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Doug Harvey lives in Quebec, Canada . He was 62 when he was diagnosed in October 2009. His initial PSA was 5.2 ng/ml, his Gleason Score was 7 (3+4) and although he does not state his staging it seems he would have been staged T1c. His choice of treatment was Radical Prostatectomy. Here is his story.

I went to my GP at the end of September 2009 for my annual check up. He did a PSA as usual and a DRE (Digital Rectal Examination). I think he suspected something when he did the DRE but he didn't say anything at the time. The next week he called me and said that my PSA was 5.12 and he sent me to a urologist who did a DRE and he sent me for a biopsy.

The biopsy confirmed that I had cancer. At the biopsy my PSA was 5.1. Of the 12 needle biopsies, two had prostatic adenocarcinoma acinar type. One was Gleason 3+4=7 and the second was Gleason 3+3=6. One very worrying thing was that the Gleason 7 specimen also said perineural invasion is identified. I'm not sure how that impacts my chances going forward, but I wasn't happy reading that comment.

The doctor who did the biopsy has an excellent reputation and he recommended RP (Radical Prostatectomy) and I decided to go with his recommendation after talking to a family friend who is a urological resident and also talking with two friends who had an RP with the same surgeon. One friend is cancer free 5 years later and the second friend had radiation 1.5 years after his RP and now he's been cancer free for the past 1.5 years. This surgical urologist sends you to a radiation oncologist if your PSA is 0.20 or greater. [after surgery, presumably] He doesn't wait.

I was operated on December 2009 and on February 15, 2010, my first post operation PSA was 0.17. After that my PSA readings have been:

March 29, 2010 PSA 0.13
April 13, 2010 PSA 0.04
June 30, 2010 PSA 0.07.

I was very unhappy and I'm worried about the last PSA. [Ultra-sensitive PSA tests, like this have a degree of inaccuracy] I just read an article about people taking statin drugs for high cholesterol and they found that it slowed down the progression of PC. I was wondering if anyone's oncologist has recommended that they take statins?

It's a wonderful thing that you've done by creating and managing YANA. It is greatly appreciated.

Thank you, Doug

 

UPDATED

October 2010

 

 

I finally got the courage to look at my post op pathology report.

Gleason score now 4+3=7; Tumor is confined to prostate. Tumor is present at right anterior, right posterior and left anterior margins. Tumor involves 10% of prostate. Vascular invasion is not identified. Extent of margin positivity: non-focal. Perineural invasion is identified. TNM Staging: pT2C, Nx, Mx

PSA June 30, 2010; 0.07 (not happy) PSA Sept 28, 2010; 0.11 (headed towards radiation)

My urologist said that we should wait for next results. He said that he only recommends radiation once PSA hits .20. I'm thinking about a second opinion. Based on pathology report and PSA velocity, maybe I should begin radiation now? Does Intensity Modulated Radiation Therapy (IMRT) have more success than External Beam Radiation Therapy (EBRT)? [The simple answer is Yes/No/Maybe. IMRT is a form of EBRT where it is claimed the focus is better because the machinery is better. There are conflicting studies about outcomes. What seems to be clear is that it is the skill of the operators that has the greatest impact on outcomes, rather than the precise therapy chosen.]

Any comments will be appreciated.

Thanks, Doug

 

UPDATED

January 2011

 

 

Just got my PSA result taken January 4, 2011 and it's 0.29 so I'm headed for radiation. My last PSA was Oct 28, 2010 and it was 0.11. So it's a very fast increase.

I want to get a second opinion ASAP at a major U.S. hospital from a radiation oncologist and I wanted some recommendations from within the Yananow membership. I've already put a call in to Dr Anthony Zietman at Massachusetts General Hospital. I would like to hear about radiation oncologists at Memorial Sloan Kettering, Dana Farber, John Hopkins and any other hospitals in the northeast.

 

UPDATED

March 2011

 

All of my treatment and PSA readings until January 4, 2011 have been done at hospital #1 which is a top hospital affiliated with a world ranked university in a major metropolitan city. After the January 4 2011 PSA of 0.29 I decided to have radiation treatment at hospital #2. Radiation oncologist at hospital #2 agreed that I needed radiation. In fact he was surprised that I didn't have adjuvant radiation as my post operation biopsy had positive margins. However surgeon at hospital #1 said he doesn't look at that, he only looks at PSA after radical prostatectomy.

So radiation oncologist sends me for blood work on January 17, 2011 and my PSA comes back at <0.10????. We re-do it on January 18 and again my PSA comes back at <0.10. So I go back to hospital #1 and on January 18 my PSA comes back at 0.07???? My surgeon at hospital #1 says that I should re-do it in one week. On January 27 my PSA is now 0.03???? So surgeon now says that he thinks 0.29 on January 4 was a lab error and that I should not go ahead with radiation.

I decided to go down to Dana Farber and I met with Medical Oncologist and Radiation Oncologist and both said I should do radiation now while PSA low. Also they re-did pathology and upgraded me to Stage pT3a as "tumor invades capsule close to but not invasive in extra prostatic tissue." From patholy D-F down graded my Gleason to 3+4=7 from 4+3=7. I now went for another PSA February 14, 2011 and it is now 0.01!! Yeah!!!! At hospital #2 on February 4 it is still <0.10. That is the lowest they go.

So Radiation Oncologist says lets wait till next PSA in March and I agree. No one really knows. All the doctors have been wonderful.

Thanks, Doug.

 

UPDATED

May 2011

 

 

My PSAs are:

March 30, 2011 0.05 (concerned as up from 0.01)

April 11, 2011 0.04 (feeling good that lower than last PSA)

April 29, 2011 0.01 (thrilled with this number)

So I put off radiation and I have my PSA checked often.

Best of luck to all! Doug.

 

UPDATED

November 2011

 

Still following up with PSA tests every two months. I'm doing it often because I had three positive margins.

June 2011 0.02

Sept 2011 0.01

Nov 2011 0.05

I'm a bit concerned about this last reading so I'll probably get tested again in one month.

Best of luck to all!

 

UPDATED

January 2012

 

Jan 3, 2012 PSA came in at 0.01!!! I am very fortunate! I wish everyone such low PSA's.

Currently no side effects from the surgery. Thanks.

Doug's e-mail address is: mtlelectronics@yahoo.com