Newly diagnosed as of last Tuesdsy...

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Mholiday
New Member


Date Joined Jan 2011
Total Posts : 7
   Posted 1/6/2011 8:38 PM (GMT -6)   
In addition to the info in the subject I have been married for 17 yrs. and I HAVE A 3 year old!! I am slowly coming out of the shock of all this. I have begun my research and so far it appears from my research and talking to others that although there are many treatment options the 3 options for my situation are: seeding, prostatectomy, & watchful waiting( I don't get a warm fuzzy feeling with this option).

My psa has been stable for 6 months. It was 8.6 in May of this year and was 8.4 in November. My primary physician failed to inform me of my May psa which was my first one, that's a whole 'noter story! Anyway, after it showed 8.4 in late Nov. that led to my biopsy. Out of the 24 samples taken 6 were cancerous. All carcinomas were 3+3 & less than 10% of the biopsy sample. My prostate is not enlarged and weighs about 42 gms, 8.62 max psa. I found all this out Tuesday.

So far as I can tell only older men in my family have gotten prostate cancer. My grandfather was diagnosed in his mid 80's, he received hormone treatment and died at 96 1 1/2 years ago. My Uncle, his brother, who is in his mid to late 80's is doing great with it. Looks fine to me, you really can't tell it. My father who is 66 psa is still < 1! I sort of wonder if both were like me years ago, pre psa testing, and just lived with it not knowing until the testing became more in use. Kinda makes you wonder???

In the time I've learned of my dreadful news I have already talked to a guy who went to college with me and he to is a 43 yr. old African-American who as of last Tuesday had a laparoscopic prostatectomy. His psa was 5.1, gleason 6, 1-12 positives in his biopsy, yet he had a prostate the size of 60 yr old. Once they removed the prostate he had cancer on both sides and was closer to gleason 7.0 yet still localized. He was in real good spirits. His surgeon at Wake Forest in Winston Salem had 20 yrs experience and had performed over 100 of these surgeries. His surgeon told him that out of the people he'd done < 3% had incontinence problems and < 3% had ED. His catheter came out Tuesday (no incontinence once the cath came out) and he expected to make a full recovery.

At this time I have not decided which treatment I'll take, but coming here and researching should help me do what's best for me. I MUST live long enough to see my son's milestones, i.e., first day of school, getting his driver's license, graduating high school, etc. I want to die old, yet I know I don't get to decide that and as my journey with prostate cancer begins so will my DETERMINATION. My determination to soldier on because no matter what I am still a husband, still a Daddy, still a son, still a brother, still an uncle, & still a friend...and STILL ALIVE!!!

Regards and God Bless!

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 1/6/2011 8:47 PM (GMT -6)   
Mholiday,

Welcome to HW Prostate Cancer, and our little corner of the world. That was a great introduction you gave there. Its important not to rush into a primary treatment at this point. Consider all options. Looks like you are surrounded by folks in your real life with PC, so at least its not alien to you.

Ask all the questions you want, no such thing as a dumb question. There are folks here experienced with most forms of treatment, including Active Surveilence. Unless I didnt see it, what is your age?

Please keep us well posted, you will fit right into the gang here.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 1/6/2011 9:14 PM (GMT -6)   
Hi Mholiday,

Welcome to our forum. The one good thing about prostate cancer is that it is normally a slow growing cancer giving you time to do your homework and make decisions that you will not regret in the future.

Can I suggest the following?
1)   Get your slides re-read by a specialist pathologist. All pathologists are not the same and your garden variety pathologist deals with hundreds of different conditions. Reading prostate cancer from biopsies is an art and you really want a specialist pathologist to review your slides. Epstein and Bostwick are two such specialist laboratories. You can organise the re-reading of your slides through your urologist.

2)  Whilst your are waiting for the re-read pick up two books. The first is "A primer on prostate cancer" by Dr Strum the second very readable book is the "Guide to surviving prostate cancer" by Patrick Walsh.

