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Thread: Another Friend Has Joined The PC Club Unfortunately

  1. #1
    Experienced User
    Join Date
    Aug 2017
    Posts
    86

    Another Friend Has Joined The PC Club Unfortunately

    I hate to say it but I have had two good friends diagnosed with PC in the last 2 months, #1 is having Robotic on the 21st of this month and I just found out another friend has been diagnosed. His Dr has told him he wants to wait and monitor and do nothing, he is panicking as he feels that his Insurance Company is controlling his Dr's decision. Couldn't get a clear answer from him on why he thought that, so I thought I would just post his results here and see what everyone thinks. My first thought was, get another opinion.
    PSA 6.9
    Everything is benign except
    Left Mid Medial 3% Gleason 6 (3+3)
    Left Apex Medial 10% Gleason 6 (3+3)

    Thoughts?
    Biopsy Date 7-14-2017
    DIAG: Adenocarcinoma
    PSA-6.3-T2A
    2/12 cores: 10 Cores Benign
    #1: 5% Gleason 3+3 Lft Apex
    # Of Cores Involved 1 Of 2
    Tumor Length 1.5mm
    Perineural Invasion Not Identified.
    #2: 25% Gleason 4+3) Right Base
    Number Of Cores Involved 2 Of 2
    Tumor Length 4mm (Aggregate)
    Perineural Invasion Not Identified
    Size Of Prostate: 50.6
    Bone Scan Negative, Prostate MRI Negative
    9/27/2017 Robotic Surgery Da-Vinci
    10/5/2017 Pathology Report
    11 Lymph Nodes Neg For Malignacy
    Prostate Weight 48.6 grams
    Urinary Bladder Neck Invasion-Not Identified
    Seminal Vesicle Invasion-Not Identified
    Margins: Involved By Invasive Carcinoma
    Margin Limitations: Less Than 3MM Rt Posterior
    EPE Present Focal: Site Rt Posterior
    Path Stage pT3A
    PSA Test 11/27/2017 <0.02
    PSA Test 12-5-2017 <0.02
    PSA Test 1-25-2018 <0.02
    PSA Test 3-28-2018 <0.02
    PSA Test 6-28-2018 <0.02
    PSA Test 10-04-2018 <0.02
    PSA Test 1-20-2019 <0.02
    PSA Test 7-29-2019 <0.02
    PSA Test 9-29-2019 0.02

  2. #2
    Top User
    Join Date
    Aug 2016
    Posts
    1,884
    The PSA seems a little high for AS. His age? Prostate size? His PSA history would help to see if it's gaining velocity or jumping around.

    No reason for him to panic. Certainly being upset about being diagnosed with cancer is in order. His doctor should not have left him in a panic, but lined out the future actions to reassure him.
    Born 1953
    family w/PCa; grandfather, 3 brothers
    07-12-04 PSA 1.90
    07-10-06 PSA 2.02
    08-30-07 PSA 3.20
    12-01-11 PSA 5.69 Internist recommends urologist, I say no
    05-16-12 PSA 4.76 manipulate w/diet & supplements
    12-11-12 PSA 5.20, Health system changes to 3 years on testing
    03-07-16 PSA 7.20 Internist adamant on urologist
    DRE smooth, enlarged
    03-14-16 TRUS biopsy-prostatic adenocarcinoma 1%-60% across 8 of 12 samples, Gleason 3+3=6
    03-31-16 MRI pelvis w/o dye
    05-04-16 DaVinci prostatectomy, nerve sparing, Dr. Kent Adkins - recommend
    Final Path; weight 65g, lymph nodes, seminal vesicles, capsule, margin all negative, Gleason 3+4=7, Tumor volume 35%, +pT2c
    Catheter out - 16 days
    Incontinence at 6mos is minimal – no pad
    Cialis 3x/wk & Viagra on occasion
    Begin self-injection needle therapy for erections, stop after 6 due to onset of Peyronie’s
    Erections 100% - 14 months
    5-21-19 PSA <0.02, Zero Club 3.5 years

  3. #3
    My advice would be for him to have a 3T mp-MRI followed by a targeted confirmatory biopsy.

