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BRONZE

Bill Klungle and Peg live in Michigan, USA. He was 64 when he was diagnosed on February 6, 2009. His initial PSA was 11.6 ng/ml, his Gleason Score was 3+3 and he was staged T1c N0 M0. His choice of treatment was Da Vinci Surgery. Here is his story.

I have been monitoring a high PSA since my first test at age 52. PSA started at 5.5 a moved back and forth between 4.4 - 10.8 for 11 years. Over the past 10 years I have had 3 biopsies, each coming back negative. In January of 2009 the PSA went to 11.6 which prompted another biopsy. This one came back positive, 10% of ONE-OF-TWELVE cores showed adenocarcinoma cells, Gleason 3+3, T1c N0 M0. My urologist called with the news right after my wife and I returned from vacation. He prefaced the news by saying, "this may sound bad, but you are in a very positive position. Your cancer is very early, completely contained, and all of the treatment options are available for you." Of course the doctors do not recommend a particular treatment for an individual but layout the options and ask the patient to decide. Like many others, I started reading; researching and talking to anybody I could find who had this experience.

Initially I was certain that brachytherapy (seed implant) would be the treatment best for me. My urologist seemed to be supporting that path as well, even though his specialty is Da Vinci Surgery. I went for consultations with an Oncologist in Grand Rapids MI at Spectrum Health where I learned that my prostate size was too large (52grm) to proceed with brachytherapy and would need to be reduced with hormones before going ahead.

Of course I was concerned about how the hormone treatments would affect me, so as I continued to research the subject through email and web sites like YANA, I started to find more and more that brachytherapy alone does not have as good a long-term outcome as I had first believed. Also I started to realize the problem I would have dealing with the uncertainty of the PSA testing after radiation therapy. One of the other elements in this decision is my occupation as a commercial pilot. Following treatment I will need to demonstrate to the FAA that cancer has been removed in order to get my flight medical renewed. As I understand it, this requires PSA testing that shows significant reduction and with radiation treatment this may take some time.

Because of all these; radiation results, hormone side effects, timing, uncertain test results, I have changed my direction for treatment and decided that Da Vinci Surgery would be my best option. Currently I am waiting for my first appointment at the Henry Ford Vattikuti Urology Institute with Dr. Mani Menon with the intention of scheduling the surgery soon.

 

UPDATED

March 2010

 

 

May 2009: My wife and I travelled to Detroit for a consultation with Dr. Mani Menon at Vattikuti. We went fully expecting to schedule Da Vinci surgery within the month. After reviewing my slides, lab tests and PSA history, Dr. Menon and his staff strongly suggested that I consider ‘Watchful Waiting’. They felt it was too early and the cancer detected was too small to go ahead with the surgery. While they were willing to go ahead if I insisted, they felt there was some chance that my PCa could be ‘indolent’ and thought I should monitor for awhile first. They had a criteria for when/if to move ahead with the surgery. They suggested PSA testing every 3 months along with DRE’s. In one year I should have another biopsy (probably a 20 needle saturation) to determine the status. If the Gleason score increased – OR- if the percentage in one core went above 30% - OR – if 3 cores showed cancer – THEN I should move ahead with treatment. I decided to follow their recommendations.

June 2009: PSA dropped from 11.3 at diagnosis to 8.9, DRE normal. Continue WW.

July 2009: This month I was successful in getting the FAA to issue my Flight Medical again. The last two months have been very frustrating trying to get the FAA Medical Standards people the documentation, reports and tests they need to understand that my PCa has not advanced and is not a threat to safe flight. One of the last tests they required was a full-body-scan to demonstrate the cancer had escaped to my bones. Now I can go back to my work as a Corporate Pilot. Very frustrating to healthy with a few cancer cells in the prostate, yet GROUNDED!

October 2009: PSA up a little to 9.3, DRE normal. Continue WW.

January 2010: PSA up again to 10.8, DRE normal. Almost a year from the first diagnosis and time to start considering another biopsy. Dr. Menon at Vttikuti had mentioned a saturation biopsy but my Urologist thought we should have another ‘standard’ 12 core biopsy so we could correctly compare with the previous year. In continuing to read and research with the help of sites like YANA and with several email-support groups, I wasn’t keen on just continuing with the blind, random biopsies. I had been learning about a process of Color Doppler Ultrasound to guide the biopsy and brought that up with my Uro as an option. At first he was against the idea, but after a long and useful discussion, he agreed that if it would make me feel more confident I should have the CDU.

March 2010: My wife and I traveled to Rochester Hills MI to see Dr. Fred Lee at Rochester Urology. Dr. Lee pioneered the use of CDU in prostate diagnosis and is renown for his work and contributions with transrectal prostate ultrasound. The CDU showed one area of concern that Dr. Lee believed to be cancerous and several areas that were suspicious. He biopsied the areas using the CDU to precisely guide the needles taking 4 core samples. The CDU showed one area Dr. Lee believed to be a tumor that was starting to aquire additional blood supply, he felt the pathology would indicate it was time to move ahead with treatment. However, when the pathology reports came back we were all surprised; the areas that showed up on the CDU were NOT cancer but areas of inflammation. There were some ‘pre-cancer’ cells in the primary suspect area, but the inflammation and prostate enlargement seem to be what are driving the increased PSA. Dr. Lee’s opinion is the original diagnosis of last year was of ‘indolent cells’, his recommendation was to treat the inflammation and the BPH, then continue WW by monitoring with PSA every 3 months and another CDU in one year.

The Color Doppler Ultrasound process would seem to provide a reliable method of monitoring the PCa status, using the biopsy when change is detected. It certainly makes more sense than multiple random biopsies that continue to increase the infection and inflammation in my prostate. This is the process I plan to follow, I certainly hope it is a correct decision.

 

UPDATED

March 2011

 

Since March 2010 I have been tracking my PSA every three months with readings of 8.8, 9.1, 10.7, & 9.1. In November 2010 there was a prostatitis flare-up that was treated with Cypro.

With the annual Color Dopler Ultrasound coming up I was feeling very positive since the last PSA had dropped. On March 3rd I went to see Dr Fred Lee in Rochester Hills MI. Since my last visit a year ago Dr. Lee had upgraded the CDU equipment, the new one being more sensitive.

The new equipment showed a suspect area with a trace of what could be an increase in blood flow, indicating a possible tumor. However, this was the same area that was biopsied one year ago and the red that was showing could be the inflammation from that biopsy so I elected to hold off on another biospy at that time. The plan is to wait 90 days, take another PSA and go in for another CDU on June 1. If there is any increase or even the same suspect area, we'll do another biopsy at that time.

I will update YANA again in June.

Bill's e-mail address is: bklungle@chartermi.net