 |
 | Home | Contact Us | FAQ | Search & Site Map | Link to Us |
 | Sign In | Join | Other 45 Sites in Network |
Medical Forum / Diseases and Disorders / Prostate Cancer / April 2008Introduction
Hi all, I'd just like to introduce myself, and give my stats. I'm 55, in decent shape. Location is San Francisco Bay Area. I just got diagnosed on Monday with prostate cancer. Have a small (1 cm) nodule that was discovered by DRE. Doesn't seem to have been there, or noticeable, 1.5 years ago. My PSA is 0.8. My prostate size is "small". Didn't get a number. Stage is probably T2A. No imaging yet. Everyone seems to think I'll be just fine, and I'm sharing that opinion. This got discovered because I was having some ED problems and went to a new GP to get checked. My urologist says its due to my testosterone level, which is 170. My Gleason is 3+4 on one sample, and 3+3 on two other samples. Only three samples were taken because the ultrasound only showed that nodule as suspicious. The samples showed high percentages, but they were specific to the nodule, not a "hunting trip". My urologist is recommending open RP (not by his office though), and suggesting radiation as second choice, and seed therapy as way down the list. He didn't feel comfortable with the robotic procedure because he was worried about being able to access all parts of the prostate. This is an older doctor, by the way. Not sure if he's up on all the latest, even though he has someone in his office who does robotic. I'm leery of radiation, but the HDR seems less threatening to me. I'm leaning towards robotic RP, but have only had a consultation with the radiation guy. The radiation guy said my situation was not one that strongly recommended itself to radiation vs surgery vs others, though he thought radiation and surgery were the top choices. Any feedback on treatment options would be appreciated, regarding long-term survivability, recurrence, side effects and prevalence of side effects, etc. > I'd just like to introduce myself, and give my stats. (snip) Welcome to the club no one wants to join. There is a lot to do, but considering the numbers, apparently time to do it. (1) I'd recommend having the biopsy specimens examined by a pathology lab that specializes in prostate cancer (PCa). Everything that is done from here on depends upon the accuracy of the Gleason scoring. Here is a list: Bostwick Laboratories [800] 214-6628 Dianon Laboratories [800] 328-2666 (select 5 for client services) Jon Epstein (Hopkins) [410] 955-5043 or [410] 955-2162 David Grignon (Michigan) [313] 745-2520 Jon Oppenheimer (Tennessee) [888] 868-7522 UroCor, Inc. [800] 411-1839 The cost, last I heard, was about $350. More if further tests are ordered. The chosen lab can give instructions on shipment arrangements. (2) The authoritative website of the Prostate Cancer Research Institute (PCRI) at http://prostate-cancer.org/index.html is an excellent beginning. Start with the section "Newly Diagnosed" at http://prostate-cancer.org/education/education.html#newly_diagnosed Some medics who specialize in treatment (tx) of PCa are listed via this portal: http://prostate-cancer.org/resource/find-a-physician.html (3) I heartily recommend this text on PCa: _A Primer on Prostate Cancer_ 2nd ed., subtitled "The Empowered Patient's Guide" by medical oncologist and PCa specialist Stephen B. Strum, MD and PCa warrior Donna Pogliano. It is available from the PCRI website and the like, as well as Amazon (30+ five-star reviews), Barnes & Noble, and bookstores. A lifesaver, as I very well know. (4) Personal contact with other patients can be very helpful. Local chapters of the international support group Us Too can be found via their website at http://www.ustoo.com/chapter_nearyou.asp And lastly, I caution against permitting anyone, medic included, to influence a decision for or against any particular tx regimen. Some will try, believe me. That choice is the patient's, and his alone, based upon education and empowerment. Good luck! 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_, subtitled "The Empowered Patient's Guide." > Hi all, > [quoted text clipped - 7 lines] > "small". Didn't get a number. Stage is probably T2A. No imaging yet. > Everyone seems to think I'll be just fine, and I'm sharing that opinion. Good. > This got discovered because I was having some ED problems and went to a > new GP to get checked. My urologist says its due to my testosterone [quoted text clipped - 11 lines] > is an older doctor, by the way. Not sure if he's up on all the latest, > even though he has someone in his office who does robotic. The objective of both open and robotic prostatectomy is to take the prostate out. His colleague should be able to explain that, in particular with a relatively "small" prostate, "access" is not at all difficult, unless may be, you are extremely "obese". You do appreciate, don't you, that the robotic alternative is considerably less uncomfortable for the patient, as is is less intrusive. > I'm leery of radiation, but the HDR seems less threatening to me. > > I'm leaning towards robotic RP, but have only had a consultation with > the radiation guy. The radiation guy said my situation was not one that > strongly recommended itself to radiation vs surgery vs others, though he > thought radiation and surgery were the top choices. Based on your data you should also discuss the option of no immediate treatment, but "watchful waiting" or "observation". See http://www.nccn.org/patients/patient_gls.asp and look for the treatment guidelines in pdf form (page 36, I believe). That way you'll avoid side effects as incontinence and impotence (assuming that is relevant). You will notice that a large group of extremist and intolerant posters in this group will try to convince you that you should "get the beast out" no matter what side effects you will suffer. > Any feedback on treatment options would be appreciated, regarding > long-term survivability, recurrence, side effects and prevalence of side > effects, etc. see http://tinyurl.com/yrgo6y http://www.annals.org/cgi/content/full/0000605-200803180-00209v1#R5-2321 Statistics about ED side effects are not very reliable, as different studies apply different definitions. See http://www.nytimes.com/2008/01/15/health/15well.html > You will notice that a large group of extremist and intolerant posters > in this group will try to convince you that you should "get the beast > out" no matter what side effects you will suffer. My initial reflex is to get the beast out. Radiation is second, though might move first. I don't know. But I'm looking for information, not to take a stand. I don't want to deal with recurrence which might go undetected until it's spread, and then kill me. I can't rely on PSA scores, evidently, given my low PSA. Hormone, external beam, etc, just aren't on the radar for me. I'm very used to newsgroups though, and how people come across, or take a stand. I've done so myself. This will not be my primary source of information, but I will take what I hear here into account. Doofy, please pay no attention to Safire. He is persona non gratis by popular acclaim. Most of us killfiled him after trying for months to persuade him to behave like a human being. All but our most ubertolerant gave up, as his objective is running people down rather than discussing or learning anything about prostate cancer. I.P. Doofy, I'd take I.P.'s suggestion to the next step and recommend just filtering Safire out now. I didn't even know he was still around, but I should have known, I guess. Burney >Doofy, please pay no attention to Safire. He is persona non gratis by >popular acclaim. Most of us killfiled him after trying for months to > >I.P. RP in 1995 (age 52) RT in 2000 ADT (Casodex) 10/06 - 8/07 Latest PSA - 0.18 burney dot huff at mindspring dot com > My initial reflex is to get the beast out. Radiation is second, > though might move first. I don't know. But I'm looking for [quoted text clipped - 9 lines] > take a stand. I've done so myself. This will not be my primary > source of information, but I will take what I hear here into account. Good......glad to see you are used to trolls, etc. Safire is just plain rude and most people on here have killfiled him. You will not find that many who have had HDR treatment in the US due to the high cost ($50,000 4 years ago) and your insurance groups refusing to pay for them. I am Canadian and our Health Care System is totally different than yours. I will say no more because there are those that start foaming at the mouth if I do. 8-)) However, Alan Meyer and my husband Ron both had this procedure and I believe one fellow in Australia. I can only speak (obviously) for my husband. He was 70 at the time and I just realized he was diagnosed exactly 5 years ago. Ron would have no part of surgery.....and chose to have this *new* method of radiation, followed by 25 conventional IMRT radiation sessions. Side effects? A bit fatigued for a couple of months and that was about it. The bladder isn't quite as elastic after radiation, so he can't hold it quite as long as before.....but he only gets up once/night, usually when the cat jumps on his bladder!! (G) Anyway....other than more frequent flatulence, I can't think of any other long lasting side effects. He was not *burned* as some would have you believe. He is certainly not incontinent. In fact, other than a rather bizarre bump (PSA jumped about 20 points in 2 months and he went on hormone therapy), he has had no problems. He is off the HT and we are watching his PSA at the moment. If it goes up again, then he will go back on HT. Btw, as our testosterone numbers are quite different than the US, I have no idea where *170* is on the scale. Ron is now normal at just under 10. Hope this little bit helps, but in all honesty, it was a rather uneventful and easy procedure....compared to surgery. He was a little sore the two days of the procedures. But he would do it again in a heartbeat!! Best of luck......Heather (Toronto, Ontario) > go back on HT. Btw, as our testosterone numbers are quite different > than the US, I have no idea where *170* is on the scale. Ron is now > normal at just under 10. I think 350-370 is kinda normal. Which means Americans have much more testosterone than Canadians, which would explain Iraq. ;-) >> go back on HT. Btw, as our testosterone numbers are quite different than >> the US, I have no idea where *170* is on the scale. Ron is now normal at [quoted text clipped - 4 lines] > Which means Americans have much more testosterone than Canadians, which > would explain Iraq. ;-) Actually, it would explain the United States. >>> go back on HT. Btw, as our testosterone numbers are quite different than >>> the US, I have no idea where *170* is on the scale. Ron is now normal at [quoted text clipped - 5 lines] > > Actually, it would explain the United States. That was the