Treatment Recommendation

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StretchDennis
New Member


Date Joined Nov 2010
Total Posts : 2
   Posted 11/15/2010 8:44 PM (GMT -6)   
I got a nasty present for my 50th birthday - my prostate biopsy results:

Age: 50
PSA: 1.00 (As reported in May of 2010 ... My PSA in May of 2006 was 0.8)
Biopsy: October 22, 2010 (1 of 12 had less than 5%)
Gleason 3+3=6

Although I am overweight (6'5" ... 250 pounds), I am in good physical condition. I have never been subscribed a prescription. I biked 1500 miles this year. I have had a physical with PSA testing biannually since I turned 40. My physical in May of 2010 had no abnormalities.

I had minor urinary complaints (occasional problems starting/stopping, emptying), so my doctor recommended seeing a Urologist. My Urologist reported a prostate nodule on my right side, so I had a biopsy. It turned out that the positive result was on the left side. A few Pathologists and one from John Hopkins confirmed the result.

My dad died a painful death form PC at age 62. His doctor asked him when he had his last physical, and his answer was during discharge from WWII 35 years earlier. I also have had 4 uncles (out of 8) who had PC. Despite my dad's early death, I have longevity in the family and anticipate living at least into my 80's unless cancer gets me.

I think that there are a lot of unique circumstances for me (low PSA, young, early detection, etc.). Is there a site out there that gives treatment recommendations based on your individual situation? I have an idea of what I need to do, but I'm not a doctor!

Thanks ...

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4235
   Posted 11/15/2010 8:57 PM (GMT -6)   
Dennis,
The Prostate Cancer Research Institute web site has a lot of information on treatment options. Since you have a nodule you are not a candidate for Active Surviellance, but all other options such as surgery, and Brachytherapy are open to you. For an unbiased opinion on your individual situation I would see a medical oncologist specializing in prostate cancer or a prostate cancer coach like Dr Barkin. Good luck, you will be getting a lot of opinions, but do your own research as every situation is individual.
The YANA site also has a lot of information including patient experiences with various treatment options.
Three books you should read: Surviving Prostate Cancer by Walsh; Primer on Prostate Cancer by Stephen Strum; Invasion of the Prostate Snatchers by Mark Scholz
JohnT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Pocketman
Regular Member


Date Joined Aug 2010
Total Posts : 121
   Posted 11/15/2010 10:46 PM (GMT -6)   
Dennis,

First of all, I am sorry to see you here. You have some challenges ahead of you, but many have gone before and there is light at the end.

As you've just identified, the first challenge is treatment options. If you're like most of us, there is not a silver bullet or a simple answer. Your young age actually complicates the situation. Hopefully you have several more years to live, so your decision will need to be not only what's the best cure, but what effect it's going to have for the next 25-30 (or longer) years.

My father was diagnosed at age 75 and underwent traditional radiation with little side effects. Radiation leaves scare tissue so should he need treatment down the road, surgery is difficult if not impossible. Given his age, he will not likely need additional treatment. I was diagnosed at age 61 and chose da Vinci RP. Like you, I am hoping to live several years and wanted the darn stuff out of my body. This doesn't necessarily mean surgery is the right choice for you.

One thing you will learn from the postings here, is none of us have the same experience even with the same treatment and similar numbers. Our bodies are different and PC treatment effects us differently.

Read the stories posted here and the material JohnT suggested. I found the information at www.prostate-cancer.com helpful. It is not very in depth, but does give an overview.

Steve
Age 61, Diagnosed July 2010
PSA 04/09 - 2.5; 05/10 - 3.7; 07/10 - 4.7
DRE and Ultrasound - Negative
Size at biopsy - 32 grams
T1C, 3+3=6, 1 core of 12 60% positive
da Vinci 10/29/10
Post op biopsy indicated bilateral Gleason 6 tumors
Post op plumbing is 95% functional.
ED - Minor

Post Edited (Pocketman) : 11/15/2010 8:49:37 PM (GMT-7)


Mavica
Regular Member


Date Joined Jun 2008
Total Posts : 407
   Posted 11/15/2010 11:40 PM (GMT -6)   
"but I am not a doctor."
 
