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    Dad Diagnosed With Gleason (3+5)
    emeraldglen posted:
    My dad is diagnosed with Gleason (3+5) yesterday.

    My parents currently live in China with my sister in a provincial capital city.

    I live in the SF bay area. My parents visited me numerous times in the last few years.

    We are in total shock and trying to cope with the news.

    My dad is 66 years old with good health.

    His tPSA is over 100. His fPSA is 16.86.

    His bone scan came back negative.

    Prostate cancer is not well recognized in China. The number of operations performed in the province where my parent live is relatively small.

    I plan to have my dad's prostate biopsy specimens sent to Dr. Jonathan Epstein in JHU or other labs for reexamination. Is there anyone familiar with international shipping of prostate biopsy specimens?

    Surgery, Radiotherapy, Hormone therapy, what should we do?

    My dad is currently on HT. Should we begin RT also?

    My sister is contacting doctors in Beijing that have more experiences with prostate cancer. I want to take my dad to a hospital with prostate cancer expertise in the SF bay area. Can anyone recommend some good hospitals and doctors? My dad has no medical insurance in the U.S.. Does anyone know the cost of the treatments in the U.S. without medical insurance?

    Your helps are greatly appreciated.


    billh99 responded:
    One of the advantages of surgery is that the whole prostrate is available for testing. Biopsy only samples a very small portion of the prostate and can miss more aggressive sections. And it can tell if the PC has moved into the margins of the prostrate (more likely that it will spread).

    And with the 5 for the secondary Gleason and relatively high PSA that would be my choice. Then the post surgery pathology reports indicates the need maybe followup with HT and RT.

    Sloan Kettering has some monographs on the outcomes of different PC treatments.

    Some doctors might feel that based on the biopsy and PSA that it is more likely outside of the prostrate and thus just do the HT & RT.

    Here are some more details of why chose surgery.

    My surgery was paid for by a Medicare Advantage plan. The amounts where negotiated and somewhat less then even commercial insurance payments. But it will give you and idea.

    Hospital billed $37,000 paid 6,800
    Primary surgeon billed $2,300 paid1,800
    2nd surgeon billed $800 paid $300
    Pathology billed $360, paid $140

    My guess is that if you negotiated with the hospital and doctors before hand and where paying cash that you might end up paying $12,000 - 15,000.
    az4peaks2 responded:
    Hi Tim, - Having a world renowned expert like Jonathan Epstein at Johns Hopkins (JH) review the Biopsy slides is an excellent choice. I would suggest that you call Johns Hopkins and tell them your Dad's situation and ask for information about international shipping of the slides and appropriate preparation instructions.

    Go here for information about the JH Department of Urologic Pathology with several "contact" phone numbers and addresses.

    Good luck and best wishes to you and your Dad. (aka) az4peaks

    emeraldglen replied to billh99's response:
    Thank you.

    I am trying to get a second opinion on the specimens done by Dr. Epstein within two weeks.

    My dad is on HT and is in stable condition.

    We will make a decision after the second opinion.

    krieb responded:
    I had a Gleason score of 7 on each side of my prostate. My PSA was .95. Stage II. Yes, that was .95

    I had a Radical Prostatectomy 4 months ago and now have a PSA of less than 0.01 (checked twice since surgery). Post-op biopsy showed that the cancer was completely encapsulated. Surgeon also removed the lymp nodes.

    Good news is your dad's Gleason score really isn't that high and the bone scan is negative. I highly recommend the robotic surgery. After 6 weeks I was in Canada fishing.

    Fortunately, I had insurance but with the bone scan, CAT, MRI, surgery, hospital, lab tests, lab results, etc. the total billed amount was approximately $63,000. As noted in one of the replys, you can negotiate with the hospital.

    Good luck. I think that your dad will be fine.
    An_248939 replied to krieb's response:
    I'm from china and have been living in U.S.A. for over twenty years (now in LA). Last year I was 67 and diagnosed PC (scored 3 3) with PSA 4.4 and positive one of twelve biopsy samples

    After consulting with three urology doctors I had a robotic surgery in Hope City Hospital by Doctor Tim. Wilson in August, 2011. The Hope City is one of the USA national Cancer Institute located in north east LA and Dr. Timothy Wilson is highly experienced and recognized world expert in PC surgery. You can get survey online.

    The surgery was successful. The pathology defied the cancer cells were1.3% of my prostate volume and no any spreading, then several testing PSA value are less than 0.1 and side effect recovers are good.

    My insurance paid all the surgery spending that almost cost $30,000 in my case.

