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Posted 1/13/2009 12:53 AM (GMT 0)
I'm in a bit of a panic right now.  I went for a physical a couple months back and my doctor gave me a PSA because my father had PC (radical) in his early 50's.  It came back 3.4, then I retested at a 3.0.  Went to a urologist, got the DRE.  Apparently, he felt a slight irregularity and "firmness" on my right side, though my prostate is of normal size.  I have a biopsy scheduled next week.

At this point, I've convinced myself I have prostate cancer because I'm not sure there's another plausible explanation between the PSA and DRE.  Of course, if it is cancer, it's yet to be determined how aggressive and/or widespread it is.

Any suggestions/recommendations?  Assuming cancer, I'm inclined NOT to have a RP, unless I have a bunch of doctors tell me it's my only solution.  My dad had it done and he had all sorts of complications with incontinence etc. until the day he died.  Moreover, I kind of like the concept of ejaculation :-) 

Thanks to all for your thoughts!

Posted 1/13/2009 1:05 AM (GMT 0)
Wow, so many thoughts. First thing I would do is get a broad spectrum of opinions and options. Second I can speak from experiance being 42 @dx that with a body full of testosterone the doc is going to want to do something to rid you of it if you dont have your prostate removed. Removal is not an option for me but with the HT that I am on I have not ejaculated in 34 months. Its kinda nice in a way cuz no-one has to clean up the mess or sleep in the wet spot. Welcome to the site. Relax and make some friends. Also dont worry too much until afer the bioptsy. This is a great place to be if you have to be here. Todd
Posted 1/13/2009 1:24 AM (GMT 0)
Hello Mike F, glad you found us. Don't blame you for being nervous, but hopefully, the biopsy will give a straight answer to your situation. Once that is done, you will be better able to start looking at all your treatment options, and there are plenty of people here experienced in all of them. Ask whatever questions that come to mind. Sincerely hope that all goes well with you.

David in SC
Posted 1/13/2009 1:46 AM (GMT 0)
Mike,
Welcome to the site. This is the best place on the web for a broad range of experiences and perspectives. First, we've all been right where you are now. Try not to panic. If there is one silver lining to all this, is that it usually unfolds remarkably slowly so that as each stage comes along you have time to digest before moving on to the next level. Don't make any decisions now. Just take it one day at a time.
I was 46 at dx. My good friend was 42 at dx and tells me PCa has not changed his life in any measurable way. He now has natural sex with no meds, and was fully continent at 2 weeks. He had sex 11 days after surgery. There ARE some benefits to dealing with this younger rather than older. For me, you see by my sig that I was dry at 8 weeks and with viagra have improved to functional sex. It's really no big deal. Life is good.

I interviewed four surgeons in and around NYC before deciding. As one told me, "If you get PCa once, you're more than likely to get it again over the next forty years if we don't take it out." It wouldn't necessarily be a recurance, it would be a totally different round. Also, surgical techniques have improved so much over the years that there is little chance that you will have any major problems.

STick around. We've all been righ where you are now. PM anyone if you have questions or wanna talk.
Paul
Posted 1/13/2009 1:49 AM (GMT 0)
Thanks, guys. What about brachytherapy? It seemed, based on my limited research, that might have the least negative impact to my quality of life. ANyone have experience?
Posted 1/13/2009 2:10 AM (GMT 0)
Mike you are putting the cart before the horse, yes lots of possible choices in protocols/treatments some are less known and effective, too. You might not even have a real issue could be clear. Or you could be diagnosed as many patients are found with early detected PCa, like my brother and found with what they (Brady Institute of Uro/John Hopkins) calls indolent or insignificant PCa via parameters ( we patients always significant to us), means you might be a candidate for monitoring only (no treatment). Wait and see your biopsy data and tell the doc you want an ACTUAL COPY of the biopsy pathology report (no ifs and or buts), then tell others herein what is written on it, also good when getting second opinions and get some answers and you can learn from books what the jargon might mean to you.

Also, slow down and take a deep breath at this time.