    That is pretty much standard practice in a formal AS program, and greatly reduces the chance that he was under-diagnosed,

    Active surveillance is a lot more than “doing nothing”, assuming that his doctor (and he) follows a strict testing protocol.
    DOB: May 1944
    In Active Surveillance program at Johns Hopkins
    Strict protocol of tests, including PHI, DRE, MRI, and biopsy.
    Six biopsies from 2009 to 2019. Numbers 1, 2, and 5 were negative. Numbers 3,4, and 6 were positive with 5% Gleason(3+3) found. Last one was Precision Point transperineal.
    PSA has varied up and down from 3 to 10 over the years. Is 4.0 as of September 2019.
    Hopefully, I can remain untreated. So far, so good.

  4. #4
    A small amount of G6 cancer, PSA elevated but not in the ballistic range, AS seems like a reasonable plan.

    And the older he is, the more reasonable and solid the plan is.
    Nov 2013 PSA 4.2 Biopsy Jan 2014- 1 core positive, 20% Gleason 6, doctor highly reco'ed robotic RP - 2nd opinion at UPMC April 2014, put on active surveillance. 2nd biopsy Feb 2015, results negative. PSA test Feb 2016, 3.5. 3rd Biopsy Feb 2016. 3 positive cores less than 5%, Gleason 6. Octotype DX done April 2016, GPS Score of 24--rated "Low risk". PSA test 8/2016, 3.2. PSA test 1/2018 2.2 (after 7 months of proscar) PSA test 7/2018 2.3, PSA test 7/2019 2.0


    DOB 1956, in Pittsburgh, USA

  5. #5
    I agree with ASA. Best to follow a formal AS protocol (and one on the stricter side is preferable). A G6 biopsy actually means that there is a roughly 1 in 3 chance that the real Gleason score is >6 (upgrading on RP). And, if you are in that group, you want to rule out aggressive PCa.

    Complacency might be just around the corner, but I would let imaging and a targeted biopsy be my corner mirror.

    Djin
    Last edited by DjinTonic; 10-17-2019 at 11:35 PM.

  6. #6
    His insurance in no way is telling your friends doctor to recommend AS. Tell you friend to get treated.
    YOB 1957

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative.

    3/6/19. Pathology - Grade Group 4 Intraductal Carcinoma
    T3aNO, 1 mm EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.

    7 Nodes, SV, SM, PNI, and BNI were negative.

    LVI and Cribriform pattern present.

    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (28 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)
    9/10/2019. <.02. (198 days)

    3 Part Modality Treatment

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  7. #7
    Experienced User
    Join Date
    Aug 2017
    Posts
    86
    Got it, will give him the advice.
    Biopsy Date 7-14-2017
    DIAG: Adenocarcinoma
    PSA-6.3-T2A
    2/12 cores: 10 Cores Benign
    #1: 5% Gleason 3+3 Lft Apex
    # Of Cores Involved 1 Of 2
    Tumor Length 1.5mm
    Perineural Invasion Not Identified.
    #2: 25% Gleason 4+3) Right Base
    Number Of Cores Involved 2 Of 2
    Tumor Length 4mm (Aggregate)
    Perineural Invasion Not Identified
    Size Of Prostate: 50.6
    Bone Scan Negative, Prostate MRI Negative
    9/27/2017 Robotic Surgery Da-Vinci
    10/5/2017 Pathology Report
    11 Lymph Nodes Neg For Malignacy
    Prostate Weight 48.6 grams
    Urinary Bladder Neck Invasion-Not Identified
    Seminal Vesicle Invasion-Not Identified
    Margins: Involved By Invasive Carcinoma
    Margin Limitations: Less Than 3MM Rt Posterior
    EPE Present Focal: Site Rt Posterior
    Path Stage pT3A
    PSA Test 11/27/2017 <0.02
    PSA Test 12-5-2017 <0.02
    PSA Test 1-25-2018 <0.02
    PSA Test 3-28-2018 <0.02
    PSA Test 6-28-2018 <0.02
    PSA Test 10-04-2018 <0.02
    PSA Test 1-20-2019 <0.02
    PSA Test 7-29-2019 <0.02
    PSA Test 9-29-2019 0.02

