Hi Stuart...Nothing like getting kicked in the gut when you least
expect it, well welcome to the club.  Truth be told, if you have to
have cancer, prostate cancer isn't a bad one to have.  It is often slow
growing, so more men die with PCa then from PCa.

A couple of inexpensive tests you might consider are free PSA (PSA_2)
and  PAP (prostatic acid phosphatase).  Both of these tests are
performed on sera samples obtained from a routine blood draw and may
help provide further information as to the extent and aggresiveness of
your PCa.

Depending where you live (let us know) there might be an expert
ultrasonagrapher with color-doppler ultrasound expertise close by.  If
so, that too might be a useful test in determining disease location and
severity.

Do you have a history of PSA readings?  If so, you can calculate the
PSA doubling time which is another useful prognostic tool.  What were
the results of your digital rectal exam (DRE)?  The result is usually
presented as a TNM stage such as T1c, T2b, etc.  This information is
necessary to estimate the severity of your disease using the various
nomograms that are available.  Finally, you mention your Gleason score
(GS) of 3+3. (BTW, the two numbers do not represent readings from the
right and left prostate, but rather they represent the primary and
secondary Gleason patterns observed in the samples).  PCa GSs are
difficult to read and because they are such a critical staging item
they are best read by an expert PCa pathologist.  Insurance usually
covers the cost of such a re-reading and if you serarch this NG for
"expert pathology" you'll turn up listings of these artists...Best
wishes and good health, Ron

Hi Stuart,

With your numbers you wouldn't expect to suffer any effects.  It's
still very early in the game.  As for the bone scan, it's a bit of a
toss-up.  Many feel, including myself, that these tests are a total
waste of time for low PSAs in the 3, 4, 5 range.  All they do is give a
lot of scary "false positives", old bone bruises/injuries.  The test is
much more valuable for PSAs in the 20 or higher range.  I guess I would
go with the doctor and do the test with a 9.9 PSA.  I know very little
about MRI tests but I think I've read somewhere that they will not show
anything at these early stages, perhaps someone can chime in on this.

The most important thing you can do right now is take the next six
weeks or so (that's how long it takes for the prostate to "heal" after
the biopsy) and gather as much information as you can so you can make
the most informed decisions regarding future treatment.  Talk to
several doctors and include those who perform the various modes of
surgery and radiation.  Feel free to ask anything here on this
newsgroup.  Nothing, and I mean nothing, from the kind of isotopes used
in brachytherapy to limp Willies is off limits.  Most everyone here has
been through what you're going through and while their information is
often anecdotal, there is considerable good information provided to new
members.  I like to tell people such as yourself to get so
well-educated in this stuff that you know more than most doctors about
prostate cancer (which is not difficult to do) and you are able to talk
informally and comfortably with the doctors who do know about
prostates, the urologists.  One thing I would ask about is the side
effects of the various treatments.  While the chances are good you
would avoid them, each treatment does have some drawbacks that could
influence you one way or the other if you are unlucky enough to get one
or more side effects.  And don't depend on luck.  If you had good luck
you wouldn't be on this newsgroup at all. :)

Dave Perry

On August 14, Stuart wrote:

Um, that is not the way Gleason scores are expressed. One specimen is
examined and graded (for example) Gleason 3 based upon its appearance
and the judgment of the pathologist. The same specimen is further
examined and the second-most prevalent carcinoma is graded, say, Gleason
4. The two scores are combined for a Gleason grade. In this example, it
would be expressed as "3+4=7."

The question question is, how many specimens were taken and how many of
them showed evidence of carcinoma. Of those, how much of each specimen
had carcinoma?

Not good, but not horrible either, on the face of it. Be advised,
though, that certain types of prostate cancer cells do not express much
PSA. This is rather rare, but it can happen.

That's uncertain, often even when the prostate is removed and examined.

There is an educational job to do.

I recommend starting with reference to the authoritative website of the
Prostate Cancer Research Institute at:
http://prostate-cancer.org/index.html
Seek out the "Newly Diagnosed" link. Very helpful.

Let us know how it goes.

Regards,

Steve J

"Empowerment: taking responsibility for, and authority over one's own
outcomes based on education and knowledge of the consequences  and
contingencies involved in one's own decisions. This focus provides the
uplifting energy that can sustain in the face of crisis."
--Donna Pogliano, co-author of _A Primer on Prostate Cancer, The
Empowered Patient's
Guide_.

We are dreadfully sorry to see you have joined our little club.  Your next
few months will be a whorlwind of activity beginning with, I hope,
significant research including bookes (Walsh, Scardino, Strum) and Internet
(phoenix5.org, etc.).  We'll do our best to get you started.