Post Edited (zufus) : 1/12/2009 7:15:47 PM (GMT-7)

Posted 1/13/2009 3:06 AM (GMT 0)
Thanks, Zufus. I have the equivalent of the cartoon angel and devil going on right now. My brain tells me that PC is pretty rare for men in their early 40's and, if I DO have it, chances are that it's at a relatively early stage. The other side of me is in a sheer panic mode and mentally arranging for hospice care :-)

As I mentioned, my dad had a RP in the early-mid 90's. That was followed by radiation and, later, by an orchidectomy. I don't think he had testicular cancer but he had chronic pain down there, which he said as a result of the radiation. I wish I'd asked more questions back then and he's not around to ask anymore (non-cancer related at least...) I know he wasn't sexually active but he continued to have procedures done up until a couple weeks before his death to resolve the incontinence issues. So, despite the technological advances since then, I have a pretty strong bias against RP and I'd probably roll the dice on dealing with a recurrance in 10 years if it buys me that much time sexually.

But I'm getting ahead of myself again!

I'll monitor this board in the interim and will post my results once received. Thanks once again!

Post Edited (Mike F) : 1/12/2009 8:10:31 PM (GMT-7)

Posted 1/13/2009 4:05 AM (GMT 0)
Mike,

How old are you? Your PSAs are not that high, especially if you're on the older side. What may be more important is your PSA velocity (rate of change of PSA with time). I guess what has your attention is that your DRE is slightly irregular. I tend to think with your PSA even if you have PCA it is likely not to be too advanced. Best of luck with your biopsy and please keep us posted.

Rich
Posted 1/13/2009 4:33 AM (GMT 0)
I am sorry your Dad had such a bad time with surgery, I was faced what you are going through now back in September, albeit I am older than you, 52. I didn't see this coming either. I had PSA's checked for 17 years, somehow I thought checking the PSA early (35+) I was some how immune to it. WRONG! PSA rose from 1.9 to 2.85 over 1 year, local urologist insisted on biopsy, first biopsy "suspicious" for ca but not diagnostic, had repeat biopsy 4 months later. This time positive for prostate CA in 2/12 cores on R, first core=5% ca, second core=25%, DRE negative, gleason score 3+3=6 , clinical stage=T1c, pathological stage=T2a. I went with robotic prostatectomy due to strong family history of cancer, and I needed to get back to work ASAP because my wife doesn't work. I don't care what anybody says, I know you want a sex life but you have to have priorities. If your biopsy comes back positive you really should consider surgery or radiation. Surgery had improved much since your Dad had it in the 90's, my surgery was 09/11/08, incontinence gone by early December, ED remains, take daily Viagra plus penile injections trimix/bimix 2x/wk to have sex with wife. First post-op PSA=.01 (undectectable, repeating this month) Remember you are trying to save your life if you have prostate CA, first and utmost. Even if you have a low Gleason Score there is no gurantee it will stay low it you do nothing. It could change at any time. Doing watchful waiting seems strange to me, do you want to wait until it progresses so far that you have to have chemical castration therapy? I didn't. Do you want repeat biopsies and repeat PSA's? I didn't. If you have radiation first and then your PSA starts to rise most doctors will not remove your prostate because of multiple complicatons. So then you go on to chemical castration therapy. I know this is a really hard decision. After viewing the results of radiation and recurrence I still think the best robotic surgeon you can find is the way to go, just my opinion................god bless
Posted 1/13/2009 9:36 AM (GMT 0)
Mike, IF you do have PCa at our age the most importatnt thing is to rid your body of the cancer. What ever means you choose to do that with is your choice. I would learn and respect the ED and UI rates of the different treatments. But, dont let those fears stop you from getting the treatment that will give you a long PCa free life.
Good Luck,
KW
Posted 1/13/2009 11:14 AM (GMT 0)
If someone chooses monitoring (w.w.-watchful waiting), you have to be vigilant in testings is wise advice, it does not mean go home and do nothing ever. I only mentioned it because it is an option for some men, it is in plenty of books and John Hopkins is the ones whom defined it under 'indolent or insignificant' Pca. In a younger mans diagnosis it probably should not go on for many years (but exceptions with PCa is the way this disease is), in an old persons scenario say 70+ under the same parameters, why under go major modality when disease control (drugs or less invasive proceedures)will handle it (should you even need it)and in majority of cases you would be dying of heart disease of something else.