inference. Iraq is the symptom. >>>> go back on HT. Btw, as our testosterone numbers are quite different >>>> than the US, I have no idea where *170* is on the scale. Ron is now [quoted text clipped - 6 lines] >> Actually, it would explain the United States. > That was the inference. Iraq is the symptom. I understood the inference and corrected same. Another thing you will find here is people who are proud of the U.S. and their history, and those who aint; blacks, browns, whites, and reds (no yellows yet, I don't think); Christians, Jews, agnostics; attorneys, accountants, professors, and laborers; octogenarians and men in their 30s; and just about every other sort of man and his loving wife, partner, son, or daughter. The only thing was have in common is prostate cancer, so discussions that go astray of that often degenerate. >>>>>go back on HT. Btw, as our testosterone numbers are quite different >>>>>than the US, I have no idea where *170* is on the scale. Ron is now [quoted text clipped - 18 lines] > The only thing was have in common is prostate cancer, so discussions that go > astray of that often degenerate. Yeah, I'll have to reel in my internet persona. Now that everyone knows I'm a bleeding butt liberal.... > Yeah, I'll have to reel in my internet persona. Now that everyone knows > I'm a bleeding butt liberal.... Hmmmmmmmmm. Another handle I'd avoid. :-) >> Yeah, I'll have to reel in my internet persona. Now that everyone knows >> I'm a bleeding butt liberal.... > > Hmmmmmmmmm. Another handle I'd avoid. :-) Damn. ;-) > The bladder isn't quite as elastic after radiation, so he > can't hold it quite as long as before.....but he only gets up > once/night I've done that for years anyway, before and after RP. Probably as much or more an issue of aging bladders than PC treatments, so maybe no loss there. I.P. > I am Canadian and our Health Care System is totally different than yours. > I will say no more because there are those that start foaming at the mouth > if I do. 8-)) Why do I get the feeling this song is about me, 'bout me, 'bout me....? :-) >> I am Canadian and our Health Care System is totally different than >> yours. I will say no more because there are those that start foaming [quoted text clipped - 4 lines] > > :-) Kissies......LOL!! Not just you though.....there are a couple of others who foam. OK....I give up. That damn song chorus is now going round and round in my head. Carly Simon? Or that era, I guess. The hippy dippy one. >OK....I give up. That damn song chorus is now going round and round in >my head. Carly Simon? Or that era, I guess. The hippy dippy one. Carly Simon, "You're so Vain"... http://www.lyricsfreak.com/c/carly+simon/youre+so+vain_20027245.html They are called "earworms!" Cheers, Larry >>OK....I give up. That damn song chorus is now going round and round >>in [quoted text clipped - 5 lines] > > They are called "earworms!" Hey Larry.....that is a neat site. And I do have that mp3 on here. Mike Maltby (MVP) is really into that stuff and usually directs me to whatever I need. (like a non-faulty memory....but I had the artist right, lol). Hmmm.....figures Little Stevie Wonder would REALLY know a song called "You're So Vain".....ROFL!! Running and ducking......Heather > The objective of both open and robotic prostatectomy is to take the > prostate out. His colleague should be able to explain that, in > particular with a relatively "small" prostate, "access" is not at all > difficult, unless may be, you are extremely "obese". You do appreciate, > don't you, that the robotic alternative is considerably less > uncomfortable for the patient, as is is less intrusive. yes, I know that. > Based on your data you should also discuss the option of no immediate > treatment, but "watchful waiting" or "observation". See > http://www.nccn.org/patients/patient_gls.asp > and look for the treatment guidelines in pdf form (page 36, I believe). No one yet has suggested that approach, and I don't like it either. Reason being, my PSA score is so low, it's not an indicator of trouble, and if another nodule grows where it is not detectable via DRE, that could mean spreading in time. > That way you'll avoid side effects as incontinence and impotence > (assuming that is relevant). I'm already having some impotence problems due to low testosterone, and watchful waiting would preclude testosterone augmentation therapy. Of course, I'm more worried about incontinence, and the level of it. >> The objective of both open and robotic prostatectomy is to take the >> prostate out. His colleague should be able to explain that, in [quoted text clipped - 14 lines] > and if another nodule grows where it is not detectable via DRE, that > could mean spreading in time. If you're concerned about another nodule, would it not have made more sense to take 6 or 12 samples rather than only 3, ultrasound indications notwithstanding? >> That way you'll avoid side effects as incontinence and impotence >> (assuming that is relevant). [quoted text clipped - 3 lines] > > Of course, I'm more worried about incontinence, and the level of it. > If you're concerned about another nodule, would it not have made more > sense to take 6 or 12 samples rather than only 3, ultrasound indications > notwithstanding? I had no control over, nor previous knowledge regarding, the sampling. I was just lying on a table in pain. So, I'm learning as I go. On March 21, doofy wrote, regarding his biopsy: > I had no control over, nor previous knowledge regarding, the sampling. I > was just lying on a table in pain. > > So, I'm learning as I go. One thing that many learn is that, when preparing for a prostate biopsy, one should demand an anesthetic. Some claim that they experienced little or no pain, others say it was agony. I say, why gamble? There's nothing to be gained. Besides, and I wonder whether this has occurred to uros who don't want to bother with their patients' physical well-being, a patient who is not tensing up makes the uro's job easier. Regards, Steve J "'MD' does not mean "Medical Deity.'" --Stephen B. Strum, MD Medical Oncologist PCa Specialist > On March 21, doofy wrote, regarding his biopsy: > [quoted text clipped - 10 lines] > > I say, why gamble? There's nothing to be gained. Except the freedom to drive yourself home or wherever you need to be after the biopsy (and possibly: additional self-confidence). > Besides, and I wonder > whether this has occurred to uros who don't want to bother with their [quoted text clipped - 9 lines] > Medical Oncologist > PCa Specialist Filling a couple of gaps in previous posts upthread: 1. The expert review of the biopsy specimens is a "second opinion" and as such is, I'm sure, covered by insurance. I know that it's covered by Medicare. 2. The anesthetic I referred to re: biopsy is, of course, a local. E.g. Novocaine, Lidocaine, and the like. Regards, Steve J “Prostate cancer is often described as a curable disease made incurable by late diagnosis." --David Wright, Advanced PCa patient East Comiston, Scotland > Filling a couple of gaps in previous posts upthread: > > 1. The expert review of the biopsy specimens is a "second opinion" and > as such is, I'm sure, covered by insurance. I know that it's covered by > Medicare. Ok. I'll check that out. The only think I'd be worried about is if the initial reading was too low. Otherwise, it needs to be dealt with anyway. > 2. The anesthetic I referred to re: biopsy is, of course, a local. E.g. > Novocaine, Lidocaine, and the like. I think he gave me a topical. I don't know, I couldn't see what was going on. He said he was giving me an anaesthetic, and I felt something that could have been a needle. If he gave me a local, the needle felt identical to the insertion of the instrument. Next time, I want flowers. On March 21, Dwight or Duh-wite replied to me, in part: > I think he gave me a topical. I don't know, I couldn't see what was > going on. He said he was giving me an anaesthetic, and I felt something > that could have been a needle. If he gave me a local, the needle felt > identical to the insertion of the instrument. > > Next time, I want flowers. How about a pretty and sympathetic nurse to hold your hand? Regards, Steve J "The author of the Iliad is either Homer or, if not Homer, somebody else of the same name." -- Aldous Huxley > On March 21, Dwight or Duh-wite replied to me, in part: > [quoted text clipped - 6 lines] > > How about a pretty and sympathetic nurse to hold your hand? yeah, that would be good. And I'll ask for the heterosexual-sized instrument next time. Living where I do, they might not see the need. Dwight replied to me: >> On March 21, Dwight or Duh-wite replied to me, in part: >> [quoted text clipped - 11 lines] > And I'll ask for the heterosexual-sized instrument next time. Living > where I do, they might not see the need. Snert! Keyboard! Steve J > On March 21, Dwight or Duh-wite replied to me, in part: > [quoted text clipped - 6 lines] > > How about a pretty and sympathetic nurse to hold your hand? Ahhhhhhhhh, Kara. I wonder what ever happened to her. I'm sure she has changed much in 7 years. >> If you're concerned about another nodule, would it not have made more >> sense to take 6 or 12 samples rather than only 3, ultrasound [quoted text clipped - 4 lines] > > So, I'm learning as I go. http://researchnews.osu.edu/archive/prostest.htm In Germany, the standard is to take 12 samples, if a biopsy is in fact necessary. >> Based on your data you should also discuss the option of no immediate >> treatment, but "watchful waiting" or "observation". See [quoted text clipped - 5 lines] > another nodule grows where it is not detectable via DRE, that could mean > spreading in time. My compliments. One of our major concerns is that of newly diagnosed patients being taken in by the drivel of one or two trolls. And you, sir, have obviously already been researching your situation. Congratulations! It will surely make your decision and your acceptance of it in the expost facto sense a whole lot easier.  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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum "doofy" wrote > my PSA score is so low, it's not an indicator of trouble I've forgotten the circumstances or explanation, but we've discussed in the past that some cases/types of PC suppress PSA. Your palpable lump worries me more than your low PSA encourages me. I.P. > "doofy" wrote >> my PSA score is so low, it's not an indicator of trouble > > I've forgotten the circumstances or explanation, but we've discussed in > the past that some cases/types of PC suppress PSA. Your palpable lump > worries me more than your low PSA encourages me. What I meant by low PSA not being an indicator of trouble is: it is not a good indicator that anything is wrong, or conversely, not a good indicator that anything is NOT wrong. On March 21, Dwight replied to IPF: > What