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Thread: nmguy

  1. #121
    Quote Originally Posted by nmguy View Post
    I was wondering why there are 2 cores listed in my left base with the same gleason and percentage. Are they taken right next to each other.
    Yup. Very common. Good luck with the surgery!
    Late 2012: PSA 4, age 62 all DRE's 'normal' ... Early 2014: PSA 9.5, TRUS biopsy negative
    2015: PSA's 12 & 20, LOTS of Cipro ... Mar'16: PSA 25, changed Urologist
    Jun'16: MRI fusion biopsy, tumor right base, 6/16 cores: 2-40%+2-100% G8(4+4)
    Aug'16: DaVinci RP, -SM, 11 LN-, 53g, 25% involved, PNI, 6mm EPE, BL SVI, pT3B
    Jan'17: started 18 months Lupron ADT, uPSA's ~.03
    May'17: AMS800 implanted, revised 6/17
    Aug'17: 39 tx (70 Gy) RapidArc IGIMRT
    Jan'18-Jan 2019: PSA's <0.008, T=9 (still on Lupron)
    Apr'18: Dx radiation colitis, Oct'18: Tx sclerosing mesenteritis
    "Everyone you meet is fighting a battle you cannot see"
    Mrs: Dec 2016
    Dx stage 4 NHL/DLBCL, Primary Bone Lymphoma
    spinal RT boost+6X R-CHOP21+IT MTX via LP. Now in remission
    Read our story at CancerCoupleBlog.com

  2. #122
    Senior User
    Join Date
    Feb 2017
    Posts
    130
    NM, it looks to me like you’ve done everything the right way. One of the great things about this forum is hearing from a lot of other guys who have been or are on the same journey. When I began this process a couple of years ago, I didn’t know what questions to ask.

    My biopsy indicated the need for surgery, and I had that done locally. After the RALP, the pathology was much, much worse than my urologist had expected. For me? I was devastated.

    To make a very long story short, I chose the next line of treatment after a consult at Johns Hopkins. I still don’t know how it happened, but I ended up with the Clinical Director of Research as my Doctor. At my first appointment, he’d already had my pathology slides read by the famous Dr. Jonathan Epstein. He verified the pathology report that I’d had locally.

    I am in a clinical trial that has involved surgery, chemo, radiation and ADT. My PSA has been “undetectable” now for 18 months, and I’ve had quarterly checkups.

    You have a lot going in your favor. Mostly, you have taken responsibility for yourself. You’ve actively sought out treatment in a world class facility that has a well-deserved reputation for excellence. Being in great physical condition will pay dividends when you get into the recovery phase.

    Will be thinking of you as you get to surgery date!
    2010-PSA 3.59; 2011-PSA 3.58; 2012-PSA 5.28, 4.26; 2013-PSA 5.98, 7.37; 2014-PSA 5.90, 4.70; 2015-PSA 5.18, 7.35
    RALP 16 March 17, Wesley Long Hospital, Greensboro, NC
    Pathology: pT3a, pN1 Gleason 4+5=9 adenocarcinoma with + surgical margin at bladder neck; 3 of 16 lymph nodes positive; neg seminal vesicles, vasa deferens
    Referral to Dr. Ken Pienta, Clinical Dir Research, Brady Center, Johns Hopkins
    Enrolled in Clinical Trial IRB002120414 “Phase II Study of definitive therapy for oligometastatic prostate cancer post surgery"
    Completed: Docetaxel 12 Jun 17, 3 Jul 17, 24 Jul 17, 14 Aug 17, 15 Sep 17
    Lupron every 90 days. 1st injection 12 Jun 17, 2d 15 Sep 17, 3d 18 Dec 17, 4th 6 Mar 18, 5th 5 Sep 18; 17 Dec 18
    Bone/Body Scans - 15 Sep 17 - neg
    EBRT: 69 Gy total (46 to fossa, 23 boost to suspect areas) 1st treatment 28 Sep 17, last 22 Nov 17
    PSA: 25 May 17=0.2; 5 Sep 17=0.1; 18 Dec 17=0.1; 6 Mar 18=0.1; 29 May 18=0.1; 5 Sep 18=0.1; 17 Dec 18=0.1; 12 Mar 19=0.1; 25 Mar=0.1

