Looking For Help

Hi,

My name is Ron.

Iam 53 yrs old.  My PSA has gone from 2.something to 4.2 over the last 3 or so years.  Most recent was 4.2 up from 3.7 approx 18 months b4.  Dr did digital and did not like what he felt.  Sent to urologist who did 12 biopsies.  Based on below the urologist says prostrate removal via da Vinci Prostatectomy.  Would you all be willing to discuss this with me based on what your experiences have been and also lend me some recommendations as I don't want to rush into this (if below numbers indicate I have time to do much needed research.

Came back left Right apex gleason score 3+3=6.  involving 30% of surface area (1 core).  perineural invasion not seen.

Right Mid gleason score3+3=6.  involving 40% of surface area (# core involved not identified).  perineural invasion not seen.

Right Lateral Apex gleason score 3+4=7 involving 20% of surface area (2 core samples).  Perineural invasion not seen.

 Right Lateral Mid gleason score 3+3=6 involving 60% of the surface area (1 core sample).  Perineural invasion present.

Right lateral Base gleason score 4+3=7 involving 60% of the surface area (# core involved not identified).  Perineural invasion present. 

Left Apex,Left lateral apex, left lateral base - Benign prostatic tissue.

Left Mid, Left Base - Benign prostatic tissue/atrophy focal.

left lateral mid - high grade prostatic inraepithelial neoplasia (pin) focal.

Ron,

It is wise not to rush or be rushed into a decision: best to gather your thoughts, don't panic and  think things through logically.

You'll hear a lot of technical views, and from many who can only think of one treatment option. One size does not fit all, and treatment choices depend  on the diagnosis and preference.

I'll try to give you a few down to earth tips without going into a lot of detail right now.

Although you have a number of positive cores, most are gleason 6 scores which are in the low to medium risk category, More agressive higher risk scores are 8 and above, which need more urgent and agressive treatment.

* Firstly, gleason readings are subjective, (it depends on who looks at the samples) so it's important  to obtain a 2nd reading of your slides, as your treatment considerations are based on those numbers.

* THE most important aspect is to select  the best available doctor regardless of what treatment is chosen: eg, the doctor  is more critical than whether open or robotic surgery is used.

* Despite what some might suggest, most of the mainstream treatments provide similar long term results, so it often comes down to personal preference and consideration of the potential side effects.

There's plenty of information on the various choices available: don't hesitate to post again with any questions which come to mind.

Best Wishes,

John 

John,

 I really appreciate the calming effect your words have had on me and do appreciate the wisdom of them.  Especially putting in focus--"...comes down to personal preference and consideration of the potential side effects".

Not leaning either way at this time as I am scheduled to meet with my "normal dr" 2morrow.  How should I go about requesting that a diff path perform reading of my slides?

It's very usual for 2nd readings to be done by one of the expert pathologists, so most doctors have no problem with it, and should suggest it as a prudent process.

In a good % of cases 2nd readings  indicate a different result. Obviously this can have an influence on how agressively you might approach treatment options.

I'd just tell him you'd like the reassurance of obtaining a 2nd reading: it's unlikley anyone will object. If necessary, reinterate that you will feel more comfortable with the process once that's done: he'll go along with it, as you're the one paying the bill, and it's in everyone's interests.

Some of the pathologists who can provide the service are at Johns Hopkins Med School, University of Virginia Med School, Stanford University Med school.

A very good book on PC is "Prostate Cancer Prevention and Cure" by Lee Nelson MD. Although written a few years ago it's one of the most comprehensive books I've seen. It might not have the latest details on some of the newer treatments like robotic surgery or HIFU, but that information can be readily obtained here.

John,

Your advice has been well taken and I really appreciate the guidance.  Went to my family Dr and I am scheduled fto see a different Dr. next Tuesday at a KU Med Center .  From everything I've been hearing and from other individuals who have had actual dealings with him, he sounds as if he a very capable and compationate urologist/onocoligist.  

 In addition to your comments, my family dr has put my mind at ease and pretty much agrees with my conclusion that total removal may or may not be the course.  However, if that is where everything points then I will more than likely opt for the da Vinci Prostatectomy.  A plus about this new Dr is that he is known to address all the different conventional procedures and in addition is that he is highly skilled in using this "robotic" surgical procedure.  Granted it really depends on this 2nd look by the new Dr. though!

Ron,

Hope all goes well. It sounds as if you are in good hands.

On 2/25/2008 oldnslow53 wrote:

Hi,

My name is Ron.

Iam 53 yrs old.  My PSA has gone from 2.something to 4.2 over the last 3 or so years.  Most recent was 4.2 up from 3.7 approx 18 months b4.  Dr did digital and did not like what he felt.  Sent to urologist who did 12 biopsies.  Based on below the urologist says prostrate removal via da Vinci Prostatectomy.  Would you all be willing to discuss this with me based on what your experiences have been and also lend me some recommendations as I don't want to rush into this (if below numbers indicate I have time to do much needed research.

Came back left Right apex gleason score 3+3=6.  involving 30% of surface area (1 core).  perineural invasion not seen.

Right Mid gleason score3+3=6.  involving 40% of surface area (# core involved not identified).  perineural invasion not seen.

Right Lateral Apex gleason score 3+4=7 involving 20% of surface area (2 core samples).  Perineural invasion not seen.

 Right Lateral Mid gleason score 3+3=6 involving 60% of the surface area (1 core sample).  Perineural invasion present.

Right lateral Base gleason score 4+3=7 involving 60% of the surface area (# core involved not identified).  Perineural invasion present. 

Left Apex,Left lateral apex, left lateral base - Benign prostatic tissue.

Left Mid, Left Base - Benign prostatic tissue/atrophy focal.

left lateral mid - high grade prostatic inraepithelial neoplasia (pin) focal.