WAITING FOR SURGERY NORMAL?
Posted , 6 users are following.
My husband has been diagnosed with prostate cancer after 2 biopsies. 1st one was negative, 2nd showed "cancer throughout prostate." NOW, he had a PET Scan 2 months ago and it did not show the cancer had spread anywhere including the lymph nodes. His surgery (prostate removal) is now scheduled for May 2nd/2017. Is it NORMAL for a doctor to wait this long to remove the prostate? Could it be he (doctor) feels that since there is no indication of spreading to the lymph nodes that he doesn't feel the need to RUSH this or is it just "us" being paranoid? But can't the cancer spread in a month (more like 6 weeks). Any replies are appreciated. THANKS!
0 likes, 17 replies
romneyj anthony70342
Posted
Hi. The urgency depends on the aggression of the tumour (ie the Gleason score) which in part depends upon the type of cancer it is (the most common and least aggressive are the adenocarcinomas and in particular acinar adenocarcinomas which make up about 90% of prostate cancers).
I was diagnosed in September and my surgery was January 27th (actually scheduled for December but I put it off till after a trip I had in January.
Everything depends on the extent and aggression. Ideally he should perhaps have had an mpMRI (multiparametric MRI) which can reasonably accurately see the current extent of the tumour, but the most important information would be the Gleason score - though this is more accurate if the biopsy was an MRI/TRUS Fusion Biopsy (ie the biopsy was targeted using the mpMRI image taken previously). I suspect though that there the score upon which your urologist and his team (the multidisciplinary team) is making their decison is on a reasonably low Gleason score (3,4 for example) and that the more aggressive cells are towards the centre of the tumour.
i don't believe you/he have/has anything to worry about - had it been an aggressive tumour he would have been pushed in for an early op and other patients' ops moved forwards.
anthony70342 romneyj
Posted
Dr. said "cancer throughout prostate." His PSA was 49. Not 4.9, 49! 5 years ago. Heard through our PCP that this type of cancer takes "decades" so no worries on the 5/2 surgery date. He had a PET Scan in Nov/2016 and it did not show cancer anywhere in his body. I wonder sometimes WHY it did not show the cancer in the prostate? I'm not God, don't want to be. Tired of dealing with his "denial" and ridiculous behavior now. Let's pray it turns out good for him as "I' his wife am tired of the b/s that goes along with denial. THANK YOU! Get better.
RichardKen anthony70342
Posted
BTW if you have not made yourselves fully aware of how the surgery may effect your sex lives you really should.
I wonder if you have considered alternative treatments. There is of course hormone and radiotherapy and some sort of light ray treatment and something similar.
Cheers Richard
anthony70342 RichardKen
Posted
Not to be TOO personal, but we have'nt had sex since the day after we got married. And we've been together for 20+ years so not TOO concerned about that aspect. And yes, the doctor told us about the "other treatments." NOT willing to do any of it as I saw my father's "spirit" go down after each radiation treatment and he died in 1986. GOOD LUCK to you Richard.
romneyj anthony70342
Posted
I have seen the other responses but generally, if it is an acinar adenocarcinoma which seems likely (your doctor's comment that it takes 'decades' - a slight exaggeration by the way!"
6 weeks is likely to make no difference. You are confusing PSA with Gleason score. The PSA is a guide as to whether a man has one of the more typical prostate cancers and a general guide too as to how advanced it is. The Gleason score estimates the agressivness of the cells taken from the prostate in the biopsy and takes a modal score and a maximum score. I would ask what the gleason score is and if it is highr than a 3,4 I would press for an earlier op. Also if he's not had an mpMRI I believe that they have too little information to make a good judgement. Neverthe less 6 weeks is not a long time in terms of acinar adenocarcinomas.
I had an extra capsular extension (the cancer had spread out of the prostate on one side) and the surgeon had to remove that neurovascular bundle. I have been continent from 6-weeks post op and am considered clear of tumour cells. Incidentally I am not totally impotent though that may not be so important from your comments.
Some men manage problems by denial. I understand how hard that is to deal with.
anthony70342 romneyj
Posted
RichardKen anthony70342
Posted
Often people are so knocked sideways by the news of prostrate cancer that they do not fully research the implications of the various options.
The new treatment options look to be safer than what was available when I had my treatment a year ago and would I think be worth investigating though I'm not sure if they are available in the UK where I live.
My best wishes to you and your husband.
Cheers Richard
RichardKen anthony70342
Posted
Cheers Richard
anthony70342 RichardKen
Posted
PSA was 49. Not 4.9, 49! 5 years ago. Dr. just said "cancer was throughout the prostate." Had a PET Scan in Nov/2016 and did not show cancer anywhere else. Hopefully it's just isolated to the prostate and once gone...? God only knows. Thanks!
chris10969 anthony70342
Posted
I was found to have prostate cancer in 2011 in March. I was reluctant to have the biopsy in the first place and when it happened my Gleeson score was 7. I did not have my robotic prostatectomy until 4th May. There were several preliminaries, one of which was a scan to check whetherthe cancer had spread beyond the prostatic capsule. It had not. Surgery was a complete success. PSA tests have since shown <0.1. Hope this reassures you. Best wishes
anthony70342 chris10969
Posted
That's GREAT Chris!! Keep on keeping on!
greg43014 anthony70342
Posted
anthony70342 greg43014
Posted
I don't believe a "Gleeson Score" was done? I'm gonna' google it to see what that is. But from all the conversations with the doctor, that word never came up. (Gleeson). ??? This truly SUCKS btw. I know God only gives us what we can handle. But this time He gave us a "little too much." Gotta' keep the faith.
RichardKen anthony70342
Posted
Cheers Richard
barney34567 anthony70342
Posted
A few things come to mind:
1. Romney makes a lot of sense so I will not repeat everything he wrote;
2. A 3T multi parametric MRI is the best imaging tool to diagnose if the cancer is significant. For instance, a radiologist may say "it is suspicious for PIRADS 4", which is evidence of high grade cancer. PIRADS is a tool measuring the aggressiveness and goes to 5. A MRI often precedes a biopsy but not always;
3. The best biopsy is an ultrasound guided MRI procedure where the urologist uses an ultrasound that is guided by what the 3T MRI scanned;
4. The urgency of surgery depends on the Gleason score. A high score say 9 or 10 means "very aggressive" and should be operated on very soon. But very soon doesn't mean tomorrow. It can mean 6 weeks as was in my case and I had a 9;
5. The PSA should be looked at not for the nominal score, but for the change in score over time. A good rule is to work out how long does it take to double? If it takes a year or less to double, then you have a reason to operate soon. A man can have an initial PSA of 70 and not have cancer, and another man can have a PSA of 2 and have cancer.
Take RichardKen's advice: take control.