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John Flynn and Rona live in Alberta, Canada. He was 70 when he was diagnosed on May 15, 2009. His initial PSA was 7.8 ng/ml, his Gleason Score was 7 (3 +4) and although he does not know his staging, it seems clear from his narrative that he was staged T1c. He is undecided as to his choice of treatment. Here is his story.

I had not had a PSA test since 2002 (3.2 at that time, which was considered normal) until April, 2008...I can't stress strongly enough how important it is to have your PSA tests done annually.

In May of 2008, I received a letter from my doctor informing me that my PSA was 7.2 and I should have it re-checked in 6 months. Both of my brothers have had cancer (one died from pancreatic cancer, the other is in remission with non-Hodgkin's lymphoma), I decided to have it tested sooner rather than later; so in Sept. I had it re-tested. After 3 weeks, I called the doctor's office to find out that my PSA had increased to 7.8. My doctor then referred me to a urologist. Unfortunately, I was unable to get an appointment until April, 2009; which is now 12 months after the first PSA test.

Two weeks later (May 1st, 2009) I had a biopsy done (12 cores). On May 15th, I returned to the urologist to get my biopsy results. I was quite positive in my own mind that I did not have cancer...I was feeling good, and had no urinary issues. I was shocked to hear that I have an extensive PCa involving both lobes that was moderately aggressive. The urologist had already booked a bone scan for me on May 26, and an appointment with another urologist June 5th.

On June 5th we met with the second urologist. The bone scan was negative (great news)!!! However, he quickly went over various treatment options, and strongly recommended RP. He said I would live 3 - 4 years with watchful waiting, [If there is one thing that annoys me personally more than anything else it is a doctor predicting life expectancy. It is simply not possible to do so accurately, but on all evidence this prediction is hopelessly incorrect for an early stage diagnosis such as this one - see The Elephant In The Room] and I probably had a 50 - 60% chance of an increasing PSA after surgery...but at that time, I could have radiation, or I could have surgery and radiation as one treatment plan. He told us that if I have the radiation first, it is very difficult to follow with surgery, due to the scarring, etc. I decided to go with the RP. I then spoke with my family doctor and he felt that surgery was the best option for me, but when I asked him what my Gleason Score was, he said he didn't know what a Gleason Score was...he used to know, but he didn't any more. I decided to get copies of my biopsy and bone scan results, and a new doctor. The surgeon had told us that 11 of the 12 core samples were positive for cancer, the biopsy said that adenocarcinoma was found in 6 of the 12 cores and that there was perineural invasion blue mucin present [There has been a good deal of discussion about perineural invasion on the Yana Forum (enter perineural invasion in the Search box): blue mucin can be seen in tumour cells, but also in benign cells.](???I still don't know what that means). I wonder if he was talking to the right patient. My new doctor is a PCa survivor,(although is he a lot younger than I am) and he told me that if he would have been a candidate for brachytherapy that would have been the treatment he would have chosen.

Now, we are wondering if I am a candidate for brachytherapy, my Gleason score is 7, and we don't know if my cancer is contained, and there doesn't seem to be any way of finding that out (at least not in Canada). [There is no definitive way of establishing if early stage prostate cancer, in diagnoses such as this, has escaped from the gland. Nomograms such as Partin Tables give some idea of probability.]

I cancelled my surgery which was booked for Aug 12th and I have an appointment for a consult at the Cross Cancer Institute on Aug 26th. I am feeling very optimistic about that appointment and I am anxious to start treatment.

A quick note: I had to have my PSA redone in July and it is now 7.7. I find it hard to believe that it hasn't increased significantly...[There is no expectation that the PSA would rise rapidly, based on the rest of the information provided. It might be helpful to read PSA 101 to gain some understanding of the basics of the unreliability inherent in PSA tests.] and I am not sure what a decrease means. I will update you after the 26th

 

UPDATED

September 2009

 

 

I had my appointment at the Cross Cancer Institute on August 26th. We met with 2 doctors (a resident, and the radiation oncologist). After doing a complete examination, as well as a DRE, they told us, that the seminal vesicles and the lymph nodes were not involved. The doctor told me that I would have to come back in 2 - 3 weeks for an ultrasound for volume testing. Unfortunately, they couldn't book me for this test until October 16th. When we called the doctor, he said that they were just so many people looking at this form of treatment, that they couldn't get me in any earlier.

I also asked him about using a DRE to check seminal vesicle and lymph involvement, and he said that while it wasn't totally accurate, they could usually tell. I really have to question that statement!!! He did say that it usually took 8 - 10 weeks after the original appointment for the treatment to be completed. We will see.

 

UPDATED

January 2010

 

 

I decided to pursue the brachytherapy, and visited the Cross Cancer Institute and met Dr. Umani. Dr. Umani has been very approachable and is easy to get hold of to answer questions on the phone, etc. We had an ultrasound booked for October to see if I was a candidate for seeds. The ultrasound showed that the prostate gland had grown around the bone. If I would have chosen the RP it would have been unsuccessful as a solo treatment.

I had my first shot of Lupron October 16th 2009 to shrink my prostate, and will have my second injection January 16th 2010 and a follow-up ultrasound mid February to see if the hormones did their job and the prostate has shrunk enough to have the brachytherapy. If not, I will go the external radiation route.

I am experiencing some "hot flashes" but I'm not having a problem dealing with them, have cut back on my caffeine intake, and that seems to help. So again, I'm waiting, but I'm feeling great and carrying on with my normal activities as usual.

 

UPDATED

November 2011

 

Sorry for not updating my story sooner, but after receiving the brachytherapy, my PSA was 0.20 within 3 months. I have been feeling good...have issues with ED (no solution for this yet, have tried Cialis and Viagra, but they have not helped).

I have been having my PSA monitored every 3 months. In June/11, the reading was 0.50, in September the reading was 1.2.[Hopefully this is the well documented PSA "bounce' that many men experience after radiation therapy - the PSA numbers rise, hit a zenith and then fall back.] Although my doctor told me not to worry until it reached 5.0, I will be having it rechecked in Dec. I will update you then.

John's e-mail address is: rflynn@denwoodmotors.com.