You Call the Treatment

Ok, my guess is surgery and no radiation. Bonus: no more BPH/prostatitis

I guess surgery. They would not recommend surgery unless you have a positive margin, or EPE, or lymph node involvement.

I would say the radiologist will say you have an option of both, but will most likely point out the advantages of radiation.

Mel,
You have gathered enough information only to know that you should take action with your disease.

The brachytherapy with external beam radiation (IMRT) option would be likely what a good radiologist would offer. And given your age and numbers, it could do very well for you. Dr. Menon will recommend radical prostatectomy, and he is very skilled in robotic surgery. And he will remind you that the best way to get definitive information about the prostate will be with surgical removal. You are a borderline high risk patient, and both methods could fail on the front line but the 2nd and third options change. With any form of failed radiation, you would likely need hormone therapy to control PSA. With surgery and a definitive pathology, you could immediately add radiation if the results confirm high risk, or you could watch and wait if your post surgery PSA cooperates.

Any further imaging could produce usable information, and it may not. If it does tell you the cancer is likely out of the prostate locally, then you are predestined for hormone therapy, but that does not preclude a local intervention. If there are metastasis that are too small to be seen then no imaging will help you. You PSA is very low still and that usually indicates you are still contained in the prostate. You can use the Partin Tables to see what your probabilities are and that may help you with your decisions.

My cores were very close to yours in grade of cancer but mine were up to 80% cancerous. I still chose surgery because I wanted that definitive pathology report. With a good surgeon (like Menon) I have had decent luck with the plumbing. Even with the cancer out of the prostate my radiologist knew where to concentrate my adjuvant radiation therapy. We added adjuvant hormone therapy, much like the radiation protocol I discussed above I have had a flatline of zeros since 4 weeks after surgery. I'll take it since my PSA was 19.8 when we started out.

I am also very glad I have that final pathology sample of the entire prostate.

Good luck to you in your decisions. May peace be with you...

Tony

My guess is that we shouldn't waste time playing guessing games on such a serious site....

Could do it with a Happy Hour crowd maybe.

Mel,

You can ask any question(s) you wish here, that is the spirit of HW. If someone thinks its silly and/or a waste of time, they will be quick to tell you as a couple of posters already have.


David in SC

I'll throw this out just for the heck of it.

When I went to a university cancer center, I first met with a radiologist.  He pushed proton beam therapy (got to pay for that expensive machine).  While he was talking, the urologist-surgeon came in; the radiologist stopped talking immediately; the urologist-surgeon started pushing da Vinci surgery (got to pay for that expensive machine).  

When the consultation was over, I was gathering up my stuff thinking that either way could work for me.  On the way out a nurse handed me a packet of information and a one-page "Summary of Recommendations."  That said that their joint recommendation was da Vinci surgery.  The next day I called the radiologist to discuss this "joint" recommendation.  He was obviously uncomfortable and his answers seemed very evasive.

I later learned that the urologist-surgeon was a full professor and the radiologist was an associate professor.  For what it's worth.

Zen9

 

Just a thought about why some doctors push their particular area of expertise (e.g., surgery vs. radiation). Bear with me on this one, please.

A friend of mine had recurrent breast cancer that had spread to her bones. She met with many oncologists, and tried every type of chemo available. Her last chance was a bone marrow transplant. She went to a major cancer center in New York City and met the head of the program there. Money was not an issue for her. She wanted into the program because this was the only thing that could save her life. After reviewing her history and stats, the doctor declined to treat her. Why? Because the bone marrow transplant would likely not be successful and this would lower their success rates which would affect their research grants. So, in this particular case, the decision was based on money. Sadly, this dear woman lost her battle with breast cancer.

I had a similar experience with the same hospital but a different doctor. When we thought that John was headed for SRT, I contacted a leader in prostate cancer at the hospital. I spoke with his secretary who explained how it worked: we would send the slides to the doctor and he would review them (for a fee). After reviewing the slides, the doctor would decide whether or not he would treat my husband - was told that the doctor would decide if my husband's case was "interesting enough". I was left feeling angry and rather disillusioned that this hospital, which is one of the most famous in the world, would treat any patient this way.

