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Brian
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- Randallstown, MD
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- Have you been diagnosed with prostate cancer?
- yes
- What brings you to the New Prostate Cancer InfoLink social network?
- internet
- Would you help us grow the network? Would you tell others about it?
- sure
- About Me:
- 60yo, just diagnosed, Gleason 6, PSA 3.2, T3
Brian's Blog
New Drug
Posted on December 30, 2008 at 9:59pm — 3 Comments
Dr. Krongrad's response
Posted on December 26, 2008 at 1:07pm — 2 Comments
PNI
Anybody has any experience on PNI and what is the significance of it other than there are cancer cells detected outside the capsule. My question is that why would a biopsy be taken outside the capsule during a normal biopsy? Friends says there should not be reason to be poking around outside the prostate unless there are suspicions of cancer in that area. (which I have none-the prostate was not palpable. The reason for the biopsy was my PSA has gone from 2.6 t… Continue
Posted on December 26, 2008 at 8:53am — 4 Comments
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Comment Wall (10 comments)
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New year, how are things going? Let me hear from you.
George
Keep us posted. Just remember, when you are on this site you are not alone. When you march into that doctors office, we go with you.
George
I am NOT a doc but a survivor, I have been where you are today as I tried to get my medical degree in two months and self diagnose, but soon realized that I had a fool for a patient. Your have just been sent some really great advise. Slow down, get a second opinion from a source like JH, and check it out with the folks that you have been communicating with on this site. I can say this as hindsight as I lived in the same information swirl as you are now finding yourself. Options will soon fall in place. Let this come to you. Relax. Keeping you in my thoughts
George
I have to be honest with you. I never heard of anyone saying that because of PNI a GS 6 should be classified a GS 7. That gives me a wrong impression and now more than ever you should go to JH and get a second opinion from another urologist. PNI can be a route for the cancer to escape, but as mentioned before this is not considered an independent predictive value for ECE or SV involvement. Be sure to get another DRE to ascertain the possibility of escape from the right side of the gland.
Proton beam treatment has been around (at Loma Linda) for 15 years at least. I am not aware of published results that are better than photon radiation. The latest image guided IMRT is targeted and tends to be able to increased doses with few side effects. Still, if your preference is for Proton, MDA in Orlando, FL has a new facility.
Best,
Ralph
I know how you must feel with a recent PCa diagnosis, but I urge you to slow down. You need a second opinion of the biopsy material by an expert pathologist. Jon Eptein at Johns Hopkins would be ideal. You also need a second opinion from a different urologist. PNI is a possible predictor of extra capsular extension, but not an absolute 100% indicator.
As a matter of fact, Dr. David Bostwick (an expert patholigist in the same class as Jon Epstein) has reported the following about the significance of PNI: :On multivariate analysis (stepwise logistic regression), only preoperative PSA, proportion of the biopsy involved by cancer, and Gleason score were significant (p < 0.05); perineural invasion and clinical stage had no independent predictive value for any of the outcome variables. We conclude that the finding of perineural invasion in needle biopsy of prostatic carcinoma has no independent predictive value for the presence of extraprostatic extension, seminal vesicle involvement, or pathologic stage in the radical prostatectomy. Accordingly, we no longer routinely evaluate this finding in biopsy specimens"
Did you have a positive DRE? How was your T3 stage determined? Were the three positive biosy cores from one side of the prostate? I have to agree with Dr. Krongrad's response to you about your reported stage. It is indeed tenuous.
Follow through with the second opinions. Slow down in decision making until you have all information confirmed. It is natural for you to try to act rapidly, but at this point your major objective should be to act based on the best information you can get. In spite of all, I hope you had a good Christmas Day.
Godspeed,
Ralph
Brian