Don't panic! Even "high grade" tumors are somewhat slow-growing, but it is important to get a plan as soon as you can.
Just looking ahead, but I would not take no for an absolute answer about
surgery, unless there is some reason your dad cannot undergo anesthesia. I think surgery is the most probable for a cure. If the cancer is outside of the prostate, many old school doctors don't want to operate, because they think, why subject the person to the stress and risk of surgery, "when the horse is already out of the barn." But, in possibly the Scardino book that I mentioned in the previous post, it is said that the surgery might be considered even there is extension of the cancer out of the prostate gland. The reason for this is that if the tumor grows enough, it may block the flow of urine which will be lots of trouble. The only reason, it seems to me, to keep the darn thing in is that there are some experimental treatments that involve gene therapy in which they use the prostate to attack itself. My doc is doing this in Houston.
The website, http://www.davinciprostatectomy.com/hospitals.html, gives names and
locations of doctors who know how to do the robotic procedure around the country. I looked and there is a load of docs in the Orlando area that do the robot. The robot is about
5 years old and not all docs are familiar with it. I don't own stock in Intuitive Surgical, the company that makes the robots, and I'm not a surgeon, but I'm just a happy, satisfied customer. The robot is not a toy, it is not experimental, and don't let any doctor tell you different. It is becoming standard of care, not only in urology, but also in OB/GYN. The robots are going in all over, and are being used for cardiovascular, GI, and the above mentioned specialties. One has to go to a doc who has done a hundred or so of these, because there is a learning curve. This is mentioned further in my doc's department website, www.baylorurology.org (go that site and click the word that lets you
open their online magazine, Pathways. There is an article about
him and his partner who do the robotic technique).
The website from the robot company also has an animation about
how the surgery is done. It is minimally traumatic, because it is laparoscopic. In addition to minimal loss of blood, a patient only has five or so little incisions in the abdomen, about
half an inch long, except for the navel one which is maybe two inches. Unless your dad is not a good surgical candidate because of an anesthesia risk, I think surgery should not be ruled out just because of his age. I mean, they do hip and knee replacement operations on folks older than him.
The books gave me information such that I would not be a big fan of anything that leaves even one prostate cell in the body, because eventually it could become cancerous. I ruled out any kind of radiation as first line treatment, because it can be fatiguing to middle-aged or older people, and, although they can focus the rays pretty well these days, they still go through the body and can affect bowel elimination, something that surgery practically never does. Nevertheless, sometimes, radiation has to be done, even after surgery, to kill off any cells that may have gotten out. The radioactive seeds can cause the bowel problem and can eventually cause irreversible erectile dysfunction, something that is usually affected but can come back with the surgery. You may hear about
cryotherapy, in which the majority of the gland is frozen then thawed and removed through a catheter. This leaves some tissue. High intensity ultrasound (HIFU), which some people go to Canada for because it is not approved in the States yet, "cooks" the gland and, then like cryotherapy, it is removed through a catheter. This also leaves some tissue. Hormone therapy, which is really testosterone withdrawal or negation therapy, is what they give to people that are so advanced that nothing else will help. It kills the hormone-sensitive cancer cells but can leave the hormone-insensitive cells.
I am probably putting a bit of a cart before the horse, because you don't have a lot of the details yet. But, if the doctor that you have already seen said it is a high grade tumor, then you have some time to study, but maybe not as long as the lower grades. So, this is just a start for your consideration. Don't be hesitant about
getting several opinions, but ask them the hard questions about
what their relapse rates are and what percentages of each kind of side effect they have had.
Keep us posted,
PSA (10/04): 2.9; PSA (2/06):4.4, on Androgel (serum T about 450) at age 56; negative DRE, no symptoms.
PSA (5/06):5.7 with a free PSA% of 8, OFF Androgel (serum T 163).
Biopsy (5/06): 4/12 samples positive; postitive samples only on right side; max Gleason 4+3=7 (in 2 of the 4 -from area nearest bladder.
DaVinci robotic-assisted laparoscopic radical prostatectomy + bladder lift + Right nerve plastic surgery (8/23/06).
Catheter out 4 weeks postop, due to internal pinhole leak at bladder-urethra junction.
Final pathology report:T2c-both sides,but in capsule; neg. margins, neg. lymph nodes, neg. seminal vesicles; final max Gleason still 4+3=7.
Follow-up PSA (11/06): <0.008; serum T: 195 OFF Androgel (at present).