3)  Unlike most cancers the first specialist the average person sees is a urologist - a surgeon. In most other cancers the person you would see first would be a oncologist who would recommend radiation, chemo or surgery. Because you see the urologist first most people automatically end up having surgery where in many cases there are better options. See a second urologist, an oncologist that specialises in prosate cancer and a radiation specialist.

4)   A radical prostetectomy is close to being the most complex operation done by surgeons. If you go down this path you want to pick someone who has done a lot of them and has a great reputation and stats. 500 ops would be the minimum and there are quite a few doctors in the US who have done over 2000 of them. You only get one shot at this op, your entire life lies ahead of you and you want the trifecta if possible - cure, continance and no erectile dysfunction.

5)   With PCa and given your post above the main options include the radical protetectomy, seeds and other forms of radiation. Each of these have pluses and minuses and there own share of risks and side effects.

Most of all, don't rush into anything. You have plenty of support at this forum, should you need it.
Regards,
An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01

Post Edited (An38) : 1/6/2011 7:18:35 PM (GMT-7)


Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 1/6/2011 9:33 PM (GMT -6)   
Welcome to the place nobody wants to be Mr. Holiday...43 years old, I can only imagine how you must feel...before you do anything, three books, by Walsh, Strum and Blum / Scholz. They are all MD's..read them all and you will have a SOLID foundation on which to base a treatment decision.. the one by Patrick Walsh, "Guide to surviving prostate cancer" is the bible, the other two offer important counterpoints..

One the bright side..Almost nobody dies of Gleason 6 PC...No matter WHAT treatment you choose, you will probably die from something else..So it becomes a choice between side-effects..

The guy has done 100 surgeries and 3% suffer incontinence and 3% suffer impotence? The best surgeon in the country has a rate of about 40% for both those 'side-effects'..Maybe a little less for incontinence.. Realize that they ALL stretch the truth about side-effects..

So for now, learn all you can, read all you can, ask all the questions you can and then and only then decide how you are going to deal with this..
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT NOW

Post Edited (Fairwind) : 1/6/2011 7:36:33 PM (GMT-7)


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4274
   Posted 1/6/2011 9:47 PM (GMT -6)   
Dear M:
 
Welcome to HW...though I am sorry you have to be here.  You have already received some excellent advice from Fairwind, An and David including some great books that you should read.  I won't add anything to their advice at this time except to recommend you read the thread started by Harryheart that is still on page 1.  Harry was just diagnosed and there are a number of replies that can apply to both of you.
 
Good luck and please keep us posted on your progress.
 
Tudpock (Jim)
Age 62 (64 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Procedure went great, catheter out before I went home, only minor discomfort. Everything continues to function normally as of 12/8/10. PSA: 6 mo 1.4, 1 yr. 1.0, 2 yr. .8. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1305643

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 1/6/2011 11:12 PM (GMT -6)   
Mholiday,
 
Welcome to HW. It looks like you are getting a good introduction here.
 
I agree with the comment that a lot of experience for your surgeon is a must, and the 3% problem rate sounds optimistic. If you have any way to get some other references for him it would help. "More than 100" does not sound like a lot, but then it might mean 101 or 500, and he may do them well, so I will only advise that you double check, perhaps ask your GP what he knows about the surgeon.
 
Again, Welcome.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Mholiday
New Member


Date Joined Jan 2011
Total Posts : 7
   Posted 1/7/2011 6:02 AM (GMT -6)   
I forgot...I am 43...the same MH found on another Pca forum. I have read Walsh's book, scanned "Invasion of the Prostate..." & I've also scanned another book I have, but I can't remember the title. I went back to my uro Wednesday accompanied by my wife, mother and father. I'd be lost without my family! My uro was impressed with how much I'd learned in a week since my Dx and said that he needed me to talk to some of his patients :). I was premed in college and that has seemed to help with learning all the lingo so fast.

I have already had my slides sent to Duke Medical Center. They are ranked #8 in urology and #12 in cancer by "US News &...".

