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Medical Forum / Diseases and Disorders / Prostate Cancer / February 2007The value of color doppler targeted biopsy
Some of you may recall my post of about a month ago regarding my husband's rising psa. A brief history: His psa rose from 1.8 in 11/05 to 2.6 in 6/06. He had a PCA3+ test in 8/06 which came back positive. He then had an 18 core biopsy later in 8/06 which came back negative. Psa in 1/07 rose to 3.5. Local uro (who did the 18 core biopsy last summer) wanted to do another random biopsy. We decided, instead, to go the color doppler route and traveled to see Dr. Bahn in Ventura CA last week. Dr. Bahn immediately saw a small lesion in the base and mid sections of the right lobe and biopsied that area (He also biopsied the left lobe just to be sure). Biopsy results came back this past Tuesday, 2/20, and were positive -- Gleason 3(80%) + 4 (20%), stage T2a, as Dr. Bahn was able to feel a fullness in the right lobe that was not present in the left. Seminal vesicles were negative. We are currently doing our research into treatments as Dr. Bahn suggested. He said we have 2-3 months to make a treatment decision, although I don't want it to take that long. We already have an appointment with a medical oncologist who specializes in prostate cancer and we're switching urologists. Somehow we just don't want anything to do with the guy who missed it last summer :). My husband is interested in proton therapy as it supposedly has the fewest side effects. We're checking that out too. Just wanted to bring everyone up to date. The moral of the story, at least as far as we're concerned, is that an 18 core biopsy can be (and was) wrong. > Some of you may recall my post of about a month ago regarding my > husband's rising psa. A brief history: His psa rose from 1.8 in 11/05 [quoted text clipped - 24 lines] > least as far as we're concerned, is that an 18 core biopsy can be (and > was) wrong. I had two 12-core biopsies with a very good urologist who found nothing the first time. Two "misses" is unusual, but probably not unprecedented in this group. I see Dr. Duke Bahn every six months, either in Ventura or Marina Del Rey, as part of my "active surveillance" regimen, and he is terrific. The MDR oncology group with which he is affiliated is also excellent, and can give you additional advice that may be very helpful. Duke has done 80 or so partial-prostate cryo treatments (as well as many more full-prostate cryos, of course) and that may be an option for you to consider along with surgery, radiation in its various forms, etc. I missed your earlier posts, but assume you are reading the Strum book, looking at the various informational websites, etc. There are also several face-to-face PCa support groups in Southern California which can be very helpful. Alex Thanks for the suggestions but we live in Nevada, about a five hour drive from Ventura. Dr. Bahn specifically recommended against active surveillance for my husband (maybe because of the Gleason 3+4 ?? -- not sure) but he did discuss (and mention in his letter) cryotherapy because of the retention of quality of life issues. We're considering it. _____________________________________________________ On Feb 23, 9:23 pm, "Alex" <tuchasoffentisch@_NO_SPAM_gmail.com> wrote: > > Some of you may recall my post of about a month ago regarding my > > husband's rising psa. A brief history: His psa rose from 1.8 in 11/05 [quoted text clipped - 42 lines] > > - Show quoted text - > Thanks for the suggestions but we live in Nevada, about a five hour > drive from Ventura. [quoted text clipped - 3 lines] > discuss (and mention in his letter) cryotherapy because of the > retention of quality of life issues. We're considering it. With a Gleason 7 (3+4), it's not surprising that active surveillance would not be a likely choice. Do look for support groups in your area if you think they might be helpful. www.ustoo.com lists one in Las Vegas and another in Carson City, but there may be others if those are not close to you. Thanks. We live in Las Vegas and already have the March meeting of ustoo on our calendar! The Nevada Cancer Institute opened here about 1.5 years ago with the goal of attracting good cancer specialists from around the country to Las Vegas (The standard joke about medical care in LV goes like this: Question: Where do you go when you get sick in LV? Answer: The