Last night my anxiety level was off the charts. I was pacing up and down, up and down - and had convinced myself by the end of it - pushing myself in certain ballet exercises - that my cancer had spread and that NOW I had bone cancer. At an earlier point I had been dwelling on the prospect of small cell carcinoma - given my history of relatively low PSA levels - but had rejected that due to the relative rarity of it. (Even in my extreme state of stress I had a small sliver of reason that appeared to work.)
Seemingly - and I say seemingly because I have yet to have a PET scan - I seem NOT to have either - or at least the pointers would have been in a different direction I think. (Perhaps I'm fooling myself thinking that.)
I DO, however, HAVE cancer. That said it IS blessedly localised - albeit 'moderately aggressive'. 6 out of the 24 general cores taken and 4 out of the 4 'area of concern' specific ones it seems had the relevant nastiness and I have ended up with a Gleason 7 (4 + 3) and am at the proverbial T2A stage. (The TP consultant clearly did a FINE job.) While I realise that is not optimum, it is at least not the Gleason 8 or 9 or Stage 3 that I was EARNESTLY expecting / fearing. Thus the announcement of the cancer - given that it was 'curative' - came as - and certainly was greeted with - a certain relief.
The reporting Registrar - a very nice chap - said that 'it should not affect your life expectancy at all'. (Let's pray.) I realise it is Ironic that I should see this as a relief. Still, at least NOW I know.
The choice for treatments presented - and at least I have two - is between either (i) surgery or (ii) Radio / Hormone therapy. In my head now I'm thinking surgery. He said there would be 'good margins'.
At least 'the prostatic capsule is in tact' - as the MRI noted - 'The seminal vesicles are normal. No enlarged pelvic nodes and no destructive bone lesion'. The Registrar said that the 8 mm lesion seen on the MRI - in his opinion - might well be 'prostatitis' given that it is 'wedge shaped'. Still, there is cancer there clearly - but only on the left side. He said the right was almost entirely normal. That means surgery would be nerve sparing on the one side. This, of course, would effect the ED. That for me is less a concern than the continence issues. It seems that has less a reference to the nerves but rather to the active preservation of the pelvic floor. Is that correct???
Again my PSAs have been - just for historical record -
2013 - 1.5
2022 - 2.2
Nov. 23 week 1 - 2.75
Nov. 23 week 3 - 2.72
Two questions -
(i) Vis a vis the Pet Scan - how often to they come up with something? Is it relatively rare? Is there anything in my details which would suggest a complication. You chaps know much better than I will ever do. You are the best.
(ii) Any suggestions / advice in terms of the choice. As I say in my head now I'm leaning toward surgery but could always be persuaded otherwise. The CNS who I met - (she is it seems a member of a team of six) - said I should be 90% fixed by the time I have my treatment meeting with the surgeon and oncologist.
That's it for now. One thing I had wondered in reviewing so many of the correspondences on this WONDERFUL forum resource is that - with supposedly 70% of chaps who choose surgery enjoying a SUCCESSFUL primary 'curative' treatment - why it seems so many here are reporting a chemical recurrence? This is, of course, just my own outside observation. Somehow the conversation ratio seemed to rank at higher than 30% ... at least to my eyes - but I now figure that may well be because those who have already actively witnessed their success have for the most part simply 'moved on'. I suppose that would - in and of itself - be a mark of victory. Would I be accurate in thinking that???? Grateful to for your kind advice on that score.
Indeed, bless you for ALL. Truly.
Just seen my reporting letter so will give the specific details - not entirely sure ALL are clear to me - but here goes -
Histology Report:
Acinar adenocarcinoma
Positive cores: 6/18 sector cores plus 4/4 target cores
Positive sites: 3/6 sectors plus target (all left-sided)
Highest Gleason score: 4+3=7
ISUP grade group: 3
Maximum cancer length: 10mm
Site of maximum cancer length: Left midzone
Perineural invasion seen.
Segments from the letter -
I unfortunately had to tell him that the biopsy report does indeed show some cancer within the prostate. ....
The good news is that the cancer is organ confined and unilateral. His MRI is scored equivocally and it may be that this is MRI invisible disease.
Regardless, both radical prostatectomy and external beam radiation are good options for him oncologically speaking. The former is probably preferred given his work which involves a lot of travel.
Edited by member 04 Dec 2023 at 18:06
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