YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

BRONZE

Herb Dicker and Vita live in New York USA . He was 64 when he was diagnosed on September 21, 2007. His initial PSA was 3.4 ng/ml, his Gleason Score was 9 and he was staged T1c. He is undecided as to treatment Here is his story.

My diagnosis in September 2007 was not a total shock, albeit unwelcome. I had undergone two biopsies in 1999 because my PSA rose to 4.5 ng/ml from 1.1 ng/ml at my prior physical exam. My GP referred me to a urologist for follow up. The first six-core biopsy in March 99 came back as low-grade neoplasia, and a second biopsy of another six cores in May 99 was benign. A follow up PSA was back down to 1.1 ng/ml in June 99, but I began to visit the urologist for routine exams in December of each year.

My PSA began to gradually increase, and was at 1.7 ng/ml (29% free) at my December 06 exam. Despite a normal DRE the urologist was sufficiently concerned to suggest a mid-year PSA, which in July 07 came in at 2.8 ng/ml (18% free). Another PSA in August 07 came back at 3.4 ng/ml, and biopsy in September 07 was positive in 6 of 12 cores, all on the left side. Gleason was 8 and 9 and stage is considered T1c or T2.

I consulted with Dr. Herbert Lepor, a pre-eminent prostate surgeon and department head at NYU Medical Center, who feels a cure is achievable with either surgery alone or surgery and radiation. He also suggested that I decide sooner rather than later because of the aggressiveness of a Gleason 9 tumor. I have scheduled a tentative RP for October 22, and I am now undergoing imaging exams, including bone and abdominal CT, although both Dr. Lepor and my urologist believe they will not show anything. I am scheduled to meet with a radiation oncologist on Thursday October 4 to get his take, but in my heart I believe that if radiation as initial therapy fails then surgery is no longer a viable option, whereas radiation remains an option if surgery fails. Both the urologist and Dr. Lepor agree.

I know the conventional wisdom is to take some time with a treatment decision, but psychologically I need to move ahead. Unless I can be convinced otherwise by either my urologist or radiation oncologist I will most likely move forward with Dr. Lepor. He is supposedly the innovator of nerve-sparing surgery and trained with Dr. Walsh at Hopkins, does over 300 of these procedures annually and has written scads of articles, so I do have confidence in him. He has pioneered removal of the catheter within one week and has a photo album of his patients at three weeks post-op, back to pretty much normal activities.

I hope to have a better handle on how I will proceed by the end of next week, once I get back the imaging results, meet with the radiation oncologist, and speak with my urologist.

More to come!

 

UPDATED

October 2007

 

 

My RP is scheduled for Monday, October 29. Given the high Gleason of 9 even the radiation oncologist felt that surgery is my best option, so I have put myself in the hands of Dr. Herb Lepor, head of the NYU Medical Center urology department.

I'm doing all of the prep, including Kegels, autologous blood donations, iron and colace pills, and my usual exercise routines to keep strong. The nurse practioner also recommended eating well and avoiding any type of restricted diet. I'm hoping for an uneventful recovery from surgery and a cure to the disease.

Wish me well!!

 

UPDATED

November 2007

 

 

I had my surgery on Monday, 10/29 at NYU Medical Center with Dr. Herb Lepor and his staff. All I can say is that they are remarkable, and anyone considering this surgery with access to Dr. Lepor ought to at least consult with him. He believes the surgery went as well as he could have hoped, and depending upon the pathology report I may not need follow up treatment.

The pain has been minimal and entirely tolerable, and the catheter is completely bearable. I see him on Tuesday, 11/6 for catheter removal (he believes in one week being adequate) and pathology review. More then.

Later:

I visited with the doctor on Tuesday, November 6, and it was mostly good news.

Pathology revealed negative nodes, margins and seminal vesicles, and Gleason 4+3=7 rather than 9 on the biopsy. The less than good news was extra prostatic extension, which results in staging T3a, but the negative margins could mean that the surgery removed all of the cancer.

No follow up treatment for now, but my first hypersensitive PSA is scheduled for February 2008, so that will determine the next step.

I did have a relatively minor setback. The catheter was removed at the 11/6 visit but later on that night I went into urinary retention (an unbelievable urge to pee but nothing comes out), so we had to return to the emergency room at NYU Medical Center at 3AM (about an hour's drive) to have it reinserted. I expected the reinsertion to be tough, but the chief urological resident took care of it quickly and painlessly. I'm going back on Monday 11/12 to have it removed once again, hopefully without incident.

The cystourethrogram shows complete healing of the anastomosis, so the doctor believes that the urinary retention was because of urethral swelling rather than blockage of some sort. I feel strong and healthy, I'm walking at least a couple of miles each day, and once the catheter is finally gone I'm cleared to resume my full lifestyle. I feel well and I'm hopeful for the future.

 

UPDATED

February 2008

 

 

Today was my three month post-surgical follow up, and it was all good news. My PSA is undetectable, I'm 95%+ continent, and I've begun to experience an occasional soft erection without Viagra, albeit not enough for intercourse, but nonetheless a start. My surgeon is thrilled with my progress.

For all of you debating a treatment choice please be sure to search out the most experienced provider you can find. It makes all the difference. Dr. Herb Lepor at NYU Medical Center is the man!

My next visit is May, at which time I will post again.

 

UPDATED

May 2008

 

 

I had my six-month post surgical follow-up on Tuesday, May 6, and the news was all good. PSA continues undetectable, urinary control is 95% and ED is abating without medication. While the surgeon would not use the word "cured" he did say that he would be surprised if anything further developed. Considering how I presented to him following my biopsy, with Gleason 8 and 9 scores, I am of course thrilled at this outcome.

My diet includes daily green tea and soy milk (vanilla flavored, tasty and low carbs)and tofu at least once or twice a week, primarily in Thai food which I enjoy.

My next appointment is in November for my one-year assessment, so for now I'm going to relax and enjoy the summer.

Keep optimistic, friends, because this disease can be managed and overcome. Good health to all of you.

Herb's e-mail address is: hvcd@optonline.net