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Regular Member

Date Joined Jan 2009
Total Posts : 40
   Posted 1/14/2009 12:59 PM (GMT -6)   

Hello Folks,

New to this board and to this health issue.  I was dx 12/08 when one out of twelve cores came back with 5% pc on the left side.  Was also told the right side seems firm and perhaps there is some pc there that wasn’t picked up with the biopsy.  I’m agonizing over which treatment would be best, if any.  One Urologist told me AS is a viable option, another said at my age it would be best to take it out.  I haven’t yet spoke with an oncologist.  I’m looking for feedback/advice from people my age with similar stats.  I just  feel with so little pc I’d be jumping the gun with surgery and the resulting quality of life issues.

Age 44
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3

Elite Member

Date Joined Oct 2008
Total Posts : 25382
   Posted 1/14/2009 1:06 PM (GMT -6)   
Hello and welcome smc64. Sorry you had the need to find us here, but it is the best place on the net for dealing with PC. It takes a while just to properly digest the ds, yours is barely a month old. Here, you can get any number opinions all the treatment methods. There are more than several younger men like yourself in their 40's, so you should find good company. With your PSA, just one core and a gleason 6, you definitely have plenty of time to find the best treatment for yourself. Not a doctor, but your preliminary stats would make it pretty likely that it is contained at this point. Now you need to research here, with other urologist from a surgical perspective and a good oncologist from a radiation point of view, and to be fair, some would advocate a period of "watchful waiting". Hope you can find the answers you are looking for, plenty of people here more than happy to help you where they can.

David in SC

What part of the country are you in?
Age 56, 56 at DX
PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4
3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4
Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9
Post-surgery Pathlogy Report:
Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer
Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.
First PSA Post Surgery  Scheduled now for 2/9/9

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 1/14/2009 1:12 PM (GMT -6)   
Welcome to the club, smc64, hate to see you here. I'm to old to fit the criteria of your qyestion, so I'll just tell you that you have found the place to be and I hope you will stay and share your Journey with us.
James C. Age 61
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy- 16 core samples, size of gland around 76 cc. Staging pT2c
7/07 Path report: 3 of 16 PCa, 5% involved, left lobe , GS 3/3:6.
9/07 Nerve sparing open Retropubic Radical Prostatectomy
9/07 Post-op Path Report: GS 3+3=6 Staging pT2c, 110gms, margins clear
16 mts: ED- 50 mg Viagra 3X week, pump daily,Trimix .35ml 2X week continues
Post Surgery PSA's: 3 mts-.04, 6 mts.-.04, 9 mts.-.04, 1 Year-.02.

Regular Member

Date Joined Jan 2009
Total Posts : 40
   Posted 1/14/2009 1:43 PM (GMT -6)   
Thanks Guys! Purg. I'm in MA
Age 44
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4250
   Posted 1/14/2009 1:46 PM (GMT -6)   
My doc says there are two types of prostate cancer, slow growing and very slow growing. With your stats you have a lot of time and a lot of options. I was initially diagonised with stats similar to yours, 2 cores less than 5% and Gleason 6. All three doctors I saw, a uro, a radiologist and an oncologist said that active survelance waiting was the best option given the side affects of all the other options. My PSA was much higher and indicated other issues, but that's another story.
Another option is to get a color doppler ultrasound from a good doctor that specializes in it, either Lee in Chicago or Bahn in Ventura ca. A base line can be established and any changes can be quickly recognized and treated. This is of course if you choose active survialance.
Take your time, in your case all options are available, but all have different side affects that you will have to live with. Delaying those side affects with minimal risk is an option you should consider.
There is also the valid point that early stage cancers stand an excellent chance of total cure. So it all boils down to your individual lifesytle, your tolerance for risk and your willingness to live with the side affects of treatment.
Diagnosed 10-08 at 63 with PSA of 33
PSA was 4.4 in 1999 and has risen steadily.
Had 13 biopsies and an endorectal MRI, all negative until 10-08. Two cores out of 25 with a gleason 6
2nd opinion with an oncologist said cancer found was insignificant, but suspected larger tumor somewhere.
Doppler ultrasound with target biopsy indicate a large tumor in the transition zone, gleason 7.
Bone and CT scans negative.
PSA3= 43; (high normal is 35)
Scheduled for Combidex MRI in Feb. (Lymph node imaging MRI done in Holland).
Location of tumor makes positive surgical margin unlikely.
Looking at IMRT with hormone therapy as soon as staging is complete with Combidex MRI.
Changed diet, eliminated all meat and dairy. Taking the normal supplements recommended for PC.

