Another New Guy, Just Diagnosed.

Bittman:

It's a tough call. In my case, with a G4+3 on biopsy, WW was not an option. However, knowing my own mental makeup, no way would I want the cancer in me. Also, there is still a good chance that the pathology after surgery will show a worse G-score. Another consideration for me was that I still had the backup plan of radiation if surgery fails. Unfortunately, in my case the pathology was bad and it looks like I will be using my second curative bullet, radiation (depends on my next PSA, tomorrow).

Incidentally, the reverse is not true. If you have radiation and the cancer returns, surgery is not an option (or at least the surgery is extremely difficult).

Now, that is the argument for surgery. Others will probably chime in and give you arguments for other primary therapies. There is no one clear cut answer. A lot of it depends on you and your mental makeup.

Mel

Bitman,
Yes it does suck, but the more you learn about PC the less it sucks.
In the vast majority of cases psa directly relates to the size of the tumor and Gleason grade. There are established formulas and the best prognosticator is psa over time. Your rise from .7 to 1.2 over 8 years indicates an extremely slow rise that could be due entirely to your enlarged prostate. A psa doubling time greater than 3 years is usually the trigger point for treatment in an Active Survelience Program.
It is not inevitable that you will need treatment; The data on AS programs across the country is pretty consistant in that 70% will show no signs of progression in 7 years. This is as far as the data at this time goes out to. Most progressions are identified in the 1st three years and treatment results in similar cure rates to immediate treatment.
Not all prostate cancer is the same. It ranges from clinically insignificant, cancer that will never hurt you in your life time, to highly agressive. A non agressive cancer does not automatically turn into an agresssive cancer over time; it retains it's gene structure and will continue to grow at appproximately the same rate.
UCSF just puplished some data on their AS program compared to a control group. Those men assigned to a diet and excercise program showed no signs of progression compared to the normal 30% rate of progression in the control group. Hopkins study showed no difference in outcomes of men that were treated immediately to those treated with signs of progression years later. Learn as much as you can. Consult with a doctor that specializes in AS to get his opinion on your individual case. A color doppler or MRIS will give you a lot more information and will establish a baseline to measure growth or progression. I personally would never consider AS, or in fact any treatment, without getting a color doppler to indicate the size and location of a tumor. The more you learn about your condition the better you will feel about it. The old saying "let's watch it for a while and see how it behaves" is very appropriate in your situation. You may also consider a PCA3 urine test which can indicate the agressiveness of your particular cancer. The more information you have about your particular cancer the better the decision and more favorable the outcome.
JohnT

All of the comments and opinions about doctors and approaches have been great, as usual , with a full range of opinions.  I too was faced with the same choices as you, both as to physicians (I chose Menon over Hopkins which Aetna paid for) and with removal versus WW/AS.   I chose removal and thank goodness I did.  As my stats indicate, I had two biopsies, the first 12 core showed no cancer but atypia in one core.  Biopsy one was reread by Dr. Epstein at Hopkins and was confirmed to be accurate.

Biopsy two done at Hopkins and read by Epstein showed 2 of 13 cores with "focal" (< 5%) Gleason 6 (3+3).  Dr. Carter explained it was completely curable and I knew I was in relatively good shape.  I took my time, spent 3 months researching, two months waiting for the surgery, and got my pathology.  Gleason 7 (3+4) with positive focal extracapsular extension (posteriolateral mid).  The chances of this outcome, according to what I have read, was about 9%.  I am very thankful the cancer is out of me and so are my doctors.

I tell you this because in the process of making your decision, you need to understand there are uncertainties even with great biospy results like yours.  Whenever I have a client who wants to go to court instead of settling a case, I, like the judges who do the pretrial mediations, always ask the client the same question"  "If you elect to go to trial and lose and gave up an opportunity to get decent money on your claim, will you be able to live with yourself?  If the answer is 'no' then you must settle.  If the answer is 'yes,' then you can go to trial with a clear conscience and hope."  Most elect settlement. 

I think you must ask yourself the same question as it relates to your decision about surgery versus WW.  Indeed, there are serious, sometimes life changing, side effects to the surgery.  Indeed, your slow doubling time is encouraging but doubling time ratios can inexplicably change over a period of months from slow to rapid.  If I had to bet, my money's on the surgery.  And if I'm right, then the only issue now is pickiing the most experienced doctor you can afford.  Yes, you must like your doctor as a person, but you must also love your doctor for his/her skill.  Compassion and bedside manner is great.  Cancer control is even better than great.  Let us know what you decide to do.

I'm 95% sure I'm going with the Davinci nerve sparing RP, ounce I find a urologist I'm comfortable with.
Now for my time frame situation.
I work road construction, laid off right now, but heading back to work in about 3 weeks.
If I get this done in the next couple months, I can take off work for a couple weeks only. No work, no pay!
If I have an incontinence issue, it's going to be hard getting in and out of heavy equip. and shoveling.
My thoughts are to get a color doppler done now to determine size.
Get my PSA and my Free PSA tested every two months.
And schedule the surgery for next winter when I'm laid off again for 3 months.
Unless of course things start to change drastically in my PSA readings.
I just think it would be so much easier trying to recover at home, instead of while working.
Your thoughts on this greatly appreciated.

Bitman:

You can't lift heavy objects for 5-6 weeks.

You probably won't have incontinence and if you do, we're talking a spritz here and there when you sneeze or lift heavy stuff apparently.

Before my surgery I had purchased diapers and wore them the first two days after surgery just in case and they're really thin and not noticeable. I was able to throw mine out along with the pads because I didn't need them.

If you do construction, you can always whip it out and pee on the road, no?

If they let you work without lifting heavy machinery, you can theoretically go back to work after 10 days. I know I could have.

btw, my kids being as spoiled as they are, I shoveled snow and ice, lots of it, three times within 10 days of surgery. You just have to be a little careful.

Bitman,

I was told by my surgeon to allow 5-7 weeks off work after DaVinci. I was on a not more than five pound lift limit for two months, then not more than ten pounds for a month (don't remember, maybe more) after that.

I am one of the two percent (98% regain continence within xx weeks). At 16 months out I am still on pads.

Consider carefully that the docs often seem to be wildly optimistic.

Davidg,

If you threw away un-needed pads and pants without first asking at a local aid organization if they needed them, I'm on your case. This one is a pet peeve for me. My local food bank does family support, and they don't ask outright, but are happy to get them - old and sick folks can be destitute just as often as the young.

Viperguy,

I wish you all the best tomorrow, and will be thinking of you.
I look forward to hearing from you in a few days, as to how your doing.
Good Luck.