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Medical Forum / Diseases and Disorders / Prostate Cancer / August 2004Positive Biopsy - 2nd Time
Last March I posted that I had a 16 needle biopsy conducted at the Wake Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year earlier) with a free PSA of only 9 percent. That biopsy found no cancer in any of the core samples. Between then and the 18th of Aug of this year (some 17 months or so), I've had at least 5 PSA checks ranging from 3.4 to 3.8 and two free PSA checks, one of which was 18 percent free, and the other was 16.3 percent free. My urologist upon seeing the July results of 3.4 on my total PSA and a free PSA of 16.3 percent felt it prudent to do another biopsy. Again, he took 16 core tissue samples and the results came in Friday indicating there was what he referred to as a very low volume cancer detected in only 1 of the 16 core tissue samples. The Gleason score was rated at a 6, but my doctor said the amount of tissue in that sample was so small that they could only really grade one sample and just extrapolated that rating once again to come up with a meaningful Gleason score. I assume the staging was established as a T1c since the cancer was detected during biopsy as a result of an elevated PSA. My uro seemed to indicated that the prognosis was very good and said I had quite a few options. The two primary ones that seemed to be appealing to me are radical surgery and seed implantation. I asked about both seed implantation plus external beam radiation but the doctor seemed to thing that with such a small tumor that it might be an overkill and not necessary. In going into the Partin tables, it seems as those there is a high probability that the cancer is contained within the prostate. My uro even went so far as to suggest that because of the grade and small size of the tumor, that a "wait and see" approach might be worth considering. However, I'm not too keen on that. He referred me to a program at John Hopkins called "Expectant Management" to educate myself which is available at http://urology.jhu.edu/prostate/advice1.php if anyone is interested. Again, I want the cancer out of my body as soon as reasonably possible after due consideration. He did show some concern about the size of my prostate (somewhat enlarged) and the fact that there is some obstruction/problem in urination (ie. he ran a test to see the flow of my urine) and that was marginal. His concern is that with seed implantation there is some initial constriction/swelling and if I already have a problem in this area it may present some unwanted problems/complications after implantation. Right now he has me on Flomax to relax the muscles for 2 weeks and then he'll run the some urine flow/strength test again to see if my urination strength improves and I completely void the bladder. Today, I left some urine in the bladder which I gather that was not encouraging. I am scheduled to talk with a radiation expert on Sep 6 (about seed implants) and will know more about the urination constriction problem on the 9th of Sep. My uro says we are not in any hurry because of the smallness of the cancer and the reasonably low grade, but it seems as though removal of the prostate will be one option that I'll weigh very heavily. I don't like the idea of radical surgery (who does), but I am attracted to totally removing the cancer and the source if there is a high probability that it has not migrated out of the prostate. This was the beginning of a new and important process and I'll have to digest what we discussed and come up with some more questions as time goes on. By nature, I am an impulsive and impatient individual, but I'll have to watch myself and give this some time and serious consideration before "leaping" into a decision. I do intend to get a hard copy of the biopsy report from the doctor when I see him again on the 9th of Sep. So, it looks as though I will be bombarding some of you "old hands" in the very near future with tips, advice and support. This is something I want to get right the first time. Thanks for your time. All suggestions and advice welcome. Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. Well, you are one lucky man to have it caught this early!!! My recommendation is to talk to Michael Hagan at MCV Hospital in Richmond, VA It's a few hours trip for you depending on where you live in NC but you'd be seeing one of the best brachytherapy experts in the nation. Write to me and I'll give you the email addy for him and phone number for his office, etc. Bev > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. Road RUnner You have found the right place for support, advice and first/second hand knowledge. I do not exagerate when I say that this NG and the regular supporters here in, made my journey through RRP much easier and less freightening. I actuall had a chance to observe that effect as my hospital roommate had the same surgery