  8. #8
    Experienced User
    Join Date
    Aug 2017
    Posts
    86
    Well my fist friend with the 21 PSA and 4+4 had Robotic Surgery yesterday, Dr said he didn't think there was anything left behind but no Biopsy report yet. He has to keep his Catheter in for 3 weeks....wasn't sure why so long and I am not sure why that would happen, any thoughts, I am not going to discuss with him as he is on a very positive vibe right now and I do not want to worry him.
    Thanks, Al
    Biopsy Date 7-14-2017
    DIAG: Adenocarcinoma
    PSA-6.3-T2A
    2/12 cores: 10 Cores Benign
    #1: 5% Gleason 3+3 Lft Apex
    # Of Cores Involved 1 Of 2
    Tumor Length 1.5mm
    Perineural Invasion Not Identified.
    #2: 25% Gleason 4+3) Right Base
    Number Of Cores Involved 2 Of 2
    Tumor Length 4mm (Aggregate)
    Perineural Invasion Not Identified
    Size Of Prostate: 50.6
    Bone Scan Negative, Prostate MRI Negative
    9/27/2017 Robotic Surgery Da-Vinci
    10/5/2017 Pathology Report
    11 Lymph Nodes Neg For Malignacy
    Prostate Weight 48.6 grams
    Urinary Bladder Neck Invasion-Not Identified
    Seminal Vesicle Invasion-Not Identified
    Margins: Involved By Invasive Carcinoma
    Margin Limitations: Less Than 3MM Rt Posterior
    EPE Present Focal: Site Rt Posterior
    Path Stage pT3A
    PSA Test 11/27/2017 <0.02
    PSA Test 12-5-2017 <0.02
    PSA Test 1-25-2018 <0.02
    PSA Test 3-28-2018 <0.02
    PSA Test 6-28-2018 <0.02
    PSA Test 10-04-2018 <0.02
    PSA Test 1-20-2019 <0.02
    PSA Test 7-29-2019 <0.02
    PSA Test 9-29-2019 0.02

  9. #9
    Senior User
    Join Date
    Nov 2016
    Posts
    310
    On the catheter, either the doc has scheduling issues or probably wants to ensure the scaffolding for the stitches does its job well.
    Age at Dx 57
    PCa History: Father, Uncles, Grandfathers

    Oct 2016 Biopsy 12 core: Adenocarcinoma, Gleason 4+3=7 Grade Group 3) w/PNI
    Left Lateral Base: Suspicious
    Left Lateral Mid: PIN
    Left Base: 4+3=7 (60% pattern 4) Core involvement 30% (5mm)
    Right Base: Suspicious
    Right Apex: 3+3=6 Core involvement 60% (7mm) discontinous
    Right Lateral Mid: 3+3=6 Core involvement 10% (1mm)
    Right Lateral Apex: 3+3=6 Core involvement 10% (1mm)

    Jan 2017 DaVinci - Dr. Grant Taylor - Pathology = pT2c or pT3a; Gleason 4+3=7; Weight: 42g

    Jun 2019 AMS800 installed - Dr. David Rapp - Jul 2019 activated

    ED: Light to moderate

    (Note: All PSA tests prior to Jun19 were done by LabCore)
    PSA_TESTS

    Apr 2016=5.1
    Jul 2016=4.7
    Aug 2016=5.13

    ----Surgery----

    Mar17<0.01
    Jul17<0.01
    Oct17<0.01
    Jan18<0.01
    May18<0.01
    Nov18<0.01
    Jan19<0.01
    Jun19<0.02

  10. #10
    Top User
    Join Date
    Aug 2016
    Posts
    1,884
    Good plan. The pathology report will tell the story.

 

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