Here
is his story to date:
After
consistently low yearly PSA ratings of 2 or so, this year it had jumped to 5.7
ng/ml. My urologist suggested a course of antibiotics and anti-inflaminatories
to reduce possibility of outside influences affecting the count, then tested again
and got a psa of 5.00 ng/ml. We then did a 12 needle biopsy. The local lab couldn't
agree if the cells were cancerous, and sent them to John Hopkins. The answer came
back that there were cancerous cells. I am to meet with the urologist next week
to discuss options. He recommends surgery right away, which he says can spare
the nerves which affect erection and continence.
I have made up a list
of questions for him concerning what my Gleason rating is, the T value of the
tumor, the location in the Prostrate, as well as his experience level in surgery
of this type and success rate.
Have read a lot and plan to read a lot
more. Found Andy Grove's article to be exceptional. Plan to get multiple opinions
before making up my mind.
This is not an easy process, tendency to turn
it into a unemotional research project in order to distract myself from the emotional
aspects.
Finally
am getting around to updating my story.
Since
my first entry I have been doing a lot of reading, mostly on the internet. The
Yananow site has been invaluable and a source of comfort. When I informed my original
urologist, who had wanted to immediately perform a pubic radical Prostatectomy
that my reading had pretty much convinced me that laparoscopic was the way to
go, he suggested Dr. Timothy Wilson at the City of Hope.
I
saw Dr. Wilson, who reviewed the charts and suggested that I should have a prostatectomy,
and that he could perform the operation. He has done hundreds and considered one
of the tops in the field. Although my original Urologist and my GP had suggested
that the laparoscopic procedure could take many hours and had serious risks as
compared to the more conventional open surgery, Dr. Wilson said that the typical
LRP only took two to three hours, which is comparable to open surgery. Recovery
is quicker according to everything I read.
I
asked him why I should rush into it, since my 12 point biopsy only detected a
few cancerous cells in one needle. He said that the prime reason would be that
the older I got, the more difficult the recovery would be. He said that waiting
a year or two probably did not increase my risk significantly. I came away from
this consultation firmly convinced that if I have the operation that I would ask
Dr. Wilson to do the procedure, but also to do more investigation to see if it
was really necessary.
I
had read on Yananow that there was a program at John Hopkins involving watchful
waiting. It is run by a Dr. Carter, who seems to be one of the very top men in
the field. I applied and spoke to Dr. Carter, and made an appointment to go back
to Baltimore for a biopsy and further qualifying interviews in three weeks time.
The program calls for an annual biopsy, I believe 30 points or so, which made
me a bit nervous. I don't like the idea of all these puncture wounds in that organ,
worry that this would just put more cancel cells in my blood stream, an idea which
has some support in the medical community.
Terry
Herbert suggested that I might want to consider a Doppler trans-rectal ultrasound
examination. He suggested a Dr. Fred Lee, in Michigan. I found that an associate
of his, a Dr. Duke Bahn in Ventura CA, (much closer) apparently equally as skilled,
and went to see him. Apparently the theory of the Doppler ultrasound revolves
around the ability to detect blood flow to areas of the prostate using sound.
Since cancerous tumors require more blood than healthy tissues, this allows for
the mapping of problem areas in the prostate and for guided biopsies of just those
areas, in contrast to the "blind" or "Easter Egg" methodology commonly used.
Dr.
Bahn showed me on the scope that there were some anomalies in the area where the
original biopsies had found the suspicious cells, and he did a four point biopsy
of this area. He also drew blood for a PSA test. He called me a few days later
with some "good news/bad news". The biopsies were clear, but my PSA was up to
7.3 ng/ml. He thought that my PSA might be high due to the earlier biopsy and
suggested that I wait 90 days and have it done again. If it is still high, or
higher, I might want to consider treatment. .
