For a person diagnosed in their early 40s surgery would be my first reaction too.
However you have years to live with the decision you make, including years of anxiously waiting for PSA test results. That's why it is so important to get it right now and I think it would be a good idea to establish the probabilities of whether this cancer is completely within your prostate.
I think you need to consider three main things in my opinion:
1. A re-read of your pathology slide by an expert. (Bostick, Epstein). If the results come back at 4+4 or a 3+3 instead of a 3+4 this would give you something to think about
2. A MRI-S or a colour doppler. This would be mostly to check whether thre are any extra prostatic extensions visible - allowing your doctor to cut or radiate that area more carefully.
3. Investigate brachytherapy: The seeds destroy your prostate from the inside and radiate the area a couple of mm beyond the outside of the prostate. Its these couple of mm that make this option attractive - you are basically doing a removal and radiation all at once. Brachytherapy's cure rates are as good as surgery with fewer side effects. Worth looking at. The big psychological hurdle to get over is the fact that the prostate is still in you - not something that someone newly diagnosed wants. It's important though to go beyond a knee jerk reaction and think about the scenario where you have a biochemical reccurrance after surgery - in this case Brachytherapy will look very attractive.
My husband waited 4 months after the biopsy to have the surgery but the surgeon said the minimum time was 6 weeks.
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) : 1/27/2011 9:59:18 PM (GMT-7)