All treatments exist because their a place for them in some PCa scenarios, no cookie cutters or one size fits all in this arena. It can look stranger than the Twilight Zone especially for the newly diagnosed....exceptions in PCa is more like the rule. If one particular treatment was perfect for all....the others would not exist or show the results they are showing. Newer treatments are either here or coming here, like HIFU....things can change how this is tackled or open up new choices. Down the line some of these treatments will fall by the way side.

Post Edited (zufus) : 1/13/2009 4:18:09 AM (GMT-7)

Posted 1/13/2009 11:30 AM (GMT 0)
Guys, I totally agree that, at my age (42) watchful waiting is NOT the way to go.  If my biopsy comes out positive, I will have to do something and the stage of the cancer will probably dictate what "something" is.  I also agree that, while I don't want a RP, if the opinions dictate that I must, then I must.  After all, life itself is most important, my sex life is very important, though clearly secondary, and continence is important. 

But if I can have a treatment that somehow impacts my quality of life less than the others, that's really important to me even if it means that I might have to deal with PC again at some point in the future.  Of course, I realize that option would also require continued monitoring and biopsies for the rest of my life.

It seems as though most of you have had RP's, whether traditionasl or Da Vinci.  Has anyone on her gone the brachy, cryo or other routes?  Just curious.

I'm going to try not to fret too much between now and when I have the procedure and get the results. 

Thanks again

Mike

Posted 1/13/2009 1:39 PM (GMT 0)

Hello Mike:

You asked if anyone had had brachytherapy...yes, I recently did (1 month ago) and have been very happy so far with the results.  If you want to read the details, please check out the post "Tudpock's Brachytherapy Journey".  JustJulie's husband also had the procedure and I would recommend JustJulie's Journey as well.  To find these go to the drop down box just beside Topic...it has "Last Comment" in as the default.  Then sort by "Started By"...these will be in alphabetical order and you can see my journey and Julie's if you scroll to our names.

Having said that, you are way early and hopefully do not have the disease.  If you do, you should consult with multiple doctors, including experienced robotic surgeons and radiation oncologists to understand your options.

Anyway, I hope for a negative on your results but, if you do get the bad news, please come back here as you will find tons of info to help you on your way.

Good luck.

Tudpock

Posted 1/13/2009 1:56 PM (GMT 0)
Hi Mike...Glad you have come here to visit and ask questions. Everything you received so far is right on the money. The only other advise I would like to add...please don't base your treatment plan solely on the side effects if you do have cancer. You will find in your research that all treatment models will have varying degrees of side effects. Some folks will fare better than others on each type of protocol. Make sure your treatment selection is what you want to do and not because your were advised that one plan was better than another. Your main objective should be dealing with the cancer should you have it with the goal of being cured...then the side effects as secondary. One last thing...don't rush to any treatment plan until you have all the facts before you and you have had some time to weigh them out.

Wishing you a clean biopsy and not have to go any further.
Posted 1/13/2009 2:04 PM (GMT 0)
Hi Mke, Since you asked about Brachy,,,yes, Pete had it in 2001....also external radiation and lupron ...You can read the story. It isnt pretty....but then that is one man......Others have fared well.
The only thing difference between my husbands story of brachy and radiation, and some of the others on this site, is that after four years, the PSA began rising.....Then we had the real trouble. Take your time in making your decisions, and remember if you talk to a surgeon he will give you the best scenario for surgery, and a radiology oncologist will paint a rosy picture of his specialty......They have to: it is what they believe in and work at..... Good luck and don't worry. Everything wil be OK.... Diane
Posted 1/13/2009 6:28 PM (GMT 0)

    Mike,  I may be getting this feeling for all the wrong reasons, but it seems to me that you are more worried about the ED and UI complications of the different treatment options than you are about the PCa.  As much as anyone I can truly understand you concerns.  As a "younger" guy here I would really focus on getting the cancer taken care of first.  Yes, I decided on RRP as my treatment option.  I was just in the unlucky minority that had long term UI.  I have really not had much problem with ED at all even loosing one nerve bundle.  Anyway, I wish you well in your reasearch, decision, and outcome on your treatment if you do get a positive DX.

