New PCa Diagnosis - Decisions?

There are a lot of strong proponents for both surgery and radiation for early stage PC like yours, and the choice may not make much difference in your likely outcome. I went the surgery route myself after considering both. In my case, I was influenced by wanting the feeling I could "get it out of there" (which isn't as true as it sounds); the desire to have the path lab report afterward to tell me exactly what I'm dealing with; and the knowledge that in the next 10-20 years there could be side effects of radiation that are not yet fully understood. (I'm a bit younger than you so that matters a bit more perhaps.) But there may not be an obvious right or wrong answer in terms of cancer control, and it could come down a question of personal preference and your tradeoff between ED right away with a good chance of recovering much of it -- or no ED at the outset with a good chance of some developing over time.

You might try a couple of things: (1) use the Sloan Kettering nomograms to see if there's an appreciable difference in outlook either way. (2) go to a major cancer center and get a second opinion, if you haven't already. At least at some of these centers they have well worked-out protocols so you're less likely to get the situation of duelling opinions where each specialist recommends the particular procedure they are skilled at performing. In my case I went to UCSF and consulted with both a top surgeon and a top radiologist there, each of whom had been recommended to me by my GP, Urologist, and others. I was surprised that that even the radiologist recommended that I go the surgical route given a combination of my cancer in the medium to more aggressive range (Gleason 7, short PSADT, PNI); but which seemed (from doppler ultrasound) to be still capsule-confined, and my relatively younger age and otherwise good health. So that made the decision a lot more straightforward.

You seem like the PERFECT candidate for seeds...G-6, detected very early, small volume, excellent prognosis for a cure with very low side effect risk..But you will want an EXPERT who uses the latest seed placement technology to realize these benefits..

The negative side? There is no going back and doing it again if it fails, and the side effects can get worse, not better, as time goes on...

You have plenty of time, no need to rush into treatment with your numbers, so talk to the surgeon and keep an open mind.. His product is the one all the others try to equal and copy. He can offer you the best overall chance for a cure but with a fairly long recovery time and a nasty basket of side effects which are hard to predict in advance. But with surgery, you will know where you stand and in the unlikely event it fails, radiation is still there for you...

My prognosis is considerably worse than yours but I have decided to keep my date with the surgeon on Sept.3 and hope for the best...But that's just me responding to my overall situation. You need to do what's best for YOU....Have you read "Surviving Prostate Cancer" by Pat Walsh? That will give you a strong foundation to work off of..

Hello and welcome,

This is a great place to be once you got that dreaded PC dx. You already sound like you got a good attitude going into this.

Based on the simplicity of your stats you posted, you very well could make an excellent candidate for seeding, or seeding along with RT or HT.
And of course, any surgeon would love to get their hands on you. You should have the full slate of choices for you, and you already know you don't need to be rushed or bullied by any doctor along the way.

I am an open surgery/salvage radiation guy with a lot of complications, not the usual incontinence//ED issues, so things can go wrong with any treatment choice.

Please keep us posted of your journey, and there's not thing as a dumb question among the brethren here. Good luck as you work your way through all your choices.

David in SC

Sorry,

Might help if I included my signature.

Retire

Welcome to the twilight zone on choices in PCa, including A.S./W.W. and say one should hope to get the best 'assessment' of your PCa case. John T (and some others herein) are among the better informed lay persons in PCa in totality from what I can see(I rarely if ever have disagreement with his words on PCa) and I have been looking at this stuff over 8 yrs.+ and read alot and question everything (with valid proven reasons which many have been confirmed from my suspecions). I questioned alot of things early on with this, as given a prognosis of maybe a couple years, that helps motivate one just slightly.

Not saying for you to necessarily do this, but you could and nobody herein will likely mention it. You could take casodex or other control drugs(TIP) and either crush this opponent fast and hard, and get a very long duration of control (especially in light of your low end stats), maybe a long shot but total remission is never guaranteed but is not 100% excluded either.