I meant by low PSA not being an indicator of trouble is: > > it is not a good indicator that anything is wrong, or conversely, not a > good indicator that anything is NOT wrong. Of course, PSA is *not* cancer-specific. The Gleason could be definitive, but I have to say that, when doing a biopsy, it does not seem to me to be prudent to rely upon ultrasound images to select areas to probe. There are other, more accurate, imaging tests such as color doppler ultrasound that are used by some to guide the needles. I don't think, though, that that is a common procedure. Seems to me that the best way to be *fairly* sure is to take as many specimens as possible, minimum 12. Even then, there is tissue that is left unsampled. There are blood tests that can provide further details. These are CGA (chromogranin A), NSA (neuron specific enolase), CEA (carcino-embryonic antigen) and PAP (prostatic acid phosphatase). PAP collects its share of sneers from the ignorant, but it is in fact useful for predicting disease that is not organ-confined where the test result is =/> 3.0 ng/mL. Seems unlikely here, agreed, but why not be sure? More can be learned about these tests on the PCRI website, to which I have previously referred. Regards, Steve J > On March 21, Dwight replied to IPF: > [quoted text clipped - 13 lines] > specimens as possible, minimum 12. Even then, there is tissue that is > left unsampled. This is why I'm asking for more imaging. I don't trust it either. > What I meant by low PSA not being an indicator of trouble is: > > it is not a good indicator that anything is wrong, or conversely, not a > good indicator that anything is NOT wrong. Ooooooohh ... IOW, you actually said what you meant and meant what you said, and I just read it too casually. I got it. ;-) I.P. >> What I meant by low PSA not being an indicator of trouble is: >> [quoted text clipped - 5 lines] > > I.P. Well, as I reread it, I could see how the meaning was vague. >>> Based on your data you should also discuss the option of no immediate >>> treatment, but "watchful waiting" or "observation". See [quoted text clipped - 8 lines] > patients being taken in by the drivel of one or two trolls. And you, sir, > have obviously already been researching your situation. Reasonable people could argue he has not researched his situation at all. He said as much himself. He went to his uro because of ED. He left his uro with both ED and a PCa diagnosis. His uro did a biopsy without any clear indication for a biopsy. His uro did not offer him pain medication. His uro took a sample of three cores, insufficient by any standard. His uro has no idea about robotic RPs. His uro suggested treatment even though his cancer may be indolent, virtually guaranteeing permanent impotence. Even socialized medicine in British North America offers better health care. Yet Kramer thinks Doofy's uro is great (see one of the other 100 posts he produced the last 24 hours - he should get a life). Doofy clearly has fallen in the hands over hemianopsious surgeons and their advocates in this group and Doofy is liable to be a victim of overtreatment: http://www.psa-rising.com/prostatecancer/surgery-v-surveillance-aua0507.htm http://jama.ama-assn.org/cgi/content/abstract/277/6/467 http://www.psa-rising.com/prostatecancer/surgery-v-surveillance-aua0507.htm Of course these are all studies that aren't worth an ounce of goose pee, as Heather, or favorite house maid, so eloquently stated after many years of serious research in her kitchen. Heather thinks a permanent incontinence is no big deal. Note that Doofy's if-statement above would justify pca treatment for any male immediately after birth and suggests he doesn't yet understand "watchful". [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] I agree with Safire. Hold off doing ANYTHING. Read my posts of last August and September and note the replies I received regarding my decision to employ "active surveillance". How did you determine your stage to be T2A? Many of the treatment options might be worse than the low-grade disease you might have. Estimates from the most authoritative sources, (Patrick Walsh, M.D. , American Academy of Family Physicians) indicate that 40+% of treatments may be unnecessary. You were just diagnosed and there is NO RUSH to do anything. I remember that how strong the temptation "to do something is. HOLD OFF!!!! Take a few weeks to intensively study this matter and you will be amazed at how many "options" there are and how much disagreement there is in this field. This entire matter is in a very primitive state of Knowledge and you don't want to be caught in the "crosshairs" of this topic by getting a treatment that could leave you in worse shape then when you began. And yes, you will get all kinds of feedback from people who may be well meaning but have a psychological investment in whatever treatment they may haver head. There will also be a few misinformed mean-spired jerks who are not well-meaning in the least but who merely want to scare you into making a decision. Sy > > Hi all, > > [quoted text clipped - 63 lines] > See > http://www.nytimes.com/2008/01/15/health/15well.html > [[ This message was both posted and mailed: see > the "To," "Cc," and "Newsgroups" headers for details. ]] [quoted text clipped - 4 lines] > and note the replies I received regarding my decision to employ "active > surveillance". How did you determine your stage to be T2A? That is purely