Having any treatment, be it surgery or radiation without knowing the full extent of your cancer is like closing the barn door after the horse has escaped. A lot of doctors and patients believe that surgery is the only way to get a good handle on your disease. It may be, but the cost is too great and it's after the fact. There are much better ways to stage PC without the affects of surgical removal. PAP, PCA3, Ploidy analysis, algrithims that correlate gleason, psa, core samles and tumor size, color doppler or MRIS. All these combined are less than the cost of a CT and bone scan. Proper staging is also an art that few doctors are capable of.
There are certain things I want to know BEFORE anyone starts cutting on me:
1. Is my gleason grade correct.
2. The exact size and
location of my tumor or tumors. (50% of all positive margins are in the Apex)
3. Is there indication of micro mets or lymphnode involvement.
4. Is there extra capusular extension.
All these can be reasonable determined without surgery. Then one can make an informed decision using partin tables and PC tools to arrive at the best treatment for the best probable outcome.
64 years old.
PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.
2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.
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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.
Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.
25 treatments of IMRT 6 weeks after seed implants. No side affects at all.
PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.