Hi, guy....

I was diagnosed at age 51.... am now 53.

Your PSA score is on the high side, yes, though it can go into the
thousands..... but several of the guys on this list had Gleason 7.... Other
things can affect the PSA level, as well, such as infection and enlargement
of the prostate, so that could be contributing.
Best thing to do now is to research and read as much as you can..... get
Patrick Walsh's *Guide to Surviving Prostate Cancer* .  And take a look at
www.phoenix5.org .  Lots of good information there.

Take a deep breath.  You don't have all the facts yet, so try not to imagine
the worst.  Great strides are being made in research to try and eradicate
Prostate Cancer....

Please keep us posted on your further tests.... and feel free to ask any
questions or vent all you want!

Take care.....
MikeH

*Just got my biopsy result back. Doc didn't say much, is waiting for
*results of a bone scan next week.

Your biopsy will tell much, and bone scan even more. In the mean time,
besides Walsh's book (highly recommended), do web searches on PCa.
Tons of information available. And get as much support from family and
friends as possible, incase you need it after your results come back.
And this group will be here for support as well.

Al
Please be quiet if replying via email,
flames will be deleted promptly.
I won't even read the whole message...

My initial PSA was 189. My 6 core samples all showed about 90%
cancerous! The Gleason score was 3+4=7.
Any ideas on what I should be doing in the mean time? I figure the
chances it has spread are real bad, that is, probably in bones and lymph
system.

By the way, I just turned 50. Clearly I should have had PSA tests
starting years ago, but always was told it was a problem for old people.
---------------
welcome to the club you didn't want to join - the hard way - here my
comments on some of your questions.

Any ideas on what I should be doing in the mean time?

do.  it is starting to shut down your hormones, so as to drop your psa
level to 1 or less.  

beliefs.  whatever you think will work is worth a try.  can't hurt.

---------
What kind of questions should I be asking the doctor?

expect at certain times.  this way, there won't be any surprises.  i
would ask if there are any clinical trials going on that i could enroll
in.

you are probably still in shock and awe.  my recommendation is to learn
as much as prostate cancer as you can.  you need an aggressive treatment
plan and one that give you the best quality of life.  

you are probably right.  with a psa of 189, there is a very good chance
that it is in the lymph system.  may not be in the bones.  only the
tests will show that.  each prostate cancer case is different and
strange things have happened or not happened.

i do wish you the very best and don't be surprised if two things
happened shortly.  your psa should drop below 1 and the nodes in your
prostate will shrink.  all a sign that the lupron is working.  

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."

Administration of Lupron by itself as an initial step is usually
discouraged.  This will produce what is termed "testosterone flare",
an undesirable event which produces a surge of testosterone that can
stimulate prostate cancer growth.  Typically, doctors will
preadminister an antiandrogen, such as Casodex, to prevent the flare
when Lupron is later injected.

During your upcoming meeting, you might ask your doc why he didn't go
the Casodex - Lupron route.  If you don't find his answer
satisfactory, then perhaps it's time to move on to a new doctor.  In
fact, I'm guessing your doc is a urologist since he did the biopsy, it
would be wise to find a good oncologist in your area who specializes
in prostate cancer.  I'd suggest that you at least speak with him to
get a second opinion and probably make him your doc if you conclude
that the PCa is systemic...Best wishes and good health, Ron

Where do you live?  A second opinion would probably be a good idea.
Some get a third opinion.  Realize that a surgeion is most likely to
recommend surgery and a radiologist will most likely recommend
radiation therapy of some kind.  Each have their own set of
alternatives to consider, e.g., for surgery there is the conventional
open incision, either retropubic (from the front) or peritoneal
(between the anus and the testicles - do not know of anyone who has
had that), then there is the laparoscipic surgery, and finally the
newest thing to come along is the Da Vinci robotic procedure.  For
radiation there are again several alternatives, about which I know
very little.  Pay attention to dates when reading about radiation.
There are a lot of procedures that are new in the last few years, so
there may not be a lot out there about them.  There are people here
who can give you very specific information on the various radiation
procedures available today.  
The point is that you have a lot to learn in a short time in order to
make an informed decision.  The fact is that there is not, today, a
"right" answer.  You could choose surgery and be fine, and you could
chose radiation and be fine.  There are side effects to consider, the
incontinence (unfortunately I am an expert on that) and impotence
(yea, that too).  This is a great place to get first hand information.
Use the resources they recommend, e.g., the phoenix5 web site, and ask
as many questions as you like.  No subject is taboo here.
Best of luck to you.
Thank you.
David S.

P.S.  I am 56 and had RRP last August.  PSA was 5, PSA Free 6%, and
Gleason 6.  

Hi, Chris (Assuming this is NoSpam Chris)

With 189 PAS, 90% is not surprising.  But, if all if it is in the capsule,
there is probably no difference between 9% and 90%.  Of course, if it is all
still in the capsule is the $64,000 question.

At this point, you ought to be getting peeved with your doc.  I am not a
touchy, feely kind of guy and I think the only rights you have are life,
liberty, pursuit of happiness, and to keep and bear arms.  But, I'll be
damned if I'd pay a doctor or let an insurance company pay a doctor without
getting full service.  By now, he knows your Gleason Score, your Stage and
your PSA.  He let you know 2 out of three.  You NEED to know so YOU can make
the decisions on treatment.  He's also had his finger up your a.s, so he has
a pretty good idea if the cancer has penetrated the prostate.

So, without consulting you and getting your input or decision based on the
criteria that he hasn't told you, he has decided that you should start
Lupron?  He's probably right, but who's he to dictate it?

I think you are correct about your chances.  Hopefully, you have been
reading up on the subject (I think you indicated you had) and you know that
"spread to bones and lymph" used to be a death sentence.  It is not anymore
because people nowadays, under the right circumstances, can be kept live
long enough to hopefully enjoy the outcome of some very interesting medical
advances.

I think I would be thinking about who you're going to switch to.  This guy
is not a good prostate cancer doctor or not a good communicator.  Right now,
and for the rest of your life, you need both.

What did he feel exactly during the DRE?  What is your stage?  Based on DRE,
Stage, PSA, and Gleason, what does he think about the location(s) and size
of the cancer?  Who does he recommend you go to (it is very unlikely he's
going to be your treating physician if you have extra-gland cancer)?  If it
is all inside the prostate, what is his track record with that type of
operation?  Or is he a surgeon?

Damn.  I thought 50 WAS old people.