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

MGL,

First off, sorry buddy, to hear the news and see you here having to ask such a question. I'm 53, most recent psa 3.76 gleason 6, 3 of 12 cores cancerous.

The general "rule of thumb" is that there isn't any one "best" procedure, because the treatment needs to address your specific situation. For example, if an individual were found to have extracapsular extension, or suspicious spots somewhere else in their body, then some of the treatments which focus on the prostate alone would not probably be appropriate.

For those of us whose cancer appears to have be caught while it is still contained within the prostatic capsule, the general consensus is that either the brachytherapy seeds or a prostate surgery are good options.  On this board, however, there seem to be a fairly large number of people who have elected to go with the da vinci robotic surgery. This is what I have chosen to do. This technique is new enough that it is not as widely known as the brachy and other forms of surgery, but the results, when the surgery  is performed by an experienced practitioner, appear to be much more encouraging, with shorter recovery times, shorter duration of incontinence and quicker recovery of erectile function.

It has been said (and I agree with this) that the treatment option selected is less important than the skill of the practitioner in carrying it out.  Case in point--Memorial Sloan Kettering is one of the top, if not The top, cancer treatment hospitals in the world. They get world-class results from the brachytherapy, as well as the option surgical procedure. They are now also doing the da vinci robotic surgery.

When choosing ANY treatment plan it is important to find a doctor who has performed 500+ of the treatments (this is my opinion), who does them often. Say, 3-4 a week. The top da vinci surgeons appear to be doing six or more surgeries a week, sometimes two or three a day.

I'm not trying to sell you on da vinci, it is just what I have researched the most, lately. Previously I was really planning on the seeds.

Whatever your choice, may God bless you and renew your strength and vitality and bring a speedy recovery.

Markus

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

mgl:

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

Regards,

Bill

MGL,

I suggest you seek several opinions..without telling the other Docs you saw anyone else!
Other than the diagnosing Doc that is. We told none of them we had planned or seen anyone else. Not even to this day. If they don't realize who all one has seen the Doc will either be pro-patient or pro-his way.

Hand carry copies of the path report and that's it. Do I believe in lying? No. I do believe in getting a first opinion every time though. If that makes sense at all. Interestingly for us, no matter what the specialty, every one of the opinons we sought had the opinion.... Paul should seek a good surgeon. Reasoning....age and stage.

Hope Healing Well can be of some help to you.

Swim

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.

MGL:

Since the treatment I chose would determine the quality of the remainder of my life, the side effects of each treatment were what I focused on.  I have a family history of prostate cancer and therefore knew what I didn't want - my older brother's Pca was not caught until it was already in his lungs and he was not able to beat it.   My younger brother had surgery by a doctor who was supposed to be the best in NC (was told all went well and margins were clean).  He has never recovered from incontinence or impotence and about 5yr after the surgery his PSA began to rise - his only recourse now is hormones.

My choice ended up being proton and I have never regretted it.  It is noninvasive and I have not had any side effects.  The protonbob.com site can give you lots of info and the book by Robert Marckini on that site "You Can Beat Prostate Cancer" is a good read - covers all treatment modalities and shows that we all go thru the same fears and concerns.

Good luck on your journey.

Dutch

 

 

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

m g l     &  Loved Ones,

  

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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

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

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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

Hi~ mgl,

 

It is truly a personal decision and the more threads you read you can get a feel for things.

Go to the Helpful Hints link in the post above and click on several of the threads to give you a really good feel for a lot of different options. 

 

This is a scary time… and we know what you’re feeling!!!  Always remember… You Are Not Alone!! We know exactly what you’re feeling.  Take comfort in knowing we will always be here for you…you just continue reaching out like you have in this new post!!!!!  It will make your journey much smoother.

 

Take time and learn as much as you can and when you feel like you are on OVERLOAD…

Stop and take a deep breath and re-group!

 

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Please ~ take time and read “Our Journey”… the link is below in our signature line.  Even if you pull only a few things to help you… from our experiences  ~  that’s what sharing our journey is all about.

 

Our thoughts and prayers will be with you as you search for answers.  Stay with us and as Wittler woulds say...

STAY STRONG....

In New Friendship ~ Lee & Buddy

 

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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

Dutch,

Debate what you want but I hear more yea sayers. I will agree that men need to be proactive.
We do need to get out of the Doc's are God mode and move into more of a paying customer mentality.

I do wish we could leave breat cancer out of it. It gets a little old hearing prostate cancer doesn't get the attention that breast cancer does. Breast cancer's attention came first because discoveries/advances in medicine preceeded the PSA. And, that happened in small part because women are proactive. Squeaky wheel and all that stuff, ya know? Where there is squeak, there is a guy just waiting to make a buck. Now that PCA is becoming a profitable medical condition, rapid advances will be seen....but that's my opinion :>)

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

 

Not upset...terrible headache for 2 straight days.... Sorry...didn't mean to sound short

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

now let me get my two words in! you have received some great advice above. it would have been helpful to know your stage of cancer (was your DRE positive or negative, what were the results of your biopsy, and be more definite about your gleason score). this would be helpful to members offering you advice.

you are still a very young guy and if you elect surgery you may have a better chance than an older man of overcoming potential impotence and incontinence, but there are no guarantees. removing the prostate is serious surgery no matter how it is performed. robotic surgery is quickly gaining favor among those electing surgery--almost 50% of surgery candidates are electing robotic surgery today from my readings. there is a good chance of penis shrinkage after surgery--many patients find this out after surgery and ask why no one told them. regaining potency can take a long time and a lot of frustrating work for most men. some lucky men get their potency back quickly and others do not. incontinence doesn't seem to be as much of a problem with younger men. so much depends on the competency of the surgeon and the extent of the cancer.

i suggest that you read my new thread entitled "Proton Radiation Therapy -- My Journey with Prostate Cancer. Others above have mentioned proton therapy and you should see if it might be an appropriate treatment for you, assuming that you are in an earlier stage of PC. in my thread, i discuss all of the treatments briefly, what i saw as negatives and why i finally decided on proton therapy. there is no one treatment perfect for everyone. do your homework and decide what you feel is best for you.

best of luck!

Dave

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68, Biopsy 9/27/06, Stage T1c, PSA 7.1, Gleason 6 [less than 5% in two areas], Gleason 7 (3+4) [less than 20% in third area], negative DRE, bone scan and MRI. Starting proton radiation therapy 2/22/07.

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