Brand New Prostate Cancer

Hi All,
I'm 59 years old and have been diagnosed with prostate cancer. My Dad had it, my brother had it, it killed my grandfather and uncle. My Dad and brother are both still alive and cancer-free. Dad nearly 20 yrs, brother, over 5. Both had radicals. My Doctor is very experienced, doesn't care for the robot, wants to do the radical. Saw the radiologist today and even he seemed to think surgery might be more effective for my condition. PSA jumped from 2 to 5 in less than 6 months, 16 biopsy samples, 11 with cancer. Gleason I think was 7 or 8. No heart problems and I think I can survive surgery (doctor does too). My goal is to be cancer-free and not have to constantly be tested for the next ten years. I want to continue working to age 66. I've had the scans and CATs and no spreading was detected.
Why am I writing, well, I guess I am looking for confirmation that surgery isn't a bad choice here and in fact would be the best option for a long-term cure. High level of trust in the Dr. and the hospital is a small one in a neighborhood type setting, not monster-med. I am annoyed and more than a little scared of all this, but I want this gone!

Welcome to HW and the forum. You'll likely get many opinions or suggestions to your question, so I'll just stick with the welcome.

First, surgical complications are not unknown, but they are not your principal or even secondary downside risk.

Second, different people here will have different opinions on the better treatment approach, see my signature for my opinion, but few will say surgery is a bad choice.

Third, annoyance and fear are feelings shared by, roughly, 99% of the guys here.

Your action point, however, is to lose the concept that there is a treatment that promises 10 years of no tests.
Even if you did not have a Gleason 7 or 8, you would need annual testing to see if the cancer had escaped the gland and needed salvage therapy. With a Gleason 7 or 8, you have the dangerous PCa, not that quasi-harmless 'you'll die with it but not from it' variant that the ACS focuses on to overstate the overtesting and overtreatment argument, and you especially need follow up testing, likely at least once a year PSA
The bone scans and CAT scans that you had are nice, but do not carry a 10 year no spread warranty.

Surgery sounds right to me, but this is your decision, based on the knowledge you will accrue in your research. I might add you sound a little cavelier about the situation, which is fine, but you can;t slough off gleason scores and what ever happens, You WILL be tested for the rest of your life. There are real differences between 3+4/7 and 4+3/7, and 4+4/8. Read some books walsh's, scardino's, strum's. I sense you may have some knowledge of PCA, with the family history. Having said that your lack of knowledge, and we were all there, is indicated in your post. Get up to speed on this disease, get a second opinion at a major medical cancer center. I sure you have a lot of respect for your doctor, but research some more. You want a really,really good surgeon, be cause it is him and his teams skill which have the most impact on cancer control, incontinence and erectile dysfunction. Get the biopsy slides reread at major cancer center also, the gleason score is critical to your knowledge of this disease and what you, not your doctor , decides. It is what it is! This is a great site to help you with all this, and don't worry, replace worry with focused research, then you will be in charge.

Hello MB, I'm sorry your prostate is doing the nasty on you, but glad you found us. Welcome.

The best treatment for you is the one you are most comfortable with. And, even if you weren't comfortable with surgery, I'd say it was a good one from what you've told us.

A surgeon who now does robotic, and used to do open, told me that after 10 to 14 days his robotic patients weren't doing any better than his open ones used to do, as far as recovery. If you accept that the surgeries have similar outcomes cancerwise, then the advantage to the patient is in being up and around and less wound pain the first two weeks. As others will tell you, I'm sure, the real issue isn't how you feel those two weeks, the real issue is how good the surgeon is.

I hope you'll keep posting and keep us informed, and when you have questions, ask away. There are always people here who have been there, done that, and are glad to share.

Sheldon AKA Sleepless

I had similar numbers to you (but Gleason 9 at biopsy), and for me surgery was the standout first choice, offering the best chance of a "cure". Robotic was not available in my area so I had radical. My recovery was trouble-free and comparable with the posters here who had robotic.

