Posted 7/19/2009 11:52 PM (GMT -6)
Hi Huey, one of my urologists told me about a 3 plus 3, "you might die of that cancer, but you're really going to have to work at it, and be willing to devote the next 40 years to the quest."
I say one of my urologists, as I met with four, talked to three/four others, and a doctor (GP) friend consulted with about five more on my behalf. Each had their own take, their own perspective.
One thing I came to understand was that a month or two here or there while I decided what treatment to get (I had a second slide read --- that's another two doctors --- which put me at a Gleason 7) wasn't critical. As one urologist said, "You've got a long time ahead of you when this cancer is curable."
If you're a 3 plus 3 you're in even less of a rush than I was.
I can't help you with your question, lots of guys here are far better informed than I, but I think all would agree that you have time and you have more to lose rushing to a treatment than you do in taking some time to learn everything you can about your particular PCa and all the treatment options available.
If my second biopsy reading had agreed I was a 3 plus 3 I'd likely have had Bill Orovan in Toronto destroy the prostate with HIFU, which I thought of as watchful waiting with the kicker of a treatment that may well be as good as surgery but done on an outpatient basis. I'm told (by two U.S. doctors) that in the U.S. doctors with huge cash and training investments in other therapies have been slow to pick up on HIFU. They also told me (their words, not mine) that the FDA with American blinkers to the rest of the world, refuses to accept studies from places like France and Germany on HIFU and so it isn't approved in the U.S. Americans think of it as experimental. In Europe, Japan, Russia, it's an accepted therapy and the results from the third generation machines seem to be producing excellent results on a par or better, with surgery. HIFU has been approved in Canada for a number of years (Orovan has done some 400 treatments, many on Americans) and there are several centers here doing it. The two issues you'll need to satisfy yourself on are: 1) will the 3 to 10 year numbers for HIFU continue to track with surgery as time goes by? and 2) can you live happily without pathology? From my research I was satisfied that HIFU results would continue to track with surgical results ---- and, don't forget, both surgery and HIFU select only patients who are likely to benefit so going into either, if you're approved, you have good Karma. What tipped the scales for me was the possibility of being a Gleason 7 and not having the pathology to know for sure. After much introspection I decided I just wouldn't be happy without the pathology. At Gleason 6 I'd have been okay. If I was a Gleason 7 I wanted to know more. And so, I had daVinci surgery, last week got my pathology, and am now a little less sleepless than I was.
There are also other therapies such as freezing and the seeds you should look into, and perhaps radiation too. I only write about HIFU as it was the non-surgical therapy I had settled on. I liked it because all of the other options, including daVinci surgery, are still open if it doesn't work out. Including a second HIFU treatment. This isn't necessarily true, best I could tell, with other therapies. (One daVinci surgeon I talked to, in Cincinatti, has successfully removed a HIFUed prostate.)
Huey, you probably want to do a crash course on PCa about as much as you want to be told the pilot of your plane has died and the other passengers have elected you to land it. The good news is that once you get in the cockpit you find from ground control the plane has autopilot and they can talk you through the levers and switches you need to throw to bring it in safely. In six/eight weeks you'll find your PCa has consumed and taken over your life as you reseach and learn, but like a plane with autopilot you'll find choosing the right treatment, in the right place, at the right time, is a lot easier than it looked when you first started, and you'll come to understand you've got a long life ahead of you.
The daVinci surgeon in Cincinatti told me the five year survival rate for all PCa cases in Ohio was 100% --- and that includes the very worst of cases. Folks with numbers like yours, or even mine, should probably be more worried about getting killed in a car accident than dying of PCa. Which, of course, is easier said than done.
I'll look forward to hearing more from you.
And, like the other have said, sorry to see you've joined our club.
Sleepless AKA Sheldon
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn --- perfect recovery spot!
Catheter out July 9, so far, so good
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"