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father's recent diagnosis

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Posted 4/1/2008 10:14 PM (GMT 0)
Hello all-

My father is 57 and has recently been diagnosed with the early stages of prostate cancer.  His PSA is only at about 2.7 as of now and he has been given the instructions to think about what his plan of action will be in the coming months.  He seems to be justifiably afraid and thinks that a good option is to wait a few years to act with either radiation or surgery.  I am afraid that his fear will deter him from making the most healthy decision.  Will someone with experience of about sixty years of age please fill me in the dangers and repercussions of surgery and/or radiation therapy.  I listened to the doctor speak about them both today, and he seems to want to try one or the other within the next six months.  I just want to be able to relay the after effects of both to my father from an unbiased source.  Thanks to all who have read.  I will surely be asking a lot of questions over the next several months. 

Posted 4/1/2008 10:45 PM (GMT 0)

My profile is very similar to your father's--I am also 57 and was diagnosed, with a PSA of 3.0, with early stage prostate cancer a few months ago.  The primary concern, I would think, should not be with side effects but with preservation of life; i.e., treating the cancer, and sooner rather than later.  For me it was not an option to consider watching and waiting, given my (and your father's) age.  I chose open surgery, and even if the post surgery side effects are significant (which doesn't seem like it will be the case), I don't think I would have regretted my decision.  Personally, I think it would be a mistake for your father to put off making a treatment decision.

Posted 4/1/2008 10:59 PM (GMT 0)
Villa
I'm 54 and was just diagnosed about 3 weeks ago. PSA was only 1.9 and within the last 5 years my PSA range was 1.3 to 1.9. Going to see surgeon tomorrow in Austin to make plans for surgery. Like Concernforall said, the first priority is to remove the cancer and the rest is secondary. Good luck to your father.

KrisP
Posted 4/1/2008 11:26 PM (GMT 0)

It's not only his PSA reading with is a consideration, you need to obtain a copy of the biopsy report which will include the Gleason scores, number of positive samples and other important information.

With more extensive screening, most men are recently diagnosed with early stage low volume  Gleason 6 tumors, which in many cases will never cause them any problems, and raises the dilemma of over treatment. The problem is to determine whether you are dealing with a ***** cat or a tiger or something which might turn into a tiger in the future.

To assist, information has been published active surveillance criteria, for example in the winter 2003 newsletter of Johns Hopkins. www.urology.jhu.edu/newsletter

Active surveillance doesn't simply mean waiting a few years: regular monitoring and lifestyle changes need to be considered.

When thinking about his plan, he needs objective information. Many people and publications have a mindset of ther favoured treatment. The fact is that there are at least several approaches and treatment options which will provide a similar outcome, which often comes down to personal preference and consideration of the potential side effects.  Side effects can be difficult to compare because there are so many variables, treatments have improved greatly and a top doctor will have a huge influence on your outcome.

Although written a few years ago, one of the best overall books is "Prostate Cancer Prevention and Cure" by Lee Nelson MD, which includes diagnosis, stages, treatment options, selecting a top doctor, lifestyle changes, exercise, diet etc. 

Biopsy readings are subjective: what looks like cancer to one person could look normal to another. The slides should be sent to an expert pathologist for a 2nd reading if this hasn't already been done.

After one positive Gleason 6 sample and PIN in my 2004 biopsy, I used the watchful waiting option. My recent biopsy was all clear. If I do need to make a future treatment choice, the treatment and doctor options for me will be completely different to what they would have been 4 years ago, and my chances of a better outcome will be greatly improved.

It's certainly not a case of one size fits all, and does come down to the individual situation and choice.

Best wishes

Posted 4/2/2008 1:49 AM (GMT 0)

Greetings, Villa.  It looks as if your Dad's diagnosis is similar to mine - I'm just a couple of years younger.  My PSA went from about 1.5 to 3.2 between annual physicals.  I also have a family history of PCa so they did 12 biopsies and 2 were cancer and 2 were inconclusive.  My urologist advised at my age that surgery was the preferred option since I should have another 30 years of more or less quality of life.  I opted for the open surgery which was performed on Feb 4 in Richmond.  My urologist recommended the open surgery - mainly because the surgeon he referred me to mainly does that surgery.  Also, he advised that if they took out my prostate and I needed follow up radiation they could do that.  However, if I went with radiation and later had further issues they couldn't then go in and take it out. 

I have been very pleased with the results.  I really like my surgeon and he seems to have done a great job.  I was in the hospital 2 nights and was back at work part time in 3 weeks and full time in 5 weeks.  At 6 weeks my PSA is zero and I have not suffered with the side effects you usually think of with RRP surgery. 

Your Dad does have time to make a good decision.  There are lots of options and he needs to find the option that is right for him.  What is right for me may not be right for him.  Find a urologist you have confidence in and study all the options.  I am convinced we made the right decision for me.  We'll be praying for you and your Dad and the decisions you face in the days and weeks to come.  David

Posted 4/2/2008 3:05 AM (GMT 0)
Hey Villa,

Sorry you have to be here but glad you came. As you can see, there are widely varying opinions about prostate cancer treatment. I chose open surgery because it gave me the best possible chance of getting rid of the cancer. Life was my first priority. Some say wait and watch but as you will see, there are young men in their 40s here that have advanced prostate cancer. Myself, I watched my father die from it. So those are the reasons that I chose to get rid of it. Even if it hadn't cause me serious problems for the rest of my life, (I am now 73) I would not have had a very good life knowing that it was still in me and could be growing. No thanks!!!

The side effects of surgery that most of us experience are incontinence and ED. I had no incontinence and have been dry since the day after the catheter came out. Call it luck or an excellent surgeon, I am thankful that I sidestepped that one. I had ED for several years before surgery and took Levitra for it. Since surgery I use Viagra and Trimix penile injections. The combination has given us a better sex life than before cancer.

The surgery itself was the easiest of the 8 abdominal surgeries that I have had throughout my life. I had very little pain and was back at work teaching school 3 weeks later.

So I am an advocate of getting rid of the cancer and leaving as many options as possible open if it every does come back.

Please stay with us. We can all get well together...

Jim
Posted 4/2/2008 4:29 PM (GMT 0)
Villa--You've gotten a number of responses with excellent information to consider. It sounds like your dad's cancer was caught in its early stages and he has a number of options for treatment.

The important thing, in my opinion, is to educate, educate, educate oneself about available treatments. Your dad has time on his side and has months rather than days or weeks to make a decision. Personally, I took several months of weighing various treatment options before deciding.

Most men choose brachytherapy (radioactive seed implants) or prostatectomy (surgical removal of the prostate). Each has its advantages and disadvantages, and has equal longevity statistics.

There are some newer treatments that he may want to consider as well, including proton therapy.

Watchful waiting for someone his age can be considered but needs to be closely and actively monitored to be effective. While most prostate cancers are slow-growing, some are very aggressive and need to be treated before they escape the prostate. I don't know that there is any sure way to predict which are slow and which are not, but the Gleason score and other biopsy results provide helpful information.

There are a number of active participants here who have experience with various treatment methods who will doubtless respond to your message here.

Take care and hang in there...Tim
Posted 4/2/2008 7:36 PM (GMT 0)
It's my understanding, though I am not absolutely positive on this, that there is no way to determine whether the cancer is of the fast or slow-growing variety, until the prostate is removed and the definitive pathology can then be done.  That why for me, at the same age as your father, it was an easy decision to go for surgery.
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