Can DNA tests determine if the cancer is high risk?

Why only then?  

Hi dbcriss,

Barney is welcome to correct me if I have it wrong (or leave something out).

If your cancer has metastasized (spread) then a prostatectomy won't do you much if any good because you will need radiation therapy anyway so you might as well avoid the prostatectomy (and all the side effects). No reason to endure both procedures and at least you get to keep your quality of life.

If it has metastasized I would strongly recommend checking into proton radiation therapy. It has had amazing results and much less long term side effects of the older more common photon radiation (x-ray) therapy.

I'm really getting the cart ahead of the horse here. You just need to know if the cancer has spread before you go under the knife. I might change your course of action.

Please look your urologist in the eye and ask if he is planning to save the nerve bundles.

The surgeon said he has done thousands of these procedures and based on his experience and my lack of symptoms and my age 59 he thinks I'll recover well.  I did have the full bone scan and the CT with dye and that didn't show any spread of the cancer.  They call it a stage 2.  The biopsy determined a Gleason score of 7 (4+3) with 7 of 12 core samples cancerous and 4 were completely cancer.  The genetic test done by the surgeon called it High Risk though the radiologist thought we were 10 years away from enough data to make that call.  My dad also had prostate cancer and had it removed at an older age than me and recovered well.  I asked about getting a MRI but they said it would not be as informative as the bone and CT scans.  So, thinking strong on the removal.  Got it scheduled for the 14th though I could easily back off.

Hi dbcriss,

Ok, glad you had the bone scan and that is excellent news there is no sign of metastasis. Also, Gleason 7 is way better than 8 or 9. Unfortunately from what I understand 3+4 is better than 4+3 (even though they both =7).

So, from what I recall about the Gleason score, you do have a more aggressive score of seven and you have a lot of cores which have cancer. I don't think an MRI at this point would be all that helpful to you.

I think your two most viable options are prostatectomy or Proton radiation. If it were me, I would probably choose the prostatectomy but I really can't say because I have talked with several people (some face to face who are extremely happy with their results from Proton therapy. Downside is it is VERY expensive $50k and it is still radiation. Look up Loma Linda if you have time. If you call them, they will send you information and an excellent book written by a man who personally went through the Proton therapy. Plus the book has tons of other useful information such as explaining the different procedures and side effects of each one and his experience with the urologist, radiologist...and how each one told him he was the "perfect candidate" for their procedure.

Personally...In your case I keep coming back to thinking that I would probably go with the prostatectomy. I just wanted you to know your options.

Also, in your case, I would strongly recommend you make a decision and move on it soon.

Hope that helps.

Please keep in touch and let us know what you decide and let us know how your recovery goes. You will be a valuable resource for others who seek advice on the forum.

God bless and God be with you.

Thanks for all the info and confirmations.  Am scheduled for the 14th.  The lack of symptoms keeps giving me doubts that I even have cancer.  Gotta force myself to trust the Drs, and that's not easy for a guy having been a child in the anit-establishment 1960's.  Will let you know how it turns out.  Thanks again, David

When I was diagnosed with cancer I had no symptoms whatsoever. 

I was actually surprised when my tests came back positive.

Me too I had no symptoms whatsoever but an elevated PSA when I took my MRI that's when they discovered the 2 legions 1% and 3% in the other I had 2 other biopsies through the urologist office and they both came back benign Wednesday I'll be having surgery all you guys say a prayer for me and I'll let you know what's going on with me day by day alright thank you for all the advice and God bless you all

Gleason score 6 low grade psa 6.3. From 5.9 in 8 months before that 4.3 in 12 in 12 months

Yes, same with me, no symptoms of cancer. I was having some urinary issues due to an enlarged prostate (getting up at night, not completely emptying my bladder...but no back pain or other issues associated with cancer. I even told my wife the night before my procedure that I still can't believe I have cancer.

I feel fortunate that my procedure not only killed the cancer but also relieved all of my enlarged prostate symptoms. It's like it never even happened.

Good luck to both of you and keep in touch on your progress. I Wish you both the best.

Good luck and have a speedy recovery

You're in my prayers.

