Newly diagnosed as of last Tuesdsy...

Welcome to HW. It looks like you are getting a good introduction here.

I agree with the comment that a lot of experience for your surgeon is a must, and the 3% problem rate sounds optimistic. If you have any way to get some other references for him it would help. "More than 100" does not sound like a lot, but then it might mean 101 or 500, and he may do them well, so I will only advise that you double check, perhaps ask your GP what he knows about the surgeon.

Again, Welcome.

Non-medical person speaking here -

I would think that if you get any significant difference between the original and second biopsy, that you send it to Bostwick. That is the lab of choice for my uro, and they are good folks to work with. I had insurance issues, and Bostwick took the initiative to resolve them in my favor. Nothing but good to say about them, based on experience.

I did DaVinci, and followed with adjuvant RT (my biopsy was much worse than yours, and it was pretty much a given that RT was coming). I wanted seeds, but was just too far along. They may offer a good option for you.

Re backup plans: Before considering backup plans it is useful to know why certain treatments fail in the first place.

Surgery fails because the PC is outside the surgical margin, is in the seminal vessicles . Most surgeons leave small amounts of prostate tissue, because they can never get 100%. The most common areas where this is left is in the APEX and around the nerves. This is the type of surgical failure than can be corrected with salvage radiation. On the flip side this type of faiure although common in surgery (21-31%) is not likely to occurr in any form of radiation.

The common cause of radiation failure is too low a dose, dead spots, and cancer outside the margin. It is also harder to kill very large tumors in a very large prostate.

The most common salvage techniques for failed radiation is brachytherapy, both low and high dose, cryosurgery and HIFU. All of these have the exact same cure rate as salvage treatment for failed surgery, because all salvage treatments are mearly cleanups for a botched primary treatment.

 For low grade PC, which you have, it is rare to have positive margins or a large tumor that spreads into the nerves, seminal vessicles or nerves.

This is why all primary treatments for PC, surgery, external radiation and seeds all have the same cure rate. Radiation does a better job in getting to the hard to get at places where cancer cells may be left behind such as around the nerves Apex and 10mm into the prostate bed.

Choosing a primary treatment based on being able to use a secondary treatment is a fool's folly. Choose the best primary treatment based on the biology of your cancer and its size and location to cure it the first time.

Also with low grade PC the risks of every dying from it are very slim, so a major consideration are the side affects from the treatment option. For a younger patient the side affects should be the primary consideration because the cure rates are so high and you have many years left in which to suffer the side affects of the treatment.

Do not exclude Active survelience, because you can always be treated later with the same results as immediate treatment. This has been confirmed by many studies.

JohnT

Post Edited (GOP) : 1/8/2011 6:05:34 AM (GMT-7)

i was 46 at dx, so I pretty much know what you're going through. Had a good buddy dx at 444 too.  My email is open in my profile if you want to talk.

Please keep in mind that this disease is mostly studied and focussed on men in their later years. For us guys in our 40's the rule DO change and the same thinking that applies to other cases does not apply here. So, all the stats, etc, do NOT apply to guys in their 40's. Even the doctors forget that from time to time. Everyone loves to quote stats, but those stats are not based on your age group. 

I am doing fine. 0's, continent, and functioning with viagra. Sex is fine, but I miss the old sex. Know one guy who was functioning 10 days after surgery. Every doctor wants to have a young patient cause the recovery of young patients improve their stats!  You will be fine - you've got some rough paddling ahead, but you'll be fine.  We were done having kids. But as Jim said, freeze your sperm if you want more. 

Paul