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BRONZE

Kent McCulloch lives in Washington, USA. He was 63 when he was diagnosed in October, 2009. His initial PSA was 14.1 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.

I have had a long history of BPH (Benign Prostate Hyperplasia) with attendant high PSA scores. My PSA has been checked every year for the last decade or more. About 8 years ago, because of a PSA of 11 (even though my urologist believed it was because of my enlarged prostate (two and a half times normal) he ordered a 6 core biopsy. It came back negative. My PSA dropped back to 8 and then over time crept back up to 11 a year ago. This year it was at 14.1 which my doc thought warranted another 6 needle biopsy. One of the six came back at 3% (.5 of 17mm) adenocarcinoma. The Gleason score was 3+3=6.

So the Gleason and the stage T1c put be at slow growth, low risk. My PSA of 14.1 is an intermediate risk factor except that at least 3 doctors unanimously suspect that number is driven by my BPH, and not the small cancer. With a normal sized prostate and not one that is two and a half times normal, my PSA might be well under 10, for instance. Which would put me well into an "active surveillance" category by the three factors of PSA, stage and Gleason.

I am now exploring options. To treat or to 'watch'. I am looking for all the data and encouragement I can find for a strategy of "active surveillance".

Treatment seems to boil down for me to going to Loma Linda, California for proton radiation, or Seattle for a robotically performed prostatectomy. I have yet to consult with Loma Linda in person but expect to before the year is over. I have gone to Seattle and consulted with Dr. James Porter, a leading surgeon in robotics at Swedish Hospital. He is not only excellent by reputation but very impressive in person. We thoroughly discussed my case with the immediate upshot being that I will have another biopsy (20 needle) this December 22nd, the findings of which to help fine tune my thinking on "watchful waiting".

 

UPDATED

January 2010

 

 

Went in for my second biopsy in 3 months, December 22, 2009. This was as a result of my consult with a robotics surgeon/urologist who I would consider using for a prostatectomy should a procedure be required. He thought my initial 6 needle biopsy was not a large enough sample - at least he prefered 12 or more. Hence the second biopsy.

It was a 16 needle (sample) procedure with the results coming back as ALL CLEAR! Hurray! Had that been my original biopsy 3 months ago I would have thought myself "cancer free". He also said during the biopsy that my prostate is over 105 c.c. That's 3 1/2 times normal - which from my reading can account for nearly half my 14 PSA score.

So for now...my hopes to watch and wait have been confirmed! I was told that statistically, my odds of ever needing a procedure to remove my prostate is about one in three. I'll take it. Now its blood draws and biopsies forever. I'll take that too. Stay tuned.

 

UPDATED

March 2011

 

 

Had my annual biopsy mid December 2010 which is part of the active surveillance plan.

The doc took 12 samples and two came back positive - TC1's - Gleason 6. Still seemed a rational course to continue on Active Surveillance as I do not want to over-react. And to follow PSA's of course. My PSA in December was 14.0, but remember my prostate is THREE AND A HALF TIMES NORMAL SIZE! Supposedly with this BPH complication, I can subtract 6 or so from my PSA number, putting me at a comparable 8 (maybe).

Well, on a hunch I went to my general health care provider for a blood draw on my own initiative this last February and my PSA was at 16.[It is important to understand that PSA results from different laboratories cannot be directly compared. They rarely agree - see PSA 101.] Ouch! Called my urologist and he said given the erratic nature of my past readings we will wait a month for another PSA draw to see if it comes down. If it does come down, or stays the same and we determine I am still "safe" to continue Active Surveillance. I might ask for a bone scan. I don't know.

My uorolgist is a smart guy who does believe that prostate cancer has been overtreated, and I do fit the pattern of a guy with very slow growning cancer with a long history of BPH, but he certainly has no desire to gamble with my life either. I already have significant ED and feel with prostate removal, the curtain will draw closed on any future sex life. I'll let you know what's up by my 65th birthday in May.

Current score card: 40 samples from 4 biopsies. 3 positives, TC1's - Gleasons 6's. 12 year movement of PSA from 7 to 16. Stay tuned.

Kent's e-mail address is: kmcculloch@foxinternet.com