Cancer diagnosed and awaiting surgery

[telboy15]

My wife suggested I had a prostate test a while back. No symptoms etc. BUT PSA was 5, biopsy showed Gleason of 8 (5+3). although 3 samples were benign, one 4+3 and one 3+3 BUT with one showing high grade PIN and one showing 5+5. MRI, full body bone scan and CT scan all show no spread. I am due to have a radical prostatectomy within weeks, but am not too sure about the op (DaVinci robotic keyhole surgery) and wonder at age 74 whether a 'watch and wait' would be a viable option. Any thoughts please.

[apdprostataportugal]

Hi,

I am not a doctor (just a patient) but with your age (74) I wonder if a hormonotherapy or brachyterapy wouldn't be alternatives to consider. Have you asked for a second opinion (another doctor) ?

[telboy15 in reply to apdprostataportugal]

Thanks. Fact is that my GP also says that surgery appears to be the best option. I also know that IF I did not go ahead, I would be forever worrying whether the 'gland' would leak out. Very strange business. A random psa check led to all of this.

[RWallace]

I am not a doctor either, but I think that with a Gleason score of 8 (which is what I have also) "Watch and Wait" is not a sensible option. That at any rate is what they told me - the consultant said that if my Gleason score had been 6 he would certainly consider it.

[telboy15 in reply to RWallace]

Thanks

Seems clear to me. I know that I will undergo the surgery anyhow. If I had not taken a purely random step of having a test (psa 5) I would not have been at this stage anyhow. Strangehow things work out.

[DesBodd]

Hi its a difficult choice for you. I am 70 and my Psa was 9 and my gleason 5-7. My Bone scan was clear and my mri confirmed the biopsy. As my father had it and died from it because it was too late to do anything for him it influenced my decision to have the op. My Psa has been 0.4 since last October. My experience was good everything took place as was discussed by the consultant and the aftercare and side effects I was made aware of. I am now back to normal walking the dog and visiting the gymn twice a week. I am still on 3monthly checks at the hospital which are a little daunting wondering if the cancer has come back. I hope this has helped and whatever you decide I wish you well and good luck.

[telboy15 in reply to DesBodd]

Thanks for that useful reply.

Terry

[ceejayblue]

My OH has PC and is on active surveillance. He was diagnosed about 18-24 months ago. His PSA was slightly raised (around 5.6 -5.9), he'd had an enlarged prostate over 11 years ago and so he was alway aware that he needed to keep having PSA tests. His GP suggested that his levels were raised enough to have further investigations done. We went to one of our local hospitals and he had a biopsy done which showed a small amount of cancer and they said it was not significant enough to warrant anything other than active surveillance. However, after a couple of months the consultants at Guys Hospital (it is linked to our local one) said they felt he should have a template biopsy, which he did last year and which resulted in some erectile disfunction (he is 64 now).

This showed that the cancer was slightly more than they had initially thought but also was not so significant that it would warrant changing from AS to full on treatment as his gleason scale was within acceptable levels. He has been followed up with 6 monthly PSA checks and his last one had gone above 6 which was worrying to us. However, his check up at Guys was due and when they saw it had gone up they weren't worried! It was explained that sometimes levels go up and down a bit, depending on whether you have a cold or tummy upset - bit like infections affect a diabetics blood glucose levels. We were told not to worry and that next time it may well have gone down. We have a friend who is 70 and who's PSA was 9 and who's biopsy didn't show any cancer at all so the PSA isn't always an indication of cancer being present.

He is booked in for another MRI in April, just as a precaution but they do not envisage any shocks being found. We did discuss all the options of surgery, hormone therapy etc but agreed with the hospital that the side effects far outweigh the benefits in my OH's case. If, however, the prognosis was poor then we would definitely go for an op or the therapy.

You have to be guided by your oncologist but at the end of the day the decision lies with you and your wife and if you feel that at your age you are happy to watch and wait then I think that you should tell your team that's what you want to do. The robotic surgery is supposed to be really good but as with all surgery that has its risks to and you need to find out all the pros and cons for that.

I hope that whatever you decide you have a good outcome but don't forget Prostate Cancer UK have some great information and help through their careline and you could always have a chat with one of the oncology nurses (I spoke to one when we were worried about everything and they are amazing).

