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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Newly Diagnosed
Jun 25, 2010
I just turned 50 and I've always been in excellent health and physical condition. During a routine physical, my first ever PSA came back at 3.5 and then 2.8 from the same blood sample.

My physician sent me to a urologist. We waited six months and did another PSA test. That one came back at 3.0. The urologist recommended a biopsy. I didn't want to have an unnecessary biopsy so I got a second opinion from another highly recommended urologist. This urologist also said "do the biopsy."

I liked the bed side manner of the the second doctor better than the first so I proceeded. Today, I learned that I had a positive biopsy report. I was floored.

The Gleason score in three of the 12 core samples is 3+3=6. Apparently, this is confined to the prostate and, according to the urologist, is on the low end for needle biopsies.

The urologist recommended robotic surgery and gave me two guys who've done a lot of them. According to my urologist, radioactive seeds are not the best option because of my age. The side effects of the radiation later on in life are unknown.

I don't even really know what questions to ask. But, here's a start:


1. Could the positive result be a false positive? Is there a chance that I don't really have cancer?

2. Does it make sense to repeat the biopsy?

3. Is removal by robotic surgery truly the best option for a fit and healthy 50 year old?


4. What questions should I be asking at this point?


Many thanks for any input you can provide.
Re: Newly Diagnosed
Jun 25, 2010
[COLOR="DarkGreen"]Hi ,

Welcome to the board! :) Also, kudos to you for asking your questions on the same day you got the news. :cool: As of this moment, Dale and JohnT have both provided responses that should help you a lot. (Also, thanks for the kind words, guys!) I'll add some comments in green to an excerpt from your original post.[/COLOR]

[QUOTE=Mr.M;4273406]I just turned 50 and I've always been in excellent health and physical condition. During a routine physical, my first ever PSA came back at 3.5 and then 2.8 from the same blood sample.

My physician sent me to a urologist. We waited six months and did another PSA test. That one came back at 3.0. The urologist recommended a biopsy. I didn't want to have an unnecessary biopsy so I got a second opinion from another highly recommended urologist. This urologist also said "do the biopsy."

[COLOR="darkgreen"]You are benefiting from the modern understanding of PSA as it relates to age and other factors, such as the size of the prostate. Not long ago, your PSA levels would not have raised concern.[/COLOR]

I liked the bed side manner of the the second doctor better than the first so I proceeded. Today, I learned that I had a positive biopsy report. I was floored.

[COLOR="darkgreen"]Welcome to the club! :dizzy: That rough initiation is common.[/COLOR]

The Gleason score in three of the 12 core samples is 3+3=6.

[COLOR="darkgreen"]Gleason 6 is the most common score for newly diagnosed men, and it indicates fairly unaggressive prostate cancer. That's a good thing, and the fact that it was based on twelve cores gives reassurance that it is a sound sample and in line with current practice. Your Gleason score is an important indicator of "low-risk" prostate cancer.

The fact that three of twelve cores were positive yields a 25% of cores positive figure. That's important, because it is another low-risk indicator, below the 34% positive that would indicate higher risk.[/COLOR]

Apparently, this is confined to the prostate and, according to the urologist, is on the low end for needle biopsies.

[COLOR="darkgreen"]Both Dale and JohnT asked good questions about the stage, etc., that you need to get from your doctor. Another important piece of data is the size of the prostate; the best estimate is based on the ultrasound used at the time of biopsy, but estimates based on DREs are also reasonably reliable. Do you have results and dates of previous PSA tests? Those would help indicate the velocity you are dealing with. (That 2.8 and 3.0 suggest the velocity is low, but more data points would help.)[/COLOR]

The urologist recommended robotic surgery and gave me two guys who've done a lot of them. According to my urologist, radioactive seeds are not the best option because of my age. The side effects of the radiation later on in life are unknown.

[COLOR="darkgreen"]Now, as Dale and JohnT have suggested, you are getting a biased and not so accurate sales pitch. :( Unfortunately, it is also a fairly common sales pitch from urologists. :( I'll join Dale and JohnT in a chorus saying that other options, especially including radiation, have [U]at least[I][/I][/U] as good a claim to being best for you, based on what you have posted. It is important to consider circumstances that can elevate or depress the worth of a therapy in your particular case. For instance, if you are already having urinary trouble, radiation loses some appeal; if you are having some cardio issues (apparently not in your case), then surgery loses some appeal).

Actually, radiation has more sound studies done for longer periods of follow-up with greater average success than surgery. The Prostate Cancer Treatment Center in Seattle, a brachytherapy center, has published a paper on that in its collection of items on "prostate cancer." There is a thread on this board that talks about that study entitled "Choosing a therapy - lessons from the Prostate Cancer Results Study Group, started on 5/22/2010.[/COLOR]

I don't even really know what questions to ask. But, here's a start:


1. Could the positive result be a false positive? Is there a chance that I don't really have cancer?

[COLOR="darkgreen"]Unfortunately, no.[/COLOR]

2. Does it make sense to repeat the biopsy?

[COLOR="darkgreen"]JohnT's comment on a a second biopsy opinion is right on the money.[/COLOR]

3. Is removal by robotic surgery truly the best option for a fit and healthy 50 year old?

[COLOR="darkgreen"]No. It may become the most attractive option to you, but there is no reason why it is the best option. One option you could quite reasonably consider, based on what you have posted so far, is "active surveillance" (AS). For men with low-risk case characteristics across the board, even with age as young as 50, AS is an option. (That said, some leading AS centers are a lot more comfortable with AS for older men.) Personally, I believe AS will be offered to most truly low-risk men no matter what their ages, in a few years, as favorable study results accumulate. There have been a number of threads featuring AS on the board. It involves quite active surveillance (at least two follow-up biopsies at the second and third year points, plus periodic PSA and DRE checks. It should involve, I think, lifestyle tactics (nutrition/diet/supplements, exercise, stress reduction as well as perhaps mild medications (a low dose statin, Avodart or finasteride). It could very well prove out that such a robust AS program will be all you will need to control the cancer throughout your life, freeing you from the burden of potential side effects of major treatment. (Those side effects are far more outweighed by the benefit of curing or controlling cancer for those of us who really need that, but many of us don't need major treatment. That's really become clear only in recent years of this decade.) However, these are my thoughts as a layman with no enrolled medical education behind them. Please consider these thoughts as leads for discussions with aware doctors.[/COLOR]

4. What questions should I be asking at this point?

[COLOR="darkgreen"]I believe the best book to orient new patients is "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen B. Strum, MD, and Donna Pogliano. Dale and JohnT have both listed some key questions, and the Primer will help you think of others. Dr. Strum was a co-founder of the Prostate Cancer Research Institute, a non-profit organization dedicated to educating patients. PCRI has many publications to help patients.

[/COLOR]

Many thanks for any input you can provide.

[COLOR="darkgreen"]Even though your doctors may not be giving you the best advice by trying so strongly to steer you toward surgery and away from radiation or other options, they did you a real service by finding that cancer early! That's key!

Good luck to you in sorting out what is best for you.

Take care,

Jim :wave:

[/COLOR][/QUOTE]





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