airport). http://www.nevadacancerinstitute.org/ We have an appointment there on 3/7 with one of the top doctors. The slides are being sent to him. ______________________________________________ On Feb 23, 11:41 pm, "Alex" <tuchasoffentisch@_NO_SPAM_gmail.com> wrote: > > Thanks for the suggestions but we live in Nevada, about a five hour > > drive from Ventura. [quoted text clipped - 8 lines] > Do look for support groups in your area if you think they might be helpful.www.ustoo.comlists one in Las Vegas and another in Carson City, but there > may be others if those are not close to you. > Thanks. We live in Las Vegas and already have the March meeting of > ustoo on our calendar! > The Nevada Cancer Institute opened here about 1.5 years ago with the > goal of attracting good cancer specialists from around the country to > Las Vegas (The standard joke about medical care in LV goes like this: > Question: Where do you go when you get sick in LV? Answer: The > airport). My brother lives in North Las Vegas. His wife is a nurse. I'll have to use this one on him.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > We decided, instead, to go the color doppler route and traveled to see > Dr. Bahn in Ventura CA last week. Dr. Bahn immediately saw a small [quoted text clipped - 4 lines] > fullness in the right lobe that was not present in the left. Seminal > vesicles were negative. Sorry to say, I already had you listed with full membership. I just knew there was cancer there somewhere. The good thing is Paul, at 64, is at an age to choose almost any treatment. With some, he has a very good chance at a cure. Please keep us informed on your choice and his progress. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06, 6/06 PSA .07 .05 .06 .09 .08 .132 .145 Casodex added daily 07/06 PSA <0.04 Non Illegitimi Carborundum > > We decided, instead, to go the color doppler route and traveled to see > > Dr. Bahn in Ventura CA last week. Dr. Bahn immediately saw a small [quoted text clipped - 26 lines] > PSA <0.04 > Non Illegitimi Carborundum You have good intuition, unfortunately :-). Glad you liked the joke. Thanks for posting the results of your visit to Bahn. Even though I'm on the East Coast, I'm considering him. I had posted before. My brief history is usually low PSA, PSA 5.4 last September, previous PSA 1.6 in 2004,. Repeat PSA in 11/05 1.9, but PSA in March /06 was 2.8. Biopsy March okay (sextant, plus targetted test) , show prostatitis, review of slides by Epstein showed more prostatits than first review. My PSA 11/06 was 3.9, repeat PSA 1/17 was 3.2. I saw a urologist last week, his recommendation was another PSA in 6 months. I think that's reasonable, based on what I've heard about Prostatitis, but I'm going to see of Bahn if I see any more rise. (I believe someone said Sloan was good at targetting, if anyone has experiece with them, please let me know.) > Some of you may recall my post of about a month ago regarding my > husband's rising psa. A brief history: His psa rose from 1.8 in 11/05 [quoted text clipped - 24 lines] > least as far as we're concerned, is that an 18 core biopsy can be (and > was) wrong. > Thanks for posting the results of your visit to Bahn. Even though I'm on the > East Coast, I'm considering him. I had posted before. [quoted text clipped - 8 lines] > Sloan was good at targetting, if anyone has experiece with them, please let > me know.) If you are on the East Coast, you might want to consider, Dr.Bahn's mentor--a Dr. Lee in Rochester (Hills ?), Michigan. He can be found on the internet and is the other expert with colored dopler expertise. We lived in California, (but recently moved back to Minnesota) and had an appointment before the move with Dr. Bahn, so carried through with that. Interesting thing happened when we had the slides and information evaluated at Mayo Clinic--they determined he was at a lower Gleaon score (a 6 versus a 7), his PSA was slightly lower (but similar) when they checked it, and they determined it to be "very treatable, very curable". We are looking at the Brachytherapy very seriously right now. Norma > > Some of you may recall my post of about a month ago regarding my > > husband's rising psa. A brief history: His psa rose from 1.8 in 11/05 [quoted text clipped - 24 lines] > > least as far as we're concerned, is that an 18 core biopsy can be (and > > was) wrong. |
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