Health-wise, everything was quickly back to normal except that two years out I still have ED -- which I can live with.

Unfortunately with PCa, you can never say you are "cured". Even with surgery, the beast can still rear its head up to 20 years later, and in my case it seems a lot sooner than that. But regardless of your surgical outcome, you can expect at least 10 years of regular PSa testing.

You cannot tell what treatment is best for you until you understand more about your individual situation. What is your gleason and has it been confirmed by an expert pathologist? What is the location and volume of your tumor? Is there evidence that it is contained or do you have evidence of capsular penetration? What do the partin tables and nueral networks say after you have input all the information? What is your ploidy? What is your PAP? Do you have a nodule? Have you interviewed a surgeon, a radiologist and a medical oncologist to get their opinions?
Until you can answer all of these questions you are just guessing that surgery will work. Your doctors should answer all of these questions before any recommendations of treatment is made. For the most favorable outcome your individual staging should indicate the treatment, not the other way around.

JohnT

Wisest answer thus far is John T's advice, knowing what those nomograms, Partin Tables and having that disclosed to you by a non-biased attitude type doctor(still can be a surgeon) (or of whatever type) is very important to know up front. If you have a say- 15% of cure for surgery (85% chance of non-success), do you do it anyway? Do you do it knowing radiation(salvage) would likely be treatment #2 (less than 50/50 odds even in great scenarios), and that treatment #3 to follow is horomone and drug therapies(no picnic either) which do not seem to support anyone being cured. Maybe treatment #4 is chemo therapy (palliative useage basically). Followed by hospice if one is lucky to have such options, I presume. This pathway is all to common for many patients, there are some other choices and many ways to go about fighting PCa. Plenty of biases and even possible agendas from various types of doctors, knowledge is power, especially the totality of truth which is usually not totally disclosed to patients and maybe from any of the docs...plenty of money made on patients at every level so be aware of such.

Do you realize how worthless the scanning methods in the USA actually are????

Will your doctor tell you the actual odds using (nomograms) based upon the informations they collected?

Do you realize that, most likely a seasoned PCa onco-doc can tell you more about yo
ur disease level and details, than most likely any surgeon or radiologists that you may see???(John T's bio is your clue to read...this is common and not just a fluke journey for him only)

You will probably do the surgery inspite of seeing an professional PCa Onco-doc for his assessment and opinion, most patients are sold surgery and plenty of surgeons out there and for the properly assessed patient can be a good way to go. The key is properly assessed!!!
Dr. Walsh (reknown surgeon) great guy, find out his cure rates on patients he treated, which are generally patients all under Gleason 7 level...call it a reality revelation. It is published.
Whatever you decide and I hope you analyze every possible thing, then best to you and plenty of people here to support your journey and add tips, advice and consoling even. If this sounds harsh, PCa can be very cruel and unfair so better to understand that concept up front, it may have no guarantees. Get a few opinions please, it is in your best interests.

Dear MB:

What you have here is a fairly typical thread with responses to a first time poster who is considering surgery.  That is, we have mostly surgery guys on this forum who will ratify your choice.  Most of their advice is good, i.e. that you will certainly not be "test free" under any circumstances.  However the problem is with the omissions.  BY FAR the best response you got (IMHO) is the one from JohnT.  Ignoring it is certainly your right but I would certainly suggest you take it very seriously.

Good luck,

Tudpock (Jim)

If you do nothing else get the slides reread by pathologists that look at prostate cancer cells all day long, so you know what you are dealing with. Small folksy hospitals usually have patholgists that look at all kine cancer cells. Are you aware that different kine cancer cells look different from each other, that prostate cancer cells look different from lung cancer cells even if they are both in the lungs. If the answer is no, there is probably alot more that you don't know and doctors dont tell you. Not that they are bad people but like all of us are prejudiced toward themselves. Hence get as much info as you can and YOU make the call. I sense that you won't do this and will go along with your doctor and and do whatever he say, cause you want it out. This is what you should do once you make the call. Sense I believe surgery is the best option to what I believe are your stats at their worse, I feel somewhat better about your results. But you really dont know what your stats are, do you? If nothing else readt the portion of walshes book that talks about getting the best surgeon you can. Bottom line this forum will support you in whatever you do, we just want You to do it , INFORMED. Again your pst indicate your lack of knowledge. There is nothing wrong with lack of knowledge in the beggining, but it is not difficult to get this knowledge. I could go on, but enough awrready.. MY brother, we have all been thru it, good luck, PS go to control panel and put your stats in so others can see it also is your gleason 7, 3+4 or 4+3 and do you know the difference?

