Treatment options

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New Member

Date Joined Mar 2009
Total Posts : 8
   Posted 5/16/2009 8:31 PM (GMT -6)   
I just had a biopsy, and I was told that I have prostate cancer.  My urologist said it was not deeply ingrained, and gave me several options.  The first is to do nothing and monitor the PSA with regular biopsies.  The second, which he highly recommends, is robotic surgery to remove the prostate, and thus eliminate any further chance for higher and more potent levels.  He recommends this treatment because I am on coumadin, and he feels that other treatments might leave me at risk for bleeding from the scar tissue.   Another is to have radiation treatment, and another is to have cryogenic(sp) (freezing) or heat treatment.  He didn't suggest or mention a new treatment the I have heard of, which is ultra sound (or something like that) therapy.  I could use some feedback on any of these treatments. 

Veteran Member

Date Joined Apr 2009
Total Posts : 990
   Posted 5/16/2009 9:47 PM (GMT -6)   
Welcome -- this is a place where nobody wants to be but we like to be here. There are a lot of good sites on the web (and some not so good ones too) that will help to start your learning process. There are also some good books available -- look at the links at the top of the forum list.

The first thing is that prostate cancer is slow and so you have time to consider your options. The second is that prostate cancer has many good options -- that is treatments that can leave your cancer undetectable for ten years or more.

As you look at this board you will see that almost everyone summarizes their situation so far by adding a sig. Look for the control panel tab at the top of the page. This lets people tailor their advice to your situation.

Once again, we are here for each other and now we are here for you.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3 + 4 = 7
CAT scan 1/09 negative, Bone scan 1/09 negative

Robotic surgery 03/03/09 Catheter Removed 03/08/09
Post surgical pathology report. Lymph nodes negative, Seminal vesicles negative
Surgical margins positive, Capsular penetration extensive Gleason 4 + 3 = 7
At 6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.

Regular Member

Date Joined Apr 2009
Total Posts : 133
   Posted 5/16/2009 10:08 PM (GMT -6)   
You need to understand what the numbers mean before you select a treatment course. There are many variables including your age, fitness, medical conditions and of course, the lab numbers associated with the psa and biopsies. Post them up and you will get replies more specific to your situation.
Also, go to a book store tomorrow and buy Dr Patrick Walsh's book "How to Survive Prostate Cancer." He tells alot about it in a way that you can understand and it is reliable. One cannot map this journey without understanding the available routes.
best wishes,
Age 55, two teens, very fit cyclist (avg 2000+ miles per year) and weight, diet, etc. consistent with good habits. Stressful job as attorney; very supporting wife who is helping me through every stage of this war.
2006 PSA - 1.5
2007 PSA - 2.3
2008 PSA - 5.3 (18 mos.)
2009 Jan. 20 - Biopsy 12 samples
        Feb 3 Dx 2/12 samples positive, low volume  (5% and 7-10%)
Gleason 3+4, later downgraded by second opinion at Johns-Hopkins to 3+3, but "it's still PCa" as my Doc said.
Laproscopic surgery April 9,  University of KY Medical Center, Lexington, 3 days in hospital, catheter removal April 21.
Pathology: clear margins, no cancer in prostate: told that this is very rare and Doc has only seen it in 3 out of over 1400 cases; I rearched the concept of "vanishing cancer" and found a tumor classification of tP0 and asked Doc if it applied to me. He said that it was unlikely because if a pathologist had done a much more detailed analysis of the tissue, he would likely find more foci somewhere, and biopsy found "needle in the haystack as opposed to the tip of the iceberg"; Nevertheless, it is a blessing;
Regardless of the science, my family says "miracle."
Now working w/ post-surgery issues....

Steve n Dallas
Veteran Member

Date Joined Mar 2008
Total Posts : 4848
   Posted 5/17/2009 4:28 AM (GMT -6)   
How old are you and what are some of your PSA scores?

Age 54   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
xx/xx/xx   - 3rd Quater skipped
05/14/09  - 4th Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

Regular Member

Date Joined Sep 2006
Total Posts : 211
   Posted 5/17/2009 6:32 AM (GMT -6)   

"I just had a biopsy, and I was told that I have prostate cancer."

Biopsy readings are subjective: what looks like cancer to one person might well look normal or like a different grade to another.

The most logical approach, if you have not already done so, is to arrange for another reading of your biopsy slides by an expert pathologist.

ie confirm where you really stand before even worrying about treatment options.

Secondly, obtain a printed copy of your biopsy report as it will contain a lot of relevant information like the number of positive samples, Gleason scores, and % of cancer in each sample. 

All of this information will help you put your situation into perspective and assist in your decision making process.

Forum Moderator

Date Joined Sep 2008
Total Posts : 4271
   Posted 5/17/2009 7:59 AM (GMT -6)   

Dear propaul:

First of all, sorry you have to join us but welcome to this forum.  As several of the others have suggested, it would be very helpful if you post your stats in your signature.  PCa is different in every individual and the advice you get on this site will be better if we know what you are dealing with.  Also, getting Walsh's book is a very good idea.

