History: Born in Kansas in 1931, two years military 1952-1954 with one year in Japan (Korean War), Washburn University (AB) 1959, To San Jose California in 1960, Businessman - running real estate schools, home builder, Cessna dealer, Real Estate Investor. Retired in 1986. Married to Sue in 1951 and lost her to breask cancer in 1977, two sons. Married to Michiko in 1988, one son and one daughter.

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PC Digest:

Updated/Corrected PC-Digest October 10,1998

Age 66, birth 06/08/31; Height 5"8" Weight 208:High Blood Pressure controlled with Monopril 10Mg and Calan SR 240Mg

05/02/95-PSA 4.8 (Hybritech), DRE Neg

05/08/95 PSA 3.7 (Hybritech)

04/22/97 PSA 5.9 (Abbott)

04/25/97 Blood Basic Chem: 04/24/97 Out of range only - Urea Nitrogen 28, Uric Acid 9.3. 07/14/97 Lipid Profile: Cholesterol 200, Triglycerides 192, HDL Cholesterol 27. LDL Cholesterol 135, VLDL Cholesteroll 38 04/30/97 PSA2 - Total 6.2, free .69, %free 11, DRE Neg

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05/29/97 Ultrasound and Biopsy-Dr. Fred Lee

DRE Abnormal, Gland Vol 32g. 1.3cm tumor involving right mid and right apex which extends to the midline. Stage T3b.

Pathology Report: Malignant locations: Right mid, right apex, trapezoid, left apex; Benign Locations: Seminal vesicle beak, right inferior NVB, medial aspect - left mid gland. Gleason grade: 3 + 4 = 7 (Partin 33 68 11 16)

Size: Right mid-8mm, right apex-9mm, trapezoid-4mm, left apex-4mm

Extraprostacic invasion: suspicious (trapezoid-see comments)

Perineural Invasion: No

Comments: Carcinoma is near the inked and of cores from the right mid, right apex, and trapezoid, and in the middle of the left apex core. Carcinoma in the trapezoid core is within fibrous stroma and among bundles of skeletal muscle. Based upon the histology, it cannot be determined if this represents definite extraprostacic invasion. Correlation with clinical and ultrasound is necessary. Ploidy study: Right apex biopsy (2) sent

Signed : David L. Klionsky M.D.

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07/15/97 PSA 8.97 (Tosoh) (A 45% rise in 76 days)

08/18/97 PSA 5.88 (Not known) back down to where it was

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Pathology Report No. 2:

Moderately differentiated adenocarcinoma (Gleason score 3=3=6) Involving 5.5mm (80% of core length), 7.5mm (65%), 4.5mm (50%) and 4mm 22% of the respective cores.

Note: Although the tumor is rather infiltrative in the specimen obtained from the trapezoid region, the constituent tumor cells appears to make small lumina consistent with Gleason pattern 3. No high grade component is identified. The tumor in the trapezoid core is present about striated muscle and librous stroma, consistent with extraprostatic extension. The nuclear characteristics of the tumor demonstrate a moderate degree of cell-to-cell variation, a feature which suggests aneuploid status if such a determination is performed via static image analysis. There is no evidence of perineural or intravascular involvement.

Signed: Jonathan R. Oppenheimer, MD

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Consultation with Dr. Stamey

Your rising PSA led you to consult with Dr. Fred Lee in Michigan on May 29, 1997 at which time some seven biopsies were obtained in a prostate estimated to be about 32 cm3. I reviewed all of these biopsies four of which were positive for cancer. The left apex had 4 mm of Gleason grade 3+3 cancer. The right mid and right apex contained 8 and 9 mm of cancer of the same low Gleason grade. Your seminal vesicles, left mid prostate and the right inferior neurovascular bundle were all negative for cancer. Dr. Lee's "trapezoid" was an 8 mm core with 4 mm of cancer spread throughout a biopsy that contained some normal prostate glands and some dermite skeletal muscle. It is impossible to say whether this trapezoid" biopsy is actually distal to the apex of the prostate since there is skeletal muscle within the distal apex of the gland normally. Thus, depending on how Dr. Lee actually angled this biopsy, it is quite possible that these 4 mm of cancer are within the apex or within the skeletal muscle immediately adjacent to the apex. I would prefer the former interpretation.

I could find no Gleason grade 4 cancer in any of these biopsies and thus believe that you have only Gleason grade 3 cancer. In a 32 gram prostate, this much tumor on biopsies would suggest a cancer of considerable size. On rectal examination in the knee-chest position there is a 1 cm palpable nodule on the left side occupying the entire left apex. It may or may not extend across the midline onto the right side. Both the left and right apex were strongly positive for Gleason grade 3+3 cancer.

The choices for successful therapy include radical prostatectomy in which the surgeon should be careful to remove 2 or 3 mm of the attached membranous urethra or radiation therapy where the therapist must include the proximal 2 cm of the bulbar urethra to make certain that all tissue distal to the apex receives full dose radiation. Our Stanrord protocol for post radical prostatectomy recurrence has always included the proximal 2 cm of the bulbar urethra to be certain that the vesical neck which now rests on the perineal membrane is included in the radiation field. We have never seen a urethral stricture and believe this aggressive field is reasonably safe. Mr. Cooley is interested in Dr. XXXXXX technique of I125 seeds followed three weeks later with external beam therapy. He is an ideal candidate but seeds will need to be emphasized at the distal apical capsule and without question the proximal 2 cm of bulbar urethra must be included in the linear accelerator field.