Plus you could still later get surgery or whatever type of major therapy you might wish to get and if failed surgery or other (no guarantees in PCa), still do further drugs and with Provenge and DCVax on the current choice lists and other stuff in the pipeline, who knows. Hey Zufus are you Dufus? Bob- this sounds insane???? I am waiting for Rick K. to hopefully post his story, I talk with him occassionally been following his "insane" protocol for 15 yrs. now....no PCa found on recent biopsies by Dr. Fred Lee under Dr. Bob B. (surgeons-directive) to see Lee. His psa is low and normal for a guy with a working prostate, he is still in no hurry to decide anything. Best of all normalcy as a man returns and is all his to enjoy. Of course no uro-doc will mention it is even a possible consideration, but some onco-docs will endorse such(he did ADT3 per the Dr. Leibowitz protocol method). My brother is like 6 yrs. now of A.S./W.W. and no psa movement, normalcy for him...appears sane and he did no drugs only minor diet or lifestyle changes, which he was kind of health nut to some degree anyway. He was assessed with basically indolent PCa, a little lesser than your stats of course.

Suggest books: Dr. Scholz book and Dr. Strums book, then read Dr. Walsh's book or others, get a huge perspective on this dragon and get multiple opinions. You have time to look it all over, you could even take casodex for a few months while waiting to make the decision of a lifetime, not many docs will tell you this. Some patients have done just that and got surgery alittle later or whatever. Dr. Stamey has stated history will show this is one of the most over treated diseases, interesting quote.  NBC or ABC did stories a few years ago, calling PCa a cottage industry...sounds like a lot of cashin being done to me. This cancer is not equated as apples and apples to other types of cancers...although alot of people try to say so..the facts and stats prove otherwise.  Best to you in whatever you decide, read the top post on this forum page, tells you exactly what you need to prepare for in doing surgery and may apply to other methods with some overlapp.

Post Edited (zufus) : 8/28/2010 7:03:17 AM (GMT-6)

AJ:

I had my surgery at Ford also (with even more disappointing pathology).

Did Dr. Menon do yours?

Mel

Pocketman,
,
Our new friend AJ makes a good point, I have preached this point since I have been here, but some will say its just a biased view toward surgery because I had surgery (I really didn have a lot of choice at the time). At best, the biopsy is but an educated "estimate" of "damages" inside you. I wish we had better and more accurate testing. AJ's examaple is perfect, at face value it appears to be a low grade, indolent case, perhaps could even "wait and watch" awhile. Only through surgery, do they get the whole thing out, and from that post surgical pathology, see that he indeed there was a dangerous situation going on. I can only hope for him, that they were able to get most of it. He is all but certain to need at least secondary treatment in the future, and yes, with what is known now, nerve sparing should have been out of the question and wide margins would have been a better choice.

The point, just based on a positive biopsy, is that all? Or did it still miss the bulk or spread of the cancer? That is where the big gamble comes into play.

I am one who often  talks about PSA velocity being a serious issue to consider. My case has been all about velocity from the start. If you have velocity issues that are steady and rising with no evidence of infections or other prostate illness, its a serious sign.

Like most men here, I never felt a thing. Never had a urinary problem in my life. Never even had a UTI before. Felt perfectly fine, as my PSA climbed and climbed each year, then finally was like a rocket about to take off that last year prior to treatment.

There is no need to rush a decision this big, but there is risk in waiting needlessly in my opinion.

David in SC

Post Edited (Purgatory) : 8/28/2010 8:35:30 AM (GMT-6)

AJ mentioned intra-operative pathology.  Is that not done at all, in prostate surgergy?  Only in certain cases or by certain surgeons/hospitals? (I know it is done in certain other types of surgery).

 

AJ,
This is why I always recommend anyone diagonosed to either get a color doppler or an MRIS scan. These will pick up extra capsualr extension, probable seminal vessicle invasion and accurrately measure the size and location of the tumor. I would never opt for either surgery or Active Surviellance with out these scans. Surgery without a scan showing that the tumor is contained and not near the margin or any other hard to get to place is just a crap shoot.
JohnT

Its like banging your head against the wall! JohnT I don't know how you take it LOL!!!! [not really funny though]

I too was hoping Volunteer (he posted here as Windquest on 8/13) would come back and write another page of his journey..I hope he did not find something he really didn't want to find...

Cooper, stop banging your head! Just back up your claims! Is there some vast conspiracy of surgeons who work day and night to suppress any data that might interfere with their cash flow?? Maybe Scholz figures he can make more money writing books than treating cancer, since he seems to feel most treatment is a waste of time..

Don't get me wrong..I have the DEEPEST admiration and respect for John T's knowledge and insights. He has forgotten more about PC than I will ever know..

I just disagree a little about Dr. Scholz's book...(I should have my copy Monday)

Post Edited (Fairwind) : 8/28/2010 9:18:26 PM (GMT-6)

I would hope it would be considered normal to read a book yourself, before having an opinion about it.