YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

BRONZE

Bob Arthur and Sharon live in Ohio, USA. He was 63 when he was diagnosed on August 7, 2008. His initial PSA was 6.83 ng/ml, his Gleason Score was 3 + 3=6 and he was staged T1c. He is undecided as to his choice of treatment . Here is his story.

My journey toward diagnosis began with an acceleration of PSA increase beyond safe guidelines. My urologist prescribed an antibiotic for a month to make sure this wasn't due to infection of which I've had a history. After a new PSA he determined I should undergo a biopsy. The results came back with one core of ten showing cancer involving 15% of the core. My Gleason score was determined to be 3 + 3.

We had a consultation in which, even though he's a surgeon, he persuaded me I should take the brachytherapy route. He arranged an appointment with a radiation oncologist for the sonographic "mapping" in anticipation of seed implants. As it turns out, I have a very large prostate (98 cc.). The amount of seeds required to irradiate the entire gland would probably do too much damage to surrounding, healthy tissue. The radiation oncologist said that external-beam-radiation-therapy (EBRT) was still an option, but I should probably consult with my "u-doc"

Just a while ago I made an appointment with the original urologist to get guidance. After considerable research I'm leaning much more now toward "watchful waiting". When I discussed this option originally with my u-doc, he didn't recommend it. He said that I was young and healthy enough that I was much more likely to recover well from early treatment than if I waited. Also, he said that if the cancer became aggressive it had a much better chance of being the cause of a very unpleasant demise, because I would likely survive for 20 years, or more.

Anyway, that's where I stand as of September 25, 08. I'm really into "watchful waiting", now, but unfortunately, I'm very susceptible to persuasion by experts. I'm hoping the info I gather on the next u-doc visit (October 7, 08) will reinforce my leanings. My main question is how does an overly-large prostate factor into the various options of treatment. I'll post things progress.

THANKS TO ALL IN YANA!!

Later: Well, I had my appointment with my urologist after learning seed-implants were out of the question due to my oversized prostate. Thinking I preferred immediate treatment he suggested external beam radiation therapy. When I asked if he'd supervise a program of active surveillance he said he had no problem with it, at all, if I was diligent about adhering to his program of tests and visits. That's what I selected.

My first new PSA sample and DRE will be in January! I'll keep you posted.

Thanks again, YANA!!

 

UPDATED

January 2009

 

I went in for my first DRE and PSA result this afternoon after deciding on the AS route three months ago. The Urodoc said my PSA was down to 5.3 from 6.8 three months ago. He was pleased, as was I, of course.

So we'll proceed with Active Surveillance and I'm to return in April.

Best wishes to all!!

 

UPDATED

February 2009

 

After further discussions with my urologist I realized I've misunderstood some of his statements. The large size of my prostate DOES rule out seed-implants, but that's because its larger size causes part of the prostate to be hidden behind the pelvic bone. This prevents sufficient implantation. I originally stated that the large prostate size necessitated too many seeds which could harm surrounding healthy tissue. I was wrong.

Also I failed to mention the medications I take while on Active Surveillance. They are:

4 mg Flomax daily

5 mg Finasteride daily Both medications help normal urination.

Except for somewhat restricted flow I have more or less normal urination. Unrelated daily doses:

1 Prilosec daily for stomach-acid control ( I had part of my esophagus removed due to cancer)

1 Mens "Silver" multivitamin (Why not?)

1 "Low-Dose" aspirin as a blood thinner (Some history of strokes in my family). Sorry for my recent "misinformation".

I hope you're all doing well!

 

UPDATED

September 2009

 

Hi All!

Well, I was once again pleasantly informed by my Urodoc that things are going well. The quarterly DRE revealed volume reduction along with normal surface texture. My PSA is down to 3.79 from 4.41 three months ago.

Here's a brief history:

January 2, 2009 DRE OK, PSA 5.28, Free PSA 20%

April 13, 2009 DRE OK, PSA 4.49, Free PSA 20%

June 11, 2009 DRE OK, PSA 4.41, Free PSA 20%

September 16, DRE OK, PSA 3.79, Free PSA 20%

I only wish all of us were able to receive such encouraging news at those anxious times when the results come in. Terry has provided a valuable resource here at YANA. It has certainly been a comfort to those of us who share this many-faceted affliction.

Til next time, God Bless and Good Luck!!

 

UPDATED

December 2009

 

 

I had my routine quarterly DRE and PSA analysis yesterday. The DRE was negative (all's well), however my PSA had elevated from 3.9 to 4.6. The concern here is that, because I'm on Finasteride, which "masks" the true level of PSA, it's probably twice that amount (9.2). So my "rosey" downward trending for the last several months seems to have ended, at least temporarily. With this news my Urodoc reminded me that we must keep more aggressive treatment as an option. From the DRE he estimated my prostate volume to be about 50 cc., down from 98 cc. at the original Diagnosis, so he said I could quit using Flomax, but should continue Finasteride.