Although I have seemed to be adjusting well to my " world- shattering" Dx, I at times find myself looking in the mirror and saying, "da#*, I'm 43, my son is 3, I'm happily married and I have cancer". Even as I type this it still feels like a dream...a nightmare which seems to never end!

Thanks for the info!!!

GOP
Veteran Member


Date Joined Dec 2010
Total Posts : 657
   Posted 1/7/2011 6:53 AM (GMT -6)   
MH, you will survive this. The question is, which treatment option best fits your lifestyle. I did the watchful waiting for 2 years and would still be doing it if I hadn't 'progressed'. I knew of a guy who 'watchfully waited' for 11 years before having treatment. You just have to have a very good doctor to keep close watch on it with you.
When I needed treatment, I chose seeds, and I have no regrets...and very minimal side effects. I would recommend the following book to you: Surviving Prostate Cancer Without Surgery by Bradley Hennenfent
Odds are that you will enjoy a long life with your family.
God Bless
Diagnosed in October, 08. One sample of needle biopsy showed Gl 6. Did watchful waiting for 18 months. PSA went fro 4.3 to 6.1. Surgery scared the heck out of me. Went to Schifler Cancer Center in Wheeling, WVA and spoke to a radiation oncologist. Had a mapping biopsy where 60 samples are taken. 15 were GL6, 1 was GL7. Had the brachytherapy on Oct. 4, 2010

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 1/7/2011 9:20 AM (GMT -6)   
Hi Mholiday,

The expert pathologist that are on Dr Strums list are listed below. I would really want one of these laboratories to look at my slides if I lived in the US.

David Bostwick (Virginia) [800] 214-6628
Francisco J. Civantos (Florida) [305] 325-5587
Jon Epstein (Hopkins) [410] 955-5043 or 410-955-2162 (Dr. Epstein does not
do ploidy analysis)
David Grignon (Michigan) 313-745-2520
John McNeal (Stanford) [650] 725-5534
Jon Oppenheimer (Tennessee] [888] 868-7522
Dianon Laboratories 1 [800] 328-2666 (select 5 for client services)
UroCor, Inc. 1 [800] 411-1839

Regards,
An
Husband's age: 52. Sydney Australia.
Family history: Mat. grandfather died of PC at 72. Mat. uncle died of PC at 60. He has hereditary PC.
PSA: Aug07 - 2.5|Feb08 - 1.7|Oct09 - 3.67 (free PSA 27%)|Feb10 - 4.03 (free PSA 31%) |Jun10 - 2.69. DRE normal.
Biopsy 28Apr10: negative for a diagnosis of PC however 3 focal ASAPs “atypical, suspicious but not diagnostic” for PC. Review of biopsy by experienced pathologist, 1/12 core: 10% 3+3 (left transitional), 1/12 core: ASAP (left apex)
Nerve sparing RP, 20Aug10 with Dr Stricker. Post-op path: 3+4 (ISUP 2005). Neg (margins, seminal vesicles, extraprostatic extension). Multifocal, with main involvement in the fibro-muscular zone. T2C.
Post RP PSA,
Lab 1: Sep10 – 0.02|Nov10 – 0.03|Dec10 – 0.03
Lab 2: Nov 10 - 0.01|Dec10 – 0.01

Mholiday
New Member


Date Joined Jan 2011
Total Posts : 7
   Posted 1/7/2011 9:33 AM (GMT -6)   
Obviously, I'm still in the research phase of what option to chose, but one question that continues to pop in my head is, if I chose brachy what is the backup plan if it fails? Actually, Cyberknife seems a viable option too, but the same question remains. I'm leaning towards RP because I could still get rad if it doesn't yield positive results. Am I correct in my conclusion?

Thanks!

Cajun Jeff
Veteran Member


Date Joined Mar 2009
Total Posts : 4119
   Posted 1/7/2011 9:45 AM (GMT -6)   
That is the kind of questions best answered by the Radiation guys. Also throw that out to the Uro as well. I actually did the RP for the same reason that you state. So for at 2 years out no PSA climbing. At this point have not had to use the other options.