my own determination based on documents pertaining to the biopsy. > Many of the treatment options might be worse than the low-grade disease > you might have. Estimates from the most authoritative sources, > (Patrick Walsh, M.D. , American Academy of Family Physicians) indicate > that 40+% of treatments may be unnecessary. Are you saying a Gleason 3+4 score is low-grade? > You were just diagnosed and there is NO RUSH to do anything. I > remember that how strong the temptation "to do something is. HOLD > OFF!!!! My doctor is saying the same thing. However, the palpable tumor was not there 1.5 years go. Some part of the tumor might have been, but it was not noticeable to DRE. So, I'm listening to what the doctor is saying, but, to me, this is not a slow growing cancer. >> I agree with Safire. Heads up, Doofy ... "Chopper", "Safire", and "Sy" are peas of one pod, maybe even sock puppets. I.P. >>> I agree with Safire. > > Heads up, Doofy ... "Chopper", "Safire", and "Sy" are peas of one pod, > maybe even sock puppets. > > I.P. I have my awares tuned up and running. But, until given good reason, I'll play nice. > I agree with Safire, who wrote >> Take a few weeks to intensively study this matter and you will be >> amazed at how many "options" there are and how much disagreement there >> is in this field. You're new here, Chopper, so let me say this much: That's about the only sane thing Safire has ever said. Heed that advice, because your cancer is going nowhere in a few weeks, but I'm not alone in warning you to ignore him otherwise, as you shall soon see. I.P. >You're new here, Chopper I don't think so - it's trollmeister sy, chopping his way through our killfilters.... >> I agree with Safire, who wrote > [quoted text clipped - 3 lines] > > You're new here, Chopper, I think it's Sy (as opposed to SY). His old (other) addy was/is stuttgart6@lycos.com Unless, of course, it's a third "Sy". >>> I agree with Safire, who wrote >> [quoted text clipped - 9 lines] > > Unless, of course, it's a third "Sy". Nah.....it is the old, obnoxious SY of Stuttgart......the dead giveaway being the following..... [[ This message was both posted and mailed: see the "To," "Cc," and "Newsgroups" headers for details. ]] I tracked this new name and it still comes up as the same ISP in NY. Cheers.....Hercule Poirot > I'd just like to introduce myself, and give my stats. Thanks, Doofy (Is that how you really want us to know you for the next 20 years?). My stats are in my signature. > I just got diagnosed on Monday with prostate cancer. Have a small (1 cm) > nodule that was discovered by DRE. Doesn't seem to have been there, or > noticeable, 1.5 years ago. My PSA is 0.8. You have a great diagnostician. You should send him a Christmas present. > Stage is probably T2A. That's excellent! > This is an older doctor, by the way. Not sure if he's up on all the > latest, even though he has someone in his office who does robotic. It's probably a good read. RLRP has got to be somewhat of an anomoly to an old surgeon. > Any feedback on treatment options would be appreciated, regarding > long-term survivability, recurrence, side effects and prevalence of side > effects, etc. Two things we all agree on. First, none of us are doctors. Second, the best way - maybe the only way - to come to the best decision is to research the issue like you've never researched anything before. Very good books have been written by Drs. Peter Scardino, Patrick Walsh, and Steven Strum. I think now, for you, in that order. There was a time that Walsh ruled the roost; but even that is just a matter of my opinion. There are really good websites, including on by the Prostate Cancer Research Institute (www.PCRI.org). As to opinions, keeping in mind that I have gone through open surgery, then when that failed radiation, then when that failed androgen deprivation therapy (ADT): aka hormone therapy..... If I were 55 with a 0.8 PSA and a T2a Stage and 7 Gleason, I would, without hesitation, let the robot to its work with a very skilled and experienced surgeon at the helm. 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum > Thanks, Doofy (Is that how you really want us to know you for the next 20 > years?). Well, my previous web name was Duh. At least Doofy feels like Duh went to Disneyland. ;-) I don't like putting my real name on the internet. >> Thanks, Doofy (Is that how you really want us to know you for the next 20 >> years?). [quoted text clipped - 3 lines] > > I don't like putting my real name on the internet. Well... there might be some other options. :-) 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 PSAD 0.19 years EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 PSAD .056 years Lupron 07/03 (1 mo) 8/03 and every 4 months there after PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years Casodex added daily 07/06 PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08 Non Illegitimi Carborundum >>> Thanks, Doofy (Is that how you really want us to know you for the next 20 >>> years?). [quoted text clipped - 4 lines] > > Well... there might be some other options. :-) "Dip Sh*t" has a nice ring to it, don't you think? Those clipped consonants make it sound a little German and exotic. ;-) >>>> Thanks, Doofy (Is that how you really want us to know you for the >>>> next 20 years?). [quoted text clipped - 7 lines] > "Dip Sh*t" has a nice ring to it, don't you think? Those clipped > consonants make it sound a little German and exotic. ;-) Actually, with the number of DRE's I've had lately, this is so appropriate, I just don't want to go there. On Mar 21, 11:42 am, doofy <n...