Hello, MB220s   I'm pretty certain that both the “ open” (done by the surgeon’s own hands) and the robotic are considered “radical”.   Robotic is known as RALP (Robot-Assisted Laparoscopic Prostatectomy) and is also called Nerve-Sparing Robotic Prostatectomy.     Please realize that open surgeons generally don’t care for the robotic method AND vice versa, but practitioners of either approach should say that to-date there is little statistical difference in the long-term outcome; statistically only the first 2 weeks tend to be easier on the patient with robotic (even the open guys told us that).          It appears that somewhere between 60 and 80 percent of radical prostatectomies are now being done robotically.   Is that due to the heavy marketing/sales pitches that robotic docs and their institutions put forth? (after all, a Da Vinci machine is well over a million bucks).     Frankly, we found that the two open surgeons with whom we consulted were much heavier “pushers” in trying to get us to go open.   They also were pretty vociferous in their poo-poo’ing of robotic.    open proponents say that  nothing can beat the tactile benefit of the surgeon's fingers.    Maybe the heavy sales pitch from the open guys is due to the fact that they are losing so much business to robotic?   Is a great robotic experience likely to trump a great open experience?     I honestly don’t think there’s enough data out there to state that unequivocally but what sold us on robotic was reconnecting the urethra to the bladder…with open much of that has to be done by feel while with robotic that step can all be seen at whatever magnification is needed (especially important if the urethra has to be reconstructed to any degree in order to match the bladder opening.)       Below is a report from April 2010 about robotic vs open at Mt Sinai School of Medicine.     http://www.news-medical.net/news/20100416/Prostate-cancer-patients-having-robotic-prostatectomy-enjoy-significant-benefits-Study.aspx   Good luck to you! - Paella Mac’s statistics: Age 65 - 5'11" Weight 210 BMI 29.1 Overall Heath Condition: Good No family history of prostate cancer PSA: November 2001 = 1.0 slowly rising to 4.4 in Feb 2010 (eleven years) Biopsy: 04/19/10: Gleason 3 + 4 with 5 of 12 positive Robotic Radical Prostatectomy on 6/14/10 with both nerves spared Path report received 6/22/10 – T3a – Gleason 3+4.   No tumor present in the seminal vesicles or margins or removed lymph nodes.     Perineural invasion? - yes.   Extraprostatic focal presence? - yes 1 st post-surgery PSA planned for August 23, 2010

mb,

I am glad its a Gleason 7, not a Gleason 8, but even a 7 is a more agressive cancer, and 7's can be unpredictable. You have got a good range of opinions from the group as expected. I think your choice of surgery and with a good doctor like yours should be a good combination. At your age, surgery can be a good choice, and with a Gleason 7, you don't want to give it a chance to escape from the prostate itself.

At my uro's practice, they do both open and robotic. In 2008, they only did open, but since then, they offer robotics. My uro/surgeon only does open, but others in his practice are skilled now with robotic. There are medical and personal reasons why one method is chosen over the other. That is something your doctor would know.

In the end, you have to do what is right for you. We are here to support your decision in the end. And despite what method you ultimately choose, you will still need to have your PSA monitered for years to come, so don't think you are getting out of that! lol. No big deal, just a simple blood test.

Think my next PSA is scheduled, for July 12th, the day before my 58th birthday. The handle Purgatory is appropriate in my journey, but in all honesty been using the name online for many years, long before my PC days. Thanks for your kind thoughts.