    KW

     

Posted 1/13/2009 8:07 PM (GMT 0)
Welcome aboard Mike,

Every thought and question you mention sounds normal. I can only speak for myself but I was thinking just like you, going into my biopsy. Once the diagnosis of PC came in though, my whole outlook changed. From that point on I only wanted to know what would give me the best chance to save my life first. I can then go to work on recovering the other functions 2nd. I had to go with an RP because I felt I owed my life to some other people who depended on me to be here and not just to myself. We all have to walk part of this road by ourselves but if we look around that are many others there to support us. Sorry, I did not mean to ramble. Hang in there and we all wish only the best of luck to you.
Posted 1/13/2009 11:24 PM (GMT 0)
I know I've implied that side effects are more important to me than treatment. I don't really feel that way but there IS something to be said for quality of life versus quantity. I DON'T want to die but we're talking about FDA approved treatments with good rates of success, depending on the circumstances. Given the choice between a high percentage treatment with unfortunate side effects and a high percentage treatment with minimal side effects, I have too many years ahead (hopefully) so it's important that I keep my quality of life as normal as possible for as long as possible while closely monitoring to ensure that any future problems will be caught early. OTOH, if I'm told by a couple doctors that, for whatever reason, an RP is the most feasible course of treatment, I'll go with it.

I especially appreciate Diane's comment about seeing both a urologist and a radiation oncologist. That might not have occurred to me but it makes a ton of sense.

Please keep the comments coming, I appreciate all who have taken the time to post!

Mike
Posted 1/14/2009 5:42 PM (GMT 0)
nono  Mike, we all can relate to your situation, and the possible decisions that may have to be made. When I was Dx my surgeon suggested surgery or seeds, but do to my age(60) and overall good health he thought surgery was my best choice.  I went to a cancer center in Ill. for a second opinion that pushed HRD Brackatherpy.  Due to the location of tumor, it was not a viable option.  The radialogist told me that surgery was my best choice, due to the possible rise in PSA down the road.  Surgery after radiation is not a good thing.  All treatments carry side effects of ED & incontenence.  After a few months on Viagra things are good, not like before, but good.  I know for a fact what the extent of the cancer was because my prostate was removed, and tested for the exact Glesson score.

Hope it works out that you DON'T have PC yeah

Posted 1/14/2009 6:05 PM (GMT 0)
Mike,

What can I say, but that I'm sorry that we have to invite you to the club at such an early age. about 18 months ago I was going through the same emotional roller coaster you are now. If you have question or concerns please fell free to call or email.

My advice is small and simple. If you are married make sure your wife is involved. You're going to need the support, and she will need the information. At our age we need the cancer gone. Watchful waiting is not an option, and brachytherapy does not have a long enough track record.

I personally used the following priorites when selecting a treatment option: Cancer first, UI second, and ED dead last. A woody in your casket will do you no good.

Now cheer up and enjoy life for every day is precious!!!

Roger
Posted 1/14/2009 7:05 PM (GMT 0)
Mike,
If your biopsy comes up positive you should also put a prostate oncologist on your list of doctors to talk to. There is a list of oncologist, surgons, and radioligists on the PCRI's web site. (Prostate Cancer Research Institute). Uros will most always recommend surgery, radioloigists will recommend radiation. A prostate oncologist is more objective and considers many other issues including lifestysle and other tumor markers before making a recommendation. Get all the different opinions you can before making a choice that will affect the rest of your life. You have plenty of time to get a lot of opinions and ask a lot of questions. Good luck and I hope everything is just a false alarm. You will learn a sot from the guys on this site.
JohnT
Posted 1/14/2009 7:16 PM (GMT 0)

Mike F said...
...Given the choice between a high percentage treatment with unfortunate side effects and a high percentage treatment with minimal side effects, I have too many years ahead (hopefully) so it's important that I keep my quality of life as normal as possible for as long as possible while closely monitoring to ensure that any future problems will be caught early...

Mike

I don't think I have ever had anyone tell me that one treatment plan vs another form of treatment plan would be easier on the side effects.  Be very wary of anyone promoting one treatment plan over another because of better outcomes with the side effects. 

