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Re: Tumour old or new.

Too right he should be kicked out. Not a day goes by when I don't feel anger about him . Thank you so much.
Unfortunately we seem so behind in the UK where psa tests are concerned. It has to change. On the bright side, my wonderful husband is doing well at the moment.

Re: Tumour old or new.

Jen,
I also would think that a 2nd PSA test just prior to treatment would have given you more information about your husbands cancer. Unfortunately that opportunity is now lost.

So now your focus will have to be on treatment, and getting information from others in similar situations (such as John Farrow has offered) will help. Best wishes from all of us as you deal with this lousy disease.

Re: Tumour old or new.

Good morning Jen. I will try to answer your specific questions, although as I am sure you will have learned by now the Golden Rule of Prostate Cancer is that There Are No Rules – so no one can ever be certain of anything, unfortunately. What follows is based on what I have learned over the past 13 years since I was diagnosed – I have no medical training.

I have to say at the outset that I am a bit puzzled by your time line. You say:

A. Your husband first discussed a PSA test five years ago – that would be 2005 – at age 60.
B. Three years later – that would be 2008 - at age 63 he discussed it again and again had no PSA test.
C. The second discussion was 2 years before diagnosis and t he has been on Zoladex for 19 months, which would seem, with the 10 weeks added from diagnosis to the start of treatment, to put diagnosis at the end of 2008 which is when you said the second discussion took place. It is also not clear just how the diagnosis came about – or who made it? Did the family doctor finally take a PSA test and send your husband along to the urologist for a biopsy? Did your husband develop symptoms? Perhaps you’d clarify the time line and the process? The comments that follow are made on certain assumptions:

You say Surely if his PSA had been taken between the first time and then again the day or two before starting treatment which was approx 10 weeks they could have seen if there was any increase before the treatment. Or could they have known by the biopsy samples that it was a new tumour. When we asked the urologist how long it had been there he said probably about a year. But how can he be sure. I would like to know if this has been growing very slowly or not.

So let’s look at those questions, although not in that order:

1. When we asked the urologist how long it had been there he said probably about a year. But how can he be sure. The short answer is that he cannot be sure. You say that your husband’s doctor did no tests prior to the diagnosis, and if this is so, then the urologist’s view is a puzzle. Did your husband’s doctor carry out a DRE (Digital Rectal Examination)? If that was negative and since your husband had no symptoms, it may well have been for those reasons that your family doctor would have not carried out a PSA test, although this would have been unusual, even in UK (I assume you are in the UK if only because you spell tumour correctly – just a joke you US citizens!). If those were the circumstances the urologist may have taken the absence of symptoms or a palpable mass as an indication of no tumour, although that would be very unusual.

2 Or could they have known by the biopsy samples that it was a new tumour. To the best of my knowledge it is not possible to estimate the age of a tumour from biopsy material.

3. Surely if his PSA had been taken between the first time and then again the day or two before starting treatment which was approx 10 weeks they could have seen if there was any increase before the treatment. Yes, that might well have been a valuable indicator and certainly should have been done. Doubling speed is a factor that needs to be taken into account.

4. The points you raise about staging are also puzzling. You refer to the stage T3b diagnosis being based on statistics and I can only think that this might have been estimate by reference to the PARTIN TABLES . T3b is defined as the tumor has spread through the prostatic capsule and the tumor has invaded one or both seminal vesicles and the Partin Tables do not go into this detail. Depending on your husband’s DRE the chance of seminal vesicle invasion according the Tables is up to 25% with up to a 60% chance of extraprostatic extension so it would be unusual to make a definitive statement. The scans, although they are very unreliable, would also seem to support at least a big question mark over the T3b staging.

However, having said that, the combination of a PSA of 93 and a Gleason Score 9 diagnosis would seem to indicate that surgery would not be the best option because of the high likelihood of the disease being systemic (there are cancer cells beyond the gland) even if there is no sign of metastasis (the cancer cells beyond the gland having starting growing)

Which all comes back to your main worry:

5. I would like to know if this has been growing very slowly or not. Although a track record of PSA results may have given a good clue to the answer to this question, it would not have reliable answered it because there are all sorts of reason why PSA levels are high and why they change. BUT given the limited data you have posted here the probabilities are that the tumour is a fast growing, or aggressive one – the profile of the relatively indolent cancers are typified by a PSA below 10 ng/ml, a Gleason Score of 6 and a staging of T1c, none of which apply in your husband’s case.

ADT (Androgen Deprivation Therapy) which is the therapy that your urologist has started would seem to be the best option for your husband right now and, as you will see if you read the stories of the men with similar diagnoses, the disease can be managed successfully for many years with this method.

The best suggestion I can make for you is to gather copies of all relevant reports – you are entitled to these and the only cost in most places is the cost of copying – and take them with you to an oncologist who should be the ‘lead doctor’ for you from now on in. Urologists are by and large surgeons and even the best surgeon will not have the detailed knowledge of cancer that an oncologist has. Prostate cancer is the only cancer where oncologists are not consulted as a matter of course.

Good luck and keep asking questions.

Terry in Australia

Re: Tumour old or new.

Thankyou for your very kind reply Terry. I think I may have the dates mixed up a little. It was in 2003 at the age of 60 when he was first talked out of having a psa test, then again in 2006 at the age of 63. in 2008 he demanded a test and his gp did a dre and said his prostate was enlarged but still no psa test was done but was referred to a urologist where 6 weeks later a psa was done. 3 days later the urologist called my husband at home to say his result was a little high and 3 days later had a biopsy. result gleason 4 + 5. 11 of the 12 samples cancerous. We have seen an oncologist who agrees with his urologist and says no operation or other treatment except zoladex, although his urology nurse suggested radiotherapy. If only they had taken a 2nd psa before treatment then we would have known if the psa had increased in that 10 weeks. Too late now. Its only after reading many stories on this site that I have found out that many men have a psa test between diagnosis and first treatment. Had I have known we would have demanded it.

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