Cajun Jeff
9/08 PSA 5.4 referred to Urologist
9/08 Biopsy: GS 3+4=7 1 positive core in 12 1% cancer core
10/08 Nerve-Sparing open radicalSurgery Path Report Downgrade 3+3=6 GS Stage pT2c margins clea
r3 month: PSA <0.1
19th month: PSA <0.1
2 year PSA <0.1
Only issue at this time is ED but getting better

Wigs
Regular Member


Date Joined Mar 2009
Total Posts : 89
   Posted 1/7/2011 10:10 AM (GMT -6)   
Mholiday,

I am glad to see that you are thinking about backup plans. By all means, discuss these with your doctors. I was 46 when I was diagnosed and chose brachytherapy. My biggest concern was being incontinent at that age. All my doctor said was if I had a re-occurance it would be a difficult surgery. That didn't register with me and I didn't ask what he meant or what my options would be.

Wigs
Diagnosed @ age 46 - September 1997
PSA 5 / Gleason 3+3
Seed Implant - January 1998 @ Trident Hospital, SC
PSA 2.4 - July 2007
PSA 2.7 - July 2008
PSA 3.0 - November 2008
Diagnosed @ age 57 - December 2007
Gleason 4+3
Salvage Prostatectomy & Colostomy - March 2008 @ MSKCC, NY
Suprapubic cathether installed - July 2008 @ Cleveland Clinic, OH
Urethral-Rectal Fistula Repair - August 2008 @   Cleveland Clinic, OH
PSA < .03 - Aug 2008
Penile catheter removed October 2008
Suprapubic catheter removed December 2008
Colostomy Reversal - January 2009 @ Cleveland Clinic
Urethral stricture removed - January 2009 @ Cleveland Clinic
(Total incontinence - 4 diapers & 6 - 8 pads per 24 hour period)
PSA < .03 - Jan 2009
AUS implant - May 2009 @ Cleveland Clinic
PSA < .03 - May 2009
AUS activated - July 2009
(Wearing a light pad daily.)
PSA < .03 - July 2009
Penile Implant - December 2009 @ Cleveland Clinic
PSA < .03 - December 2009
Penile Implant activated - February 2010
PSA < .01 - April 2010 
 

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 1/7/2011 10:10 AM (GMT -6)   
Welcome to HW, sorry you have to be here. The others have answered and suggested various things, but one hasn't been mentioned yet. We usually don't discus this here, because of our ages. At your early age, and with a 3 year old, if you are a late starter and still building your family, then you will need to decide if you are gonna plan for more children. If so, that aspect must enter into your planning. RP results in instant sterility, and there's other dangers to sperm in Radiation. So depending on your family planning goals, this should be a part of your discussion when talking to the doctors. Consider sperm banking if you wish to add to your family later. Just another thing to add to your list. tongue
James C. Age 63
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 01/11-.09
ED-total-Bimix 30cc

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7084
   Posted 1/7/2011 10:14 AM (GMT -6)   
MH,
 
Non-medical person speaking here -
 
I would think that if you get any significant difference between the original and second biopsy, that you send it to Bostwick. That is the lab of choice for my uro, and they are good folks to work with. I had insurance issues, and Bostwick took the initiative to resolve them in my favor. Nothing but good to say about them, based on experience.
 
I did DaVinci, and followed with adjuvant RT (my biopsy was much worse than yours, and it was pretty much a given that RT was coming). I wanted seeds, but was just too far along. They may offer a good option for you.
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

MCinNC
New Member


Date Joined Sep 2010
Total Posts : 13
   Posted 1/7/2011 10:40 AM (GMT -6)   
Noticed you mentioned Duke - wasn't sure if you live in that area or not. If so, you should know that both Duke and UNC have prostate cancer clinics where one visit will get you in to see a surgeon, a radiation oncologist, and a medical oncologist - all who compare notes on your situation and can provide you feedback. I was diagnosed last fall and went to both, and found each to be a very helpful, and very different experience. Also, UNC has a CyberKnife group too if that is one of your interests.