[telboy15 in reply to ceejayblue]

Thanks for that useful reply.

Terry

[sofirose]

Hi.My husband was on active surveillance for nearly 3 years,psa6.6 and Gleason 6 at diagnosis. We were happy with this although always rather nervous when psa or biopsy time came round again. However in March psa started to rise and again in June,then 13.5,mri was reassuring,but in September he was sent to addenbrookes for a trans perineal biopsy under general anesthesia. The results a couple of weeks ago was more areas 8 out of 12 biopsies with Gleason 6 and 1 biopsy core a Gleason 7,because of this he has been asked what treatment he would have,consultant said at 71 and quite fit with no other health problems the da Vinci operation would be okay for him. Although we know there are side effects,we are reluctant to go for radiotherapy as my husband has quite a lot of urinary symptoms already which sound like they could be made worse. He said could continue active surveillance but the last biopsy caused him to go into urinary retention with a result of needing an emergency catheter, like you we are having trouble deciding. Next step is result of bone scan,hoping that is clear as the operation won't be a choice if it isn't. Let us know what you decide and how you get on. All the best to you both.

[telboy15 in reply to sofirose]

Op under Da Vinci on 24 Nov. Am pretty well sure that that is the right way now.

Terry

[telboy15]

OK. Update. The davinci op was done on 24th Nov. Catheter being removed Wed 2nd Dec. Just one second after chatting to the Anethetist. I was in recovery (actually it was 3.5 hours later). Went home on the day after the op. Surgeon said that all went very well. I am due to have the 6 week follow up in early Jan 2016. Just a little sore around the tummy area where the instruments were inserted. I really do hope that the procedure was 'worth while', but all of the comments I hear from others is that 'of course it was'.

Again, PSA of 5, Gleason of 8, staging of T2; N0; M0. Scans all clear. SO the op was needed.

Terry

[Loyola]

Hi telboy15. If you had no symptons then why would your wife suggest a medical test? Does she often sugest random tests for illness and disease? What triggered her suggestion at the age of 74 for you? PSA tests are recommended from age 40 onwards and because they do not detect cancer only suggest a risk they are not screened in the UK. You can ask for a test from age 50 on the NHS from your GP who cannot refuse it. You and your wife waited another 24 years and with no symptons suddenly decided you wanted to be tested? Sounds like you found something that was slow growing, would be unlikely to kill you, and now you have faced treatment and all the complications of a prostatectomy such as incontinence and Erectile Dysfunction. You must be understanding to your wife. Good luck.

[fiem48]

I got 3 opinions on my cancer, so I would get another opinion first

[Nuray]

Have the operation I had key hole operation it's was ok but my biopsy results showed breakage through the prostate wall? In till you have yr biopsy results after surgery you weren't know if it was confined with the prostate yr cancer?

[Dr_WHO]

I had a similar diagnoses (Stage 4, G 8, T3N1), but where it had spread to my pelvic lymph nodes. Here is some advice:

1) the long term outcomes of open or DaVinci surgery is the same, recovery is easier with DaVinci

2) experience counts. You want a surgeon who has done hundreds if not thousands of surgeries. Please consider that when deciding point #1

3) they usually take out a lymph node or two to test for cancer before they take out your prostate. The standard procedure is to not go through with the operation if they find cancer in a lymph node. Recent studies have shown positive long term results for going ahead with the operation even if it had migrated. Discuss this point with the surgeon.

Wish you the best of luck!

[Nuray]

Think you best to have Operation to remove the prostate completely?the Davinci Robotic is simple procedure?even at your age?lifes still precious Talboy?

[MelbourneDavid in reply to Nuray]

Nuray, the operation is very complicated which is why the keyhole surgery version takes around 2 hours. The prostate is hidded deep in the pelvis , hard to access, surrounded by bladder,nerves,bowel and pelvic wall. Part of the urethra has to be removed to remove the prostate.

This is why you need a surgeon who has done this operation hundreds of times and does it several times a month, at least. Almost all men lose erections for months and urinary control for months. Some lose one or both forever.

The operation is not always needed, not always successful at controlling the cancer and not always worth trying. It depends on your cancer.