@would.nt.be.prudent> wrote...snip... > I'm 55, in decent shape. Location is San Francisco Bay Area. > [quoted text clipped - 7 lines] > as suspicious. The samples showed high percentages, but they were > specific to the nodule, not a "hunting trip". Hi doofy...A couple of things in your stats catch my eye. First, I'm surprised that a urologist would only take 3 samples given that you have palpable disease. But in any case you know you have a palpable tumor and you don't know what may or may not exist beyond that. A palpable tumor with low-mid Gleason score (GS) will often leak enough PSA to put an individual's PSA over 4 ng/ml. That's not the case with you, you have a very low PSA. The higher the GS, the less PSA leaks from the tumor; men with high-grade disease will sometimes have a very low PSA. So I'm puzzled that a palpable tumor (therefor, significant tumor size) that is at least GS 3+4 (as Steve J pointed out, this needs to read by a pathologist expert in PCa) is putting out such a small amount of PSA. In any case you might want to talk with your uro and understand why he only took 3 samples. I might be inclined to have a full 12-sample biopsy done and then send the 12+3 samples out for reading. I'd make sure up front that my information is correct and complete...ron > On Mar 21, 11:42 am, doofy <n...@would.nt.be.prudent> wrote...snip... > [quoted text clipped - 13 lines] > surprised that a urologist would only take 3 samples given that you > have palpable disease. I asked him that. He said that the ultrasound did not show any other areas to be concerned with. They did have a whole slew of sample jars laid out, and were anticipating taking more samples, but made that decision at the time. >> On Mar 21, 11:42 am, doofy <n...@would.nt.be.prudent> wrote...snip... >> [quoted text clipped - 16 lines] > I asked him that. He said that the ultrasound did not show any other > areas to be concerned with. That doesn't really make sense. There could easily be prostate cancer elsewhere in your prostate which didn't show up in the ultrasound. My case, which was not untypical, was T1c, meaning the urologist felt nothing unusual, and also when performing the ultrasound, he saw nothing except an irrelevant cyst. But after my surgery, it turned out that there was cancer through out my prostate. According to Walsh, the median number of PC sites found by a pathologist after surgery is seven. Now that you know there is prostate cancer in the "suspicious area", you don't really need another biopsy to find out if there is more, but you shouldn't assume he found all there was. Steve Jordan's suggestion that you have another pathologist look at the samples that were taken makes a lot of sense. The Gleason score is somewhat subjective, so it is worthwhile confirming the Gleason score findings. In any case, you still should have your PC treated. If another analysis results in higher Gleason scores, that just makes it more pressing. If it lowers the Gleason scores to say all 6 = 3+3, watchful waiting, which might be appropriate for an older man, is not a good choice for a man your age. Ron's observation that the cancer doesn't seem to be producing much PSA also warrants attention. It could be that the cancer is just very small or it could be that it is the kind of cancer that produces very little PSA. If the latter is true, that might mean that you can't completely rely on PSA readings following treatment to see if the cancer has recurred. It would also mean that watchful waiting would be a bad choice, whatever your age, since there would be no early warning sign through rise in PSA that the cancer was becoming aggressive. > They did have a whole slew of sample jars laid out, and were > anticipating taking more samples, but made that decision at the time. Hello Doofy, I live in fort Bragg, Calif. In 1999 I had similiar diagnosis and I was 49. I also had ideas about radiation therapy and such, and went to Stanford. Dr. James D. Brooks is a wonderful teach, professor, and Urologist @ Stanford. I would recommend seeing him and if you need a reference, I can offer that. You need to bring all your lab work with you and any history you have of diagnosis. He will review the slide you may have and go from there. Dr. Brooks is not the only Urologist there. They also have Oncologist, and Da Vinci......all depends on what the plan is decided upon. I had RP in 1999 and have had a great record since......less than 0.01 or 0.02 depending on test sensitivity. I have no incontinence issue, and lost one set of nerves during surgery and can and do have a wonderful sex life. I may take 30% of a 100 mgs viagra for help now and then...... If you want to discuss this with me, I would be happy to help you out. Good wishes, jloomis > Hi all, > [quoted text clipped - 34 lines] > long-term survivability, recurrence, side effects and prevalence of side > effects, etc. > Hi all, > [quoted text clipped - 34 lines] > long-term survivability, recurrence, side effects and prevalence of side > effects, etc. You will probably do fine, but whatever treatment you choose, you may end up with erection problems. If you choose surgery done by an experienced, skilled surgeon, the odds for avoiding permanent impotence are high for someone your age, but