  3. #123
    Nmguy..
    Just something to think about when you discuss your RALP procedure with your surgeon. My husband asked our experienced Mayo surgeon's PA if only "his hands " would be on the "controls". She said.."You know Mayo is a teaching facility, so the resident could do some of the procedure". We stated we didn't want to put anyone out, but we've read how important experience is in this surgical procedure, so could we ask for our surgeon to do the entire surgery? She said yes, if we wanted it that way, she would talk to him about doing the entire procedure. We read surgical notes following, no mention of who did what, but we were told he would. Just something that I was glad we asked. I understand everyone has to start somewhere, but we wanted experience. Prayers for a cancer free future without long term issues.
    Wife of newly diagnosed husband...he is 62 years old
    Family history..dad passed away from PCa...brother has very aggressive PCa Gleason 8 , outside capsule..is winning for 15 years now
    March 2017 Self referral to Rochester for 2nd opinion due to slowly elevating PSA with negative DRE over a 5 year period
    1st MRI March of 2017 negative, Neg DRE
    3 mo PSA for 18 months...Nov 2018 jump in PSA from 4.2 to 6.8
    2nd MRI Nov 2018..Fused Targeted Biopsy Dec 2018 (Mayo Dr. Mynderse)outpatient
    DX 3+3 Gleason 6 (all 6 of 14 cores ), bilateral involvement, all cores under20% except one at 40% and another at 80%
    Jan 17th RALP done Dr. Igor Frank , Methodist Hospital Rochester
    Pathology: 3+3 Gleason 6, SV-, EPE-, SM abuted less than 3mm, no LN taken, catheter 7 days, urine retention, catheter 5 days, min incontinence so far. ED improving . 20 mg Sildenafil daily for 3 months post RALP and as needed

  4. #124
    Senior User
    Join Date
    Nov 2018
    Posts
    171
    Thanks BAB. I have read a lot of your post. You have had a long journey and are a real inspiration. Good luck with your treatment. Best wishes.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Biopsy 11/2018 12 cores 3 positive one 5% left mid two 50% left base
    Gleason 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews
    MRI Scheduled 2/27/2019 Mayo Phoenix AZ
    RALP Scheduled 2/28/2019 Mayo Phoenix AZ Dr. Paul Andrews
    Path: Gleason 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents with moderate to extensive volume mainly on the
    posterior portion of prostate. The largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    Extraprostatic Extension: Absent
    Urinary Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Positive (right seminal vesicle)
    Margins: Positive at left lateral base margin and central base margin 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Pathologic Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx

  5. #125
    Senior User
    Join Date
    Nov 2018
    Posts
    171
    WifeOfGolfer I didn't think to ask that at the consult but I was thinking he would be doing the surgery. I may call the P.A. on his team and ask tomorrow. Of course a little late now guess they could let someone else do some and I wouldn't know. He is the Chair of Urology and I waited a extra 3 weeks to get him. Thanks for the well wishes. I hope all goes good also.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Biopsy 11/2018 12 cores 3 positive one 5% left mid two 50% left base
    Gleason 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews
    MRI Scheduled 2/27/2019 Mayo Phoenix AZ
    RALP Scheduled 2/28/2019 Mayo Phoenix AZ Dr. Paul Andrews
    Path: Gleason 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents with moderate to extensive volume mainly on the
    posterior portion of prostate. The largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    Extraprostatic Extension: Absent
    Urinary Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Positive (right seminal vesicle)
    Margins: Positive at left lateral base margin and central base margin 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Pathologic Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx

  6. #126
    Senior User
    Join Date
    Nov 2018
    Posts
    171
    Well surgery in about a week. Nerves are stressed out as gets closer wondering if 3+4 will be cured or is there something worse. Mind games will try not to think about it for a while.
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Biopsy 11/2018 12 cores 3 positive one 5% left mid two 50% left base
    Gleason 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews
    MRI Scheduled 2/27/2019 Mayo Phoenix AZ
    RALP Scheduled 2/28/2019 Mayo Phoenix AZ Dr. Paul Andrews
    Path: Gleason 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents with moderate to extensive volume mainly on the
    posterior portion of prostate. The largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    Extraprostatic Extension: Absent
    Urinary Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Positive (right seminal vesicle)
    Margins: Positive at left lateral base margin and central base margin 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Pathologic Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx

  7. #127
    Moderator Top User HighlanderCFH's Avatar
    Join Date
    Nov 2011
    Posts
    7,078
    NM, you can go into the surgery with the confidence of a patient with a relatively lower PSA, a T1c prediction and a Gleason 3+4, which often behaves like the very low risk 3+3. The chances of anything drastically different being found are not all that high.

    All the numbers are on your side.

    If it helps to hear another person's experience, I'm the type who gets nervous just getting my teeth cleaned. And I always figured I'd be going off my ass if I had to face a major surgery. Well, I'm happy to report that I was wrong.

    I had always expected to not get a wink of sleep the night before going into the hospital. But, you know what? I just took things soberly, somberly & matter-of-factly and was pleasantly surprised to get a good, full night's sleep the night before. And, when I got up in the early morning (I opted for an 11 a.m. surgery), I groomed myself the same as any other day.

    I walked (accompanied by my Mother) from the motel to the Mayo (Rochester) Methodist Hospital and could not believe I was actually checking in for surgery. But, once again, I just kept calm, somber and made myself realize that this was NECESSARY and that it was also expected to cure me. There really isn't much else to it.

    I remember being rolled down the hallway on the gurney, the double doors opening up and the friendly robot standing with its arms up (hmmmmm, looking like one of the space pods in 2001: A Space Odyssey) waiting for action. Then they moved me onto the surgical table and suddenly I was in the hospital room, pain free and all finished with the surgery.