on the same day with the same doctor. He however did not have the advantage of this NG and his journey was easied by this NG second hand through me. Someone here says "Knowledge is power" you can gain both here. Also check out www.pheonix5.com. Good luck with your process, we are here for you Mike S Roy, Your experience is amazingly similar to mine and at almost the exact same point in the "process". My PSA scores were slightly higher, but still not extreme (5.1 max), same enlarged prostate, same flow problems, a 12 core with one positive. The advice from several Uros and two radio-oncolgists pretty much the same. (One interesting note: One of the radio-oncolgists said I should NOT have radiation therapy, but should have surgery!) Currently, I seem to be on course to have surgery next month. I'm not really very excited by the idea, but, like you, I don't want to "live with" cancer in my body so....... This is really a much harder decision than if we had PSA's of 8 or 10, and/or multiple biopsy hits, or palpable tumors. But, to me, it's like the old joke: "You can't be just a 'little bit' pregnant!". As far as I'm concerned, I HAVE CANCER!, and I just can't let that stay. As far as the "Surgery or Radiation" choice goes, I have no idea whether I've made the right choice or not...and I doubt that I ever will know. As for now, I'm trying to get my head adjusted to the coming "torments" of incontinence, impotence, and whatever else. I wish I were just a little stronger, because the whole damn thing is just scary as Hell! (And this isn't the first time I've had to face surgery....two hernia repairs, an 'open' kidney stone removal, and a replaced knee. But it IS the first time I've faced surgery where the outcome and side-effects were so undeterminable) Sorry for the rant....I just don't really have anywhere else to get this OUT! John >Last March I posted that I had a 16 needle biopsy conducted at the Wake >Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > >Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. jp "I may be old, but I know what I like!" Hello Roy...Two things I'd suggest for your consideration at this time. Both items will help you obtain a more accurate diagnosis, and, in turn, better enable you to pick the best treatment method for your condition. First, if you can travel, you may want to consider having a color-doppler TRUSP performed by one of the following "artists" (Dr. Shinohara actually performs a spectroscopic MRI). In cases were biopsy initally fails to detect PCa, these more sensitive methods typically allow for a more complete inspection of the prostate. Duke K. Bahn MD Medical Director, Department of Radiology Prostate Institute of America Community Memorial Hospital of San Buenaventura 168 N. Brent Street, Suite 402 Ventura, CA 93003 888-234-0004 805-585-3082 Fax: 805-641-3965 dkbahn@cmhhospital.org Fred Lee, MD Crittenton Hospital 1135 W University Dr, #420 Rochester, MI 48307 (248)650-4699 Katsuto Shinohara MD 1600 Divisadero Street, 3rd floor UCSF San Francisco, CA 94115 Tel:415-476-1611 Fax:415-476-8849 kshinohara@urol.ucsf.edu Assistant, Mary, at 415 353 9877 If they see something during their examination, they will biopsy the questionable area (targeted vs. random biopsy sampling). A second suggestion would be to have your biopsy samples (or the samples collected by any of the above doctors) read by a pathologist who specializes in PCa. It is relatively difficult for a pathologist to grade PCa. There's not one big solid tumor to examine; rather PCa is typically a diffuse, multifocal tumor. It becomes even more difficult when all you have to examine are small biopsy fragments. That's one of the reasons that an expert PCa pathologist (there are roughly a dozen or so around the US, see http://www.prostate-help.org/cagleex.htm for a listing) should examine PCa biopsy slides. Because many people don't have their Gleason Score determined by one of these experts, there is a documented "under-grading" of Gleason scores from PCa biopsy specimens (to be accurate, I should say that there is both over- and under-grading, but, on average, there is more under-grading). Said differently, the GS from the pathologic specimen obtained after RP frequently comes in higher than the GS determined from the biopsy specimen. This means that sometimes people pick the wrong treatment method because their tumor GS was under-graded. It would probably be worth having your biopsy slides reread by an expert since so much hinges upon the GS. Insurance often covers this re-reading. BTW, if you are taking any hormonal medications (Propecia, for example), it is important to let the pathologist know this as there is some data to suggest that changes in hormonal levels can affect Gleason grading....Best wishes and good health, Ron > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. Roy, Tough call. There's a real possibility (I can't calculate the odds, I'm not a doctor) that