Almost certainly, your Gleason is 3+3=6 (having nothing to do with left and
right side).  That is a fairly good Gleason as Gleasons go.

Then your Stage is T2a or T2c, depending on whether it was palpable.  When
your doctor performed the DRE (digital rectal exam) did he feel the cancer
or hardened nodules?  If so, it's T2c for now.

Your PSA is moderate.  Your Gleason is pretty good.  That 5% and 25%, if it
holds, is really good.  It's good that you're researching.  You need to do a
lot more.

Most of us were asymptomatic when diagnosed.

Some docs don't think a bone scan is necessary with your numbers.

I'd get a second opinion, but not here.  We will help all we can, but you
really need to talk with another uro for answers like that.  You may also
want to get a second opinion on your Gleason scores.  The difference between
6 and 7 are not all that much, but if it's really an 8, you may have another
decision.

Since I seemed to have translated my Gleason wrongly I thought I'd
read it off from my copy of the report.  And I also want to thank
everyone for their responses.  

So here seem to be the significant points from the pathology report:

Tissue:
A: Prostate Needle Biopsy - Right
B: Prostate Needle Biopsy - Left

Gross description:
"Right lobe bx prostate" in formalin, tan gray-white to tan 0.2 mm in
diameter needle biopsy fragmente ranging from 7 to 133.  Also in the
container is a wisp of tissue.  The speciman is submitted in toto (A1)

#2 - 1t lobx bx prostate in formalin . tan-gray-white to tan-brown
0.2mm in diameter needle biopsy fragments ranging from 1 to 19mm with
a combined length of approximately 142mm

[So here is the part I guess I was confused or confusing you about]

Diagnosis
A: Right prostate needle biopsies
Prostatic adenocarcinoma , Gleason's score 6 (3.3) involving
approximately 25% of the tissue examined and six of tencores.

B: Left prostate needle biopsises
Prostatic adenocarcinoma , Gleason's score 6 (3.3) involving
approximately 5% of the tissue examined in three of ten cores.

Then further down it has the level (hand written ) T2b

I think I'm gearing up for an appointment next week with my Urologist
to ask questions.  I'd like to be able to consider Proton therapy and
contacted Anderson (down in Houston) to at least get the ball rolling
even though they still need all my reports and slides.  It seems like
it maybe an option I want to consider. Having the flexibility to go
away for 3 months (btw I live in Colorado - Denver / Boulder area),
may not be an option, mostly due to expense.  But I'll hold off on
that bitchin :) for another post.

Stuart

This can all be very confusing.  I strongly recommend reading "The
Prostte" by Peter Scardino.   The author is a leading prostate cancer
researcher and one of the best porstate cancer sugeons.   The book
explains things in plain language.

You didn't mention your age or state of health.  What you do next could
be highly dependent on that.

There are ways to estimate whether or not the cancer has extended beyond
the prostate.  One thing you haven't told us was whether your urologist
felt anything suspicious on digital rectal examination.  That would
determine the so-called stage: T1c, T2a, b, or c.  With the information
you gave, and knowing the stage, it is possible to calculate the
likelihood that, if the cancer were surgically removed, the pathologist
would find it had extended beyond the prostate.  (See
www.mskcc.org/mskcc/html/10088.cfm)   But the clinical stage would make
a big difference in the result.   Note however, that even if a cancer
has extended beyond the prostate, it may still be curable.  Also, even
if after surgery the cancer appears organ confined to a pathologist, it
is unfortunately possible that it may have escaped to remote sites.  But
in a case like yours, that might not be too likely.

While you are trying to decide on a treatment option consider brachytherapy.
Not everyone qualifies for it but your scores right now say yes, you are a
candidate. You would need to see a radiation oncologist.

No matter which treatment you choose be careful about choosing the doctor.
Find out what his or her statistics are for things like incontinence, bowel
problems, erectile dysfunction, and most importantly prostate cancer failure
as in how many men had their PSA rise after treatment.

You don't need to make a snap decision, not that sitting on it for months or
a year is smart. But take some time to educate yourself. If you are married,
talk to your spouse. The better educated you are the better you will
understand what the doctors are saying, you will be better able to express
your concerns, and ask intelligent questions.

Visit several doctors in your area and maybe even visit a Us Too or Man2Man
meeting. There are several  good books on the subject approached from
various view points. Strum's and Walsh's books are probably considered the
top books. There are also some excellent web sites. You've been given a few
already I will just add  http://www.cooleyville.com/  for info on radiation
therapies.

This group is made up mostly of the RP gang but there is probably just about
every treatment method represented by at least one person. So the odds are
somebody has BTDT and tell you something about it.

You already know you have cancer so the fPSA test probably isn't worth the
additional cost.
Bev