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newly diagnosed

I am writing this for my husband.

Went to doctor in November for annual exam. PSA was 4.4. Doc gave Cipro and repeated PSA along with Free PSA abt 23 days later psa was 5.6 and Free psa was 13%. Sent to urologist. Dre was normal. But recommended biopsy. Thanks to information I learned here, I reqsted that my Mike have an MRI which showed 2 lesions suspicious for cancer 4/5.

We were petrified!

Biopy on Feb 12th. After a single valium pill, Mike slept thru the whole thing. LOL. All that worry-time for nothing! But thank goodness.

Got results back last Thursday.

Biopsy done Feb 12, 2016. Mike had been prescribed a Valium and slept thru the whole thing.

Dr says he took 16 cores (3 from lesion1 identified by 3t MRI and 1 from Lesion2 also identified by 3tMRI and 12 random)

Results:

Lesion 1:Adenocarcinoma. Length 0.8, 1.4, 0.8 cm (left medial peripheral zone) Gleason 3 + 4 = 7 involving 25% of the specimen (3 of 3 cores contain cancer) Gleason pattern 4 comprises 10% of the cancer. cancer length is .75 cm.

Lesion 2:Adenocarcinoma. Length 0.7, 0.5 cm (right medial peripheral zone) Gleason 3 + 4 = 7 involving 30% of the specimen (1 of 1 cores contain cancer) Gleason pattern 4 comprises 5% of the cancer. cancer length is .36 cm.

Of the 12 random cores: 5 were positive adenocarcinoma 3+3=6 All involving 5% or less of specimen. All .08 or less in length. variously located: right mid, right lat base, let apex, left lat apex, right lat apex.

1 atypical small acinar proliferation suspicious for but not diagnostic of malignancy in left lat mid. 0.8 in length-benign

5 cores benign

staging: T1c

Bostwick pathology

Consultation with urologist March 4th.

No matter how prepared you think you are, there's nothing like hearing the words, "cancer". We were really shook up for several days, but have calmed down now and are gathering information for decision on treatment. Leaning towards Di Vinci prostatectomy. Want the best opportunity for eradication and recovery.

Please offer feedback on treatment and prognosis given this report.

Questions:

- When we plug info into nomograms, do we count the 3 cores in lesion #1 as 3 cores or as 1?

-For purposes of staging, since cancer is found on both sides of the prostate, why is the stage t1c, instead of t2c? (Some sites say that a single tumor must extend into both sides of the prostate)

-With these numbers should we expect the cancer to be confined to the prostate?

-What are the most important questions we should ask the doctor at consultation?

-Since Bostwick was the pathologist that reported the biopsy and Bostwick is a recommended lab, is it still important to get a 2nd opinion?

-Should his treatment be influenced by the fact that he is African American and black men tend to have worse outcomes?

Thanks in advance for any advice,
Mike's Lady

Mike's e-mail address is: dbmcwhite@yahoo.com

Re: newly diagnosed

Hi Mike's lady and welcome to the forum.

My complements on your detailed post, however you did not tell us Mike's age and any existing co-morbidity. Please do so and I will be happy to answer your questions.

best wishes
john

Re: newly diagnosed

Thank you for you reply, John.
Mike is 59 years old. Other than pc, his only other health problem is well-managed high blood pressure. He is VERY active at work and and is also physical in a side-business he runs. Weight is excellent- no fat/all muscle! (Wish I could say the same for me).

Re: newly diagnosed

Questions: Reply below questions.

- When we plug info into nomograms, do we count the 3 cores in lesion #1 as 3 cores or as 1?

Each core taken is counted as one irrespective of sampling area.

-For purposes of staging, since cancer is found on both sides of the prostate, why is the stage t1c, instead of t2c? (Some sites say that a single tumor must extend into both sides of the prostate)

I agree that Mike's samples suggest a staging of T2.

-With these numbers should we expect the cancer to be confined to the prostate?

It is still entirely possible that such is still the case.

-What are the most important questions we should ask the doctor at consultation?