you could get away with doing nothing. In case no one has suggested it, have you tried to estimate your expected lifespan without PCa as a factor? This is something many people probably avoid. If the normal lifespan of the men in your family is 15 years beyond your current age, then that low-grade PCa might get you if you don't do something in the next few years. But if the normal lifespan of the men in your family is less than your age now, maybe you should just get the flow problem treated and enjoy life. Whatever you do, don't rush your decision. jimhoney standard RRP age 52, cured, no significant aftereffects life expectancy 90 or so I was in a similar situation last December. Slightly more cancer in my biopsy samples than you have but still pretty minimal. I, too, didn't think much of the "watchful waiting" option, although some advised me to go that route. I wound up getting a seed implant from Michael Hagan at MCV in Richmond (the doctor Beverly referred you to). There is some debate as to whether it is advisable to get EBRT in addition to SI. Dr. Hagan felt that the EBRT would give me a minimal benefit in exchange for the possibility of some significant side effects, so I went with his recommendation. Don Cooley, something of an authority on PCa (although not a doctor) who runs a good website with a discussion forum: http://www.prostate-help.net/ advocates ALWAYS combining SI and EBRT. That said, surgery is certainly an option for you. From what little I know about this disease, I would say you have an excellent chance for a cure no matter what option you choose. The most important thing you can do, though, is choose the best possible doctor you can find for whatever procedure you decide on. Best wishes to you. > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. Hi Ron, It sure looks like you are doing a good job of studying the situation and have the facts you need to move forward. You've apparently nailed it down to two choices: Seeds, and RRP. Both good choices in my opinion. One deciding factor might be the side affects. I had seeds and don't regret the choice. I also had EBRT but that's not germane to you because it's contained. It wasn't in my case (lymph node involvement). Also, since I live on the Left Coast, my choices of doctors won't be of much use to you either. For what it's worth, I too have a retention problem but have for a long time. It did get worse following the seeds but not bad and almost like turning off a switch, improved greatly after two months (and five days) :-) Still on Flowmax though. Each time I try to wean myself off of it, I regret it. Will try again in about two weeks or so. Good luck, Larry (age 61 and excellent health otherwise) er, ROY! Sorry! Roy, In addition to the fine advice already posted, I would add that if you have not read Dr. Patrick Walsh's Guide to Surviving Prostate Cancer that you get a copy. It is excellent, in my opinion, and helped me when I was trying to decide what treatment to pursue. BTW, I chose RP...done May 18...am doing great. Today was the first day I decided to try workng all day without a pad. Joy! Now, I wonder about working out this evening???? Good luck to you, whatever you decide. Sounds like a case of getting it early.  SignatureJerryW jweindel at flash dot net > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. Roy, It sounds like you're very much on top of this whole situation. You've kept a close eye on the indicators and caught it early. You're consulting with more than one doctor. I am no doctor and my advice isn't worth what you can get from the pros. But from what I have read, if you do choose treatment over watchful waiting, all the treatments have excellent outcomes when applied at your early stage of disease. If that is true, you might be able to choose on the basis of what the side effects are as much as anything else. Which side effects seem most threatening to you? Which sets of possible complications of treatment seem to you most likely to happen, and most dangerous if they do? All of the treatments can have nasty side effects. Whether you get them or not depends in part on the skill of your surgeon or radiation oncologist (and yes, even with radiation there is apparently some skill involved), and on the luck of the draw. So you want to evaluate the doctors that you see as well as the treatments that they offer. Best of luck to you whatever you decide to do. Alan Now I'm confused and not quite as confident as before. When I first talked to my doctor on Monday, I assumed after we we over his understanding of the pathology report for the biopsy that I was lucky in that the report reflected a very small tumor and it was low grade. I guess thats still true given the fact that out of 16 core tissue samples they only found cancer in one core sample which was less than 1% of the sample. Apparently the amount of cancer found was so small that it was hard to estimate the Glease