Best of luck in the journey.

Mac
Age 56. 7/22/10 biopsy results confirmed on 8/17/10 showing 1 of 12 positive, with 5-10% of core tissue involved. Gleason of 3+3=6, PSA before biopsy 2.3. Nothing on DRE. Family history (father) with PC. Stage: T1c. General health good.

Currently on active surveillance.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/7/2011 12:37 PM (GMT -6)   
Mholiday,
Re backup plans: Before considering backup plans it is useful to know why certain treatments fail in the first place.
Surgery fails because the PC is outside the surgical margin, is in the seminal vessicles . Most surgeons leave small amounts of prostate tissue, because they can never get 100%. The most common areas where this is left is in the APEX and around the nerves. This is the type of surgical failure than can be corrected with salvage radiation. On the flip side this type of faiure although common in surgery (21-31%) is not likely to occurr in any form of radiation.
The common cause of radiation failure is too low a dose, dead spots, and cancer outside the margin. It is also harder to kill very large tumors in a very large prostate.
The most common salvage techniques for failed radiation is brachytherapy, both low and high dose, cryosurgery and HIFU. All of these have the exact same cure rate as salvage treatment for failed surgery, because all salvage treatments are mearly cleanups for a botched primary treatment.
 For low grade PC, which you have, it is rare to have positive margins or a large tumor that spreads into the nerves, seminal vessicles or nerves.
This is why all primary treatments for PC, surgery, external radiation and seeds all have the same cure rate. Radiation does a better job in getting to the hard to get at places where cancer cells may be left behind such as around the nerves Apex and 10mm into the prostate bed.
Choosing a primary treatment based on being able to use a secondary treatment is a fool's folly. Choose the best primary treatment based on the biology of your cancer and its size and location to cure it the first time.
Also with low grade PC the risks of every dying from it are very slim, so a major consideration are the side affects from the treatment option. For a younger patient the side affects should be the primary consideration because the cure rates are so high and you have many years left in which to suffer the side affects of the treatment.
Do not exclude Active survelience, because you can always be treated later with the same results as immediate treatment. This has been confirmed by many studies.
JohnT

An38
Veteran Member


Date Joined Mar 2010
Total Posts : 1152
   Posted 1/8/2011 4:20 AM (GMT -6)   
An important lesson we took away was the importance of gathering as much information as possible about the cancer we were dealing with.

Mholiday, a biopsy is only a snapshot of the prostate and sometimes not a very accurate one, often low grade cancer ends up being higher grade post surgery or in the next biopsy. However since you can only work with the biopsy you have, you need to work out what is happening in your prostate by verifying the biopsy with the best possible patholgist (eg Bostwick or Epstein), gathering additional information (MRI or colour doppler, additional blood tests). These tests will halp you assess the consider the likelihood of whether your cancer is close to the margin or has left the prostate completely - and that helps in choosing the right treatment.

Dr Strum, a hightly respected oncologist in the field of prostate cancer, used to do free consulations with patients online. This is a discussion with patient with a prostate size similar to yours but a lower PSA.

http://www.prostatepointers.org/p2p/2003/Dec/0012.html

It is important to try to get as much verified information as you can prior to making your decision as to how to proceed. Obviously as John says above, issues with side effects are another set of issues to consider.

An

Post Edited (An38) : 1/8/2011 2:30:40 AM (GMT-7)