The truth of the matter is...side effects are strickly individual...which means for example some people that go through surgery are totally continent from the day the catheter is removed and the ED issue was never a factor.  By the same token someone else has incontinence and ED issues that were very long term.  So it all depends on you as the individual.  So again and I repeat what other experienced survivors here are saying...don't base any treatment by the success or lack of success that another individual had with a particular treatment plan, because you will not have the same results...either way.

Posted 1/15/2009 5:28 PM (GMT 0)
I have been advising multiple opinions, and not from the same treatment types. It is educational stuff in the real world, that cannot be more individualized than 'your' particular case/situation. Just like mentioned just because someone did bad or good on something does not necessarily mean it works the same for all. Although comparisons and abstracts, are worth something of value, they are imperfect and even nomograms, partin tables etc. are based upon population tested 'averages' some above the middle of the pact and some below. So how do you know where you fall??? Ho do you fair???? It is imprecise as is about every single thing about PCa, it is like a jungle in unknows. Hopefully down the road it can be assessed and defined much easier than currently.

Z-bob
Posted 1/16/2009 2:21 AM (GMT 0)
hello there mike f i was 43 when ddiagnosed and let me tell you WHAT A SCARE ,we all know what your talkin about ,c,mon were guys.i would copare my sex life to any guys,i have wonderful wife whom i married the same year i was dxd,we were rabbits and with out a doubt the best sex ive ever had with a woman  ,just happen to be lucky enuff to marry her,never have to beg for sex and she is always willing to please, however i said that to say this,youWILL be the same again,instead of 100% it might only be 90% ,i am young like you ,the best cure for a younger man is get it out .i was dry at 10 weeks and the ed thing is coming along great ,slow  but great,i am the head of our local man 2 man group here , it is a prostate cancer  suppport group sponsered by acs and the localhospital, i am the youngest in the group by a long shot, and most of the men in the group are radiaion guys,your overlooking several things here ,maybe you should reconsider,radiation does have similar cure rates to radical ,however , your gonna have the same results ,just down the road,first the radiation kills the cancer,then the prostate ,then things connected to the prostate ,(the nerve bundles) and wa lah  no ejaculate. we are both young,got kids? wanna see them graduate ,or get married ,think it over my brother, call me email me were all here for ya,remember so you have (not 10 yrs) more like 5 yrs of good sex left with ejaculate  so what,if the raiation fails your screwed,rememberthe beam only has to miss 1/1000th of the tumor and youve still got cancer,when i say your screwed  what i mean sure you can have surgery after, most say you cant,but it is possible,(gotta find the surgeon willing to accept that kind of liability first ,,,,,good luck) it a MUCH more difficult surgery and you chances of perminant incontinence just quadrupled ,please think it over r.p. is a excellent option, with todays,advancement  i went robotic ,and guess what? id do it again in a minute i know its gone, case i have a path report that says so,radiation wont give you that.radiation is an excellent option ,however this is just my opinion ,its not the best option considering your age everything ive written is only my opinion but were all here to give you just that ,in the end its your decision ,hang out here for awhile ,these people are the greatst,there almost lke family ,and they do indeed care as much as family ,they were here for me and we will be here for you ............good luck were all here together


Posted 1/16/2009 4:07 PM (GMT 0)

Mike F

I’m potentially in the same boat as you; difference being I had the biopsy and know its positive…Just received my second opinion on that yesterday.  I’ve done a lot of reading/research and concluded that surgery is probably the best option for me, especially considering my age.  I have an appointment with an oncologist next week just the hear what they have to say, I feel that need to cover all my bases.  Honestly, the idea of the surgery and its side effects suck.  It’s a tough one to swallow at 44 but I have two boys and a great wife, want to be around for another 30 years+ to enjoy them and to enjoy life in general.   There are no guarantees no matter which treatment you choose.  There is a better chance the pc will be gone if you do the surgery and as many have said on these message boards, it’s could be ugly if you go with radiation first then have the pc return.  My only decision I’ve been struggling with is whether or not to watch it for a while…although I know at some point I’ll have to deal with it.  Although PC is probably not the best thing to procrastinate about.

I’m hoping you are worrying about nothing and it are comes back negative.  Best of luck!

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