Grade. In fact the lab indicated that it was at least a Gleason 3. And that alone gives me some concern since the words "at least" implies it could be worse. On the other hand, finding so little cancer tissue should be a good sign. If you recall, my first biopsy in toot place in March of 2003 (again 16 core tissue samples taken) and since the inital PSA of 4.02 that started this mess, the subsequent 5 or so PSA's have varied from a low 0f 3.4 to 3.83. The reason for the second biopsy was the concern of the 16 and 18% Free PSA. So, I have taken Bill's advice from a previous reponse and asked Wake Forest to send the tissue slide to Bostwich Lab in Richmond, VA for a second opinion. With such a small tissue sample in the 1 core, I don't know if they can be any more definitive. And I certainly don't want to go through another biopsy fishing for more cancer unless absolutely necessary. That would make 3. At any rate, I am typing in below the imporant part of the pathology report I received todaay and if any of you think I am off base or can shed some light on what it really says, let me know. Significant parts of the report follow: **************************************************************************** ******************************************************** FINAL PATHOLOGIC DIAGNOSIS MICROSCOPIC EXAMINATION AND DIAGNOSIS A. Needle Biopsies, Right Side of Prostate: Focal adenocarcinoma (see comment) B. Needle Biopsies, Left Side of Prostate: Benign prostate tissue showing areas of atrophy and areas of acute and chronic inflamation. COMMENT (Ref A. Above) The tumor present in specimen A is seen focally in only one core in the firstlievel on the A1 slide. It represents well less than 1% of the total amount of prostate tissue available for examination. The focus of tumor appears to be at least Gleason grade 3, but too little tumore is present to give meaningful grading/scoring. GROSS DESCRIPTION: A. Eight needle core biiopsies ranging from 0.4 to 2.0 cm are wrapped and entirely submitted in A1-2. B. Eight needle core biopsies ranging from 1.5 to 2.0 cm are wrapped and entirely submitted in B1. **************************************************************************** ******************************************************** I have another meeting with my doctor in about 2 weeks. I hope my original optimism was warranted? I should also note that the fact that I apparently have serious inflamation problems on the left side of the prostate gives some concern for potential problems if I go the seed implantion route? Roy in Winston-Salem ----- Original Message ----- From: "Road Runner" <rbensonjr@triad.rr.com> Newsgroups: alt.support.cancer.prostate Sent: Tuesday, August 24, 2004 4:59 AM Subject: Positive Biopsy - 2nd Time > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. Here's 2 cents from someone who, remember, is not a doc. First, a recent study indicates that treating PC "later" (like after watchful waiting and the cancer grows) has its problems in that as the cancer grows it may become more aggressive (and thus it may spread and be harder to cure). So there's a vote for getting it out now. Second, even when a so-called "small" amount of cancer shows up in the biopsy, it is just about always the case that when the prostate is removed and examined, there is more cancer there than the biopsy indicated -- PC is (as someone else in this thread mentioned) multi-focal (occurs in multiple locations at the same time) and the biopsy is literally hit-or-miss -- it doesn't "see" all the cancer as the cores have a very small diameter. Another vote: my biopsy was also graded T1c and the patholoogic grade after examining the removed prostate was T2a -- yours is probably similar or the same -- and my doc said after the surgery that he has never seen anyone (he's seen 1000s of PC patients) with that pathology ever have a recurrence after RRP. This is, to me, a ringing endorsement to get it out now even if it's T1c -- but that is just my opinion. By the way, you can have your biopsy slides sent to Johns Hopkins for a 2nd opinion -- they have one of the world's foremost PC biopsy pathologist, I believe his name is Epstein (see Walsh's book for his name), and he can read your slides. Thank you for you reply. I agree with you that although they found less than 1% on only 1 of 16 core tissue samples, the proability that more cancer exists is real. Based on several great replies, I have already asked that the biopsy slide be sent to Bostwick Lab in Richmond. Again, thanks for the advice. Roy > Here's 2 cents from someone who, remember, is not a doc. First, a > recent study indicates that treating PC "later" (like after watchful [quoted text clipped - 18 lines] > pathologist, I believe his name is Epstein (see Walsh's book for his > name), and he can read your slides. > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. You are in fact a very good candidate for watchful waiting, or as it