GOP
Veteran Member


Date Joined Dec 2010
Total Posts : 657
   Posted 1/8/2011 8:02 AM (GMT -6)   
I gave more consideration to the primary plan than the backup one. I found a world renown oncologist and tried to give myself the best first option possible while avoiding the side effecs of surgery. For the record, while it is much more difficult, surgery after brachy is possible, but again I rolled the dice on what I though was the best first choice. So far, no regrets.
Right now I am struggling with another problem. I have a friend who was diagnosed recently. His diagnosis is far less 'significant' than mine was, and I was able too watch and wait for 2 years before even considering treatment. He has been ooffered this option, but instead has chosen to have an open prostectomy next month. I think he is making a horrible mistake, but he is at peace with his decision, so I hesitate to say too much. What really pisses me off is the way he was manipulated by the surgeon. I won't mention the name here, but many of you would recoognize him. My friend told me that after his biopsy, he had some pain when he gets an erection. The good doctor used this by telling him that if he watched and waited, he would have to go through this every year. What he didn't tell him was that if he has the surgery, he sure as hell won't have to worry about a painful erection...or any other kind. In my opinion, he is pushing my friend to have this most radical of surgeries on what most would consider an insignificant cancer. And I don't think this type of behavior is rare.

Post Edited (GOP) : 1/8/2011 6:05:34 AM (GMT-7)


Herophilus
Veteran Member


Date Joined Sep 2009
Total Posts : 664
   Posted 1/8/2011 12:41 PM (GMT -6)   
M
Sorry about the news. I can't add a thing to what has been shared.
Except as you say... God Bless.
Hero

Putt
Regular Member


Date Joined Aug 2010
Total Posts : 154
   Posted 1/8/2011 6:21 PM (GMT -6)   
Looking ahead is a fools folly??????
Mholiday, you are going to find opinoins here that are based on personal experience of each writer. They can vary as wide as what is going on in the political world. Surgery | Radiation. Most writers in this forum can be found in the center of the spectrum, but those with narrow vision are also posting their recommendations. Always keep in mind that right now you should gather facts, consult with the professionals, and make a decision that is comfortable for you and your family. A lot of excellent information can be found on this site, just take it all with a grain of salt until it can be confirmed by your medical team.
PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3bc NO MO, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.42, 12/10 47. Will start ADT3 after PSA reaches 1.2.

Mholiday
New Member


Date Joined Jan 2011
Total Posts : 7
   Posted 1/9/2011 1:17 PM (GMT -6)   
I went to a RO Friday. He discussed brachy & rad for me as options. He was very knowledgable. Also, my family and me liked him. Buuuut, he was young! about 30 if I had to guess and he has performed about 80 brachy's while on his own and more while in residency. I asked, "What skills of another older dr. with more experience have gained that he wouldn't?". Almost without hesitation he stated, " Would you rather have a Dr. who had done several hundred and not be as detailed or someone who hadn't done as many who is very detailed and pays attention to the details"? I thought, "D$&m, he's good and confident.". Also, he'll be working as a "team" with my uro. Which I guess is good because he "knows" my prostate.

Anyway, no decisions have been made. My next trip is to Duke Med Ctr. For a tour of their "Multiple Disciplinary Facility", but that young fella is on my short list! Besides, my current primary is in his 60's, is well known as a good doc in our area, but he had my psa, first one, taken in May. It was 8.6 and he didn't say a word!! I didn't know until December! In fact, back in May his nurse left a voicemail stating that he said, "Everything looks good. Keep up the good
work." The tests were part of my normal blood chK because I take a statin. So having a more experienced doc didn't payoff that time!!! His office is always overbooked and he always seems rushed. I had been debating with myself for about 1 year to find someone else, but I was trying to stay with the same doc so that he would be familiar with "me". Boy, was I wrong! He missed that May psa, you could see it on his face as I recall now!

Sorry so long, but you guys are MAJOR THERAPY for me!

Thanks!!

Kongo
Regular Member


Date Joined May 2010
Total Posts : 36
   Posted 1/9/2011 5:55 PM (GMT -6)   
Mholiday,

Let me add my welcome to the forum as well. One of the options you mentioned was CyberKnife and I chose that as my treatment course with a 3+3=6 Gleason, PSA of 4.3, 1 of 12 cores positive with 15% involvement. No physical symptoms and DRE was normal.

During the course of my investigation and research I consulted with open and robotic surgeons, a brachytherapy specialist, another radiologist that uses IMRT, and proton therapy at Loma Linda Medical Center in Southern California.

