappropriate treatment (in terms of
efficacy that is) method because their tumor GS was mis-graded. It
would probably be worth having your biopsy slides reread by an expert
since so much hinges upon the GS. Insurance often covers this
re-reading.
2) Have Bostwick Labs do a ploidy analysis on your biopsy specimen.

If you conclude that the disease is sytemic, then no therapy will be
curative, but treatment can allow you to live long enough that you'll
probably die of something else. Hormonal therapy. probably ADT3 or 4
(a mix of 3 or 4 chemicals to suppress Testosterone and DHT formation
and binding) is often used. Sometimes surgery to remove the prostate
(debulking) is also practiced.. This quickly reduces the tumor burden
and removes the oldest, most highly mutated tumor cells, giving the
hormone therapy a better chance to have a significant effect. As
others have pointed out, all of these treatments come with side
effects. So you need to select your treatment pathway based on your
personal preferences for quality of life vs. lenght of life...Best
wishes and good health, ron

Tim wrote:
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.
>
> Tim, Easton, PA

I am not a doctor and my thoughts may be worth even less
than you are paying for them. But for whatever they're worth,
here they are.

I won't repeat what others have said, but I think a lot of it is
good advice. Here are some additional thoughts.

Radiation sounds to me like a good approach for your case.
With cancer in every sample taken and a PSA over 20,
there is a significant chance that some cancer has penetrated
the prostate capsule. Radiation may offer more chance to
treat it than surgery would. So your urologist's approach
sounds like a good one to me.

I also like the idea of starting off with some hormone therapy.
There is mixed information about this. Some studies found a
significant benefit from neo-adjuvant (prior to the main treatment)
therapy and some did not. Some studies claim that there is
increased risk to patients with heart problems from taking HT.
If you have heart or other problems, name all of them when
talking to the doctors and be sure they are aware of them.

Hopefully, you will be able to start the HT very soon. Getting
on HT as soon as possible seems very smart to me. The
HT will likely stop the cancer in its tracks and give you a
a chance to take some deep breaths, study, and check out
options, without having to worry about whether your cancer
is galloping away inside you.

Normally, Lupron will be preceded by a week or two of
Casodex to prevent the "testosterone flare" that Lupron
can cause. If the doctor isn't planning to do that, ask him
why.

I like that you are getting the extra scans. These often are
not done, but you have a high risk case and, even though
they are not likely to reveal anything, they are worth doing.

Your urologist strikes me as doing an excellent job.

I presume that the urologist is, himself, a surgeon and will
not be the doctor administering radiation. If he is the guy
that refers you to a radiation oncologist (he probably is)
tell him that you want to go to someone who really does
a lot of prostate cancer work, and who has the latest
equipment. Some rad oncs may specialize in breast
cancer or other cancers and not do much prostate
treatment, and some may not have the latest equipment.

I don't know how important the latest equipment is, but
it's something I'd ask about.

Tell the uro you want to go to the guy that he, the urologist,
would go to if he needed prostate radiation.

If you're able to travel for radiation, tell the uro how far you
can go. I went every day during treatment to a site 40 miles
away from my home because I thought they were very good.

When you see the rad onc, ask what treatment he would
prescribe for you. Issues include: What kind of machine
and treatment type (IMRT, IGRT, 3DCRT, etc.)? How
big a dose? Does he recommend a brachytherapy boost?
If so, which kind (high dose rate temporary or lower dose
permanent seeds)? How will he guide the radiation - with
an initial CT scan plus XRays? How often will he check
with new CT scans? If he also proposes brachytherapy
(brachytherapy all by itself is not recommended for high
risk cases but is often used in conjunction with external
beam radiation), how will he guide it - with MRI, ultrasound?
Will he implant seeds that can be used as radiation targets
for the external beam? How far around the prostate will he
radiate (the wider the field the more likely it is to catch
cancer cells outside the prostate, but side effects are more
likely too.)

You're not really in a position to evaluate his answers, but
you can get an idea about how many options he's considering
and you can write down what he says and bring the answers
back to this group for more info, or lookup things on the
web and in the library.

So far, unless the scans show otherwise, you have a
fighting chance for a cure. And if not, you have a fighting
chance of living another decade or even longer.

Best of luck.

Alan

I wish could could add some in-put but the Dr.s here on the News Group seem
to have a pretty good idea.......
I would take the advice of those that have been there, and especially with
hormone therapy first, and then radiation.
You will get many years out of your Michelin Tires... (making a joke) I you
keep inflated...
Trust those who have had Hormone shrinking, and then radiation.
I do wish you well.
John Loomis
RP 1999 @ age 49. 6 to 7 on Gleason.....squeeking through?
0.01 or less ever since...
Many helpful names on board......
Love You all.
Keep up the work!

"Tim" <timeastonpa@yahoo.com> wrote in message
news:1163695829.600509.43220@e3g2000cwe.googlegrou ps.com...
> Biopsy confirmed malignant in all 12 samples; Glesen score of 7 each
> Seminal vessels were OK in one sample each.
>
> So Uro. is planning for full-body bone scan, CT scan, Lupron,
> Radiation.
> My PSA was 23, then 20 at diff. lab 3 months later. Biopsy results
> yesterday from procedure done last week.
>
> Any thoughts on this course of action? Age: 59.5.
>
> Tim, Easton, PA
>