is now called expectant management. The only way to get the cancer out is to take it out with surgery. Radiation, either external or internal with seeds, may possibly leave some behind. But given the very early stage, and your age, surgery would seem to be unnecesarily aggressive. So either waiting to see what happens with regular followups or radiation of some sort would seem more appropriate. In your circumstances I would prefer external radiation to seeds if I had decided to go the radiation route. The problem is that it is suspected that many cancers discovered early by PSA testing would never bother the patient during his lifetime. There is a good chance that a cancer like yours could take 20-30 years to get somewhere or perhaps it never would. Unfortunately, no one knows what the true odds are of that happening, so whatever you do, you are making a bet with mortality. I was about your age when I was diagnosed with a Gleason 7 tumor, found in 4 of 6 samples on one side, so I didn't have as many choices. I chose surgery. Had I had a low volume Gleason 6 tumor, I'm not sure what I would have done. Good luck whatgever you decide. You're probably beginning to suffer from information overload at this point. I remember that well. The more I read, heard, and learned about this disease and the treatment options, the more confused I became--almost to the point of being unable to make a decision. My advice is to take your time. Fortunately, you have plenty of time to take, given the small amount of cancer that has been found. Eventually, you will come to a decision that you are comfortable with. That said, I want to disagree slightly with Leonard Evans' otherwise excellent advice. He states that "The only way to get the cancer out is to take it out with surgery. Radiation, either external or internal with seeds, may possibly leave some behind." I would amend that to "the only way to BE FAIRLY CERTAIN IMMEDIATELY that you have gotten all the cancer is to take it out with surgery." With surgery, you get a pathology report indicating whether or not the cancer has progressed beyond the prostate. (Even so, I recall one individual--in this NG, I believe--reporting a recurrence despite the fact that his pathology report indicated that the cancer had been contained within the prostate. An inept surgeon CAN leave some behind.) With radiation, you wait. But the recurrence rates for radiation and surgery are almost identical, so there would seem to be no greater chance of leaving some cancer behind with radiation than there is with surgery--IF the radiation is administered by a competent oncologist, preferably an "artist." Given the small amount of cancer found by your biopsy (and assuming that the reading is confirmed by Bostwick), I would say the chances of leaving cancer behind are almost non-existent in your case. Unfortunately, there are no iron-clad guarantees with this disease. As I noted in an earlier posting, I had seeds implanted on May 7. It will be probably a year before I have a good indication as to whether or not the seeding has been effective. In the meantime, I am trying to live my life as fully as possible. This afternoon, I leave for Peru for a hike with a good friend and two of my sons on the Inca Trail to the ruins at Machu Picchu. In some ways, PCa changes your life for the better by reminding you that it will end one day, in one way or another, and that what's truly important is to focus on the people you love and the things you love to do. Ron Carter > Last March I posted that I had a 16 needle biopsy conducted at the Wake > Forest Baptist Hospital due to an elevated PSA of 4.02 (up from 3.3 a year [quoted text clipped - 63 lines] > > Roy in NC (age 68 - 69 in Jan) and in excellent health otherwise. > You're probably beginning to suffer from information overload at this > point. I remember that well. The more I read, heard, and learned [quoted text clipped - 23 lines] > I would say the chances of leaving cancer behind are almost > non-existent in your case. I don't disagree substantially with what you say, but I think it is a bit more complicated. First, the figures on recurrence only apply for up to about 10 years. No one knows if with a longer time horizon, the recurrence rates will remain about the same. The reason is that the modern forms of radiation have not been in use long enough for large scale studies to have been done. It would be unfair to include earlier radiation data because the methods used at that time weren't very effective. It is not unreasonable to believe that in the long term, the results will be similar for radiation and surgery, in cases like roy's, but we just don't know that for sure now. Second, the issue is really more psychological than medical. He wanted the cancer out. I understand that feeling because it influenced me. The way to do that is to physically remove it. Then, provided the post-surgical pathology report confirms the initial