the fact that you already have erection problems suggests that they certainly won't improve after treatment and may get worse. Similarly for radiation. Also, most physicians would be leery about raising your testosterone levels given that you have prostate cancer. But there are a variety of ways to treat impotence, so you need not assume this will be the end of your sex life. Even though the cancer is small, the fact that one sample showed a Gleason of 7 = 3+4 suggests you should not put off treatment too long, although you certainly have time to decide. When considering treatment choices, keep in mind that even if radiation kills off your current cancer, since your normal life expectancy is fairly high, you could develop another cancer some time in the future in the prostate tissue that may be left behind. I recommend that you read one of the two standard books on the subject. I like the book by Peter Scardino and Patrick Walsh's Guide to Surviving Prostate Cancer. Both Scardino and Walsh are prostate cancer surgeons with first rate reputations, but they are also leaders of research teams which investigate prostate cancer. As such they are pretty familiar with all aspects of the disease. Steve Jordan always recommends Strum's book and his website. Keep in mind that Strum is a medical oncologist and even in that field, I think it is fair to describe his opinions make him an outlier. His book contains lots of valuable information, but it might be more helpful if you were a candidate for hormone therapy, which you certainly are not now, and let's hope you never get to that stage. On March 22, Leonard Evens wrote, in pertinent part: (snip) > Steve Jordan always recommends Strum's book and his website. Keep in > mind that Strum is a medical oncologist and even in that field, I think > it is fair to describe his opinions make him an outlier. His book > contains lots of valuable information, but it might be more helpful if > you were a candidate for hormone therapy, which you certainly are not > now, and let's hope you never get to that stage. I see that poor Len (a) still thinks that he is qualified to give medical advice, (b) alleges or perhaps hints regarding the tx Dr. Strum will prescribe (he'd be amazed at what Dr. Strum does when he considers a case to be best treatable by urologic methods), and (c) that he quite obviously has little idea of Dr. Strum's methods. Dr. Strum is not, as Len enjoys sneering, an "outlier." He is a leader. Regards, Steve J "Do not go where the path may lead. Go instead where there is no path and leave a trail." -- Ralph Waldo Emerson Oh, in my above post I neglected to address this: Len wrote >> Steve Jordan always recommends Strum's book and his website. Well, (1) The book has two authors, and Dr. Strum is always careful to make sure that his co-author, Donna Pogliano (who originated the book project), receives her full share of credit. (2) Len refers to "his (Dr. Strum's, presumably) website." Dr. Strum does not have a website. If Len was making an oblique reference to the website of the Prostate Cancer Research Institute, I'll once again write that, while Dr. Strum is one of the founders of the PCRI, he has not been associated with it for some years. Regards, Steve J "Do not go where the path may lead. Go instead where there is no path and leave a trail." -- Ralph Waldo Emerson > Hi all, > [quoted text clipped - 34 lines] > long-term survivability, recurrence, side effects and prevalence of side > effects, etc. Hi doofy You have a lot of good suggestions from others here. I've been fighting my PCa for 9 years now and will give my comments for your consideration. First get a lot of second opinion from different doctors - you do have some time to do the research - your best chance of knocking it out of your body is the first time. Choose the best artist - most surgeons quote generic stats for incontinence - it is a selected doctors own stats that matter. I would be concerned about a few items in your case; - that your PSA is low, that it was palpable by DRE. PCa is often multi-focal even if not detected as such, being on the outside edge of the prostate - cancer cells can easily spread outside the capsule and cancer with very low PSA can often be hard to eradicate. With any radiation therapy, you will never know the full extent and grade of cancer and salvage surgery is really bad after radiation (that is the problem I have). You have some great doctors in your area so you should do very well. Lud Sy, Jim, other aliases, pounded on the keyboard to produce: > And yes, you will get all kinds of feedback from people who > may be well meaning but have a psychological investment in > whatever treatment they may haver head. That from someone who wrote on March 25, 2008 in alt.support.arthritis (for the 2nd time): "I am 60 years of age and in generally good health but have the usual arthritic aches and pains exacerbated by my exercise routine." How does anyone with PCa consider themself "in generally good health?" You seem to have a psychological investment in trolling. ___ Blue Wave/QWK v2.12 |
Reply to this Message |
 Sign In
 Join
 My Latest Posts My Monitored Threads My Blog My Photo Gallery My Profile My Homepage Start New Thread Enable EMail Alerts Rate this Thread
|
©2008 Advenet LLC Privacy Policy - Terms of Use
This website includes both content owned or controlled by Advenet as well as content owned or controlled by third parties.