I'm a 59 year old male, and live in Texas. In August, diagnosed with prostate cancer. My wife and I decided on the da Vinci procedure with Dr. Randy Fagin in Austin, Texas. Initial biopsy: LEFT PROSTATE BIOPSY SHOWED: PROSTATIC ADENOCARCINOMA, GLEASON SCORE 5, INVOLVING APPROXIMATELY 25% OF THE SUBMITTED SPECIMEN. ALSO SEEN ARE NUMEROUS AREAS OF HIGH GRADE PIN AND A FOCUS OF PERINEURAL INVASION. RIGHT PROSTATE SHOWED: BENIGN PROSTATE TISSUE SHOWING ADENOMATOUS HYPERTROPHY. Dr. Fagin called and thought we caught it early enough and scheduled surgery for September 30th, 2009. Surgery was performed and released the following day with a followup in 8 weeks. Never had 1 day of problem with leakage and never wore a pad. Went through physical therapy to strengthen muscles. Then back to work. Post Biopsy report: DIAGNOSOS: PROSTATE AND SEMINAL VESICLES(RADICAL PROSTATECTOMY):
Histologic Type: Prostatic adenocarcinoma.
Histologic Grade: Gleason grade 3+4=7
Laterality: Bilateral, involving approximately 35% of left prostate and less than 5% of right prostate.
Margins: Focal involvement of peripheral surgical margin measuring 3mm in greatest dimension.
Extraprostatic Extension: Focally present
Seminal Vesicle Invasion: Not identified
Perineural Invasion: Present
Angiolympatic Invasion: Not identified
Lymph Nodes: Not identified
Stage (AJCC, 2002): pT3a, NX,MX
My eight week followup, with PSA bloodwork done the week before the visit showed 0.15. Dr. Fagin ordered another PSA in hopes of a false reading. This result showed 0.12. The number did go down. He expressed to me the number was real and suggested Radiation Therapy. He said this procedure would last Mon-Fri for 4 to 8 weeks, and suggested a radiation onogologist in Austin. The only problem with that is, it's a 2 hour drive one way for me. I told him of a cancer center in Brownwood, Texas, which is only 50 miles from where I live. I work in Brownwood, so I drive it everyday and have for the past 20 years. The facility (WALKER CANCER CENTER) is relatively new, been the since the late 80's, with one radiation onogoligist, Dr. Alan Cass. I scheduled an appointment with my Urologist, Dr. Daniel Allstatt, in Brownwood, Tx. He's the Dr. who performed the initial biopsy. We talked, and he as well suggested radition therapy, moreless to nip it in the bud, or wait a couple of months to perform another PSA test. The decision was entirely up to me as to what to do. Based on the initial biopsy and the post biopsy, and the agressiveness from 25% to 35% in a month, and not knowing how agressive the exsisting cells may be, I've scheduled an appointment with Dr. Cass for next Monday, the 28th of December. This option is clearly up to me as to where to have the treatments. Are all cancer centers the same when it comes to radiation therapy or are there some better than others? Is Proton therapy used to combat these exsisting cells? And if so, there is only one center in Texas that offers Proton therapy and that is MD Anderson, in Houston. As you can tell I'm a little concerned as to my choices. I definitely want to make the right decision. Should I wait a couple of months for another PSA or go ahead with the radiation? Any suggestions??? My wife and I are going to meet with the Dr. on Monday, feel him out, and ask questions about how many of these he does for prostate cancer, and the success rate to rid of this disease. I'm just hoping for some positive feedback on those of you who have had to do this, and the time frame to get it done. Needless to say my anxiety and stress level are high and just want to make the right choice. As far as ED goes, the pills did not work, never tried the pump, using the injection therapy with some results, not lasting that long after orgasm, may try the trimix next. The injection medication I'm now using is: C-ALP20MCG/PHEN1MG/PAV30MG/ML20MCG/1M. Any info on the trimix would be helpful as Dr. Allstatt suggested this to me as well. My fear is will this type of therapy work after radiation, and what other side effects could I encounter after radiation therapy.