diagnosis, you can be as certain as you can be given current medical knowledge that "it is out". With radiation, it takes some time for the cancer cells to die off, up to two years in some cases, so you don't ever have the feeling you have got it out. As you note, even with the best possible post-surgical pathology report, the cancer can recur. That can happen with any form of treatment. Some cells capable of surviving outside the prostate might have escaped before the treatment began, and that would not be detectable by a pathologist. In most cases where prostate cancer has been detected early and where PSA and Gleason scores are not too high, this is not very likely, but it can happen. So that psychological feeling would be an illusion, but it is hard to be completely likely. One has the feeling that as long as some of the cancer is still there, it can metastasize, so waiting the time for the radiation to work its wonders can be trying. Purely from the figures, it may not actually make much difference, but it can affect one's mental attitude. Finally, it should be noted that many cases of prostate cancer will never bother the patient during his lifetime and should not be treated at all. This is particularly true of low volume Gleason 6 or below cancers meeting certain other criteria. Unfortunately, there aren't good figures on just exactly what the probability of such a cancer spreading is, but some studies have shown it is low enough that expectant management is a reasonable treatment choice for such men in the late sixties or older. But this requires even more faith in statistics and may not be tolerable for someone who "just wants it out". > Unfortunately, there are no iron-clad guarantees with this disease. As > I noted in an earlier posting, I had seeds implanted on May 7. It [quoted text clipped - 8 lines] > > Ron Carter I know some people swear by seeds, but I've never understood their attraction. Had I chosen radiation, which was a real possibility at the time, I would have opted for external radiation. The idea of carrying radioactive seeds in my prostate I find particularly unappealing. But, with all the uncertainties, there is no one solution to dealing with this disease, so each of us has to make his own choice. > I don't disagree substantially with what you say, but I think it is a > bit more complicated. [quoted text clipped - 8 lines] > similar for radiation and surgery, in cases like roy's, but we just > don't know that for sure now. I did a search on the following terms in PubMed: prostate cancer "15 year" radiation I also substituted 20 for 15 and got one hit. There are some results. As always, they are a mix of apples and organges. Some of them are showing recurrence rates that are a lot higher than I would like to have seen (being a radiation patient myself). I don't know whether the techniques they are measuring are comparable to what is being done today or not. It is my understanding that most radiation oncologists are using heavier doses of radiation today than was done in the past. But you don't get enough information in an abstract alone to know exactly how the patient population was treated, or even whether the researchers know. So, while information is now available for longer than 10 years, your general point about the difficulty of interpreting this information still seems to apply. Alan Just minutes after posting, I got a call from the doc about my 3-month post-implant PSA. It's 0.4. That's down from 4.6 at the time of seeding. Still too early to be meaningful, but hey, it's going in the right direction! Hey Ron: Good for you and I'm glad it looks like its going in the right direction. As you know, I am torn (and still mulling it over) about radical surgery and seed implantation. My only concern about seed implantation that complicates my decision is the inflammation and apparent obstruction in my urinary track. I've read a lot of horror stories about the immediate swelling from the implantation of seeds and when you consider that I got some problems in that area, it sends a little chill down my spine. As I've indicated before, my uro has had me on Floxmax since Monday night, and I've not frankly noticed a significant increase in the flow or reduced times going to the "john" at night. And, this seems to be the medication that would give you to help with the restriction problem after seed implant. So, if its not working now, I have my doubts about after seed implantation if that's the way I finally decide to go. Enough for me. Its great your going in the right direction and I'm sure it will get better. Roy in Winston-Salem (still muddling through the options) > Just minutes after posting, I got a call from the doc about my 3-month > post-implant PSA. It's 0.4. That's down from 4.6 at the time of > seeding. Still too early to be meaningful, but hey, it's going in the > right direction! |
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