Paul
D and Yolanda live in California, USA. He was 52 when he was diagnosed on April
30, 2009. His initial PSA was 4.8 ng/ml, his Gleason Score was 3+4=7 and although
he does not know his staging it seems from his narrative that he was staged T1c.
He is undecided as to his choice of treatment. Here is his story.
Hi.
I
got my yearly physical in January, and got flagged because of my PSA jumping from
2.4 to 4.6 in a year's time. I turned 52 in January. I did a follow-up blood test
a few weeks later and the PSA was now 4.8.
I was referred to a urologist
and agreed to undergo a biopsy on April 23, 2009. While I was getting the biopsy,
the doctor was commenting that my prostate looked normal and the ultrasound saw
no noticeable signs on cancer or calcification, which was good in his opinion.
He took six samples altogether, He finished and made an appointment for a week
later to go over the results. Imagine my surprise a week later, on April 30, 2009,
when he went over the results with me. All six samples showed adenocarcinoma,
with the results as follows :
A) Right Prostate Base GS 3+3 with 40% tissue
involved
B) Right Prostate Mid GS 3+3, 30%
C) Right Prostate Apex GS 3+3,
30%
D) Left Prostate Base GS 3+4, 95%
E) Left Prostate Mid 3+4, 95%
F)
Left Prostate Apex, GS 3+4 90%.
I have no idea what the staging was. I
was stunned. The urologist was a surgeon, and he coldly gave me my options of
removing the prostate through surgery or getting radiation. I am seeing the radiologist
as soon as the HMO approves, which is usually pretty quick.
This whole
thing is still sinking in and I am not looking at it as a death sentence or anything
like that, but I am definitely expecting a change in my quality of life when this
is done with.
Does anyone have any ideas, looking at my biopsy findings,
what the best options would be?
Well
it's been a long 3 months. After my initial findings at the end of April, I looked
into all the options. The urologist wanted to cut and the radiologist wanted to
do brachytherapy - seeds. On June 1st my insurance changed from HMO to PPO, giving
me better choices.
I
decided on Proton Beam Radiation at Loma Linda, 2 hours from my home. In the middle
of May I set up a consultation there and was given an August appointment. Quite
a waiting list at Loma Linda, as lots of men are looking into Protons. However,
one thing always bothered me : the amount of cancer in my prostate - 6 of 6 cores
positive with 90-95% involvement on the 3 cores on the left side. Most of the
men I read on the proton blogs had Gleason 6's and maybe 2 or 4 of 12 cores positive
with lower percentage involvement.
In
early July I decided to get some more opinions. I went to a radiation oncologist
with an excellent reputation and he spent 3 hours with me going over different
scenarios. He recommended surgery since, as he put it, my prostate was "swimming
in cancer". A radiologist recommending surgery impressed me greatly, and I went
ahead and cancelled the Proton Radiation consultation. He had me do an MRI and
a new PSA test in mid-July. The MRI showed the cancer mostly contained but with
a possible minute capsular penetration, no perineal, lymph, or bone involvement.
My PSA actually dropped from 4.9 in February to 4.3 in July. He referred me to
a well regarded local urologist, who talked to me about surgery.
Because
of my age, the urologist offered to send me to City of Hope Hospital near Pasadena,
to undergo robotic surgery with his colleague Dr. Mark Kawachi, the West Coast
"Jedi Master" of Da Vinci. I met Dr. Kawachi in late July. He was a fantastic
man to talk to and answered all my questions thoughtfully. I asked the million
dollar question - "How many of these surgeries have you done?", and was floored
with his answer "over 2,200 !!". He said after looking at my charts he could probably
spare most of the nerves. That was enough for me. We scheduled the surgery that
day for Aug. 25th. I did my pre-surgery stuff 2 days ago and everything is a go.
I
am comfortable with my decision. If I had a small tumor and less agressive cancer
I would have probably gone with protons, but I am glad I took the time to get
3rd 4th and 5th opinions. I will continue to update my story after the surgery.
Take
care for now !!!
Paul's e-mail address is : paul.dacko@verizon.net