I'm only recently researching HIFU as a candidate for treatment. My Urodoc said he'd been approached by the HIFU community to participate. He's going to send me literature on the process, and even offered to join me "offshore" if I elected to pursue that course of treatment. It turns out he was a "pioneer" locally in the field of brachytherapy (seeds) years ago. He said HIFU intrigues him, especially because of its non-invasive qualities. He's always looking for the newest methods with enhanced "efficacy".

Anyway, I hope all are doing well! HAPPY HOLIDAYS!!!

 

UPDATED

October 2010

 

Hi All!

Well, I've neglected to update for quite awhile, so I thought I should catch up. I received an email from another member today, the first in quite awhile, so that tended to spur me on a bit, too.

It's now Oct. 6th and I've just returned from my quarterly DRE and blood-work. My last PSA update, in Dec. 14th, 09 was:

Dec. 2009-4.5

March 2010-4.15

June 2010-3.23

Oct 2010-3.82

All these PSA results have been influenced by a daily dose of 5 mg. of Finasteride, so the real values could as much as twice as high, ie., 7 or 8. My urologist still is recommending some sort of radiation therapy, and he assured me he'd do a biopsy before continuing, but I said until there was an alarming increase in my PSA values I wanted to continue Active Surveillance.

I must admit that my PC, which seems to be indolent, has become almost a non-issue in my daily life. I'm in my fourth year of remission from esophageal cancer, which is usually more lethal than PC. I'm due for a "scan" and exam from the oncologist in two weeks for that ailment. If all's well, there'll be one more check-up in a year. If that's good I'm an official survivor!

Other issues related to aging, and having been a smoker, may "come to fore" prior to any bad outcomes from the two cancers.

All in all I think I'm doing pretty well for being an old reprobate. I walk at least 3 miles, or ride my bike for 10 or 12 miles, almost every day. I began this regimen only recently because of a lazy summer due to the heat here in Ohio.

My only prescription medication is the Finasteride. Other daily dosages include:

1xMulti-vitamin: 2x1000 I.U's of Vitamin D; 2x1000 I.U's of Fish-Oil; 1- Low-Dose Aspirin

Recent articles have suggested that might be a little over-kill on the Vitamin D, but not so much to be harmful.

Well, I apologize for the lack of recent updates, but maybe my wordiness will compensate!

Good Luck, Guys!

 

UPDATED

February 2011

 

 

In late October of 2010 I went in for my yearly cat-scan for monitoring the fourth year of remission of esophageal cancer. The radiologist found minute areas of metastatic tissue in my pelvis and lower spine. Because I have PCa as WELL as esophageal cancer my oncologist wanted to determine which cancer was the cause of the lesions because the therapies to treat either cancer are different. He decided I should have a Prostascint scan.

This scan indicated some "take-up" of the markers for PCa with which I had been injected. Because my PSA levels had been trending downward, and through my research I'd discovered that some experts questioned the efficacy of the Prostascint scan I expressed my concerns to the doctor. He agreed and offered to bring my case before his weekly review with his peers. The results were degrees of agreement and disagreement all across the spectrum.

I also learned that the radiologist who examined the original cat-scan had inadvertently compared it to my original scan 3 years earlier instead of the most previous scan. Because of this, the changes, though minor, seemed much more dramatic in that he thought they occurred over only a year's duration.

I also expressed my concerns about Prostascint-scans on P/to/P in "Prostate Pointers". I received a generous response from Dr. Israel Barken. To my dismay he expressed confidence in the Prostascint scan. My very shorthand translation of his reasons are: Many false-positives determined by subsequent biopsies after Prostascint scans are very suspect in that they are determined at the microscopic level. Prostascint scans reveal results at the MOLECULAR level which, of course, are far more precise. I also learned that it's not unheard of for metastasis to be occurring at the same time as a down-trending PSA! I was feeling pretty gloomy.

My oncologist recommended that I should have an additional cat-scan along with a bone-scan after a 90-day waiting period. To my relief the bone-scan was negative and the cat-scan indicated that the suspected lesions, already determined too small to biopsy, had noticeably diminished! Great news!!

So my oncologist scheduled my 5th and final cat-scan related to esophageal cancer for Oct. 2011. If it's clear I'm officially "cured". My urologist has increased the duration between PSA-checks and DRE's to 4 months from 3. My most recent PSA was 2.9, but I'm still taking Finasteride, so it could really be as high as 6.

Anyway, I wish we all could have such sunny news as I've had lately. My only regret is the tens of thousands of dollars worth of testing required to bring me the good news. I wish we could get a handle on these costs, but that's for other forums, I guess.

Best of luck to you all!!

Bob's e-mail address is rarthur1@columbus.rr.com