These are things you should first sit down and discuss with your Primary Care Physician, followed by a consultation with a Urologist the Primary Care Physician recommends.  You'll get well-meaning advice here, but it's no substitute for advice received from medical professionals who know you, know your medical history, and know of this specific situation.  Best wishes for a successful outcome to your concerns.
Age: 61 (58 at diagnosis - June, 2008)
April '08 PSA 4.8 ("free PSA" 7.9), up from 3.5 year prior
June '08 had biopsy, 2 days later told results positive but in less than 1% of sample (Gleason's 3+3=6)
Developed sepsis 2 days post-biopsy, seriously ill in hospital for 3 days
Dr. recommended robotic removal using da Vinci; Surgery 9/10/08
Northwestern Memorial Hospital, Chicago, IL; Dr. Robert Nadler, Urologist/Surgeon
Post-Op Gleason's: 3+3, Tertiary 4; Margins: Free ; Bladder & Urethral: Free
Seminal vesicles: Not involved; Lymphatic/Vascular Invasion: Not involved
Tumor: T2c; location: Bilateral; Volume: 20%; Catheter: Removed 12-days after surgery
Incontinent: Yes (1 to 2 light (woman's style) pad per day)
ED: Combination of Cialis and MUSE (alprostadil) once weekly: started 9-27-08
Returned to work 9-29-08 (18-19 days post-op)
PSA test result, post-op, 10/08: 0.0; 12/08: 0.0; 4/09: 0.0; 9/09: 0.0; 3/10: 0.0; 9/10: 0.0

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6979
   Posted 11/16/2010 12:04 AM (GMT -6)   
Dennis,
 
Although the context of the book is different, I'm going to suggest a recently posted download pdf booklet that I wish I had been given at my first diagnosis:
 
Now, this is a booklet that is talking about helping men understand what screening is all about, and the fallout of being diagnosed, so do not look for suggestions from it.
 
I am a 57 year old, and with a much worse biopsy, I chose DaVinci surgery. Given that I was diagnosed late, possibly due to a lack of PSA tests (my fault), I was already over the hill, so to speak. I also elected to do follow-up radiation based on post-op pathology.
 
If I had been earlier in the evolution of the PCa, I would have elected seeds (not a casual comment, I have some experience with the statistics and process as an investor in a company in the marketplace). Pity that I was too late, an understatement.
 
What do I like about my choice -
They cut the little bugger up, and I know for sure that the worst case scenario was brutally true. (I was not left with false hopes).
I probably added at least a few years to my life. At least five, perhaps many more.
 
What do I regret about my choice -
Nerves are gone, and ED is guaranteed for life.
Incontinence is real. I will be wearing pads for an unknown time into the future.
I had to do radiation, and still have bowel, incontinence, and fatigue issues at four months out.
It (PCa) is tough on your body, harder on your mind.
 
That is my experience - none of us on the board can/should suggest a treatment, as I see it. 

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 6979
   Posted 11/16/2010 12:08 AM (GMT -6)   
Dennis,
 
Sorry - should have started my previous post with a Welcome. We hate to see you here, but welcome to a crew of folks who will do their best to help where they can!
 
 

Sephie
Veteran Member


Date Joined Jun 2008
Total Posts : 1804
   Posted 11/16/2010 7:43 AM (GMT -6)   
Dennis, while 50 is a bit on the young side for PCa, sadly there are men younger than you being diagnosed.  Something in your post struck me:  the urologist felt a nodule on the right side of your prostate but the biopsy showed cancer on the left side.  Keep in mind (and I'm sure you know this already) that a biopsy is a sample and is not definitive.  It is not uncommon for the extent of the disease to be upgraded after surgery because the entire prostate and all the bits attached are tested. 
 
Have you discussed treatment options with your medical team yet?  More importantly, do you have a preference:  surgery, radiation (seeds or external beam)?  With a strong family history of PCa, I imagine that active surveillance (doing nothing but monitoring the situation frequently with PSA tests and more biopsies) might not be a viable option for you.
 
