Neighbor with PCa

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ButtercupsDad@dog.net - 26 May 2004 13:49 GMT

Had another impromptu neighborhood prostate cancer support group
meeting last night. My neighbor who was recently diagnosed said his
Gleason was 8. I asked him if he had made a treatment decision yet,
and he said that his doctor told him to come back in a month. He
obvisously did not understand what the Gleason meant. I just
encouraged him to get back to his urologist A.S.A.P. and make a
decision on which treatment to pursue.

I also asked him about getting a second opinion. He said that he
did ask his doctor about that, but this is a group practice, 3 doc's,
and his doctor told him that they all reviewed the case and agreed on
how he should be treated (sounded like LRP). Does that wash?

For those so inclined, please say a prayer for him. His wife died
over ten years ago and he lives alone. I told him to let me know if
there was anything I could do to help.

Thank you.
David S.

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olfart - 26 May 2004 14:15 GMT

> Had another impromptu neighborhood prostate cancer support group
> meeting last night. My neighbor who was recently diagnosed said his
[quoted text clipped - 15 lines]
> Thank you.
> David S.

Hi David;
The high Gleason is a good reason to get a second opinion. Just as important
a factor would be his age and general health as far as choosing a treatment
option. As far as I'm concerned another Doc in a group practice is not a
reliable second opinion if the Drs are all URO's or all RAD ONC's. Also a
second reading of the slides should be made to confirm the Gleason.
I got my second opinion from an Oncologist MD and I feel very comfortable
with it. He had no reason to "push" one method of treatment over another.
Your neighbor might want to persue this route.
I wish him the best..and yes I put a prayer in the big inbox in the sky for
him. Keep us posted.
Age - 69
8/12/02 - PSA 3.7
10/13/03 - PSA 4.69
11/11/03 - PSA 4.8
11/18/03 - Biopsy - 10 cores
one core-25% of core-Gleason 4+4=8
all other cores benign tissue
12/10/03 - Consult - Oncologist
12/16/03 - Consult - Radiation Oncologist
Treatment Plan - Northeast Ga Cancer Center
HT - started 12/17/03 - Eulixen & Lupron (2nd 4 mo Lupron-4/26)
2/10/04 - Started - Flowmax and Megastrol
Radiation - IMRT to begin 3/30/04 - 42 treatments

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Leonard Evens - 26 May 2004 15:56 GMT

> Had another impromptu neighborhood prostate cancer support group
> meeting last night. My neighbor who was recently diagnosed said his
[quoted text clipped - 8 lines]
> and his doctor told him that they all reviewed the case and agreed on
> how he should be treated (sounded like LRP). Does that wash?

There certainly should be a check on the Gleason score. If it is
really a 7, that could make a big difference in the treatment decision,
and Gleason scoring involves some subjective judgements.

It seems unusual to suggest RP (or any kind) for a Gleason 8 case,
particularly in an older man. How old is he?

> For those so inclined, please say a prayer for him. His wife died
> over ten years ago and he lives alone. I told him to let me know if
> there was anything I could do to help.
>
> Thank you.
> David S.

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David S. - 27 May 2004 01:53 GMT

Hi Leonard:
I did not ask his age, but he said he retired in 1992. He looks to be a
young 70 or so. He walks his dog, Cosmo, and dates a lady that lives about
a two hour drive from here. This morning he left at 6:00 A.M. to drive an
hour and a half to some town to get his oil changed (no I do not know, maybe
they have really good coffee). So he appears to be in good shape. He is
the man who helped my wife when she fell and broke her leg. I do not really
know him that well, but some of his comments are scary. I think he said his
PSA was 14, but he spoke about a friend of his whose PSA was 56. His
comment was that he "did not think it could go that high". See what I mean?
Hope you are doing well.
Thank you.
David S.

> > Had another impromptu neighborhood prostate cancer support group
> > meeting last night. My neighbor who was recently diagnosed said his
[quoted text clipped - 22 lines]
> > Thank you.
> > David S.

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Steve Kramer - 26 May 2004 17:35 GMT

I once heard a joke about that.

A second opinion comes from a source other than the first. As I recally,
your neighbor is older. That, combined with a Gleason of 8, and other
factors, may make him an LRP risk. I would get a second opinion from
another group.

SRK

Signature

Prostate Cancer Survivor (so far), not a doctor
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000
PSA .1 .1 .1 .27 .37 .75
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32
Erection 05/12/2003 @ 48
HTbegins 07/21/2003 @ 48
PSA .07 .05
Lupron 7/03, 8/03, 12/03, 4/04

> Had another impromptu neighborhood prostate cancer support group
> meeting last night. My neighbor who was recently diagnosed said his
[quoted text clipped - 15 lines]
> Thank you.
> David S.

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David S. - 27 May 2004 01:57 GMT

I did suggest that he get another pathologist to review the biopsy
slides, but he seemed to be trustful of this doctor. Hard to get in the
middle of that.
Next time I see him I will again suggest that he ask for a second read
on the slides, and I will try to suggest, without scaring him, that he ask
his doctor about the LRP with a Gleason that high.
Thank you all for the input. I feel like I want to help this man, but
do not want to go too far. I think his son lives in another state, so there
is no one close by for him.
David S.

> I once heard a joke about that.
>
[quoted text clipped - 24 lines]
> > Thank you.
> > David S.

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Alan Meyer - 28 May 2004 04:25 GMT

> Had another impromptu neighborhood prostate cancer support group
> meeting last night. My neighbor who was recently diagnosed said his
[quoted text clipped - 15 lines]
> Thank you.
> David S.

I would suggest to him a consultation with a radiation
oncologist.

One problem with Gleason 8 is that the likelihood of
the cancer having already spread beyond the prostate
capsule is high. External beam radiation can treat that
as long as it is still in the vicinity of the prostate - which
it will be if he's caught it early enough. Surgery would
be more problematic in such a case. At any rate, that's
what I've heard from radiation oncologists.

I'm no expert on this, but it would be a good idea
to talk to a doctor who is.

Alan

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