Same for you on the 14

In my experience, ES you are spot on. If the PCa has spread to the skeleton then surgery will not rid you of the PCa so it would not be ethical for suggest a prostatectomy.

If it has spread to the Skelton then I would look into all useful options including radiation ( external beam), proton therapy and hormone therapy.

I wonder what type of CT scan you had. The latest and greatest as far as I know is the PSMA PET CT scan. But even then, it is not very sensitive to very small metastasis. That said, if a scan shows no metastasis then radical prostatectomy would be my choice.

You mention 'stage 2'. I presume you mean 'tumor stage'. Please note that there are three such tumors: T2a, T2b and T2c. They are quite different with the T2a being the least invasive.

ES is right when he says 4+3 is worse than 3+4.

I insisted on a MRI before biopsy so as to be able to have an u/s guided biopsy. The MRI was very useful in denying I had extraprostatic extension.

You don't mention anything about extra prostatic extension.

The more you know before you decide on what therapy to choose, the better off you will be with respect to Quality of Life. Hence the excellent point made by ES: "No reason to endure both procedures". 

dbcriss

Forgive me for sounding like an echo for ES but his thinking mirrors what I went through 10 weeks ago.

Yes proton therapy is expensive and to the $50k you need to add up to 8 weeks accomodation near the hospital. And living expenses. And yes, side effects are said to be better than those from surgery.

But, and this is why I opted for surgery: long term studies that I saw show no difference in biochemical recurrence rates between proton and surgery. That means, neither is significantly a better bet in assuring you the PCa doesn't return.

In short, my biopsy was 4+5 with no metastasis or extraprostatic extension. I chose radical surgery and in your case would do so as well.

Wishing you a speedy recovery.

Whoa there mate ( or "pal" as the case may be).

Big misunderstanding!

Early in the disease, there may well be NO symptoms.

I had no symptoms. None whatsoever. For the last few years I almost religiously do comprehensive blood tests. It was me, not my GP or PCP that queried a low but quickly escalating PSA measurement that convinced me to have a MRI, long before I thought I would need a biopsy.

Best wishes.

I forgot about the huge time commitment required for Proton therapy. You basically have to take 2 months out of your life for the treatment. But that's, (relatively speaking), not that much time if it saves your life. Plus there are places that rent or offer free housing for patients.

Barney, I didn't know you had a prostatectomy. (There are so many posts, sorry, somehow I missed it.) It's only been 10 weeks but how is your recovery going?

The Radiologist called it a stage 2 cancer in that it 7 of 12 cores had cancer but it appeared to be not out of the prostate.  He said that was an opinion based on the tests and my symptoms.  And unless I missed it, I don't recall anyone mentioning T2a, T2b, or T2c.  Also, the best guess of the Urologist is it's not out of the prostate, yet.  I'm still thinking surgery.  

I don't think any Dr is going to commit to any definite words.  Seems risky on their part.   BTW, has anyone else noticed there is always a "scribe" in the room?  All 3 Drs I've seen had a scribe.  Is it more like a witness?  And I checked in with my family Dr yesterday to get one more general opinion and would you know he also brought in a "scribe."  His exact words; let me get my scribe.  That was in addition to a tech clicking away on a laptop.  It's sorta freaking me out, like are they really just taking notes or are they there like a witness?  Prior to cancer I didn't see Drs hardly ever, so maybe these extra people in the room is the new normal.  In one appt there were four of us in the room (two women) and I sorta shut down and could not ask questions.   

db, are you going through this alone? Isn't anyone (family, wife, close friend going to these office visits with you?

No it always had that been me and the doctor at all times and that's my wife was in there other than that no nobody dictated anything it was just me and him hope that helps

I know what you mean by having trouble following so many posts. Me too. As for me, thank you for asking, I am now down to using just one #1 pad a day and have the occasional leakage. My surgery was nerve sparing and I can categorically state that one 5 mg tablet of cialis daily makes a world of psychological difference to sexual function.

So far I have not had sex, but feel more 'complete' with Cialis than without it.

Your doctor's use of terminology like Stage 2 is not very common. Most urologists use the TNM clarification. T for tumor be it 2a, 2b, 2c, 3 or 4. N to indicate if the cancer has spread to the nodes ( O if it has not, 1 if it has) and M to indicate if it spread to the skeleton.

