← Return to Living with Prostate Cancer: Meet others & introduce yourself

Discussion
Comment receiving replies
@noladave

Hello all, My name is Dave. New to this place and actually new to all of this. I recived my diag 3 days ago on 2/1/23. Prostate cancer 3+4 Gleason, grade 2. PSA been rising everytime we check, over the past 18 months gone from 9 to over 11, i thought that was bad but from what im reading people are talking about their PSA doubling, so im not sure if going from a 9 to 11.1 over that time period is considered bad or not. As i said i am very new to all of this and am a little overwhelmed. I have a Bone Scan and Cat Scan coming up next week. I guess depending on how those tests come out Doc is telling me in his opinion best options are Surgery or Radiation he recomends surgery just remove the prostate. I have some questions from my results that i need answered still. Doc is telling me i am on the upper end of the intermediate scale as far as having an aggressively growing cancer. From what im reading from my results i dont see that, and thats why i have a few questions for the doc still. Anyway i am glad to have found this group, hopefully i can meet some new people make some friends and get some needed info and support. I think i am still waiting for all of this to really sink in. I dont belive this has really hit me yet, and im reaching out.

Jump to this post


Replies to "Hello all, My name is Dave. New to this place and actually new to all of..."

Welcome. This is Jim. This is a great place to learn.
The correct use of PSA is tracking of annual values rather than using a single value as a "cutoff". Example: For men < 40 yrs, the "cutoff" at Johns Hopkins was 1.8 ng/mL The cutoff of 4.0 ng/ mL was established without any clinical assessment of the men involved. In truth, one would have to take out men's prostates and step section them to establish they are "normal", which is close to impossible. Having said that, I tracked mine for 30 yrs and it slowly rose to around 1 as my prostate also enlarged. Then the hiatus of my healthcare system denying routine PSA. Before the "pandemic", it was 2.0, A year later it was 4.0 (I was allowed PSA as a professional courtesy). No action was recommended because it was "normal". A year later is was 6.9. That got my doc's attention. Diagnostic MRI sees a lesion. MRI-guided 12 core biopsies reveal cancer in 10, eight of which are Gleason 7, but two being Gleason 8, i.e. high risk disease. PSMA PET sees no signal outside the prostate (but I don't think the detection limit is known).

So, now the dilemma: radiation vs prostatectomy. If all the disease is in the prostate, prostatectomy is a cure with very manageable side effects. The main factors are your general health and age, and access to PSMA PET. In my opinion, a healthy man in his 50s - 60s with low - medium risk pathology and negative PSMA PET is a good RP candidate. However, I swung toward radiation for the following reasons: Improvement in avoiding radiation side effects. I had access to MRI-guided radiation which minimizes likelihood of radiation damage to colon and adjacent structures, and is completed in five days versus thirty. I also had access, prior to treatment, to Hydrogel placement. This gel serves to separate the colon from the prostate. In my case, my large prostate was pressing against the colon, so this was a key to my success: no urinary or intestinal changes.

One caveat. Many radiation patients are recommended to take androgen deprivation therapy such as Lupron, starting 2 months prior to treatment, and continuing for a total of 18 months. It drove my testosterone to zero in 3 months and PSA to 3, and then to zero three months later, but everyone hates the side effects of Lupron. I agreed to this because, regardless of the surgeon and radiation oncologist's optimism, I know something about prostate cancer and pathology. Given my high risk pathology, I would be very surprised if all of the disease is confined to the prostate. Lupron/anti-androgen is for me a low-tech insurance policy. It is claimed to "slow" the growth of prostate cancer. Perhaps. I have not seen the data. However, it is not curative.

Back to you. I would not be concerned with PSA 9 vs 11. I would be extremely concerned with both. Do you have prior values such that you could look at the trend? In any event, how was the biopsy done; how many were taken; what were their pathology? I would not act on a single needle biopsy. Next, you didn't mention your age or general health. I look at radiation as taking a bit of a roll of the dice: are you likely to die of other medical problems before any missed cancer would have a clinical effect? In my case, when my surgeon (original doc I saw) called to tell me about the pathology results (I had already seen them), his first words were: "the good news is, you won't die of prostate cancer". Well, he probably felt somewhat secure in saying that since he knew I was 80 yrs old. However, he knew nothing about my overall health, which it happens, is extremely good for any age, so he made some assumptions. I was not reassured by his statement. I hope this starts to get you back on your feet after your news.