Increasing PSA Levels in Master Athletes

bcdoo · Regular Joined: 09 Feb 2008 Posts: 18 Location: Texas

Hi Marathon Man.......you'll do fine. I am a long distance biker and tri athlete and had the Da Vinci radical surgery 1/22. I am 57 years old and, while I don't get the miles in as you do, can tell you that being in shape makes a world of difference on the recovery side. I have 3 weeks to go before I can get back to my regular training, but was up walking the halls of the hospital at the Mayo in Phoenix within 4 hours after surgery.

Best of luck on your journey...reading the string of emails was helpful to me as well.

BDOO

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

Hi guys, I'm back with the Urologist next Monday, to decide on procedure. I'm almost certainly goint to opt for RP, main Qs now are when , who and where.

At our last meeting, when I got the diagnosis, he said he'd send me for an MRI, once the bruising from the biopsy calmed down. A friend (nurse) strongly recommends a bone scan also. What do you guys think? And......should I be looking for any other tests? If so what do you suggest?

I always reckon you should know your enemy, but one can analyse this thing to death (no pun intended Smile

) At this point, I feel that I should just get on with it...........and start recovering!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

It's the norm to have various scans, especially a bone scan, before a prostatectomy.

In my case I had a bone scan and pelvic CT. A few weeks earlier I had had a chest x-ray done to make sure my lungs were fine for general anesthetic (for the biopsy).

The scans will almost certainly be clear of signs of cancer. It's just due diligence on the part of the surgeon.

I stored up my own blood before surgery. That's an optional step. Turns out I didn't need the blood (and that's usually the case) but I was more relaxed going into the operation knowing that if I needed blood, it would come from me.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

goruck · Posted: Wed Feb 27, 2008 2:46 pm Post subject: good luck

because you are such a good athlete, i would give strong consideration to brachytherapy.
I have seen awful incontinence in the best of hands.
I have a blog I am starting describing various patients who had different types of surgeries.

I will include the following ones in my next posts.

patient a: he was prominent physician and relative of a top physician at the united states premier cancer center. When this poor guy had his nerve sparing radical prostatectomy by one of the world's three greatest rrp artists (walsh and catalona being in the top three also at time), he was supposed to go home on day 3. Unfortunately, the resident on closing placed the drain into his small bowel. This poor prominent rheumatologist spent the next four months on intravenous nutrition until his bowel closed.
Now this happened at a world class center where people pay cash from all over the world to be treated. My point is that bad unrelated life altering events can happen during surgery. Sadly, I lost my first radical prostatectomy patient ever right on the table at cornell where I trained. We still dont know why he passed away. Maybe myocardial infarction? I never take surgery lightly. I dont mean to scare with anecdotal evidence, but do take the option of brachytherapy seriously.

patient b: This is a friend and patient of mine who I sent to a very good lap rp specialist. They entered his pelvic cavity and encountered scar in such a manner that lap rp had to be aborted. Subsequently he went to moffitt cancer center in tampa; There his prostate was removed piecemeal due to scar. He now has severe ED, and I am not sure of his continence.

caveat emptor!

now I do have a list of brachy complications too; but as a marathon guy (and i do know how they are), I would be more wary of surgical therapy unless you truly have poor xrt facilities in ireland. At least in the us, i would have no qualms over sending you to a good xrt oncologist.

best
_________________
George Rucker
Urology/Urologist
http://prostateconcerns.blogspot.com/
www.urology-partners.com
http://www.cornellurology.com/past-res.html
http://www.lakewoodranchmedicalcenter.com/index.php?&PageID=1088

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

Well the decision has been made. I spoke to at length to lots of people, particularly survivors & spouses, been researching this for months, but more focused for the past few weeks. Discussed with my GP (MD to you guys) for approx. 1 hour.

I saw the urologist on Monday. I'd already decided that I'm going for a RP. U wanted me to tell him what I wanted to do, but I told him I'd aleady decided but wanted to hear his recommendation before I told him. He also recommended RP.

I'm going to see the surgeon on Fri 14th Mar. Don't know when surgery is going to happen, but I expect soon after that. The surgeon has carried out several thousand RPs and is highly regarded. I'll have to travel to Dublin (160 Miles) but my daughter lives very near the hospital (not relevant to decision). I could have had it locally, in about the same timeframe, but nerve sparing wasn't a possibility. I did ask about going to the UK or US but U reckoned that our man in Dublin is as good as any and therefore travel is an unnecessary hassle.

