Treatment options

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New Member

Date Joined Mar 2009
Total Posts : 8
   Posted 6/19/2009 2:42 PM (GMT -6)   
In April of '09 I had a PSA reading of 3.62 (up in 1 year from 2.7) and a free PSA of 17%.
My Urologist performed a biopsy and the results showed a small focus adenocarcinoma of the prostate grade 3+3=6 in 2 of the 6 slides, but representing 5% of the biopsy specimen in each of the positive slides.  The results were confirmed by the Johns Hopkins reference labratories.
My Urologist Dr. R. Carey (Sarasota) recommends robotic surgery, which he performs.  He also recommended that I talk to 2 other Dr.'s for other treatment options, while also suggesting the option of watching and testing on a regular schedule.  I was informed of the rasiation options by an Oncologist.  I was also informed by Dr. Barzell (Sarasota- who pioneered the high density technique) of a treatment called 3-D mapping that takes 114-118 cores samples from all sides of the prostate and shows a more precise picture of the area(s) of
cancer.   This is an outpatient procedure that is less invasive than the biopsy I had performed on me.
The concensus among all 3 Dr.s seems to be that I  can choose any of the 3 options because of the low grade and level of the depth of the cancer.  
Obviously I am not sure what I will do, and I would appreciate any comments or information
that any of you can provide.
Thank you
Paul in Sarasota
I really prefer to choose the least invasive procedure, but also want (who doesn't) to choose the procedure that

Veteran Member

Date Joined Jul 2008
Total Posts : 966
   Posted 6/19/2009 3:16 PM (GMT -6)   
Hi Propaul have several choices in front of you including the active surveillance. The good news is that you have time to make that decision and you are doing the right thing by looking at each and every one of them. I was a surgery guy, and so I can only suggest that if you go the surgery route, try to find a surgeon with the most experience. I am sure the same would apply with radiation treatments, but I will let those guys chime in. Don't forget, there are several other treatment options depending on where you live. Proton Beam, TFT and HIFU might be something to look into as well.

Best of luck and when you have more questions, just ask away.
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
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month April 2009 .06

Forum Moderator

Date Joined Sep 2008
Total Posts : 4277
   Posted 6/19/2009 3:35 PM (GMT -6)   

Hello Paul:

Sorry you have to be here but welcome.  Re AS, here is some info including guidelines from Johns Hopkins:

Most of the guys on this forum are surgery patients, so you should get lots of good advice from them.  There are not many AS guys and they don't post often but, hopefully, at least one of them will weigh in on this thread.  From what you say, the good news is that you have all of the options and the bad news is that you have all of the options.  It's a major decision that will probably affect the rest of your life so my advice is to take your time, read a lot (Walsh's book is an excellent primer), talk to all of the right docs and gather as much info as you can so you can make an informed decision.  Then, should you choose treatment over AS, make sure you choose a doc who has experience, i.e. at least 250 procedures under his belt (there is definitive evidence of that, at least for surgery).

I do think it's a good idea to do the more extensive biopsy if you can.  I didn't know about that option and doubt if it would have changed my treatment choice but nevertheless would have done it if I had known about it.

Finally, there are a few of us on this forum who have had brachytherapy (seeds).  My experience with this is 6 months old and you can read my "journey" by clicking the link at the bottom of my signature below.  I have been very pleased with this non-invasive choice.  Another longer term poster whose hubby chose this procedure is JustJulie and she has a journey posted as well.  Also JohnT recently had this - he is a regular poster with great insight who may chime in as well.

There is a ton more I could write but I'll leave it for now with what I have shared.  You'll find everyone here most willing to share knowledge, opinions and support.

Good luck.




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 6/1/09.  6 month PSA now at 1.4 and my docs are "delighted"!

Regular Member

Date Joined May 2009
Total Posts : 476
   Posted 6/19/2009 6:53 PM (GMT -6)   
For early stage, low grade cancer, there is no one right treatment, instead, there few of them. The cure rates are about the same and you have excellent prognosis with any of these choices. So, it comes down to personal preference, availability of best doctors, and trust you develop with them.

Previous 5 biopsies over 4 years negative

PSA going from 3.8 to 28

Father died from PCa @ 78 - normal PSA and DRE

Dx Nov 2007, age 46

PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke

6 rounds of chemo (Taxotere+Avastin)















followed by RRP at Duke (Dr. Moul) on 6/16/2008


Gleason downgraded 4+3=7

  Duke: T2c N0MX, one positive margin

  Sloan Kettering: T3a N0MX, extraprostatic extension, two positive margins

PSA undetectable for 8 months, then









6 Months ADT started 6/12/2009

IMRT to start mid-Aug

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4269
   Posted 6/19/2009 6:55 PM (GMT -6)   
You are the poster child of all treatment options including watchful waiting. You may even have indolant prostate cancer which doesn't require any treatment. With 3D mappping you will get more information about your individual situation and can make a better decision.
Since all treatments will result in a very favorable cure rate given your stats I would focus on the side affect of each treatment option as this is what you will have to live with for the rest of your life.
Delaying the treatments to delay the side affects is also a good option with very little risk.

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July


Veteran Member

Date Joined Dec 2008
Total Posts : 673
   Posted 6/19/2009 7:21 PM (GMT -6)   

I didn't see your age. However, you have many options and AS may well be one of them. Ask more questions and do much more research. If I had low volume and Gleason, I may have chosen AS. I didn't have low volume and my Gleason increased after surgery pathology, as it does for many.

Research, ask questions, research more.




Lower left groin hernia: mesh and large scar: surgery early 2006
Nov/Dec 07 and March 08 and now Dec 08: Severe perineal pain (between scrotum and rectum). Septra/Bactrim for 8 months (Nov 07-Jun 08) for diagnosed prostatitis.
PSA start of 2008: 5.3..... PSA June of 2008: 7.3
14 DRE all benign or nothing felt
TRUS Biopsy Nov 08: Got copy of pathology (see below). Prostate about 40 cm sq.
General Health: pretty good, 5' 10", 180 lbs, slim.
Bone scan Dec 08: Negative
Barium enema X-ray (March 09 due to several days of blood in stool)
MRI with endorectal coil (April 09 as part of a study)
3D advanced TRUS (April 09 as part of a study)
CT (April 09 as part of a study)
Biopsy Pathology: 5 of 8 cores positive, adenocarinoma in both lobes. 30%-65%. One core perineural invasion. 2 cores "foamy" and suspicious. All +ve cores, 3+3 GS 6.
Open RP surgery: May 5/09 Surgeon spoke to my wife and was very positive. Said both nerve bundles spared and not damaged. Bilateral lymph node dissection performed. Discharged 48 hours after surgery. Staples out, catheter out and pathology sheduled for May 21.
Post Surgery Pathology: pT3a N0 MX, extraprostatic extension (EPE), stage III prostate cancer, lymph nodes clear, seminal vesicles clear, Gleason upraded to 3+4 GS 7. EPE within surgical margins. Other than prostate and EPE, all tissue removed negative for cancer involvement.
Physical State: Getting back to working out slowly. Urinary control pretty much from the time of catheter removal. Rectal pain, sometimes bad but, told is normal. Erectile function at best 25-30% of presurgery. Trying Levitra...first 10 mG dose gave me nasal congestion, 50% chubby and a 24 hour headache...may go away with more use or change of meds. Considering pump. Recovery from surgery going very well.
Mental State: Pre-surgery anxiety gone. Positive attitude. Some anxiety about seeing radiation oncologist and upcoming 3 month PSA. 

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