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Re: Re: Re: Re: Re: Turp followed by radiation therapy, especially proton?
Indiana, huh. That’s one of the few US States I haven’t visited yet – hope I’ll make it one of these days.
As to your specific questions:
Were these based off of the same slides or different biopsy's? Same slides, same biopsy
Would you consider these reputable pathology labs where they were read? Initially they were read by the two best labs in Cape Town, South Africa, where I was living at the time. The third reading was from a recognised lab here in Australia and the final one from a so-called Centre of Excellence in the US. (Mind you they sent back another man’s slides to me – and never found mine, so I was never too sure that the score was mine or his.)
You say Here at home I actually have found out that there can be some variance even amongst the "best" labs. The ascertaining of the grades of atypical cells in the prostate is indeed a process which is subjective and therefore produces variable results.
Do you think another opinion would hurt? No, but it might confuse!
One of the issues about this disease is the labelling of a wide variety of conditions as “prostate cancer” What a number of well known doctors have said is that some of the 'cancers' diagnosed at present are not 'cancer' if we mean by that word a disease that will, untreated, continue to progress until it kills us. Dr Jonathan Oppenheimer says it better than I can on his BLOG In part he says:
It is time to reconcile the discrepancy of the term that pathologists assign to a microscopic finding to the historical and practical significance of that term. The most common significant finding made by contemporary pathologists on prostate biopsies cannot be adequately described by “tumor” (Greek: swelling), “cancer” (from the crab-like extension), or “malignant” (threatening to life or tending to metastasize). I propose the terms “prostatic tubular neogenesis” (creation of new epithelial tubes or acini) and “potentially malignant” to better describe the microscopic findings that we have in the past labeled “adenocarcinoma” “cancer” “tumor” and “malignant.”
Dr Christopher Logothetis put it this way in a talk to US-Too: One of the problems with prostate cancer is definition. They label it as a cancer, and they force us all to behave in a way that introduces us to a cascade of events that sends us to very morbid therapy. It's sort of like once that cancer label is put on there we are obligated to behave in a certain way, and its driven by physician beliefs and patient beliefs and frequently they don't have anything to do with reality.
Some time back cells with a Gleason Grade of 1 and 2 were labelled ‘prostate cancer” but this is no longer the case in the US, which is why you don’t see any Gleason Scores below 6. But of course in the period since that decision was made, there has been a so-called ‘migration’ of Gleason Grades and what would have been a Gleason Score of 5 (and not labelled as cancer ) previously is now a 6 (and labelled as a cancer). Similarly, of course the rather common or garden GS 6 tumours that were invariably associated with indolent disease are now labelled as GS 7 or even 8, making them appear to be much more dangerous and in need of immediate attention.
All of which makes for some confusion in the Strange Place that is the PCa World.
Re: Turp followed by radiation therapy, especially proton?
William, please read Terry's posts very carefully. His prognosis was far worse than yours, or mine was, and he watched and waited for many years.
I had TURP at age 60 during which a biopsy was done and small (insignificant?) cancer was found in approximately similar amounts to yours. I later had robotic prostatectomy which was not completely successful because of the prior TURP.
The TURP itself was expertly done and actually improved my sex life because it removed all inflamation caused by obstruction and the surgeon preserved ejaculation. But however good the TURP was it fouled up later surgery.
If, I stress IF, you do decide on treatment, you should seek a second opinion other than from a radiologist, since it MIGHT be better in that case to have the prostate removed, rather than first have it bored out and then have it hit with other treatment.
But my opinion is that if I were you I would explore every medical way of improving my flow rate without any intervention to treat the cancer yet (which might not even be cancer!) and without having a TURP yet. I would actively watch things by having DRE and sophisticated MRI and Ultra Sound scans and watching the PSA movement and trajectory.
I am a guy who has had a TURP and a prostatectomy, yet still has enough prostate left to produce 0.42 PSA. So after all that - I am actually still doing watchful waiting! My new uro, who is a leading HIFU expert in the UK, says he thinks this is what I could have been doing all along.