As to the scribes you mention, I have not heard of these, but am not surprised to hear that they are used.

I am following many posts, so forgive me for asking  something you may have already mentioned: did you have a MRI? If not, then how did your urologist conclude that the cancer has not escaped the prostate?

In my case the MRI was far more definitive than any urologist's best guess.

I did not have a MRI.  How they are sure it's not escaped is a good Q. The surgeon feels confident that it has not escaped but I should of pressed him on why he is sure.  He did say that if has then there will be follow-up treatments with the radiologist.  The biopsy report says the clinical stage is T1c.  

The radiologist was the one to say stage 2 though thinking back he might have just been agreeing to my question.  The radiologist also thought it not escaped though thinking back maybe due to my lack of symptoms.  

Well darn, ................. hesitant again.

 

My wife went once.  My take-away from the urologist and surgeon are full recovery other than spurting.  That's what my wife heard, too.  I guess I'm approaching this more like a hernia surgery but with a longer recovery time.  You know, I don't think the Cancer part has fully sunk in.  I think I'm blocking something out.  

dbcriss,

When a Professional tells me, "I don't think you have this or that" without tests to back up their thinking, I don't trust them anymore.

When my family Doctor sent me to an urologist after a small rise in a PSA test. The urologist told me I didn't have PCa, he didn't even examine me, just sent me on my way, and told me not to worry.

Turns out I did have PCa, I found out just a few months after that visit. So,it pays to be vigilant and pro active and be aware of Doctors who guess, or just in a hurry, and do not do a half A.. examination or diagnosis.

T1c is good news.

I agree that the CT is informative, but wonder why it did not mention anything about extraprostatic extension. After all, my MRI concluded there was none, but only the post op pathology would prove this.

If your urologist is someone you trust then you may conclude that as he has done many  surgeries, he

a) doesn't need your money per se. He is telling you honestly that surgery is your best bet. 

b) believes that there is no extra prostatic extension is based on his experience and

c) that belief is backed up by the radiologist.

These are strong views which may dispense with the need for a MRI.

 

Dbcriss

Note my comment on " if your urologist is someone you trust". If you don't, then keep looking for a urologist.

As to data revealed I scans, I am no expert, just a patient, but feel that CT looks for spread to nodes and bones.

It does not reveal extraprostatic extension.

Everyone has different levels of confidence in physician. That said, I would want a MRI before surgery.

How would the results of the MRI effect your decision to go with surgery or with radiation, or some other treatment?

If a MRI shows extraprostatic extension ir pT3 or pT4, it reasonable to asume the possibility of metastasis. If that is the case, surgery would not be indicated as it would not get rid of the PCa.

The fact that a scan doesn't show metastasis doesn't mean that metastasis has not taken place.  Instead it means that the scan is not sensitive to detected very small metastasis.

db,

You just asked the perfect question!!!

If the MRI shows metastasis then you will need to do radiation regardless of having a prostatectomy. Your doctor has already (intentionally or subconsciously) prepped you for this next step. Remember his statement earlier in your post... "He did say that if has then there will be follow-up treatments with the radiologist". So when you come out of surgery if he says it has metastasized he can then tell you your next visit will be with the radiologist. He still gets paid for performing the prostatectomy even though you could have avoided the operation and just done the radiation treatment had you known about the metastasis ahead of time. That's why an MRI could help you decide what course of action to take.

Three days after prostatectomy.  I'll ask at the Drs office why they felt no need for a MRI.  However, the urologist, radiologist, and surgeon all were confident that a MRI wasn't necessary.  Am curious how they knew.  Anyhow, the surgeon said the planes on the gland he removed looked good, (meaning looked normal?) and I'm feeling pretty good.  Go back Wednesday to have the catheter removed.  Looking forward to that.  

So glad thing are going well for you. I had a catheter with my procedure too. I was so glad to get that over with. But I had to have mine in for minimum of 7 days. Not the worst thing in the world (and I had to travel on a plane with mine) but I was glad when I was finally done with the catheter. FYI, I pulled mine out at home myself. That was a little nerve racking. But it worked out fine. Keep us posted on your progress. So far it sounds very promising for you.