This year's physical revealed PSA of 43.8; now I'm diagnosed with cancer

[surudu]

Hello. On July 14 I went in for my annual physical. On July 15 the doctor's office called me and said that I should consult with a urologist as soon as possible. The PSA was 43.8. I am 57.5 years old. My last PSA was from April 2020 - it was 2.4.

On July 19 the retest showed that my PSA was 45.9.

Here is what my biopsy on July 29 revealed:

A. Prostate, left apex, core biopsy:

– Benign prostatic tissue.

B. Prostate, left mid, core biopsy:

– Adenocarcinoma, Gleason score 3+3 = 6 (grade group 1), less than 5% of the tissue core.

C. Prostate, left base, core biopsy:

– Adenocarcinoma, Gleason score 3+4 = 7 (grade group 2), approximately 50% of the tissue core.

D. Prostate, left lateral apex, core biopsy:

– Benign prostatic tissue.

E. Prostate, left lateral mid, core biopsy:

– Benign prostatic tissue.

F. Prostate, left lateral base, core biopsy:

– Benign prostatic tissue.

G. Prostate, right apex, core biopsy:

– Adenocarcinoma, Gleason score 4+3 = 7 (grade group 3), approximately 30% of the tissue core.

– Perineural invasion is present.

H. Prostate, right mid, core biopsy:

– Adenocarcinoma, Gleason score 3+5 = 8 (grade group 4), approximately 95% of the tissue core.

– Perineural invasion is present.

– High-grade prostatic intraepithelial neoplasia (PIN).

I. Prostate, right base, core biopsy:

– Adenocarcinoma, Gleason score 3+5 = 8 (grade group 4), approximately 90% of the tissue core.

– Perineural invasion is present.

– High-grade prostatic intraepithelial neoplasia (PIN).

J. Prostate, right lateral apex, core biopsy:

– Adenocarcinoma, Gleason score 3+4 = 7 (grade group 2), approximately 5% of the tissue core.

K. Prostate, right lateral mid, core biopsy:

– Adenocarcinoma, Gleason score 4+3 = 7 (grade group 3), approximately 50% of the tissue core.

– Perineural invasion is present.

L. Prostate, right lateral base, core biopsy:

– Adenocarcinoma, Gleason score 3+4 = 7 (grade group 2), approximately 95% of the tissue core.

– Perineural invasion is present.

On August 3 at my urologist's appointment I was informed that I have aggressive prostate cancer that must be treated.

Have any of you been in a similar situation?

I am having a bone scan and CT scan of the abdomen and pelvis 6 days from now. I'm told this will determine if the cancer has spread beyond the prostate.

Thanks for your comments.

[Tall_Allen]

I'm sorry to hear about your diagnosis, which must have you very worried. You have to take this one step at a time. As your doctors have told you, the bone scan/CT will tell you if your prostate cancer is curable (about 85+% of "high-risk" men are curable with the right kind of radiation) or if it is a disease that can be managed for a long time. If the bone scan/CT is negative, it is a good idea to get a PSMA PET scan, which is approved for "high risk" patients. If your insurance says "no," fight them and appeal until they say yes - they will eventually, and it is important for your treatment plan.

Please let me know when you get the results, and I can help guide you through this- one step at a time. Where are you located?

BTW - when I was first diagnosed, I saw a psychotherapist to help me with the anxiety. I also learned to practice mindfulness, and 12 years later, I still do.

[surudu in reply to Tall_Allen]

Thanks. I live in East Point GA, one mile from Atlanta’s airport.

[FLLStan in reply to surudu]

I am sorry to hear about your diagnosis. It is not an easy time.

I found that switching from my local urologist to a teaching/research hospital in my area gave me better insight into my prostate cancer and available treatments when my PSA started rising after surgery. It is a calming environment to explore your options. They have a lot of resources to help you with your journey. Search for the NCI Cancer Center in your area. I know that traffic in Atlanta is not easy, but it would be worth your time and effort to meet with them if you haven’t already met with them.

[Aodh]

I am sorry to hear of your preliminary diagnosis. I remember being where you are now and waiting for further tests; feeling shocked, nervous, unsure of my present let alone a future.

Once you have the full scan results, it will be easier to discern what the next steps ought to be and how you can plan a way forward. I was a year older than you when I was diagnosed in 2019. I used the initial time after my first PSA test to learn all that I could about prostate cancer, the various treatment options available. I also ensured that I understood the possible side effects of the various options and how I felt about them.

To be honest, there was no easy option and in my case my diagnosis of cT3bNxMx with a high PSA of 87 with regional spread into the seminal vesicles meant that I was at very high risk of recurrence after primary treatment.

My urologist offered to perform a prostatectomy but said that when I came round from surgery, I would still have cancer; so I thanked him, said no and moved on to a radiation oncologist. In the end being in Ireland meant that I would need to undergo 39 external beam radiation sessions including the pelvic lymph nodes together with 3 years of androgen deprivation therapy (ADT). That was the Stand of Care (soc) then (it’s improved already!!).

Last Friday I had my first 6 monthly telephone consultation with my radiation oncologist since I completed my 3 years ADT. My PSA remains undetectable to which he stated some pleasant surprise.

My testosterone level hasn’t yet improved but that’s to be expected. If the current “me” could talk to the earlier me waiting for the scans after my initial PSA test results, that earlier version of “me” wouldn’t have dared believe that I could be where I am, looking at the possibility of a durable remission.

The one thing that I did that really helped me through the past few years of treatment and change was taking it one day at a time, living in today; not being remorseful about yesterday and not fretting about tomorrow.

I only have today, I can live just for today.

Easy, hell no; worth working at, absolutely.

I hope that the scans confirm no distant spread of disease and I wish you well in the decisions ahead of you. I found tremendous help and support on this Malecare site.

I hope that you have a support network in your life that you can lean on at this difficult time for you.

You can always come here with any questions, nothing’s a dumb question; nothing’s taboo to ask.

Best wishes,

Hugh

[Thomkin]

Would also recommend doing an MRI of the prostate after the biopsies have healed and before any treatment. This gives good info on extent of disease and if there's spread beyond the prostate. This test should be done at a center that does lots of Prostate MRIs, not a small MRI center as experience doing and reading the scans is very important.

From the sound of the grade (7s and 8s) and extent of prostate involvement, I think the recommendation for treatment would be local brachytherapy (direct placement of radiation into the prostate directed by CT/ ultrasound), androgen deprivation therapy (ADT), and external beam radiation assuming you do not have tumor extension beyond the prostate.

[surudu]

Update: RALP with BPLND on 9/22/22 - pathology (patho: pT3BN1, GS 4+5=9 (GG5); LN 5/19 positive on L side, 3/13 positive on R side, 0/1 common iliac node ; + EPE; NEG bladder neck invasion; + SV; + PNI/LVI; NEG margins) - ultimately need RT with ADT, this is generally done at the 6 month post op period allowing for time to heal and work on incontinence