The likelihood of extra capsular penetration (spread outside of prostate)? Is Mike a good candidate for RP? What are the possible post operative complications and what can be done about them, should they occur. What is our plan b should Mike have positive surgical margins? Would radiation perhaps be a better option for Mike?


-Since Bostwick was the pathologist that reported the biopsy and Bostwick is a recommended lab, is it still important to get a 2nd opinion?

Only if you are doubting the report validity.

-Should his treatment be influenced by the fact that he is African American and black men tend to have worse outcomes?

You have done your homework. Yes, statistics do indicate that black men are more likely to progress with PCa. Thus I think active treatment is warranted for Mike.


Now for the good news. Statistics suggest that Mike should do very well disease progression wise with an active treatment. Consider if possible impotence and urinary incontinence as a result of RP, would be issues for Mike?

Do let us know how the uro consultation goes on the 4th?

best wishes
john

Re: newly diagnosed

Just to add my 2 cents worth. My PSA had climbed to 4.3 as of late last year so primary care physician referred me to urologist at UC Davis (fantastic care).

For background, I am 52 years old, had no traditional signs of prostate issues. Pretty healthy, run 3-4 miles/day and bike 15-16 miles every other day.

Biopsy confirmed cancer with Gleason score of 3+4. Underwent MRI and scheduled surgery. MRI indicated the left side nerve bundle was not involved, but right side could not be excluded. Went into surgery knowing reasonable chance that at least 1 nerve bundle would have to be removed.

I had surgery 3/11. Everything went as planned. Pathology reports:

PROSTATE SIZE WEIGHT 61.8 GRAMS SIZE 4.7 X 4.7 X 4.4 CM
HISTOLOGIC TYPE ADENOCARCINOMA, ACINAR NOS,HISTOLOGIC GRADE
PRIMARY PATTERN GRADE 3
SECONDARY PATTERN GRADE 4
TERTIARY PATTERN NOT APPLICABLE
TOTAL GLEASON SCORE 7
TUMOR QUANTITATION
PERCENTAGE OF PROSTATE
INVOLVED BY TUMOR
BETWEEN 5-10%
EXTRAPROSTATIC EXTENSION NOT IDENTIFIED
SEMINAL VESICLE INVASION NOT IDENTIFIED
MARGINS UNINVOLVED BY INVASIVE CARCINOMA
TREATMENT EFFECT ON CARCINOMA NOT IDENTIFIED
LYMPHVASCULAR INVASION INDETERMINATE
PERINEURAL INVASION PRESENT
PATHOLOGIC STAGING
PRIMARY TUMOR (pT) pT2c: BILATERAL DISEASE
REGIONAL LYMPH NODES pN0: NO REGIONAL LYMPH NODE METASTASIS
NUMBER OF NODES EXAMINED 6
NUMBER OF NODES INVOLVED 0

Post op, minimal pain, 1 night in hospital. The catheter was the biggest (mental issue). Once I overcame the mental part it was not that big of a deal (but certainly happy to have it removed).

I did swell up, it was like carrying a very large grapefruit between my legs. That started about 4 days post op, went away about 12 days post op.

Now dealing with incontinence. Not too difficult until about 2PM or if on my feet for a long period of time. I can make it through the night with hardly any leakage as I lay on my back.

I worked from home for 2 weeks and this week returned to the office.

I've had some erectile response, not a full erection but showering with my wife the other day I got 1/2 way to full erection. I don't know if that means anything, I'm forever hopeful!

Just thought I'd share my experience in hopes that it might ease others concerns and/or worries.

Prayers for all with similar issues. We'll get through this together.

Re: newly diagnosed - Adam

Congrats Adam on your good results! Sounds like you are well on your way to as good as it can get. Not many are so fortunate. You caught it early enough that you will hopefully be able to forget the whole episode someday. It is always a catch -22 situation but I am convinced early detection and treatment is the answer even though it often means many more years of dealing with the side effects - the key words being many more years! Quality of life is important but there is a lot more to quality of life than just the sexual part of it. It is an important part also but not worth dying for. Jon.

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