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Old 08-20-2012, 07:21 PM   #41
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By low grade I assume Gleason Sum 6. You have a lot of options to consider. Take your time, but keep the big picture in mind- you will probably do well.
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Old 08-20-2012, 07:42 PM   #42
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Originally Posted by Disappointed
Finally had my biopsy done August 3rd. The results are positive with low grade, low volume cancer in 3 out of 14 samples. I have been frequenting the Healingwell board and Healthboards.
I was diagnosed in 2006, and have similar low volume numbers. Have had 6 biopsies and am on watchful waiting. You have to trust your doctor. I left a smaller urology practice, went to a University cancer Center, and I feel there is a wider range of options when 'the day' comes.

That's just personal experience. No recommendation intended.
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Old 08-20-2012, 08:53 PM   #43
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Finally had my biopsy done August 3rd. The results are positive with low grade, low volume cancer in 3 out of 14 samples. I have been frequenting the Healingwell board and Healthboards.
I'm sorry to hear your results. I assume you have a Gleason 6 score.

Continue to educate yourself and keep communicating with your doctor.

My best to you...
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Old 08-20-2012, 09:22 PM   #44
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Originally Posted by lightspeed
By low grade I assume Gleason Sum 6. You have a lot of options to consider. Take your time, but keep the big picture in mind- you will probably do well.
All three samples are Gleason 6, two right base 10% and 20%. One left apex at 20%. Forgot to ask about the stage. Cancer in three cores may not be suitable for active surveillance. Choosing the treatment(s) is probably the most difficult thing.
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Old 08-21-2012, 04:16 PM   #45
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Finally had my biopsy done August 3rd. The results are positive with low grade, low volume cancer in 3 out of 14 samples. I have been frequenting the Healingwell board and Healthboards.
I'm sorry to hear about the positive test results. You will be in my thoughts. DH had prostate cancer successfully treated with surgery. We opted for surgery rather than seed radiation because his PSA doubled in 6 months !

Hang in there. I know its scary. Research the treatment options and find a urologist that you trust.

WebMD's pca board was fantastic when I frequented it.
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Old 08-21-2012, 05:02 PM   #46
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Thoughts with you. Hang in there.
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Old 08-21-2012, 09:45 PM   #47
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I think I may have alluded to this earlier in the thread--- go to a center that has the whole range of options. Make sure you see a radiation oncologist that does more than one type of radiation, in addition to your urologist. You do not want your choices limited because someone does not have all the skills or tools. Watch out for docs who own radiation machines-- more and more urologists own these, and get $40K for a pt they send for imrt if they own the machine, while they get approximately $1200 for prostatectomy or brachytherapy.
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Old 08-21-2012, 10:25 PM   #48
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Originally Posted by lightspeed
I think I may have alluded to this earlier in the thread--- go to a center that has the whole range of options. Make sure you see a radiation oncologist that does more than one type of radiation, in addition to your urologist. You do not want your choices limited because someone does not have all the skills or tools. Watch out for docs who own radiation machines-- more and more urologists own these, and get $40K for a pt they send for imrt if they own the machine, while they get approximately $1200 for prostatectomy or brachytherapy.
Lightspeed, thanks again for such kind recommendations. I read a few books on PCa. While I am aware of the treatment options, I am pretty clueless on who to consult with.
So far I have not been able to make an appointment with my Uro, his girl has not returned my phone calls despite the fact that he told me to call her to make an appointment. I called City of Hope today trying to make an appointment with a surgeon. His nurse has not called me back. I am cluless about radiation and so far don't know who to call, I was hoping my Uro would give me a contact. It is exhausting and confusing, my Uro office is so busy you get voicemail most of the time. I was trying to arrange for a second opinion on my pathology report but can't find anybody to speak to at my Uro's office. I did consider surgery but had my gall bladder surgery in April and not sure if I am up to another surgery.

Please feel free to contine to suggest, PM is also welcome.

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Old 08-21-2012, 10:27 PM   #49
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Thanks everyone for all of your support, deeply appreciated.

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Old 08-21-2012, 11:04 PM   #50
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Originally Posted by Disappointed

Lightspeed, thanks again for such kind recommendations. I read a few books on PCa. While I am aware of the treatment options, I am pretty clueless on who to consult with.
So far I have not been able to make an appointment with my Uro, his girl has not returned my phone calls despite the fact that he told me to call her to make an appointment. I called City of Hope today trying to make an appointment with a surgeon. His nurse has not called me back. I am cluless about radiation and so far don't know who to call, I was hoping my Uro would give me a contact. It is exhausting and confusing, my Uro office is so busy you get voicemail most of the time. I was trying to arrange for a second opinion on my pathology report but can't find anybody to speak to at my Uro's office. I did consider surgery but had my gall bladder surgery in April and not sure if I am up to another surgery.