    Actually now in china PC is getting more common. The different between USA and China is that most PC diagnosed in USA are very early (local and no spread found) as popular PSA screening, but in china they are advance. My two brothers-in low had PC surgery before 5 or 10 years in China, their surgery results are good. even they are advance.

    I suppose you could choice an experienced PC Doctor and hospital, contact them. Talking can include the cost which can be negotiation in most situations.

    I hope my information can give you some help, Best wishes to your father and you.
    emeraldglen replied to krieb's response:
    Thanks, krieb.

    I really appreciate your helps.

    Good luck to everyone.
    emeraldglen replied to An_248939's response:
    Thanks, An_248939.

    Good luck to everyone.

    My sister is in Beijing now to meet one of the best PC surgeons in 301 hospital.

    We are also contacting a well-known PC surgeon in Shanghai.

    After the slides are reexamined, we will make a decision.
    Basir U Tareen, MD responded:
    Did you say the PSA was 100 ? That is very high and if that number is real (ie, from cancer, but not from prostatitis or other non-cancer reasons) then there are few surgeons in the United States who would pursue surgery alone as a curative options. If you plug those values into most nomograms the likelihood of metastatic disease is high -- likely well over 50%.

    In addition to getting a second opinion on the biopsy I would strongly consider doing a prostate/pelvis MRI at a high volume center. You may very well find suspicous lymph nodes, extracapsular extension beyond the prostate, or other findings which may help guide your treatment decision.
    emeraldglen replied to Basir U Tareen, MD's response:
    Thanks, Basir.

    I think that my dad has prostatitis for some time. During his hospital stay, he was given antibiotic shots and no HT treatment. During his hospital stay, his urination problems were reduced and he did not woke up as often as before.

    He was given HT after he was released from the hospital.

    His doctor in the local hospital advised against MRI. His reason is that if PC is not spreaded to the bone, it is probably not inlymph nodes. We are contacting doctors with more experiences now.
    emeraldglen responded:
    Some updates.

    Opinion from Dr. Epstein is worse. 100% of the 12 slides are positive. Gleason score is now 5 4.

    He suggests HT and RT. Said surgery will probably make no sense at this point.

    Bone Scan negative (11/05/2012).

    I think that CT scan is also negative.

    Current Treatment:
    Patient is on Hormone Therapy, beginning from 11/08/2012.
    Bicalutamide tablet 50mg (AstraZeneca): 1 tablet daily, beginning from 11/08
    Leuprolide injection: Once every Month, beginning from 11/08
    Other Medication:
    Tamsulosin Hydrochloride Sustained Release Capsules: 1 capsule daily, beginning from 11/08
    Liptor tablet: 1 tablet daily, beginning from 08/28/2009

    I read Dr. Walsh's book and Dr. Meyer's Book at HT and diet.

    I am going to buy the recommended diet supplement in Dr. Meyer's Book.

    Is there anyone experienced with taking diet supplement in Dr. Meyer's Book?

    What should we proceed from this point? What is the expected life span for this stage of prostate cancer?


    emeraldglen replied to emeraldglen's response:
    Dr. Epstein's suggestion echoes with the opinions we got from some experts in China.

    I bought the following supplement for my dad.

    Source Naturals Vitamin D-3 -- 2000 IU - 200 Softgels

    Schiff Natural Vitamin E Complex -- 200 IU - 100 Softgels

    Nature's Bounty Lycopene 10mg, 60 Softgels

    Nordic Naturals Ultimate Omega, 1,000 mg Fish Oil, 180 Soft Gels

    POMx Pills

    Nature's Way Soy Isoflavones Standardized -- 60 Capsules

    Source Naturals Selenium, 200mcg, 60 Tablets

    These are mostly suggested by Dr. Snuffy Myers.

    Anyone have experiences of taking these supplements?


    emeraldglen responded:
    some updates:

    After 1st month HT, tPSA dropped to 28.10, FPSA dropped to 4.37

    After 2nd month HT, tPSA dropped to 11.53, FPSA dropped to 2.77

    I am a bit worried about the 2nd month result. The PSA drop is only around 60%.

    Should we add Radio Therapy or other hormone drug into the mix now?

    One thing that hinders the possible addition of RT treatment is the weather there.

    Currently it is very cold in my hometown (lowest temp is around minus 10-15 celsius).

    Thanks and happy new year.
    jameshodge responded:
    Without Medical, the price will be very high. I don't know what to say--shipping samples sounds very expensive as well. Have your dad try natural supplements and read Super Beta Prostate testimonials to help you choose but that is obviously a temporary solution. I think that he should seek treatment in China or some other nearby country that has better medical care.

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