Goruck, Good Brachy is available just 4 miles away but I rejected it because I'd like to know that this is gone, gone, gone, I want the path. and I reckon, with my fitness, that, barring complication, RP will give me the best outcome. Da Vinci is also an option but the surgeons (highly regarded) haven't built up big enough a track record for my, or U's, liking.

To be honest, I'm more relieved now that I know what I'm dealing with and how we're going to tackle it.

A friend said, following my diagnosis "PMA! That's what it's all about! Positive Mental Attitude! .......and you're ****ing full of it!"

Let the journey begin! (says he, cringing)

God Bless!

PS I had a full body bone scan done Wed. Surgeon may recommend MRI.

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

My urologist referred me on to a different urologist, the guy whom I'd hoped would carry out a nerve sparing RP.

I saw him today and his pathologist has upgraded my 3+4 to 4+3. In addition he did a DRE and found palpable indications. He reckons that there is a strong possibility that the tumor has escaped. He wants an MRI done before deciding what to do.

If the MRI shows indications of escape, he reckons that surgery is not an option and extrenal beam is the only answer. If it doesn't show, then either surgery or external beam are the options. If however surgery is carried out, external beam may still be required.

I'm going to arrange the MRI next week and that may decide.

I had decided on the RP route, but now I'm not so sure. Basically I'm looking for advice/opinion. I'll make up my own mind, together with the surgeon, and also with my doctor, but I badly need some informed advice.
I'll do my best to get that from my own contacts, but input from you guys would be appreciated.

God Bless!

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

MM,

All this doesn't mean the cancer can't be cured. It usually takes PCa some time to develop the ability to survive away from the prostate. Even after it penetrates the capsule (like mine did) it might still be in the immediate vicinity and curable by radiation (mine MIGHT have been cured by radiation. PSA points in that direction. I won't say "cured" for many years, though.)

'm not sure what the doctor hopes to see with the MRI. I thought cancer would have to be pretty far past where you seem to be with your stats in order to show up on MRI. Then again, I'm not your doctor. I'm sure they're trying to spare you surgery if radiation is a better idea in their view. There's also the viewpoint that it's good to remove a cancerous prostate even if the cancer has spread--this is called debulking the tumor.

From what I've read, and from my own experience with external radiation (in the form of IMRT), radiation side effects are much milder and more transitory than those that come from surgery. And the treatments themselves are a breeze--no sensation at all. So if you and your doctors decide that's the way to go, don't lose sleep over that part of it. If you have radiation, I would ask about having a course of hormone therapy (androgen deprivation) to go along with it. There are some studies that show ADT makes radiation more effective.

I'll be interested in hearing what others have to say on this. These are just my late night musings. Don't take them as advice.

Marathon Man, I'll be lifting a mug of beer (maybe green beer!) here in a few days to your health and successful treatment.

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

Just wondering what others think on DRE frequency. Hindsight is a wonderful thing and, looking back, I wonder how I got to this point.

I first saw the urologist in Jan '07, PSA 4.9, having been 4.3 six months before. He performed a DRE and found nothing abnormal.

I next saw him in May '07, PSA 6.3. No DRE but biopsy carried out - 12 cores, all negative. Follow up after biopsy, no DRE carried out.

Next consultation was Dec '07, PSA 9.4. No DRE but another biopsy scheduled for late Jan '08, 10 cores, 3 positive. Follow up 2 weeks later no DRE carried out.

I saw a different consultant last week and he did a DRE and found abnormality - and reckons there is a strong liklihood that it has "escaped".

Q I'm asking is, would one expect to have a DRE carried out at each visit? What's your experience?

What bothers me in hindsight is that a DRE probably ought to have been done in June '07, in spite of negative biopsy - after all the doubling time was 17 months?

As an Engineer, I believe that, in 'similar' engineering related circumstances, I would always do the check. I can't help but think we missed an opportunity to catch it earlier, specifically last June - we'll never know now.

I have an MRI scheduled for Thursday - couldn't get one any earlier. Hopefully that won't show anything outside the gland (say a few, please) and surgery will still be on. Otherwise EBRT will then be the only show in town.

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

I had the MRI last Thursday and, thank God, the genie is still inside the box! I have now got a date for surgery, May 22nd.

I know it's a while off, but I trust the surgeon (who has a well earned world class reputation), so I figure all will be fine. I'm going for nerve-sparing RP.

However, now that the spectre of the 'escape' is gone, I'm starting fret over whether I'm doing the right thing. Radiation or RP? Neither appeal to me, but I reckon that, in the peak of fitness ( I was third M50 in a race last Sunday), with the entire thing gone, my long-term prospects are better with the RP.

