Which way to go?

Thread view:

Enable EMail Alerts

Start New Thread

Thread rating:

anycall - 14 Jan 2005 15:38 GMT

I would appreciate any advice/comments

57 years old
large prostate 100g plus
PSA over last five years between 5 and 10 (currently 9)
catheter in place following cyscoscopy and biopsy last week
first uro says have TURP but may have to abort during operation and do a
simple prostatectomy
found out last night that biospsy shows High Grade PIN- I don't know much
about this yet but from what I have read so far I feel like "dead man
walking"!
second uro says he can do greenlight laser with no open surgery and will
take further biopsies during operation,
second uro says there is a small risk of prostate absorbing "operating
fluid" if I had to have the prostatectomy and says he has done plenty of
laser treatments on glands of upto 270g

Questions:

TURP or laser?
Significance of High Grade PIN on choice of TURP or Laser?
Anything else?

Many thanks

Reply to this Message

Stephen Jordan - 14 Jan 2005 17:26 GMT

> 57 years old
> large prostate 100g plus
[quoted text clipped - 18 lines]
>
> Many thanks

This was also posted on science.med.prostate.cancer.

My response:

(1) Was the biopsy performed solely on the basis of the PSA?
(2) Is there a PSA test history (dates and scores) by which one can
judge the doubling time/velocity of changes in scores?
(3) If he has had PSA scores between 5 and 10 for five years, he has
been beyond the recommended score (4.0 until recently; now 2.5) for that
long. What advice has he had for that period??
(4) Are there other symptoms, such as urinary difficulty?
(5) Did the uro check for other causes of the PSA score such as
infection, inflammation, BPH (benign prostate hyperplasia)? The large
prostate may be a sign of the latter, and the operative word is "benign."
(6) Have any other staging or diagnostic tests been done? Examples would
be PAP (prostatic acid phosphatase), CGA (chromagranin A), bcl-2, etc?
(7) Was a DRE performed? If so, what result?

*It is absolutely vital that the biopsy result be validated by a
specialist laboratory.*

Though not a medical practitioner, I recommend that NO treatment be
undertaken without further testing as above. There is no hurry.
Prostatic intraepithelial neoplasia (PIN) is *possibly* a precursor of
PCa, and the time before development of the latter is as much as five
years. See the website of the Prostate Cancer Research Institute at
http://prostate-cancer.org/index.html

On that website, a discussion of PIN is found at
http://www.prostate-cancer.org/education/preclin/pin.html

I strongly recommend that "anycall" consult a medical oncologist. Right
now, his only advice seems to be coming from a uro, who is a surgeon and
naturally advocates a surgical solution (to a problem that may not even
exist).

Please let us know how it goes.

Regards,

Steve J
__
"Never give in--never, never, never, never, in nothing great or small,
large or petty, never give in except to convictions of honour and good
sense. Never yield to force; never yield to the apparently overwhelming
might of the enemy.''
--Sir Winston L. S. Churchill

Reply to this Message

anycall - 14 Jan 2005 19:05 GMT

Thank you Steve

In answer to your questions:

(1) Was the biopsy performed solely on the basis of the PSA?-

No- just before Christmas I noticed a small amount of blood at the
commencement of urination. This happened three times over a period of about
six weeks. I reported this to my uro and he arranged for bladder and kidney
scan (OK), PSA (9), cyscoscopy and biopsy

(2) Is there a PSA test history (dates and scores) by which one can
judge the doubling time/velocity of changes in scores?

Aug 98 2.4
April 00 9.6
Aug 00 6.8 Free PSA 1.6
Feb 01 7.3 Free PSA 1.0
April 01 9.5
Dec 01 5.4 Free PSA 1.04
June 02 8.2 Free PSA 1.50
Dec 02 6.0
Jun03 5.5
Dec 03 7.5 Free PSA 1.70
Aug 04 10.0
Jan 05 9.0

(3) If he has had PSA scores between 5 and 10 for five years, he has
been beyond the recommended score (4.0 until recently; now 2.5) for that
long. What advice has he had for that period??

Uro diagnosed BPH and has been recommending TURP for last 3 years. Two
previous biopsies and 1 previous cyscoscopy were clear

(4) Are there other symptoms, such as urinary difficulty?

Yes intermittent bouts of urgency, difficulty in urination, weak flow.
Culminating in a total retention following cyscoscopy last week resulting in
catheter still in place.

(5) Did the uro check for other causes of the PSA score such as
infection, inflammation, BPH (benign prostate hyperplasia)? The large
prostate may be a sign of the latter, and the operative word is "benign."

See above

(6) Have any other staging or diagnostic tests been done? Examples would
be PAP (prostatic acid phosphatase), CGA (chromagranin A), bcl-2, etc?

No- only the tests described above

(7) Was a DRE performed? If so, what result?-

Several times- no concern expressed by Uro. Last week he said it felt "fine"

*It is absolutely vital that the biopsy result be validated by a

> specialist laboratory.*

I presume that the Pathologist he is using is suitably qualified.

I strongly recommend that "anycall" consult a medical oncologist

Could you please explain what is an "oncologist"

advice seems to be coming from a uro, who is a surgeon and

> naturally advocates a surgical solution (to a problem that may not even
> exist).

He advice is really directed to relieving BPH rather than dealing with a
potential cancer

Thanks for your comments, look forward to any further observations

Regards

>> 57 years old
>> large prostate 100g plus
[quoted text clipped - 66 lines]
> might of the enemy.''
> --Sir Winston L. S. Churchill

Reply to this Message

Leonard Evens - 14 Jan 2005 19:33 GMT

> Thank you Steve
>
[quoted text clipped - 29 lines]
> Uro diagnosed BPH and has been recommending TURP for last 3 years. Two
> previous biopsies and 1 previous cyscoscopy were clear

I presume he has tried to treat it with drugs and that didn't work too
well. If that is not the case, consider finding another urologist who
will do that. It is my impression that most cases of BPH are treated
successfully with drugs and it is only when it is clear that has failed
that surgery is considered. Of course, since I am not a physician I
might have it wrong as applied to your case, but you should at least get
this straight.

> (4) Are there other symptoms, such as urinary difficulty?
>
[quoted text clipped - 26 lines]
>
> Could you please explain what is an "oncologist"

An oncologist is someone who treats cancer. In the case of prostate
cancer, this is done with drugs which suppress your production of
testosterone or interfere with its functioning in the prostate. These
drugs have serious side effects. The vast majority of urologists and
oncologists only use this form of treatment for advanced metastatic
prostate cancer. And, it is generally agreed that it almost always
fails after some variable number of years. But all that is irrelevant
for you at this point. No one has verified that you have prostate
cancer and I find the idea that any competent oncologist would start
treating you now incredible.

It is certainly possible that you do have prostate cancer, and, as Steve
Jordan pointed out, pathologists can differ about biopsy results. It is
always a good idea to have it confirmed. If you do have cancer you will
have to figure out just how to handle it after learning as much as you
can about it. But I think your doctors think they have to take it one
step at a time. If you think the possibility of cancer might alter the
treatment for BPH, ask them probling questions about it. But again, let
me recommend that you not take too seriously anything you read here,
including what I say.

You probably need to have your BPH treated and fairly soon.

> advice seems to be coming from a uro, who is a surgeon and
>
[quoted text clipped - 3 lines]
> He advice is really directed to relieving BPH rather than dealing with a
> potential cancer

As I said.

> Thanks for your comments, look forward to any further observations
>
[quoted text clipped - 70 lines]
>>might of the enemy.''
>>--Sir Winston L. S. Churchill

Reply to this Message