 

GTOdave
Regular Member


Date Joined Oct 2010
Total Posts : 175
   Posted 11/16/2010 8:27 AM (GMT -6)   
Dennis, I made this very same first post about 6 weeks ago. Sadly, allow me to welcome you to the club nobody really wants to belong to - but is glad that it's here.

Best and worst thing about PC is that there are a number of excellent choices you can make, from surgical to radiation therapies. Some weeks ago, I was daunted by having to make the choice I did, but found amazing comfort in the advice of a poster on this board who said his cancer was caught so late he had NO choice.

Your PC looks to have been detected at a very early stage, so take comfort that you have time to think this through.

If you want, you can IM me and we can talk on the phone. Our ages and scores are very similar and as others have been enormously generous with their time and advice, I'm more than happy to do the same.

Dave
52 yr old, newly diagnosed. PSA 3.5, Gleason 6 with 3 of 4 top nodes (0%;1%;10%;1%) cancerous. Bottom 2 floors are clean.
Da Vinci surgery scheduled for 12/30/10
Hoping that the robot does not become "self-aware" (we all are old enough to get this reference)

Woodworker
Regular Member


Date Joined Apr 2010
Total Posts : 90
   Posted 11/16/2010 11:24 AM (GMT -6)   
Dennis

Nobody wants to be a member of this discussion group. However, we are here. This group has been a huge help for me. I picked up a lot of information the Doctors just don't cover.

The problem I faced was, the Surgeon was pushing surgery and the radiation people were pushing their product. I decided to go to my Primary Care Physician and talk to him (after all he is the one that started the whole mess by doing a good job on my physical). My rationale was, the PCP does not have a particular preference other than what is good for me.

Like you, my PC was detected very early. I have always been very grateful for that. I chose the DaVinci surgery. I had very specific reasons for making that choice and I do not have any regrets.

When I made my decision there were quite a few people that felt like I was making the wrong choice and they were not shy about telling me why I was making a bad choice. Ironically, those people with the opinions had never dealt with cancer of any kind.. I did talk to several people that had been treated for PC. None of them judged my choice.

At the end of the day, it is what is good for you. My two suggestions are 1. Talk to others that have been through this. 2. Research, research, research
Age : 56
Diagnosed 3/29/2010
5mg Cialis daily
PSA 2.7; Gleasen (3+4) Biopsy 2 cores of 12 25% positive
DaVinci surgery 6/25/2010
Returned to work: 7/12/2010
Post Surgery
Final Biopsy report
5 slides of 35 were 2% positive for cancer
Clear Margins
Final Gleason (3+4)
Incontinence: None
ED: 5mg Cialis Daily
Just started on BIMIX. First results were very good

Pocketman
Regular Member


Date Joined Aug 2010
Total Posts : 121
   Posted 11/16/2010 12:42 PM (GMT -6)   
Mavica said...
"but I am not a doctor."
 
Mavica is correct, there's no substitute for professional medical advice.  We will tell you our stories, but your body may not react the same as any of ours.  Which treatment is best for you is between you and your doctor(s).

Age 61, Diagnosed July 2010
PSA 04/09 - 2.5; 05/10 - 3.7; 07/10 - 4.7
DRE and Ultrasound - Negative
Size at biopsy - 32 grams
T1C, 3+3=6, 1 core of 12 60% positive
da Vinci 10/29/10
Post op biopsy indicated bilateral Gleason 6 tumors
Post op plumbing is 95% functional.
ED - Minor

lnwm
Regular Member


Date Joined Oct 2010
Total Posts : 21
   Posted 11/16/2010 9:22 PM (GMT -6)   
Lots of good info and resources listed here. As you will discover, each specialist will push for thier treatment. You have to weigh what is best for you - both pro and con. Have a list of questions prepared for each treatment.

I am 58 and diagnosed in April with Gleason 6 and Stage T1c with PSA of 3.2

I struggled with all of the options but decided on da vinci for a couple of reasons:
1. I wanted the cancer out of me and a pathology report. With radiation, you need to wait over time to see if it is working.
2. My prostate was enlarged already and would still need to be treated for uninary issues
3. I wanted a fall back option if the first treatment failed. With surgery, you can still have radiation as additional treatments. With radiation treatment first, surgery is almost out of the question as radiation turns your organs to a bit of a mess. I had several surgeons tell me they did not know of anyone that would operate on someone that had radiation treatment first.

