My plans

[MZB]

OK, I appreciate all the responses to my bad news post. That is helpful. You
all said don't panic and that I would have plenty of time to arrive at a
decision.

Well, I have had since August to think about it and I have made plans (from
a clear-thinking non panic mode status).

I would welcome your comments:

First a question, if the biopsy is negative, isn't there a STRONG chance
that they just didn't find it (given my PCA-3 score of 75.9). . I almost
think the best thing is to find cancer but not have it be the aggressive
kind. I understand the biopsy will give me a good idea about that (# cores
bad, Gleason score, degree of infiltration, margins, etc.).

I've already done the research. I've decided if it is operable, I would go
with the surgery (if it isn't operable, well, I haven't thought that one out
yet! )My research shows that the #1 guy (arguably) in Da Vinci robotic
surgery for all of this is Dr. Menon, who practices at Ford Hospital in
Detroit. I've already made contact and will send them the biopsy report to
see if it is feasible. He will NOT do surgery if it is not a good option,
given the report. Ford Hospital is in my home State, 2 hours away.

The reason I'm choosing surgery is that I think it is better than radiation.
As radiation goes on, the side effects multiply and don't go away. With
surgery, there is a risk of incontinence, but 90% (?) are pretty much
resolved after 6-8 months. ED is just not a concern, given all the other
concerns. I might change my tune if that happens. But, again, people that
have no problem with ED before generally are okay over time after. But
again, for ME it seems like no big deal. Also, if surgery fails (PSA starts
creeping up) you can get radiation. If radiation fails, surgery is very
questionable. Another reason I'm choosing surgery is that the BEST guy is in
Michigan. So, even with two equal modalities, I'd go with the best in one
modality.

Incidentally, I would also consider watchful waiting if I get a Gleason
score of 6 or less. I doubt if that's going to happen.

All of these decisions were made (in my mind) weeks ago, when I could do
research and think clearly. I am now a mess, so I welcome comments. Perhaps
there are reasons I haven't considered?

Mel

[chasjac]

Hello again, Mel:

I just posted to the other thread, but I hope you don't mind my
reiterating here: I don't know that a PCA-3 score of 75 means
anything other than it's over 35. I looked at some of the specifics
of the test at pca3.org and will spend some time this pm crunching a
few numbers, but offhand, it just seems that PCA-3 is catching a
genetic marker, so it wouldn't be detecting things like capsule
penetration or distant metastases.

And in any case, the time to worry about the negative biopsy is when
you get one.

All the best,

Charlie

[Steve Kramer]

"MZB" <m...@noway.prudigy.net> wrote in message
news:he9mv4$45u$1...@news.eternal-september.org...

: First a question, if the biopsy is negative, isn't there a STRONG chance

: that they just didn't find it (given my PCA-3 score of 75.9).

IMHO, no. Your prostate is enlarged. Your PSA is normal. Your fPSA is
great. If I reacall correctly, even you DRE was negative. The only result
that is positive for a 50/50 chance of cancer is an assay for the unproven
PCA-3. Statistically, needle biopsies find far more cancers than they miss.

: I've already done the research. I've decided if it is operable, I would go

: with the surgery (if it isn't operable, well, I haven't thought that one
out
: yet! )

This depeends on your Gleason and Stage, of course, but otherwise, it is
sound.

: Incidentally, I would also consider watchful waiting if I get a Gleason

: score of 6 or less. I doubt if that's going to happen.

Of all the people who have come by this NG during the last seven years and
who reported their Gleason scores, 44.2% had a Gleason </= 6. Once again,
you're really close to that 50/50 chance.

--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA undetectable since; last checked on 06/04/09
Illegitimati non carborundum