Gleason Score 9 PSA 105 up from 33 in 5 months

[WhiteWind]

Looking for answers on this latest development in my life.  PSA has been really moving very fast, up over 95 points in less than a year.  A Bone Scan was ordered and shows very little other than osteoarthritis and a couple of bone spurs. X-Rays followed shortly after and confirmed osteoarthritis and bone spurs but obvious evidence of metastic cancer.  TRUS needle biopsy with 7 cores produced the Gleason Score of 9.  More blood tests and an abdominal CAT Scan was ordered last friday(still waiting on results of that).  My urologist has said I have cancer but is not very forthcoming on details just yet.  What's going on?  

[WhiteWind]

Thank you for your prompt response.  I did indeed have a serious discussion with my urologist, first on Jan 2nd by phone and again in his office on Jan 5th.  The cancer appears to be contained with the caveat that one lymph node may be affected.  The bottom line is choosing the course of treatment or not.  The option offered to me was radical prostatectomy (RP) with follow up radiation and continued follow up tests.  I said I would make a decision within 2 weeks.  When I left his office my leaning was to go ahead.  Since then I continued my lengthly research on the subject and have come to the conclusion that (RP) has a lot of drawbacks with respect to quality of life.  It was that approach I focused my research.  Radiation therapy seems to be little better in that area.  I also have talked to a few men that have actually had (RP) and I confess I did not get any encouragement there either.  One report that has all but convinced me is a study, reported by the New England Journal of Medicine (NEJM) entitled "Quality of Life After Radical Prostatectomy or Watchful Waiting"  Volume 347:790-796, September 12,2002   Number 11

http://content.nejm.org/cgi/content/full/347/11/790

The entire article can be summed up in the last 2 paragraphs.  

"Erectile dysfunction and urinary leakage are important sources of decreased well-being after radical prostatectomy, whereas obstructed voiding is an important source after watchful waiting. The distress induced by a specific symptom varies considerably among patients. Moreover, some men give full priority to survival — even when the gain is small — whereas others want to avoid therapy-induced distressful symptoms, even when faced with certain decreased prospects of survival.

For all these reasons, we cannot say that radical prostatectomy is better than watchful waiting for all men with localized prostate cancer. These alternatives are associated with complex and incommensurable outcomes, and each man must judge for himself which treatment is preferable."

There are several guiding factors in my decision making and key among them are: 1) I'm 69 and have lived a full life, 2) Married to the same woman for 50 years, 3) I remain active in my life.  There are others, not the least of which is my faith in God, and I have often said many times in my life that when my life is over it will be His decision.  My wife and children support me in my decision, so barring any last minute event to the contrary I likely will opt for a watch and wait.

Life is very short and gets shorter by the minute and is also full of risks, cancer being only one.  I would like to think my decision is right for me, at this time.  If I were 10-15 years younger I might be inclined to think quite differently though.

You were very kind to respond I felt I owe you the professional courtesy of a reply.  Thank you very much once again.

[Ash Tewari, MD, M.Ch.]

After having the prostate biopsy, you do indeed have biopsy-proven prostate cancer.  Now you need to think about treatment options.  If the prostate cancer has spread to other organ systems (bone, lymphatics) then having a prostatectomy is not the best option. Instead hormonal treatment may be employed.  If the cancer is confined to the prostate then having your prostate removed or radiation therapy may be the best option, but you need to have a serious discussion with your urologist after all the tests have been completed. I wish you the best.