My point is that perhaps when a doctor "pushes" his or her particular treatment, they might do so because they believe the treatment will be successful and will boost their success rates. I'm not saying this is so for all doctors or even for most of them but obviously it was true in these particular situations.

Good luck Mel you probably have plenty of things to weigh on this. I am not endorsing this for you but you might want to atleast hear of another twilight zone approach that is possible and not often chosen, but the results don't look ridiculous.

I have mentioned this before herein it is way different: Rick K. (Michigan guy, too) back in 1995 diagnosed with psa around 11.0 area, had two positive cores found and graded low at (2+3) Gleasons, but was not reviewed by experts. Rick said no to major treatments, decided on the then almost new concept of drug therapy as major treatment. Did ADT3 (lupron+casodex+proscar) for 13 months, then quit and took only proscar for maintenance purposes. Manhood and all normal within months (he says) and got rebiopsied two times in different years, later....nothing was found in those. Went about 12 Yrs. after ADT3 and finally psa moved up to where he decided recently to go back into round #2 of 13 months of ADT3 and quit. Yes, he still could do surgery, radiations and basically all treatments and surgery is more difficult with shrunken gland...but he has those options still.

So is this option totally beyond belief (lol) or is in insane? I have talked to Rick a little while back and he is a happy camper so far in his journey. This is how wild PCa can be, may ways to either try to fight it and none come with a guarantee. The plus on Ricks side for a newbie is that research is headed more into gene therapies, dendretic cell manipulations and that kind of stuff that will likely produce results for better control or cures. Leukine therapy is being used right now by Dr. Sholtz (Calif.) (some other onco-docs too) and is not a hormone therapy but on the cellular level this works, maybe not perfectly yet...but has like no side effects (per se). So if someone choses such a thing, you can also buy time.

Again not endorsing it and only mentioning it so you get an idea of, yes there are other protocols too. I know of a guy whom did chemo(1st)+brachy+IMRT rad and his results from 2002-3 are excellent, in the zero club and his stats were not low end. Unique protocol? Yeah especially in 2002-3 era. Alot of ways to fight PCa at any stage, alot of them render results....so when a patient is told you have 2-3 choices....question everyting. Maybe the standard issue protocols are all sane...but question it anyway.

Good luck to you Mel, both places you are going are well regarded and I was pleased with both of them compared to someother places checked out.  Dr. Menon told me I will not do surgery on you. (I appreciated an honest reply like that, didn't like the message of course, an honest messenger is a righteous one) so that is my bias on him.

Post Edited (zufus) : 12/11/2009 8:15:50 AM (GMT-7)

Oopsss... in the post I just made I said PSA-3 but I meant PSA-free

Mel

Mel, despite your occupation with math, you will have to accept what we all have to come to terms with, PC is very unpredictable, all the studying and formulas and what if's will never give you a complete piece of mind. Easy cases sometimes turn agressive quickly and some cases that start out agressive never materialize along the way. Good pathology reports have lead to reaccurances, and Bad ones just stay the say, and then in some cases, good is good, and bad is bad.

You will drive yourself crazy if you try to fit your PC into some precise box or set of logic or rules. Your journey and outcome will be unique to you, Mel. You will have to make your own decisions, and let it play out beyond that. And be prepared for anything or everything the best you can. Not wanting that to sound cold, but I have been a professional accountant/finance guy most of my life, and I can't make my own PC fit into any standard format, just not going to happen.

You probably be better off to have your arranged meetings, and start coming to terms with how Mel wants to treat it. Then get into your primary treatment, then into your recovery, then into whatever side effects do or don't happen. Instead of seeing PC as this overwhelming monster that makes no sense. Work on on piece of the puzzle at a time. There be plenty of time to worry and think about the next step along the way.

David in SC