The other thing you should do right away is schedule appointments with a radiation oncologist and a prostate oncologist.  Your urologist is a surgeon and is likely to favor that treatment.  That may indeed be the path you choose but you need to get fully informed and one of the best ways to do that is by seeking other opinions from qualified professionals.

I'll stop here but will come back with some other commentary after you post your stats.

Best wishes,


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 5/1/09.

55 and healthy in NJ
Regular Member

Date Joined Apr 2009
Total Posts : 58
   Posted 5/17/2009 9:20 AM (GMT -6)   

You came to the right place for advice. There are many men here that have gone through what you are going through, so the good news is you/we are not alone. May I also suggest as a resource Dr. Scardino's book (see below) which was written specifically for guys like us whose heads are initially spinning about what to do, and is very readable. As you do your research, you will hear lots of case studies and opinions from people who have had different treatments, some more successful than others. The main thing to remember is that there is no "best" treatment for prostate cancer, and every individual's situation is just that -- individual. The best advice I have for you is, (a) get multiple opinions from several physicians, (b) tell everyone you know about your problem, because as I found out, most of the people you tell will know someone that has gone through this and they will be happy to talk to you personally about their experiences, both pre- and post-treatment, (c) ask questions, and (d) ask more questions. Best of luck as you go through your journey.


Age 55
Physical exam (01/22/2009): blood pressure 130/85, good EKG; basically all-around healthy
PSA 4.9 (02/05/2009)
Urologist DRE observed slightly hardened left lobe (02/19/2009)
Chest X-ray normal (02/23/2009)
Biopsy (03/03/2009)
PCa present in all sextants, <5% to 50%
Prostate gland 37 grams
Gleason score 7 (in two sextants, scored 6 elsewhere)
Cystoscopy (05/08/2009), showed clear
MRI (05/08/2009), "No findings are present to suggest extracapsular tumor."
Robot-assisted laparoscopic radical prostatectomy scheduled for 05/18/2009 - getting admitted at 5:30 am
Surgery (daVinci robotic) consult with Michael Esposito, M.D., (03/30/2009)
Radiation oncology (Varian IMRT/IGRT RapidArc) consult with Mark Macher, M.D., (04/08/2009)
Other resources: Dr. Peter Scardino's Prostate Book (Peter Scardino (Sloan-Kettering), 2005); Urologic Robotic Surgery (Michael Esposito, Vincent Lanteri & Jeffrey Stock, 2007)

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 5/17/2009 11:24 AM (GMT -6)   
Pro Paul,
The Prostate Cancer Research Institute''s web site has a section on treatment options. Click on papers, then newly diagonoised.
You shoud also read the following books:
Walsh or Sardino on Surgery.
"Brachytherapy and IMRT" by Dattoli
Compassionate Oncology web site by Liebowitsz on Hormone Therapy
"A primer on Prostate Cancer" by Strum
These will give you a good idea of all the treatment optiions.
I don't know any reference books on Cryosurgery or HUIF
Strum's book is probably the best book in helping you decide what type of cancer you have and fitting the best option to your cancer.

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

As of April 10 and 7 weeks on Casodex and Proscar PSA has gone from 30 to 0.62 and protate from 60mm to 32mm. Very minor side affects. Doc says all this indicates tumor is not aggessive

Awaiting schedule for seed impants


Regular Member

Date Joined Jun 2008
Total Posts : 440
   Posted 5/17/2009 10:12 PM (GMT -6)   
Steve n Dallas, your PSA was only 1.3 and they did a biopsy ?? That doesn't sound real high for 54 yrs old, was DRE negitive ??

will be 50 years old this year ( 2009 )
Uro said enlarged prostate 
DRE Negitive
Psa  2003- .55
     2007 - .99
     2008 -  1.01
watchfull worrier , lol

chris nz
Regular Member

Date Joined Sep 2007
Total Posts : 33
   Posted 5/18/2009 3:01 AM (GMT -6)   
Hi pro paul
the first thing is not to panic, and don't be panicked into treatment decisions you do not understand and are not sure about. I am on Warfarin [Coumadin] , I had Brachytherapy after 5 years of active surveillance . I was told to stop the blood thinner one week before the procedure, I wore elastic hose and I had no problems,
chris nz
Dx Nov '03, age 61, 1 of 8 +, 3 + 3, PSA before biopsy 6.5.
after biopsy PSA went 10.5 and stayed there.
Tried a lot of the can't fail 'cures'. Found 'Prostasol' a version of PC Specs.
PSA dropped to less than 1.
Still tried other supplements but reverted back to 'P'. [ a herbal estrogen.] Had problems with hereditary Deep Vein Thrombosis, now on blood thinner.
March '08, second biopsy, 3 of 10 + [10-50%], 3 + 4, PSA 1.0. T2A.
Bone scan didn't show much, bone density showed early osteo in places.
Had Brachytherapy Aug 23 08. 75 seeds, started work again 2 days later
PSA after 6 weeks 7.8
PSA after 3 months 4.2, everything still working well, absolutely no problems. next check in May '09

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