    Never had any pain at all -- and the surgeon came in the next morning and congratulated me on being cured.

    In a nutshell, it was like a great adventure. The day approached, the day came, and the day passed. A couple months later it was hard to believe I even had any surgery. Life quickly returned to normal and it's been that way ever since.

    And that, my friend, is the way I think it is going to be for you.

    Think of next week as the day you become cancer free & healthy again!

    Hang in there, it will be just fine,
    Chuck
    July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA 9/ 2011 = 5.7.
    Local uro DRE revealed significant BPH, no lumps.
    PCa Dx Aug. 2011 age of 61.
    Biopsy DXd adenocarcinoma in 3/20 cores (one 5%, two 20%). T2C.
    Gleason 3+3=6. CT abdomen, bone scan negative.
    DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
    Surgeon was Dr. Matthew Tollefson, who I highly recommend.
    Final pathology shows tumor confined to prostate.
    5 lymph nodes, seminal vesicules, extraprostatic soft tissue all negative.
    1.0 x 0.6 x 0.6 cm mass involving right posterior inferior, right posterior apex & left
    mid posterior prostate. Right posterior apex margin involved by tumor over 0.2 cm length,
    doctor says this is insignificant.
    Prostate 98 grams, tumor 2 grams.
    Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
    Seven annual post-op exams 2012 through 2018: PSA <0.1
    Semi-firm erections without "training wheels," usable erections with 100mg Sildenafil.
    NOTE: ED caused by BPH, not the surgery.

  8. #128
    nm, you've done all your homework and have every reason to be optimistic. Worrying is futile! Let the medical profession work for you. As Chuck said, this will all be behind you very soon.

    Djin
    69 yr at Dx, BPH x 20 yr, 9 (!) neg. biopsies, PCA3 -
    2013 TURP (90→30 g) then PSA 2x/yr, DRE yearly
    6-06-17 DRE: nodule R, PSA rise, on finasteride: 3.6→4.3
    6-28-17 Biopsy #10: 2/14 cores: G10 (5+5) 50% RB, G9 (4+5) 5% RLM
    Bone scan, CTs, X-rays: negative
    8-7-17 Open RP, neg. frozen sections, Duke Regional
    SM EPE LVI SVI LN(16): negative, PNI+, nerves spared
    pT2c pN0 bilat. acinar adenocarcinoma G9 (4+5) 5% of prostate (4.5 x 5 x 4 cm, 64 g)
    11-10-17 Decipher 0.37=Low Risk: 5-yr met risk 2.4%; 10-yr PCa-specific mortality 3.3%
    Dry; ED OK with sildenafil
    9-16-17 (5 weeks) PSA <0.1; Pomi-T (2/day)
    LabCorp uPSA (Roche ECLIA):
    11-28-17 (3 mo. ) 0.010
    02-26-18 (6 mo. ) 0.009
    05-30-18 (9 mo. ) 0.007
    08-27-18 (1 year) 0.018
    09-26-18 (13 mo) 0.013 (checking rise)
    11-26-18 (15 mo) 0.012
    02-25-19 (18 mo) 0.015

  9. #129
    Senior User
    Join Date
    Nov 2018
    Posts
    171
    Thanks Djin I know you are right. I was ok until started getting close then I found myself going back through every old thread I could find that had a biopsy similar to mine to see how they came out. Of course I find the ones that had BCR or + margins or seminal vessel invasion because mine is near them at the base anyway you get the idea. My wife says the same as you. She says you have to stop going through that. Anyway going to try. Thank you guys for letting me rant. It helps.
    ML
    DOB 1955
    63 at dx
    3/2018 PSA 4.05 DRE normal refer to URO small town
    10/2018 PSA 6.28 DRE normal
    Biopsy 11/2018 12 cores 3 positive one 5% left mid two 50% left base
    Gleason 3+4=7 T1c
    Appt Mayo Clinic Phoenix Az 1/4/2019
    Dr. Paul Andrews
    MRI Scheduled 2/27/2019 Mayo Phoenix AZ
    RALP Scheduled 2/28/2019 Mayo Phoenix AZ Dr. Paul Andrews
    Path: Gleason 3+4=7, Tertiary Gleason Pattern none, Grade Group 2
    Tumor presents with moderate to extensive volume mainly on the
    posterior portion of prostate. The largest tumor nodule measures
    8 mm.
    Prostate: 21g 3.5 x 3 x 3 cm
    Extraprostatic Extension: Absent
    Urinary Bladder Neck Invasion: Absent
    Seminal Vesicle Invasion: Positive (right seminal vesicle)
    Margins: Positive at left lateral base margin and central base margin 2mm focus each
    Lymph Nodes involved: 0
    Lymph Nodes examined: 16
    Nerves spared right side only
    Pathologic Staging (AJCC 8th Edition)
    Primary Tumor pT3b
    Regional lymph nodes: pNO
    Distant Metastasis: Mx

  10. #130
    Rant all you like! Also remember that many men who have put their PCa in the past don't stay around to post!

 

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