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Posted 2/6/2009 1:28 PM (GMT 0)
You are quite right Astro, one of the benefits of surgery, is knowing for sure what is going on.
Your G6 T1C is way different than your now G7 T2c. Your pathology reports still sounds good, as to the containment.
Posted 2/6/2009 2:59 PM (GMT 0)

David:

I have a slightly different interpretation of post surgery pathology.  You state that "...knowing for sure what is going on."  I don't believe, strictly speaking, that is totally correct even though some surgeons would have you believe that.  True, you know more definitive info than from the biopsy but you never know "for sure"....otherwise why would you and others be worried about upcoming PSA tests?

I point this out only because jbm is seriously considering another protocol and I want to make sure he doesn't think surgical info is totally definitive.

By the way, I know your zero is coming early next week and I'm waiting to hear the good news!!!

Tudpock

Posted 2/6/2009 3:17 PM (GMT 0)
tudpock, should have said the post surgery pathology lets them know a lot more, not everything, was speaking a bit literal there. sorry. my real point being, assuming you have surgery, they will know much more after looking at the surgical remains in pathology, then can be estimated from just a biopsy.

jbm needs to pick the protocal that is right for him the one that he can live with.

and yes, can't wait to get that psa on monday. seems like things for me are never on a friday, always have to sweat out a weekend.

david
Posted 2/6/2009 3:19 PM (GMT 0)
Tudpock,

I think that is an incorrect interpretation of Purgatory's remark. You don't "know for sure" that you're 100% cancer free, but, you do know with 100% certainty to what extent was the cancer. A biopsy cannot tell you that - it's a mathematical impossibility.

However, please do not construe my remarks as anything negative against other forms of treatment. There is no "correct" answer for everyone and each has to pursue their own best course of action. Your #2 above was a huge factor in my decision process. At 47, I decided to withstand the complications of surgery now, rather than have those same issues creep up on me 10 years down the road with no viable option for recovery.
Posted 2/6/2009 3:28 PM (GMT 0)
Chris,

Based on your posted stats, and if I were your age, 9 years younger than I, I would have done what you did without hesitation. Especially since the post surgery pathology results showeda much more serious growth of the cancer. Thank goodness it appears contained. Hopefully, yours will never come back, but if it did, you still have arrows on your quiver to use in the future. May you live many long years to come.

David in SC
Posted 2/6/2009 3:36 PM (GMT 0)
PS to Chris:

Your consideration about #2 above is way more important than some actually realize. Let's face it, and I have heard this from medical people all my life, and I am married to a news. There are loads of men that won't go to the doctor, period. For any reason. There are men that are afraid of the sight of blood, of taking shots - they don't like needles, and they would do anything to avoid surgery, not just minor in the dr. office stiching, or a simple 20 minute day surgery, let alone a major surgery like as related to PC treatment.

Sometimes, have no one in mind with this remark, I promise, just a general statement, I think some men once they are forced to deal with a dx. of PC, will think or do anything to block out surgery from their minds, it would be a natural reaction to that kind of mindset. In its own way, its a form of denialism.

Not at all saying or insinuating that surgery is the answer, but it may be the best shot at survival for many, and it is well known, not just my opinion, that the sequence of treatment can be critical in one's long term survival.

When we receive new men and/or their wives here at HW, I want to know how they are feeling as much as any of their stats, I want to make sure that we don't overwhelm them or worse, scare them off. We all through the PC process have had to fight fear demons, panic attacks, thoughts about our mortality, etc. Don't care how tough we pretend we are on the outside, we have the same fears on the inside. People just handle things in different ways.

Just some passing thoughts and opinions.

David in SC
Posted 2/6/2009 4:06 PM (GMT 0)
Sorry to see you here JBM, as you've learned by now this is largely a surgical site. But don't let that weigh too much in your choice. It's your life after all, you're the one who has to live with whatever treatment you choose afterward.

I tell everyone new here to take your time and learn the treatment options available, their side effects and the impact of all this on your lifestyle and family. There is no need to rush and remember there are no do overs. Knowledge is empowerment. Urologists will near always recommend surgery, that's what they do. While radiologists will near always recommend radiation. Please take that into account. Do get other opinions from other doctors. There's much to take into account. For example I first was leaning towards robotic surgery, then brachytherapy radiation. Finally I rejected both and went with a new clinical research study I'm very happy with and it had minimal effect on me and my life. But first and foremost DON"T RUSH TO CHOOSE A TREATMENT!!!!

When everything you soon will learn becomes overwhelming I suggest you take a week off away from all of it. Later when you decide take a few days off to reflect before making the final decision. Then once you do don't look back.
Posted 2/6/2009 5:40 PM (GMT 0)
One of the best sources for information on all treatment options is the Prostate Cancer Research Institute's web site. Click on newly diagonised and read the published papers. You will get a good idea of all the options, their effectiveness and side affects.
Good Luck.
JohnT
Posted 2/6/2009 8:13 PM (GMT 0)
You and I were the same age at diagnosis. My diagnosis was more severe than yours. I initially started on a route to do seeds, but before the radiation therapy diagnosis was complete it was going to be a fuller package - external beam followed by seeds, and also taking harmones.

Along the way I did a good deal of research on seeds. They do have a good track record depending on who you get to do it. I know there is an excellent radiation group in Seattle, and I also understand a very strong group in Atlanta. There are likely strong brachy guys all over the world, but as with surgery I would be careful as to who is selected to do it. I am pretty well sure that seeds are a good way to go. On the other hand here are some negative things:
- Your biopsy could show a better situation than you actually have. You will note on HW that often the pathology report will be worse than the biopsy shows. Rarely does it go the other way.
- The only way you will know the actuality of your condition is via surgery and the pathology report.
- If you do surgery you always have radiation as a back-up should the surgery not get it all - with seeds it is unlikely you will be able to fall back on surgery should the seeds fail.
- The downside effects of seeds are usually better at first (but not always) but often cause flow and ED problems later - surgery is just the opposite and with nerve sparing surgery the effects are worse at first but normally improve in time.
- Information on seeds beyond 10 year cure rates is more sketchy than with surgery - I would also say that I found the definitions for cure different for surgery than with seeds. With seeds some PSA is expected and sometimes the PSA bounce and numbers can be confusing as to whether cure has taken place or what to do.

My apology if you think all of this is negative. I just wanted to share with you some of my thinking as I dealt with it. For you - you have an apparent very early catch on the cancer and therefore you will likely be fine with seeds, and many who have had them are basically leading normal lives. Blessings to you as you make your hard decisions.
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