50 with prostate ca

Can anyone suggest the best procedure for a 50 year old, psa 5.4 gleason 3/4 healthy ,active not overweight

mgl,

Markus has given you the basics around surgery. I will add just a little more information. First of all you do not say what your stage is but if the cancer was found by a biopsy that was prompted by a rising PSA then your stage is T1c. A Dr. Alan Partin at John Hopkins has developed tables based upon statistics that provide probablitlities of the extent of PC using the Gleason score, PSA and staging. These tables were updated in 2001. I took your PSA and Gleason scores and I assumed your stage as T1c. Based upon these the Partin Tables project that for a Gleason of 6 that there is a 67% probability that your cancer is confined to the prostate organ. For a Gleason of 7 it drops to 49%. The tables also provide a projection for prostate capsular penetration. For your Gleason of 7 the probability is 40% and for a 6 it is 36%. Remember that these are projections not absolutes but it is a piece of information that you should have in making your treatment decision.

One step that I would suggest that you take is to have your biopsy path slide read by another pathologist. Many of us have had our slides read by Dr. Jon Epstein at John Hopkins as he is a noted expert in the field of prostate cancer. Since the first reading had a 6 and 7 it would be good to know if this is confirmed. It also makes a difference as to how the 7 is derived. Either 4+3 or 3+4.

You have not said what your urologist has recommended. If he/she is a local urologist then most likely the recommendation is an open radical prostatectomy. The question comes down to the basics of surgery versus radiation then within those two what type of surgery and what form of radiation. The determination of whether or not the cancer has been addressed is different between the two. With radiation continuing PSA checks are the only way to know. With surgery the prostate is removed and pathologically analysized. This confirms whether or not the cancer has been contained in the prostate and/or additional treatment is required. Within the surgery field there is open and robotic(Da Vinci). The results of both for incontinence and impotence are close to being the same. With surgery if the cancer has gotten out of the prostate then it is known and additional treatment is done with radiation and or hormones. With radiation in general surgery as a follow up is not possible due to the tissue damage done in the prostate area by the radiation. There are several forms of radiation which you can research. I would suggest that you go to www.yananow.net and when you enter the site click on mentor experiences and scroll down. You will find here the stories of men that have chosen a treatment for PC and their experience with that treatment. The stories are listed by type of treatment. When I was at the point on my journey that you are at I read everyone of these stories. Some of them are scary so I warn you in advance.

In closing you should be comforted in the knowledge that your PC is curable. Do your research. Get more opinions from different providers of treatments. If you can make an appoitment as a major medical center or univeristy based medical center. You will get less biased based recommendations at these centers then a private practice urologist or oncologist.

Keep us informed and ask any and all questions of us on this forum. You will quickly get a lot of hits on your posting.

Good luck!

Tamu

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Diagnosed 7/6/06

I suggest that you also research Proton Beam and Image Guided radiation therapies.  Go to protonbob.com and Google IGRT and IMRT.

Regards,

Bill

I had surgery Jan 19, and am glad I did.  While my pre surgery biopsy was small, the post surgery pathology report was worse, with positive margins and gleason raised to 7.  Now I'm waiting until March 13 to get my PSA test results and praying/hoping for good results.  My surgeon's words were that the best news is that the prostate is out of my body now!  Bottom line is that you don't really know the full extent until they can look at the whole thing.  As far as side effects of surgery, the catheder wasn't as bad as I had feared, and one week from removal, I'm wearing a pad, but only get a "drip" occasionally.  Still working on Kegals and getting better.  I'm walking a couple of miles a day - split into two sessions - and feel very good.  I only have to watch myself so I don't try to do too much.

Proton has a wonderful reputation. Those who report their experiences have pretty much had nothing but good things to say. Those who have brachy successfully also say good things....this is true with virtually every procedure. If things went great it's a great procedure. If things weren't so great, a few regret their choice.

There is one slight difference with surgery patients that is not found with any other procedure though. For those who cannot handle being in the dark on the exact extent of thier cancer, they will choose surgery every time. For some surgery represents removing a very scary cancer so he can emotionaly move forward. In otherwords, surgery is more than a treatment with side effects. For some it is relief.

Paul would have chosen Proton perhaps had he been able to have radiation by the way, Dutch.
JustJulie's hubby would maybe have chosen surgery had he been able to perhaps. It's all a personal decision. It is rare that a man regrets his own decision

Welcome Dutch, Maybe in the future we can hear from you on your own personal thread...sharing your journey.   It’s a wonderful gift we can give to others.  Take care and our thoughts and prayers will be with you and your brother.   In Friendship ~ Lee & Buddy mama bluebird - Lee & Buddy… from North Carolina Link to our personal journey…>>>      Our Journey ~ Sharing is Caring   April 3, 2006  53 on surgery day RRP / Radical Retropubic Prostatectomy with "wide excision" PSA 4.6   Gleason  3+3=6    T2a   Confined to Prostate June 29th ~ PSA Less than 0.1 Non-detectable

Swim:

In reply to your comment "It is rare that a man regrets his own decision" - I know of 5 men in my close circle who regret their decision (3 surgery, 1 IMRT, 1 Cryo).  Being men it might be more accurate to say it is rare to find a man who will admit regret in his decision.  Unlike breast cancer that has been discussed for years, Pca has only fairly recently come out of the closet so to speak.  Men are beginning to learn that they can say "No" to their doctor and do their own research.

Dutch

Swim:

I agree with your opinion on breast cancer and that was the point I was trying to make - that men need to take a more active role in their health as women have done for years. 

Sorry if I upset you.

Dutch

 

Sorry to hear that.  It's no fun but remember, you can live without a prostate!

There are several options and one that is right for me might not be right for you!  I was 50 when I was diagnosed with prostate cancer and am 51 now.  I had a radical prostatectomy using the daVinci robot in June, 2006.  I am well now with NO CANCER and feel great.  I can't stress enough that you need to get a good urologist.  He will be your best friend...and you will ask him questions you haven't ever thought about yet, ones that you wouldn't ask anyone else...or at least that has been my experience.

Each person's situation is different so talk with your urologist.  If you don't feel comfortable with him get another one.  I think we ask questions that we wouldn't normally ask when we are faced with something as serious as cancer can be.  Don't be inhibited.   Urologists have heard it all and are not embarassed by anything you might ask them.

Best of Luck!

 

 

mgl - I can only echo what others have said. the hardest part was making the decision, even though Jeff would not even consider anything other than surgery. but once the decision is made and a date is made, you will mentally and emotionally feel better. you have time to do your research so read and ask anything you want. take care, kat

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Husband Jeff 56 years old diagnosed July 27, 2006
PSA 6.5, 2 positive areas in biopsy, Gleason 3+3=6
Radical Retropubic Prostatectomy August 30, 2006
pathology report - all clear - cancer gone
1st post-surgery PSA test 0.1, 2nd post-surgery PSA test 0.1
no more pads Oct 12, 2006
first "real" erection with use of pump 12/16/06