Regular Member

Date Joined Dec 2008
Total Posts : 60
   Posted 1/14/2009 1:47 PM (GMT -6)   
Welcome home smc64, the home where nobody really wants to be but where you are always welcome to sit and chat. I come close to fitting your criteria. 48 at dx. I looked at all the answers and chose roboticRP and here is why. Others will offer different opinions but at an early age we will live longer with this disease than those who are dx'd in their mid 60's. I spent alot of time looking and found that almost all the data is geared around a 65 year old being cursed with this. That data leaves little for us who will have this 15-20 years longer. After considering all options, the survival rates look better with the cancer removed and if by chance there is a recurrence, we have additional options to eradicate it. There are so many other sides to this disease. You will read about ED and other sexual side effects by looking around here. There is always the continence issue. Frankly all of it sucks but it beats the alternative. I was going to write a rant today about feeling like a broken man sexually. I may still write that but when I look where I am and where so many others are, I feel shame because I am lucky. All things considered, I am a blessed man and would have chosen surgery over the other options to have the best survival rate. I have 5 children (26,23,20,9,7) and a beautiful wife of 28 years who would be worth living for even with the other struggles. I wish you the best in your research and will pray for you.
Age at Dx:48, currently 49
PSA May 08 2.96
referred to uro
PSA June 08 3.44
biopsy 7/25/08-29 core samples
path 7/31/08-8 of 29 PCa/10% involved L/R base and mid
high grade PIN in apex/seminal vesicles clear stage GS 3/3=6 pT2a
10/7/08 robotic at Cleveland Clinic-Dr. Kaouk
10/10/08 path GS 3/3=6 pT2c
cancer contained/neg margins
PSA Jan/09 .03

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 1/14/2009 1:57 PM (GMT -6)   
Hi SMC...welcome to the forum. Don't have anything specific to add that the others haven't already pointed out. The best news is that the cancer appears from the biopsy to be small and slow growing. So that leaves you with plenty of time to decide on the direction you wish to go. If you choose sure to find a doctor that will monitor your stats accordingly...seems alot of urologists don't like to do that these days (I think it has to do with the possibility of being subjected to liability) Regardless what you do, ask questions and use this forum to research for your answers. There are lots of good folks here that have all started where you are at right now and can help guide you through this.

Best of luck to you.
You are beating back cancer, so hold your head up with dignity
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA Oct 2008 <.05
       Jan 2009 .06

Regular Member

Date Joined Aug 2008
Total Posts : 328
   Posted 1/14/2009 2:12 PM (GMT -6)   
Welcome to best place in the World to disucss PCa, I totally agree with vs1vs2! Being very young myself when diagnosed the stats of survival for us are looked at differently then most. I have ED but still hopeful and only 5 months out of surgery. The most important thing is to be strong dont keep your emotions inside, talk to people. I know for me the 1 priority was to be cancer free, then deal with the possible side effects.
Age Dx 37, 7/2008
First PSA : 4.17 5/2008
Second PSA After 2 weeks of antibiotics : 3.9 6/2008
DRE: Negative 5/2008
Biopsy : 6 out 12 Postive all on right side, Gleason 7 (3+4).
Bone Scan/CAT Scan: Clear 7/2008
Cystoscope: Normal 7/2008
Prostate MRI: Normal 7/2008
Da Vinci Surgery 7/2008
PostOp: T2c (On Both sides), margins clear, seminal clear, nodes, clear. Gleason 6(3+3).
First PostOp PSA 9/2008: <0.01
2nd PSA 12/2008: <0.1 (Different Lab then 1st)
3rd PSA 3/2009

Regular Member

Date Joined Nov 2008
Total Posts : 30
   Posted 1/14/2009 2:18 PM (GMT -6)   

Hi Smc64,

I have a similar Dx to yours and I am 52.  After reviewing the various options and information I have been able to find I have decided to have the robotic lapro surgery in February, but I didn't decide that right away.  I think one of the most important things to do is educate yourself and don't jump to any particular conclusion until you feel that you have a pretty good understanding of all the possiblilties, both pro and con.  It may take a little while for the shock of the Dx to wear off, and in some ways it never does, but after awhile you'll start evaluating options and finding out how you want to approach this disease.  I know for me at my age I want to kill this PC as effectively as possible and I believe that the most sure, certain way with the best possible chance for success is to have the surgery to remove it.  Others have come to different conclusions for perfectly valid reasons and it's up to each person to find out the way that they want to deal with this.  The more you know the better decision you will make! 

Good luck and welcome to the forum!



Age     52
Dx      11-07-08
PSA    3.1
fPSA   26%
1 of 12 cores with 5% adenocarcinoma
11 of 12 cores clear
Gleason grade 3+3=6

Forum Moderator

Date Joined Sep 2008
Total Posts : 4240
   Posted 1/14/2009 2:45 PM (GMT -6)   

Dear smc:

Sorry to have you here, but welcome.  Purgatory (David in SC) gave a nice, quick summary of your options and I agree.  You DEFINITELY want to get multiple opinions from at least an experienced robotic surgeon (300+ procedures) and an experienced radiation oncologist.  At your age and stats you have an excellent chance of cure and you may have the option of watchful waiting...however, if you choose that route, you need to be diligilent in terms of repeat testing.  And, frankly, while the cancer may never get more serious, chances are that it will and that you will have to undergo treatment at some point.