As it turned out, the surgery was the right choice for me. During the operation, they discovered two hernias that also needed attention that I was unaware of. With radiation treatment, I'm not sure how the hernia repair would have been handled.

I am also on blood thinners which presented their own set of complications. So take into account all of your personal health issues and options. But once you have made your decision, don't second guess it and find the most experienced practioner you can find.

I wish you the best of luck. You are young and have the odds working with you at this stage.
Age 58 Gleason 6 T1C 7/12 samples with 5%-40%. No prior family history of cancer.
Da Vinci Oct 6 2010. Negative margins. Gleason raised to 3+4. Both nerve bundles spared.
First post-op PSA on Nov 17.

Highwayman
Regular Member


Date Joined Sep 2010
Total Posts : 148
   Posted 11/17/2010 12:48 AM (GMT -6)   
Dennis,
At 50 years old and with a low PSA. You probably have three good options. So research. You have a little time to get second and third opinnions. I'm 49 and chose surgury. Sorry you joined the club, but welcome and good luck.
Mike
Age 48 w/diagnosed
10/06 PSA 3.0
11/06 PSA FREE %13.2
10/07 PSA 3.4
12/07 Biopsy-neg
1/09 PSA 4.6
6/09 psa 5.8
2/10 psa 8.7
7/10 PSA 10.8
8/2010 3rd biopsy GG 3+3=6, one of eight cores -2%
Lap 10/22/10 Dr. Troxel
Path- Neg Margins, Gleason 6, Nerves spared, 85 gm
Cath out Nov 2, Ohh! lots of pads.

StretchDennis
New Member


Date Joined Nov 2010
Total Posts : 2
   Posted 11/17/2010 6:00 PM (GMT -6)   
Thanks for all of the good information .. One other thing that I forgot to mention is that my prostate was only 21 grams ... considering my height and weight, that seems to be on the low side for someone with PC also.

I have made an appointment with an oncologist who is also a Urologist who also specializes in the seeds. I am leaning towards DaVinci.

Age: 50
PSA: 1.00 (As reported in May of 2010 ... My PSA in May of 2006 was 0.8)
Biopsy: October 22, 2010 (1 of 12 had less than 5%)
Size at biopsy - 21 grams
Gleason 3+3=6

MrGimpy
Veteran Member


Date Joined Jul 2009
Total Posts : 504
   Posted 11/17/2010 6:34 PM (GMT -6)   
Hi Dennis,

I was also about your age I when first had PC detected, also a very low PSA but a nodule found

You will be meeting a few different Dr's

At 50 you want a backup plan going forward should this rise again..so

ask each Dr

"What would you do if you had done to yourself what you are proposing and the PC returns ? "

Ziggy9
Veteran Member


Date Joined Jul 2008
Total Posts : 981
   Posted 11/17/2010 10:31 PM (GMT -6)   
Please take your time educating yourself on the available treatment options and possible side effects. Some short lived to permanent possibilities.

Do remember that this is largely a radical surgery site and thus most here will recommend that treatment most.

Also in the vast majority of PCa individuals there is no big rush to treatment. You have time to consider, reflect and take some time off when overwhelmed and you will be. Then reconsider all options and be sure you know what you are getting into before the final decision for there are no do overs. Once you make a decision, don't look back. Good luck
Diagnosed 11/08/07 - Age: 58 - 3 of 12 @5%
Psa: 2.3 - 3+3=6 - Size: 34g -T-2-A

2/22/08 - 3D Mapping Saturation Biopsy - 1 of 45 @2% - Psa:2.1 - 3+3=6 - 28g after taking Avodart - Catheter for 1 day -Good Candidate for TFT(Targeted Focal Therapy) Cryosurgery(Ice Balls) - Clinical Research Study

4/22/08 - TFT performed at University of Colorado Medical Center - Catheter for 4 days - Slight soreness for 2 weeks but afterward life returns as normal

7/30/08 - Psa: .32
11/10/08 - Psa.62 -
April 2009 12 of 12 Negative Biopsy

2/16/10 12 of 12 Negative Biopsy
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