Thomas A. Stamey, M.D. Professor of Urology

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August 5, 1997: Bone Scan at University of California at San Francisco (UCSF) ordered by Dr. Eric Small. Report negative.

August 18, 1997 TRUS by Dr. Katsuto Shinohara (UCSF), Gland Vol. 26cc, .6cc tumor in the left peripheral zone at mid gland. Second one is located at left apex to the midline. Suggested tumor extension through the capsule at both sites. PSA 5.88 PSAD 0.23

August 12, 1997 MRI/MRSI (UCSF) Gland vol. is 27cc PSAD 0.22, Low T2 at right apex crosses the midline to left apex. Strong suspicion of extracapsular extension to the left apex. Dominant lesion is right-sided. Additional low T2 in base of gland bilaterally. Magnetic resonance spectroscopy unusable or of intermediate values.

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NOTE: The MRI and TRUS do not agree nor do they agree with Dr. Fred Lee's TRUS above.

RECAP:

Dr. Fred Lee (TRUS) Gland Vol-32cc, 1.3cm tumor involving right mid and right apex which extends to the midline. Stage T3b.

Dr. Katsuto Shinohara (TRUS) Gland Vol-26cc, 0.6cc tumor in left P zone at mid gland, + left apex at midline. Tumor extension through both.

MRI (TRUS): Gland Vol.-27cc, Low T2 at right apex crossed midline to left apex, Suspicion extracapsular at left apex, dominant lesion is right sided, low T2 in base of gland bilaterally.

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October 1, 1997: Seeded by Dr. Hamilton Williams of the Radiotherapy Clinic of Georgia in Atlanta. Implanted 124 Iodine-125 seeds.

December 19, 1997: Completed 35 fractions of 150 rads each over a 7 week period. On no medications.

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01/05/98 PSA 2.07 (Tosoh)

02/25/98 Urgency and frequency was biggest complaint. No medicine other than Ibuprofen. The procedure thru EBRT has been very easy for me.

03/17/98 PSA 1.34 (Abbot)

07/14/98 No major problems at all. Still urinate frequently but not always. Sleep good and usually will wake up once per night about 4:00am - go to bed around 11:30pm. A little more tired then before but I think due to inactivity on my part and putting on a little weight.

08/07/98 I still am doing well with the exception I seem to be going impotent. The desire is still there (but less often) but cannot get an erection. Still can climax as usual but certainly cannot insert. The other interesting thing is that there seems to be more ejaculate at this time. I guess it is Viagra time. Maybe it is just a little bump in the road and it will return to normal at a later date.

08/07/98 I still am doing well with the exception I seem to be going impotent. The desire is still there (but less often) but cannot get an erection. Still can climax as usual but certainly cannot insert. The other interesting thing is that there seems to be more ejaculate at this time. I guess it is Viagra time. Maybe it is just a little bump in the road and it will return to normal at a later date.

09/20/98 Have developed a rectal pain about 2 weeks ago. Not painful enough to take any meds. Stools are OK and BM's are as usual. No blood. This seems to have almost gone away in the last two days. In addition I have had some of my erection return but at this time not enough yet to insert. I urinate about the same as I did pre treatment and also I get up about once per night, again about the same as before treatment.

10/02/98 PSA 0.80 (Abbot)

01/10/99 PSA 0.80 (Abbot) This may be a flattening prior to the "bounce".

04/25/99 PSA 1.00 (Abbot) Hopefully this is part of the bounce that usually starts in the 12 to 24 month time.

06/21/99 My potency has returned!!! Sexual activity is not back to a complete normal but allowing for age and treatment received, I think it is probably very close to normal. Small amount of ejackulate at this time but normal erections. Sometimes not as long as I would prefer but enough to have penetration.

09/21/99 PSA 1.21 (Abbot) Hmmmnnn don't like this I think I will do something to see what happens.

10/08/99 PSA 0.70 (Abbot) Following two weeks of Ibuprofen - 600mg 4 times a day. Amazing - a 43% reduction in a couple of weeks!!

04/01/00 PSA 0.50 (Abbot)

10/01/00 PSA 0.10 (Abbot) Finally it is down!!!

03/15/00 PSA less than 0.10 (Abbott.

09/26/01 PSA 0.00 (Bayer Immono 1) Change in assays

04/01/02 PSA 0.03 (Bayer Immono 1) A difference in reporting

10/01/02 PSA 0.05 " Apparently a little rise - could be a change in assays

04/01/03 PSA 0.05 " Holding

10/01/03 PSA 0.05 " Holding

12/28/03 PSA 0.05 " Ordered in error

01/09/04 Everything is OK and no lasting side effects. Have lost a little in the ability to hold an errection. Treatment or age related - I don't know but I believe more age related. Still small amounts of ejaculate but able to climax.

11/09/04 PSA 0.05 (Bayer Immono 1) Holding at 7 years. Am becoming more impotent but can still climax. Age or treatment I don't know but it is not a major matter to me or my wife. We get by and I use other things to give her pleasure.

01/12/05 PSA is bouncing between 0.03 and 0.05 - nothing to worry about. I have diabetes II, high blood pressure, some heart conditions, all probably coming from being obese and not much activity. All pretty well controled by meds.  Continue to add weight mostly due  to the diabetic medicines I believe.

My PSA bounces between 0.00 and 0.05 since 2000, unless my PSA changes outside of these numbers there will be no further updates.