YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

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Ron Gerard and Pat live in British Columbia, Canada . He was 67 when he was diagnosed on November 24, 2008. His initial PSA must have been less than 4.0 ng/ml, his Gleason Score was 3+4=7 and he was staged T1a. He is undecided as to his choice of treatment. Here is his story.

I spent a number of years suffering with BPH (Benign Prostate Hyperplasia) and up to mid 2007 the only advice I got from my urologist (on three separate occasions) was to avoid caffeine.

From July 31, 2008 until early October, due to extreme difficulties etc urinating, I lived off and on with the use of a catheter. I changed to a younger urologist, and on August 27, 2008 subsequent to looking (not sure what procedure is called) at my urethra, prostate and bladder he advised a TURP (Trans Urethral Resection of the Prostate) was definitely in order. He put me on Flowmax and Proscar prior to the TURP which really seemed to help.

On October 9, 2008 the urologist performed the TURP operation. The following day I was released from the hospital without a catheter feeling just great. I arranged for a six week follow-up appointment with him for November 24, 2008.

To complicate things, I had a heart attack on October 19, 2008, ten days after the TURP. I am therefore on all kinds of heart medications which undoubtedly compromise my future options.

On November 24, 2008 at my follow-up meeting with the urologist he advised that the pathology report from my TURP indicated cancer was present in the prostate.
Immediately the word cancer was mentioned I was somewhat stunned as I'm sure is normal. I asked him what should be done next, and he said that one option is to "wait and watch". He said this would entail PSA tests in mid-January 2009 and then again two months later in mid-March 2009. He said that a PSA could not be done any sooner than Mid-Jan/09 since it would be too soon after the TURP and would therefore be inaccurate. I said I would find it somewhat difficult to sit for four months without taking some form of action other than waiting for the PSA tests.

I then went home with a copy of the pathology report in hand to share the information with my wife. I was somewhat taken aback when I observed the dates etc on the pathology report and concluded that he knew of the cancer some 4 to 5 weeks prior November 24 when he informed me. When asked he said his reason for the delay was that he felt I had enough on my plate due to the heart attack.

He scheduled a bone scan which was done on December 15, 2008. I have a follow up appointment with my GP on December 19,2008 to get the results of the bone scan.

I am also awaiting for an appointment to be made with an oncologist as well as the PSA test to be done on January 21, 2009.

My PSA tests from the past are as follows:

04/01/2005...........2.0
06/18/2001...........1.4
08/03/1999...........1.4
09/28/1998...........1.4
04/11/1994...........1.0


In the interim, confusion reigns in the thought process and I am not too sure what to do next, so any advise or information would be greatly appreciated.

Thanks,


Ron

 

UPDATED

February 2009

 

 

February, 2009 Update:

Results of a recent entire body bone scan came back as "completely normal".

On January 19, 2009 I met with Radiation Oncologist (Dr. Alexander). He reports that I am a stage T2a. He recommended, (subject to change once current PSA test known) that I do not have surgery or Brachytherapy due to previous heart attack as I would have to go off my blood thinning medication thereby incurring risk of another heart attack.

In view of this and prior to PSA tests he suggests External Beam Radiation. If PSA tests come back less than 5.0 he may suggest consideration of Watch and Wait and radiation would be contemplated if PSA came in at 10 or more. Radiation would be done over a seven week period. A DRE indicated a moderate sized gland with a small nodule palpable at the right apex.

The results of two separate recent blood tests indicated as follows:

January 19, 2009.......1.01 ug/l

January 21, 2009........0.93 ug/l (lower than any previous PSA tests)

On the first PSA test above the DRE was done 20 minutes prior to the blood been drawn (as opposed to the other way around) which therefore must have compromised the results of both tests in some way.

A CT scan also done on January 21, 2009 indicated that there are two small lesions noted in liver. Neither definitively characterized due to their small size. The liver was otherwise unremarkable. The adrenals, pancreas and spleen are normal. A small cyst is noted on the left kidney, otherwise unremarkable. There is nothing that is characterizable and therefore unlikely to be metastasis prostate cancer, but this cannot be entirely excluded.

On January 28, 2009 I met with Urologist (Dr. Morrison). He concurred with above Radiation Oncologist in regard to exterior beam radiation and that surgery and brachytherapy should not be considered. He has scheduled further PSA tests in 3 months and will arrange for another CT scan near the same time.

He suggested that if I am mentally OK with it, I might consider a "watch and wait" approach since the bone scan, CT scan and PSA tests all came back relatively OK. Watch and wait, with the information at hand, therefore seems to be in order.

 

UPDATED

May 2009

 

 

I returned from an appointment with my Urologist, Dr. Ken Morrison on May 06, 2009 at which time we went over the results of my last PSA test and Cat Scan. This was immediately followed by the good old dreaded DRE.

The last PSA test of April 21, 2009 came back at 0.97 ug/L which was only very slightly higher than my test three months ago which was 0.93 ug/L.

The CAT scan of my abdomen done on April 28, 2009 came back as "normal". There was reference to "two tiny well circumscribed lesions within the liver" identical to the last CAT scan, however there was new reference to "several tiny cysts scattered throughtout the pancreas". Fear was my first reaction when cancer and pancreas are merely mentioned together. Dr. Morrison allayed my fears and assured me that the cysts are not considered to be cancerous. I assumed from his certainty that the difference between a cyst and a tumor when viewed via a CAT scan is very obvious. The last sentence of the report stated "There is no evidence of metastatic disease".

Todays DRE also indicated no irregularities of the prostate. This observation is contrary to that of radiation oncologist Dr. Alexander Abraham and the DRE performed by him on January 19, 2009 at which time he noted a "small nodule at the right apex" of the prostate.

Since there seems to no radical negative changes to any aspect of the previous tests and with the further concurence of Dr. Morrison I will therefore continue with the "Watch and Wait" approach until the next scheduled PSA scheduled for three months.

The only concern I have is that the PSA, CAT scan and DRE tests related to WW/AS is, if I am correct, usually combined with a needle biopsy (which I have never had). Due to my heart condition I believe that a needle biopsy will not be done due to risk of bleeding and or further heart complications.

Since the PSA, Cat scan and DRE are by no means definitive tests and due to the absence of this needle biopsy, how incomplete is the information I have to make the descision to continue with WW/AS?

This is all very confusing and at times very depressing as I can't think of any other ailment a person could be faced with that has so many alternative treatments available, all of which seems to be at the patients discretion. Thank you for this great web-site.

Ron

 

UPDATED

December 2009

 

 

Nothing too much to report as an update other than latest PSA results as follows;

July 21, 2009....................0.77 ug/L

December 16, 2009..........0.86 ug/L

The urologist, in both instances did a DRE and did not encounter anything that seemed significant or unusual. I am still in the category of uncertainty as I am not a candidate for anything such tests as a needle biopsy as to do so would necessitate stopping my heart medication thereby risking another heart attack. So I must rely solely on PSA and DRE results, which to date have been encouraging. I shall therefore continue to Watch and Wait.

Ron's e-mail address is: rongerard@telus.net