Treatment Recommendation

I got a nasty present for my 50th birthday - my prostate biopsy results:

Age: 50
PSA: 1.00 (As reported in May of 2010 ... My PSA in May of 2006 was 0.8)
Biopsy: October 22, 2010 (1 of 12 had less than 5%)
Gleason 3+3=6

Although I am overweight (6'5" ... 250 pounds), I am in good physical condition. I have never been subscribed a prescription. I biked 1500 miles this year. I have had a physical with PSA testing biannually since I turned 40. My physical in May of 2010 had no abnormalities.

I had minor urinary complaints (occasional problems starting/stopping, emptying), so my doctor recommended seeing a Urologist. My Urologist reported a prostate nodule on my right side, so I had a biopsy. It turned out that the positive result was on the left side. A few Pathologists and one from John Hopkins confirmed the result.

My dad died a painful death form PC at age 62. His doctor asked him when he had his last physical, and his answer was during discharge from WWII 35 years earlier. I also have had 4 uncles (out of 8) who had PC. Despite my dad's early death, I have longevity in the family and anticipate living at least into my 80's unless cancer gets me.

I think that there are a lot of unique circumstances for me (low PSA, young, early detection, etc.). Is there a site out there that gives treatment recommendations based on your individual situation? I have an idea of what I need to do, but I'm not a doctor!

Thanks ...

Dennis,

First of all, I am sorry to see you here. You have some challenges ahead of you, but many have gone before and there is light at the end.

As you've just identified, the first challenge is treatment options. If you're like most of us, there is not a silver bullet or a simple answer. Your young age actually complicates the situation. Hopefully you have several more years to live, so your decision will need to be not only what's the best cure, but what effect it's going to have for the next 25-30 (or longer) years.

My father was diagnosed at age 75 and underwent traditional radiation with little side effects. Radiation leaves scare tissue so should he need treatment down the road, surgery is difficult if not impossible. Given his age, he will not likely need additional treatment. I was diagnosed at age 61 and chose da Vinci RP. Like you, I am hoping to live several years and wanted the darn stuff out of my body. This doesn't necessarily mean surgery is the right choice for you.

One thing you will learn from the postings here, is none of us have the same experience even with the same treatment and similar numbers. Our bodies are different and PC treatment effects us differently.

Read the stories posted here and the material JohnT suggested. I found the information at www.prostate-cancer.com helpful. It is not very in depth, but does give an overview.

Steve

Dennis,

Although the context of the book is different, I'm going to suggest a recently posted download pdf booklet that I wish I had been given at my first diagnosis:

http://purl.library.usyd.edu.au/sup/9781920899684

Now, this is a booklet that is talking about helping men understand what screening is all about, and the fallout of being diagnosed, so do not look for suggestions from it.

I am a 57 year old, and with a much worse biopsy, I chose DaVinci surgery. Given that I was diagnosed late, possibly due to a lack of PSA tests (my fault), I was already over the hill, so to speak. I also elected to do follow-up radiation based on post-op pathology.

If I had been earlier in the evolution of the PCa, I would have elected seeds (not a casual comment, I have some experience with the statistics and process as an investor in a company in the marketplace). Pity that I was too late, an understatement.

What do I like about my choice -

They cut the little bugger up, and I know for sure that the worst case scenario was brutally true. (I was not left with false hopes).

I probably added at least a few years to my life. At least five, perhaps many more.

What do I regret about my choice -

Nerves are gone, and ED is guaranteed for life.
Incontinence is real. I will be wearing pads for an unknown time into the future.

I had to do radiation, and still have bowel, incontinence, and fatigue issues at four months out.

It (PCa) is tough on your body, harder on your mind.

That is my experience - none of us on the board can/should suggest a treatment, as I see it. 

Dennis, while 50 is a bit on the young side for PCa, sadly there are men younger than you being diagnosed.  Something in your post struck me:  the urologist felt a nodule on the right side of your prostate but the biopsy showed cancer on the left side.  Keep in mind (and I'm sure you know this already) that a biopsy is a sample and is not definitive.  It is not uncommon for the extent of the disease to be upgraded after surgery because the entire prostate and all the bits attached are tested. 

Have you discussed treatment options with your medical team yet?  More importantly, do you have a preference:  surgery, radiation (seeds or external beam)?  With a strong family history of PCa, I imagine that active surveillance (doing nothing but monitoring the situation frequently with PSA tests and more biopsies) might not be a viable option for you.

 

Dennis

Nobody wants to be a member of this discussion group. However, we are here. This group has been a huge help for me. I picked up a lot of information the Doctors just don't cover.

The problem I faced was, the Surgeon was pushing surgery and the radiation people were pushing their product. I decided to go to my Primary Care Physician and talk to him (after all he is the one that started the whole mess by doing a good job on my physical). My rationale was, the PCP does not have a particular preference other than what is good for me.

Like you, my PC was detected very early. I have always been very grateful for that. I chose the DaVinci surgery. I had very specific reasons for making that choice and I do not have any regrets.

When I made my decision there were quite a few people that felt like I was making the wrong choice and they were not shy about telling me why I was making a bad choice. Ironically, those people with the opinions had never dealt with cancer of any kind.. I did talk to several people that had been treated for PC. None of them judged my choice.

At the end of the day, it is what is good for you. My two suggestions are 1. Talk to others that have been through this. 2. Research, research, research

Lots of good info and resources listed here. As you will discover, each specialist will push for thier treatment. You have to weigh what is best for you - both pro and con. Have a list of questions prepared for each treatment.

I am 58 and diagnosed in April with Gleason 6 and Stage T1c with PSA of 3.2

I struggled with all of the options but decided on da vinci for a couple of reasons:
1. I wanted the cancer out of me and a pathology report. With radiation, you need to wait over time to see if it is working.
2. My prostate was enlarged already and would still need to be treated for uninary issues
3. I wanted a fall back option if the first treatment failed. With surgery, you can still have radiation as additional treatments. With radiation treatment first, surgery is almost out of the question as radiation turns your organs to a bit of a mess. I had several surgeons tell me they did not know of anyone that would operate on someone that had radiation treatment first.

As it turned out, the surgery was the right choice for me. During the operation, they discovered two hernias that also needed attention that I was unaware of. With radiation treatment, I'm not sure how the hernia repair would have been handled.

I am also on blood thinners which presented their own set of complications. So take into account all of your personal health issues and options. But once you have made your decision, don't second guess it and find the most experienced practioner you can find.

I wish you the best of luck. You are young and have the odds working with you at this stage.

Thanks for all of the good information .. One other thing that I forgot to mention is that my prostate was only 21 grams ... considering my height and weight, that seems to be on the low side for someone with PC also.

I have made an appointment with an oncologist who is also a Urologist who also specializes in the seeds. I am leaning towards DaVinci.

Age: 50
PSA: 1.00 (As reported in May of 2010 ... My PSA in May of 2006 was 0.8)
Biopsy: October 22, 2010 (1 of 12 had less than 5%)
Size at biopsy - 21 grams
Gleason 3+3=6

Please take your time educating yourself on the available treatment options and possible side effects. Some short lived to permanent possibilities.

Do remember that this is largely a radical surgery site and thus most here will recommend that treatment most.

Also in the vast majority of PCa individuals there is no big rush to treatment. You have time to consider, reflect and take some time off when overwhelmed and you will be. Then reconsider all options and be sure you know what you are getting into before the final decision for there are no do overs. Once you make a decision, don't look back. Good luck