My
PSA history is
Feb 2002 3.1 ng/ml
Jan 2003 2.9 ng/ml
Mar 2004 5.7 ng/ml
May 2004 5.0 ng/ml
Sept 2004 7.3 ng/ml
My
Gleason score was 6, and nothing was amiss on the DRE.
While
PSA is being debunked as a reason to have surgery (only biopsies count), my GP
makes the point that while a high PSA might not mean cancer, a high velocity probably
does.
Will
hopefully have good news in December when I will have my PSA results.
A
brief note from Bill, who is travelling the world to say:
My
PSA dropped from 7.3 ng/ml to 5.8 ng/ml, so certainly for now, you can put me
down as watchful waiting, or whatever it's called. Will report in more detail
later.
Had
another PSA done, back up to 7.3 ng/ml, with 16.44% free. I had had a week of
mildly painful aches in the waterworks, and some aching in the prostate area,
so think (hope) an infection or prostatitis might be responsible for the increase.
Will go to a urologist to see what he thinks.
I
saw my local Urologist last week. The PSA was 5.9 ng/ml, so holding relatively
steady, and the free psa was 16%. The urologist counsels waiting, he says there
is a very good chance it will never bother me. (exactly what I wanted to hear!).
Saw
my Urologist after 7 months since the last visit. Good news is that my PSA is
holding steady at 5.3 ng/ml and he thinks PC is not an issue. This after two years
ago my first urologist pushing me hard to have a pubic prostatectomy!
Bad
news is that I am not emptying my bladder, normally retaining 200cc after urinating.
He wants me back in to test to see if it is a blockage problem (BPH), or if my
bladder has simply "given up" and lost elasticity.
Kind
of scared me. Anyone out there had a similiar problem?
My
urologist performed some tests on my bladder (not particularly pleasant but not
painful), and concluded that I needed a Green Laser VLAP (Visual Laser Ablation
of the Prostate) in order to relieve symptoms of BPH (Benign Prostate Hyperplasia)
, primarily the typical urgency, frequency and not emptying my bladder problems.
He proposed that he also do a biopsy at the same time since I would be under general
anesthesia anyway.
Had
the VLAP on June 27, which went well, had to wear the infamous Foley catheter
for three days, which was not pleasant, but not as bad as I had imagined. By the
way, anyone getting a Foley should make sure that when they send you home they
give you an overnight bag as well as the small leg bag, otherwise you won't get
any sleep that night! I had to stay awake to empty it every two hours.
Got
the results of my biopsy on the 30th, and there WAS NO EVIDENCE OF CANCER!! according
to the urologist. My urologist is Dr. Brad Wolfson, and if you are anywhere near
Palm Springs and need an objective (not slice and dice) opinion, I highly recommend
him. He was the first urologist I have seen who didn't pull a scalpel out of his
breast pocket when I walked in the door!
I
am to see him again in three months, but now he is basically treating urinary
problems, and, although we will continue tri-monthly PSA tests, the PC thing has
receded to the background.
I
don't have much to report, went to my urologist again for my six month checkup,
and was pleased to find that my PSA has dropped to 4.3 ng/ml, the lowest it has
been in several years.
He
still seems to feel that I am essentially cancer free, or at least that it is
so small as to be (hopefully) insignificant.
Still
treating me for incomplete emptying of my bladder, just so my visits won't be
a waste, I guess.
I
am continuing with daily doses of Alfusen and Fincar, and in February my PSA had
dropped to 3.7. My urologist has me on a every six month schedule, so will be
seeing him this Fall. So far there seems to be no sign of cancer, although have
not had a biopsy since year before last.
My
main problem is still incomplete emptying of my bladder, but that is sympthom
free, so I feel in good health.
Bill's e-mail address is: wbayles@gmail.com
Bill
B lives with his wife Rosemarie in the United States of America. He was 65 when
he was diagnosed on 5 May 2004. His initial PSA was 5.7 ng/ml but he was not told
his Gleason Score or Staging.