Post by johnt on Jun 18, 2014 9:47:37 GMT -8
In the early 90s I had a psa of <1 and my next test in 1998 showed a psa of 4.4 and a free psa of 15 which prompted a naturally aspirated biopsy which was negative. Over the next 10 years my psa rose to 40. I had psa tests every 3 months, had several courses of antibiotics and 10 more negative biopsies from 4 different doctors, all negative. I also had a negative MRIS. In 2008 I had my 12th biopsy, a 26 core that found a G6 <5% and immediately started to schedule appointments with surgeons. On my wife's oncologist's recommendation that I see Dr Scholz or Dr lam before I made any decision I scheduled an appointment.
Dr Scholz after reviewing my history said that the biopsy of 1 core <5% did not match my psa history and was certain I had a much more serious cancer that was still undiscovered. He laid out three possibilities, skip matastatisis, where the cancer in the prostate went into remission, but was still active in the lymph nodes. A large transition zone tumor or psa leak. His goal was to eliminate each possibility to discover the reason for the high psa. He performed a color doppler and spotted a suspicious area in the transition zone and recommended I get a guided CDU biopsy from Dr Bahn in Ventura. Dr Bahn sampled the transition zone and also the area from which the positive core was taken. The area of the positive biopsy was negative, but the TZ showed a 18mmX16 mm tumor, G4+3.
Dr Scholz was still concerned about lymph node spread and recommended a Combidex nano particle MRI for Dr Barantsz in Holland. The Combidex MRI showed the lymph node clear at a 96% probability and confirmed a 2.5cm tumor in the TZ.
All three doctors recommended radiation as the tumor was around the nerves and in the apex. Surgery would have a high risk of incontinence, ED and positive margins due to tumor location.
I had brachytherapy, 65 PD105 seeds followed 6 weeks later by 25 sessions of IMRT. I also took Casodex and Proscar to shrink my 60cc prostate to 32 cc prior to treatment. My psa went immediately to 0.1 and has stayed there for the last 5 years. I have no side effects from the treatments and have never used meds for an errection.
The take home lesson is that over 10 years 5 different doctors Dxed me with BPH even though PSA doubling time, PSA density, velocity and free psa all indicated prostate cancer. There is a huge skill and experience gap between a urologist and a specialist in prostate cancer. My initial decision to have surgery would have been a massive error due to tumor location. Proper staging by a specialist using imaging and fitting the treatment to your staging is crucial in getting a favorable outcome. Over the last 5 years I have been actively involved as an advocate and am on the staff of this board and hope my experience will help other patients.
Dr Scholz after reviewing my history said that the biopsy of 1 core <5% did not match my psa history and was certain I had a much more serious cancer that was still undiscovered. He laid out three possibilities, skip matastatisis, where the cancer in the prostate went into remission, but was still active in the lymph nodes. A large transition zone tumor or psa leak. His goal was to eliminate each possibility to discover the reason for the high psa. He performed a color doppler and spotted a suspicious area in the transition zone and recommended I get a guided CDU biopsy from Dr Bahn in Ventura. Dr Bahn sampled the transition zone and also the area from which the positive core was taken. The area of the positive biopsy was negative, but the TZ showed a 18mmX16 mm tumor, G4+3.
Dr Scholz was still concerned about lymph node spread and recommended a Combidex nano particle MRI for Dr Barantsz in Holland. The Combidex MRI showed the lymph node clear at a 96% probability and confirmed a 2.5cm tumor in the TZ.
All three doctors recommended radiation as the tumor was around the nerves and in the apex. Surgery would have a high risk of incontinence, ED and positive margins due to tumor location.
I had brachytherapy, 65 PD105 seeds followed 6 weeks later by 25 sessions of IMRT. I also took Casodex and Proscar to shrink my 60cc prostate to 32 cc prior to treatment. My psa went immediately to 0.1 and has stayed there for the last 5 years. I have no side effects from the treatments and have never used meds for an errection.
The take home lesson is that over 10 years 5 different doctors Dxed me with BPH even though PSA doubling time, PSA density, velocity and free psa all indicated prostate cancer. There is a huge skill and experience gap between a urologist and a specialist in prostate cancer. My initial decision to have surgery would have been a massive error due to tumor location. Proper staging by a specialist using imaging and fitting the treatment to your staging is crucial in getting a favorable outcome. Over the last 5 years I have been actively involved as an advocate and am on the staff of this board and hope my experience will help other patients.