I really know now what is meant when people talk about being "between a rock and a hard place" - and how ironic that phrase is in the current circumstances.

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

I'm finally heading in tomorrow for a full blown "old fashioned" RP, with the op taking place on Thurs morning.

Since the posting here, in early March, about the benefits of cayenne pepper, I've been taking two capsules a day, however I stopped taking them on Sun May 4th, as I didn't want to risk any possible inflammation close to the op. I don't know what, if any, effect the pepper will have. I just thought 'what the heck!, if it works, why not? and if I just think it works, then that's good too. Incidentally, I read over the weekend (I didn't check it out further) that sesame seeds are also supposed to kill off prostate cancer cells.

I intend keeping a diary during my period in hospital and afterwards during recuperation and, hopefully, a return to running.
_________________
Marathon Man

Dx Feb 2008, PSA 9.4 @age 54 - Biopsy Gleason 4+3
RRP 22 May 2008 - Gleason 4+4, Tumour Vol 5%, T2a, N0M0, Negative Margins

http://prostaterunner.blogspot.com/

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

I'm finally heading in tomorrow for a full blown "old fashioned" RP, with the op taking place on Thurs morning.

Since the posting here, in early March, about the benefits of cayenne pepper, I've been taking two capsules a day, however I stopped taking them on Sun May 4th, as I didn't want to risk any possible inflammation close to the op. I don't know what, if any, effect the pepper will have. I just thought 'what the heck!, if it works, why not? and if I just think it works, then that's good too. Incidentally, I read over the weekend (I didn't check it out further) that sesame seeds are also supposed to kill off prostate cancer cells.

I intend keeping a diary during my period in hospital and afterwards during recuperation and, hopefully, a return to running.
_________________
Marathon Man

Dx Feb 2008, PSA 9.4 @age 54 - Biopsy Gleason 4+3
RRP 22 May 2008 - Gleason 4+4, Tumour Vol 5%, T2a, N0M0, Negative Margins

http://prostaterunner.blogspot.com/

Replicant · Moderator Joined: 01 Nov 2006 Posts: 206

We'll see you on the other side of surgery. Best of luck!

I'm going to read your blog today. Looks good.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1
http://pcabefore50.blogspot.com

Marathon Man · Regular Joined: 17 Jan 2008 Posts: 14 Location: Ireland

I had the RRP on May 22nd and stayed in hospital until May 29th. Surgeon was very pleased with the results; "We both had a good day". He also said that my fitness level had a huge bearing on the surgery.

I've been keeping a diary since going into hospital and am slowly entering these on my blog. I intend synopsising all my tips and advice at the end. hopefully these will help others.

I was back at the hospital yesterday to get the cathether removed. Had a few "self-start" accidents to begin with, but 36 hours later things seem to be going OK. I could live with the current status - don't know about running witha pad though. I won't even think about thinking about running for another three weeks minimum. My wife and I have been walking (slowly) 2.75 miles most days. We will probably get in a bit more now that I don't have the bag to worry about any more.

Anyway the Pathology. Got that yesterday too: Gleason score on surgery was 4+4=8, Tumour size was 5% (didn't think to ask about gland volume), negative margins, no seminal vessicle involvment and no lymph gland involvement. I also forgot to ask what clinical stage I was at - I think I'm still T2a. PSA wasn't taken when I went in, so I've no idea if the daily dose of two capsicum (cajun pepper) capsules I took for approx. 6 or 7 weeks prior to surgery had any effect.

The surgeon told my wife & I that I was "a very lucky man"

I'm back with the surgeon for a checkup in 6 weeks.
_________________
Marathon Man

Dx Feb 2008, PSA 9.4 @age 54 - Biopsy Gleason 4+3
RRP 22 May 2008 - Gleason 4+4, Tumour Vol 5%, T2a, N0M0, Negative Margins

http://prostaterunner.blogspot.com/

brainman

Great to hear from you. So far, so good? Smile

I hope you continue to recover well.

Regards.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendoglioma grade 3, same location.
My Story Part 1: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 2: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

Athletesforacure · Posted: Mon Jun 23, 2008 8:33 am Post subject: Masters Runners

Marathon Man,

Scott from Athletes for a Cure (Prostate Cancer Foundation). We've got hundreds of men running as well or better post treatment. Happy to connect you when you're ready to go again. Best of luck. Remember what Pre said, "I'm going to work so that it's a pure guts race at the end, and if it is, I am the only one who can win it. Sounds like your kind of guy!

Scott

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