Sorry you have to be here. Now you need to get informed as possible so you can make the right decision for you. The 1st thing you need to do is get an accurrate staging of your PC. There are some questions and areas that need to be explained to you before you choose a treatment. The nodule felt is a problem. I would request an MRIS or a color doppler ultrasound to see if the nodule has penetrated the capsul and it's exact
location. This will affect the treatment and its success.
4 out of 12 positive cores indicate a large tumor volume and this does not correlate with a very low psa and a Gleason 6. There are very specific formulas for how much psa a Gleason 6 generates with a prostate and tumor volume. The PCRI web site has tools you can download to calculate this. Your doctor must correlate your psa to your gleason grade and to your prostate volume and estimated tumor volume. If he cannot do this then get a doctor who can.
Make sure your doctor uses the partin tables and artificial neural networks before recommending a treatment.
I can only echo Dr Strum's mantra:
For a successful outcome:
1. Know the biology of your cancer. There are a lot of
open questions as to the biology of your PC.
2. Choose the best treatment that matches the biology.
3. Choose the very best "artist" to perform the treatment.
I would get a 2nd opinion from a prostate oncologist, one who specializes in PC only. Most Urologists are not equiped to handle or stage unusual cases. Your initial Dx has some
open questions that I don't think a urologist can answer.
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.