As another poster noted, most of the research has obviously been done on older men since that's when the cancer is most often manifested.  So...the statistics reflect that.  However, the research I did showed that the cure rates for the most common treatments are essestially the same.  But, if you choose surgery and the cancer returns, you can treat the cancer further with radiation.  If however, you choose radiation first, then salvage surgery is very risky...I certainly would not do it...and you would need to go to the other options available.

Having said that, I chose radiation (seeds).  I'm playing the odds that the cancer is cured and my SE's are non-existent so far and are likely to me less problematic than if I had chosen surgery.  But...that's for MY particular need to consult with your docs and make a decision for your own situation.  If you are interested in my decision making process and progress to date with seeds, just go to "Tudpock's Brachytherapy Journey" on this forum.

Good luck and please let us know how things progress and what you decide.


Age 62
Gleason 4 +3 = 7
PSA 4.2
2 of 16 cores cancerous
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 12/30/08.

Regular Member

Date Joined Dec 2008
Total Posts : 194
   Posted 1/14/2009 2:55 PM (GMT -6)   
Welcome to the club smc64,
Sorry you had to join but you are no longer alone. In my own case it came down to, what can I do to save my life the fastest? Surgery, I can have radiation later if needed. Radiation, or cryogenics, surgery is no longer an option. I chose surgery and am glad for myself. We are all individuals, study, talk to your doctors, question and listen to them. Take your time and make the decision that is best for you in your situation. Good luck.
Age at DX 57
5-18-07 PSA 7.7
5-06-08 PSA 4.6  8% free psa
10-23-08 PSA 5.65 4% free psa
11-04-08 biopsy
11-11-08 2 of 12 cores positive
Gleason 3+3  6  stage t1c
CT and Bone scan negative
Da Vinci RRP 01-09-09
Time to heal now.

Regular Member

Date Joined Feb 2008
Total Posts : 308
   Posted 1/14/2009 3:16 PM (GMT -6)   


I was diagnosed at 54 years in January and had my surgery in March.  I had 10 cores with 1% in one core.  Gleason 6.  T1C.  After surgery they found that my tumor was 10 % of both lobes and that my gleason was actually 7 ( 3+4).  Not much different but different just the same.

You have plenty of time to determine your course of action for sure.  It seems to me in my brief 9 month experience that clinical diagnosis more often have a lesser Gleason score and smaller tumor than is found if you choose surgery and subsequent pathology.

This site is a great forum to ask questions and learn from others.  You will realize very soon that this journey you are about to embark on is so very linked to the skill, experience and knowledge of those you choose to hire.  Seek and obtain the very best you can.

As you meet with Doctors and consider treatment options go ahead and schedule the procedures even if you have not decided.  This way when you do decide you can quickly cancel the other procedures.  I was explained that smart patients do this all the time.  This way you wont have to wait 6 months to get it done.

All the best,




Age 54
DRE normal , 2004 Biospy negative - 2008 Biopsy positive (01-08-08)
10 cores, 1 positive and at 1% of that one core
PSA @ surgery 6 
Bone and Ct scans negative
clinicaly Staged at T1C - Gleason 3+3 = 6
Robotic Da Vinci performed March 27th, 2008, University of Chicago.
Catheter out in 7 days normaly expected leakage
Post Pathology T2C, Gleason 7, (3+4) 10 % of both portions of prostate
Seminal vessels clear, fat tissue clear, single positve margin at apex measuring less than 1/2mm. 
PSA Six week < 0.1 4 month PSA <.05 6 month PSA<0.01,9 month<0.01
Watching PSA @ 3 months for 2 years,  will do salvage radiation if necessary.
Fair to Good results with Viagra,  side effects are bothersome at times. 

Ken S
Regular Member

Date Joined Nov 2006
Total Posts : 120
   Posted 1/14/2009 4:29 PM (GMT -6)   

I came across this chart ( that lists all the different options and side affects. It may be helpful. At you age I would assume that most doctors will recommend surgery. I'm right down the street (kinda) in RI if you ever want to hook up for lunch or whatever and talk just drop me an e-mail (in my profile).

Age 54 (2006)
PSA: 2005 - 3.2, 2006 - 3.7
Biopsy 8/06, Gleason 6 (3+3), T1c
Radical Retropubic Prostatectomy 11/3/06
Memorial Hospital, Pawtucket, RI
Post-Op Biopsy, Gleason 6 (3+3), T2c,
right apical margin positive
CT Scan 1/07, tumor discovered on right
kidney (unrelated to PCa)
Partial Nephrectomy 3/9/07
R.I. Hospital, Providence, RI
IMRT (37 Treatments) 4/23/07 - 6/14/07
PSA: 11/08 - 0.03

Regular Member

Date Joined Jan 2009
Total Posts : 40
   Posted 1/15/2009 10:45 AM (GMT -6)   

Hi all,

I wanted to say thanks for all the responses!  There is certainly no easy answer, but agree with the consensus, take the time needed to make a well informed decision.  Again Thanks!


Age 44, DX 12/08
Psa 2.6 free 11%
One of twelve cores pos. with 5% pc Gleason 6 3+3

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