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Got a second opinion today
SteveK364
Posted: Wednesday, July 18, 2018 9:41 AM
Joined: 6/26/2018
Posts: 69


Well, after being diagnosed about a month ago, I got a second opinion today from a long-time urologist in the area, who thought we could simply observe things for awhile and have my PSA checked from time to time. He said he has a number of Gleason 7 patients with 4+3 scores like myself, who are on active surveillance. Is this a reasonable option for me? That being said, I will probably move forward with treatment this fall, but atleast I don't feel a sense of urgency to have something done tomorrow, like I did before conferring with him. Any thoughts? My Stats: My age: 63, healthy, very active PSA: 3.2 (3 years ago: 1.6) 2 of the 12 samples showed cancer: 1 spot had 5% cancer, the other 30%. Stage: 1 (The doctor didn't want to apply a number to it and preferred the term "early" but said technically it would be "1" -- or maybe "2") Gleason: 7 (1 spot was 3+4 at 80%/20%, the other was 4+3 at 20%/80%) Cancer is "localized" Prognosis: Excellent Aggressiveness: Intermediate. Treatment recommendations: Surgery or radiation.

SteveK364


DXM
Posted: Wednesday, July 18, 2018 10:22 AM
Joined: 9/10/2016
Posts: 20


I am not a doctor. But here is my opinion after living with the disease (now hopefully cured) for 20 years. My observations formed from regular attendance at support group meetings and attendance at prostate conferences as well as experience with my case. The doctor is following current standard guidelines recommending active surveillance. But active is the key word if you choose this. Getting regular PSA's may not be enough. I would get baseline imaging of the gland in the form of a mpMRI (3 Tesla preferred) or a Color Doppler by Duke Bahn in Ventura, CA or Dr. Lam in Marina Del Rey, CA. Also note that 12 cores misses a lot of the gland, and most likely the transition zone. That is why imaging is important. In my case the 4+5 tumor was in the transition zone and would likely have been missed with the 12 core standard. Luckily I had mpMRI and color doppler imaging and a saturation biopsy to reveal the tumor. But consider this: The cancer is not likely to go away and it is doubtful that there will be a miracle, no side effect, cure any time soon. So, depending on your insurance you might well consider Cyberknife soon or when you reach 65 and Medicare kicks in. With the current technology, urinary, rectal, and sexual problems are minimized. Just one man's opinion.

DAMorris
Chico
Posted: Wednesday, July 18, 2018 1:41 PM
Joined: 10/10/2008
Posts: 446


Steve, In January of 2007, ( I was 68 yrs old), I was diagnosed with Prostrate Cancer with a gleason score of 5 (3.2) and 6 (3.3) . MY PSA was 1.4 I really did not understand the score information very well, but I knew that I had a form of Cancer and was worried about it. Watchful Waiting/Active Surveillance was an option for me, And, at that time, CK was not be covered by all Medicare Regions. I was, and probably still am, a high anxiety person. I know nothing about Prostate Cancer. I only know that few of my family had died of different types of Cancer and I wanted to deal with it immediately. Based on test scores, I could have waited for long time to make my decision, but I did not like the thought of having regular tests follow up for an extended period of time. CK CK, at that time was being denied by many Insurers ( Including Some Medicare Regions. So, Active surveillance , was an attractive option for many. I decided, however, that I would bite the bullet an be prepared for the Insurance Denial and have the Procedure. Others, who have posted on this forum, had to make similar decisions and initially had their insurance claims denied. I fortunately had my procedure approved, but had signed paper work that I would pay, if the Insurance claim was denied. I am very happy that I did it. My decision, however, was not based on detailed information and many years of CK Procedures which is now available for you. I am not an MD and don't have any scientific/technical background. My decision was based on the information available at the time , my not wanting to be tested periodically ( anxious each time), and I was very encouraged about post procedure effects when compared to Surgery and other types of Radiation Procedures ( Only Five Days for CK vs other long period procedures). chico PS Steve, there are a lot of interesting stories/posts on the archived CK Forum that you might want to review when you have a lot of spare time . Due a Cut and Paste of the link below and then Select the Prostate Forum - The former forum was archived in 2008. Many of the topics show what candidates for CK were considering when there was not too much data or support groups that were aware of CK for Prostate . http://www.cyberknifesupport.org/forum/default.aspx
JAV
Posted: Wednesday, July 18, 2018 5:14 PM
Joined: 10/29/2010
Posts: 800


Question for Dr. Medberry & Dr. Katz : If Steve's Gleason increases to an 8, would he still qualify for CK ?

Treated with CK 4-2011.  Gleason of 3+4 , PSA 3.7 , two cores positive, 5% & 12%
 PSA on 7-13 0.3  PSA on 11-13 0.3 PSA on 5-14   0.3  
PSA on 7-14   0.2 PSA on 11-14  0.2 PSA on 3-15 0.2
PSA on 7-15, 0.2 PSA on 7-17 0.1 PSA on 1-18 0.13
SteveK364
Posted: Wednesday, July 18, 2018 6:45 PM
Joined: 6/26/2018
Posts: 69


DAMorris, Thanks for the thoughtful reply. Although the doc today said surveillance was an option, I'm pretty sure that I will pursue CK treatment soon. I don't want to take any chances. In fact, I am meeting with a CK team in Ann Arbor next week for a consultation. Thanks again. Steve

SteveK364


radsrus
Posted: Thursday, July 19, 2018 9:05 AM
Joined: 10/10/2008
Posts: 4435


I think that is better for a 4+3

Clinton A. Medbery, III, M.D. Southwest Radiation Oncology buddy@swrads.org
SteveK364
Posted: Thursday, July 19, 2018 9:14 AM
Joined: 6/26/2018
Posts: 69


Thank you, Chico!

SteveK364


SteveK364
Posted: Saturday, July 21, 2018 8:35 AM
Joined: 6/26/2018
Posts: 69


Will do, thanks, Chico!

SteveK364


 

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