As you're learning now, most of the treatments for initially diagnosed low risk PCa have similar success rates. For me, it became a matter of minimizing potential side effects while getting the best shot of eliminating the cancer. I built a matrix that listed treatments across the top and side effects and other factors important to me along the Y-axis and ranked them according to my priorities of quality of life after treatment. At the end, I ended up with CK and I have no regrets.

I agree with another poster who suggested that choosing a primary treatment based on secondary options was foolish. I think you should go for the best option possible and CK, like other forms of radiation, has back up options too although to date very few have been needed.

I encourage you to consult with a CK radiologist directly if you are interested in this procedure. Most other radiologists or surgeons will not be familiar with this hypofraction approach or why CK is particularly effective for low risk prostate cancers because of alpha/beta ratios and dosage patterns.

I had my treatment in June 2010 and have zero side effects. No urinary issues, no bowel problems, no ED, no fatigue. My PSA has steadily dropped from pre-treatment PSA of 4.3 to 0.83 at the end of December.

Other treatments will probably be equally effective for you in treating the PCa but all will have varying degrees of side effects. Make sure you understand them all completely before you make your decision. I also suggest that you consult directly with a specialist in the area you are considering. Don't ask a DaVinci surgeon about open surgery and don't ask a IMRT specialist about brachy or protons or HIFU.

As others suggested, I would also get a second opinion on your biopsy report.

Best of luck to you.
============================
Age:  59
Dx:  March 2010
PSA @ Dx:  4.3 (Latest PSA = 2.8 after elimination of dairy)
Gleason:  3+3=6 (confirmed by second pathologist)
Biopsy:  1 of 12 cores contained adenocarcinoma at 15% involvement and no evidence of perineural invasion
DRE: Normal
Stage:  T1c
Bone scan and chest x-rays:  Negative
Prostate Volume: 47 cc
PSA Velocity:  0.19 ng/ml/yr
PSA Density:  0.092 ng/ml/ccm
PSA Doubling Time:  > 10 Years
Treatment Decision:  CyberKnife radiation treatment in June 2010.  Side effects:  None
 
 
 

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/9/2011 10:54 PM (GMT -6)   
Cyberknife is a treatment option that has been rarely discussed on this forum. I was initially very skeptical of cyberknife. I have recently read some preliminary 5 year data on cyberknife and it appears to be very favorable; especially the lack of side affects. It is definately an option worth researching and I hope others that have recieved this treatment would post their experiences.
I totally agree with Kongo that information about other treatment options outside a doctor's speciality may not be reliable. I was told by my surgeon that I was not a candidate for brachy when if fact it was the best treatment for my particular tumor.
JT
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.

Paul1959
Veteran Member


Date Joined Nov 2007
Total Posts : 598
   Posted 1/10/2011 11:58 AM (GMT -6)   
Mholiday
i was 46 at dx, so I pretty much know what you're going through. Had a good buddy dx at 444 too.  My email is open in my profile if you want to talk.
 
Please keep in mind that this disease is mostly studied and focussed on men in their later years. For us guys in our 40's the rule DO change and the same thinking that applies to other cases does not apply here. So, all the stats, etc, do NOT apply to guys in their 40's. Even the doctors forget that from time to time. Everyone loves to quote stats, but those stats are not based on your age group. 
 
I am doing fine. 0's, continent, and functioning with viagra. Sex is fine, but I miss the old sex. Know one guy who was functioning 10 days after surgery. Every doctor wants to have a young patient cause the recovery of young patients improve their stats!  You will be fine - you've got some rough paddling ahead, but you'll be fine.  We were done having kids. But as Jim said, freeze your sperm if you want more. 
Paul

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 1/10/2011 2:03 PM (GMT -6)   
You have been getting a lot of good information about treatment choices, and are probably feeling overloaded. But let me urge you to read the thread about walking. Aside from making an informed choice there isn't much you can do about your cancer treatment but you can make lifestyle changes right now to improve you chances of having many more years to watch your child grow up.
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