Welcome to the club that no one wants to join. I imagine that you would be shocked by your husband’s diagnosis – 39 is a very young age for this type of cancer. But you are very lucky that he tested for it so early in his life, many men don’t start testing till a decade later.
There are a few things I would do before making a final decision as the consequences of your choices are long lasting.
1) Get a expert to review your biopsy slides. This may seem like a time wasting exercise but what I have learnt pretty early is that you really want someone who has looked at 1000s or 10000s of prostate cancers to look at your biopsy slides. You garden variety pathologist deals with hundreds of diseases and cancers and therefore tends to be tentative with his/her diagnosis. I suggest you look up Epstein or Bostwick laboratories and get a second opinion.
2) Read, read and read some more. Two good books are written by Patrick Walsh (Guide to surviving prostate cancer) and Dr Stephan Strum (a primer on prostate cancer).
3) We are not doctors here but a PSA of 10 seems high for someone with such a small amount of cancer. The vast majority of people without prostate issues would have a PSA of less than 2. I would try to find out whether this high PSA is caused by infection, by BPH or by cancer not seen by the biopsy. A good first step would be to get a free PSA test which can help you work this out. People with BPH tend to have a high free % PSA. A course of antibiotics may help determine whether the PSA is caused by prostatitis (if it is the PSA should drop). In your husband’s case it would seem prostatitis was a factor as the PSA did drop so dramatically.
4) There are broadly three options available to you, surgery, radiation (including seeds) or active surveillance. My personal view is that at age 39 I would considering the first two following confirmation of your status. Some people are lucky enough to have an indolent version of the disease and there have been studies showing that if you fit a set of criteria and follow strict guidelines on monitoring that you would not have a worse outcome than if you went into definitive treatment. However in the case of your husband, who is probably not halfway through his life so even slow growing disease would probably affect him at some stage.
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) : 1/12/2011 5:11:33 PM (GMT-7)