Please feel free to contine to suggest, PM is also welcome.

Mp
In that part of the country you have good choices. City of Hope would be my choice, so be persistent. They have one of the best robot-assist laparascopic prostatectomy programs in the world, and good radiation options too. If they continue to give you trouble, try UCLA. Both those places will request your path slides and have their own path department review. Good luck.
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Old 08-22-2012, 05:36 AM   #51
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Lightspeed, thanks again for such kind recommendations. I read a few books on PCa. While I am aware of the treatment options, I am pretty clueless on who to consult with.
So far I have not been able to make an appointment with my Uro, his girl has not returned my phone calls despite the fact that he told me to call her to make an appointment. I called City of Hope today trying to make an appointment with a surgeon. His nurse has not called me back. I am cluless about radiation and so far don't know who to call, I was hoping my Uro would give me a contact. It is exhausting and confusing, my Uro office is so busy you get voicemail most of the time. I was trying to arrange for a second opinion on my pathology report but can't find anybody to speak to at my Uro's office. I did consider surgery but had my gall bladder surgery in April and not sure if I am up to another surgery.

Please feel free to contine to suggest, PM is also welcome.

Mp
One of the reasons I went with a major university hospital is to get access to a wider range of opinions. On my first visit, I met with four doctors. Some were radiation-oriented, some were surgical types. None talked about why the other docs were wrong.

When you're with academic people, it's very different. They're willing to review articles, suggest books, etc.

Good luck with your search. I'll PM a phone number to you.
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Old 08-22-2012, 07:30 AM   #52
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That sounds pretty good, considering the range of possibilities. Best of luck as you work your way down this path.

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Old 08-22-2012, 09:32 AM   #53
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One of the reasons I went with a major university hospital is to get access to a wider range of opinions. On my first visit, I met with four doctors. Some were radiation-oriented, some were surgical types. None talked about why the other docs were wrong.

When you're with academic people, it's very different. They're willing to review articles, suggest books, etc.

Good luck with your search. I'll PM a phone number to you.
Target, who helped arranged for you to meet four doctors? I am trying to get an appointment at City of Hope with Dr. Timothy Wilson, a surgeon. I wonder if I need a different Uro than what I have now to help me navigate and provide me with contacts. My Uro seems not to worry too much about my case. He described mine as low grade and low volume, he said I have time to explore (which I agree - but how much time?). I see low risk defined (for the purpose of Active Surveillance treatment) as two cores or less with cancer, mine is 3 cores out of 14.

Thank you all for your support.
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Am I doing the right thing or overreacting?
Old 10-02-2012, 10:16 AM   #54
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Am I doing the right thing or overreacting?

I thought I posted this message but the original is not showing up so pardon me if I end up double posting.

A year ago I had a PSA test which showed a 0.5 which for a 60 year old man was good. I also had a DRE and it showed nothing abnormal with my prostate. Recently I've had something going on that caused me to have an urgency to go so I made an appointment with a urologist I've seen in the past on another issue. Although whatever I had appears to have cleared up I went ahead and met with the Urologist yesterday. Initially, he said that at my age it was probably a prostate infection of some sort but he did another DRE and said he fould a nodule. Although he gave me some options I was kind of freaked out and scheduled myself for a biopsy for next week. Although I understand that a PSA test and even a DRE is not a diagnosis one way or another some folks have suggested that I have overreacted and that I should make a biopsy the last thing vs. the first thing I should do. I've read on the internet that not all nodules on the prostrate are cancerous but 50% are. Am I overreacting and should I back off and have more tests before having the biopsy or for my sanity should I go ahead and get it done next week?
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Old 10-02-2012, 10:43 AM   #55
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I thought I posted this message but the original is not showing up so pardon me if I end up double posting.

A year ago I had a PSA test which showed a 0.5 which for a 60 year old man was good. I also had a DRE and it showed nothing abnormal with my prostate. Recently I've had something going on that caused me to have an urgency to go so I made an appointment with a urologist I've seen in the past on another issue. Although whatever I had appears to have cleared up I went ahead and met with the Urologist yesterday. Initially, he said that at my age it was probably a prostate infection of some sort but he did another DRE and said he fould a nodule. Although he gave me some options I was kind of freaked out and scheduled myself for a biopsy for next week. Although I understand that a PSA test and even a DRE is not a diagnosis one way or another some folks have suggested that I have overreacted and that I should make a biopsy the last thing vs. the first thing I should do. I've read on the internet that not all nodules on the prostrate are cancerous but 50% are. Am I overreacting and should I back off and have more tests before having the biopsy or for my sanity should I go ahead and get it done next week?
For me, it would depend on how well I know and trust my urologist. A small minority of very aggressive prostate cancers do not produce PSA. If a new nodule was felt and it clearly was not there before, then I would do the biopsy.

But now the cynical side of me is going to come out here--- with the recent task force recommendation to not screen anybody for prostate cancer anymore, the referrals to urologists for elevated PSA have dropped off significantly, so some urologists will look for any reason to do a biopsy. And the DRE is so subjective....
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Old 10-02-2012, 01:08 PM   #56
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Although he gave me some options I was kind of freaked out and scheduled myself for a biopsy for next week. Although I understand that a PSA test and even a DRE is not a diagnosis one way or another some folks have suggested that I have overreacted and that I should make a biopsy the last thing vs. the first thing I should do. I've read on the internet that not all nodules on the prostrate are cancerous but 50% are. Am I overreacting and should I back off and have more tests before having the biopsy or for my sanity should I go ahead and get it done next week?
You might want to read Rich_In_Tampa's thoughts on prostate cancer, and maybe wait for more indications than a DRE. At the very least you should go get more DRE opinions-- ideally from experts with small fingers-- because that risk is practically nil. Or go for a twofer at your next colonoscopy, when you won't have to be awake for either one. There is a small but significant risk of prostate biopsy complications.

In my father's case, he paid no attention to checkups. When he finally visited a doctor (after more than a decade), both the PSA and the DRE were alarming enough to schedule the surgery. Even once a year over that decade would have allowed him to keep an eye on any nodules before they turned into Stage IV tumors.
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Old 10-02-2012, 01:41 PM   #57
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For me, it would depend on how well I know and trust my urologist. A small minority of very aggressive prostate cancers do not produce PSA. If a new nodule was felt and it clearly was not there before, then I would do the biopsy.
I would say that I trust my urolgist. I was referred to him by my regular MD as I have had trace amounts of blood in my urine since at least 1994. The concern there has always been cancer elsewhere in my urinary tract but (knock on wood) everything has been OK. He's always taken a wait and watch approach to my treatment so I can't say that he's over testing just to make a buck.

It's doctor week this week so today I met with the doctor that oversees my sleep apnea and was talking to him about it and he suggested that having the biopsy was not out of line. He did say because of the infection of the prostate I may have had that may be the cause of the nodule and it may go away on it's own but he kind of downplayed the risk and suggested that more and more, these biopsies are outpatient procedures.
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Old 10-02-2012, 01:44 PM   #58
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FWIW, I've had three prostate biopsies, all negative. Two of them were wide awake, and they were pretty uncomfortable (not painful, just uncomfortable), but over in less than 10 minutes. One doc rams the ultrasound probe up there and wiggles it around, the other one inserts the huge needle and extracts tiny chunks (click ... click ... click ...). The other biopsy was with the same sort of mild sedation used for a colonoscopy, so that was a complete cinch.

I know you'll hear plenty of cautions about the chance of potential problems from a biopsy, but IMHO it's not a big deal.

Hope that helps ease your mind a bit. Good luck!
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Old 10-02-2012, 02:46 PM   #59
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fwiw, a low psa combined with a nodule is cause for concern. Low psa cancers are often the more aggressive Gleason 8, 9, or 10's. These cancers are more aggressive than a Gleason 5, 6, or even 7's if it's a 3+4. A 4+3 is often an aggressive cancer as well. Any biopsy result that contains a 4 or 5, is not a good thing, and surgical removal is usually the best way to go. This of course, depends on heart health and other factors.

Personally, I would have another DRE by a different urologist, and if he/she also feels a nodule, a biopsy would be in order. Ask for a "free psa" blood test. If that result is under 25%, that would also suggest possible cancer.

My regular doc did not feel anything, but my psa was up slightly. Free psa was 18%. Biopsy results were a highly aggressive Gleason 4+5=9 cancer.

I had surgery followed by two years of hormone treatmemt. Now, only time will tell.

Good luck
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Old 10-03-2012, 09:11 PM   #60
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fwiw, .... Any biopsy result that contains a 4 or 5, is not a good thing, and surgical removal is usually the best way to go. .....
Actually there is no evidence surgery is better for high risk disease than any radiation modality. The best outcomes for high risk disease, at least in retrospective studies, (no prospective, randomized trials have been completed), is the combination of hormone blockade, five weeks of radiation therapy, followed by a seed implant. Surgery makes no sense in high risk disease, where there is a higher likelihood of micro metastatic disease that needs to be addressed with a wider field of treatment (radiation) to encompass it. Surgery is just to focal of a treatment for high risk disease.
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