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Posted 6/26/2011 4:46 AM (GMT 0)
about three weeks after hearing my positive biopsy results, I'm no closer to deciding on a treatment. After reading many studies, books and stories, it seems that there is no solid proof that any treatment is better than any other. If so, why do anything?

My feeling is that at least with low risk disease, less is more and radiation is the way to go. I am anxious to hear stories and opinions. Thanks and G- d bless.
Posted 6/26/2011 5:53 AM (GMT 0)
Welcome to HW FrackMe,

Be sure to understand the quality of life issues.

I went the radiation route and am very glad I did. I'm one year out now.
Posted 6/26/2011 6:32 AM (GMT 0)
Hiya, sorry about your diagnosis but glad you found the forum,

I am no stranger to surgery due to mobility problems that i have, so i chose the surgical route. My attitude is that if there is something wrong that should NOT be there, then have it removed. I know we are all different and have different choices but i fely surgery was the right choice for me.

I urge you not to ignore it though as it will not go away

Take care, Bob (the crazy English guy)
Posted 6/26/2011 1:34 PM (GMT 0)

FrackMe said...
about three weeks after hearing my positive biopsy results, I'm no closer to deciding on a treatment. After reading many studies, books and stories, it seems that there is no solid proof that any treatment is better than any other. If so, why do anything?

My feeling is that at least with low risk disease, less is more and radiation is the way to go. I am anxious to hear stories and opinions. Thanks and G- d bless.

Yeah you're at the overwhelmed with information stage. It happens to most of us. I'm sure you learned by now that there's isn't an immediate rush to decide a treatment. I suggest you best try to take a cancer week off. Do your best to put it out of your mind. Go somewhere if you can or just take a few days off work if you are working. What's needed is to give it a rest and come back in a week with somewhat a new perspective. Then you can go back to checking on treatment options and side effects. It sure helped me out way back then. To show you what a journey it can be I first arrived here favoring radical surgery to then brachytherapy, finally out of the blue another alternative arrived by pure luck and timing to join a TFT clinical study. If I had been diagnosed a couple of years later I may have well gone with AS.

Give yourself a short break is what I recommend now.
Posted 6/26/2011 2:23 PM (GMT 0)
When members post asking for opinions and information about treatment, it is very helpful if we can consider your basic diagnosis..

PSA number, DRE result, Gleason score, number of positive core samples, percentage of positive material in those cores..

Otherwise, any discussion will be very general in nature...Appropriate treatment choices vary greatly and depend on the above information...

Best of Luck to you...
Posted 6/26/2011 3:22 PM (GMT 0)
Thanks all. Here are my stats. I have to figure out how to make a signature.

Age 54. PSA over the last six months has been 3.2, 3.7, 3.5 and 3.1. Free PSA has been 25, 26 and 27% and PCa3 15. Prior PSA's never higher than 1.8, although may have been depressed from 18 months on Avodart. All DRE's normal. Volume 90 cc.
14 core biopsy. 1 core positive, less than 5%, Gleason 3+3=6. Pathology second opinion from MSK concurred.

Post Edited (FrackMe) : 6/26/2011 9:30:33 AM (GMT-6)

Posted 6/26/2011 4:43 PM (GMT 0)
You look like a very good candidate for High Dose Rate brachytherapy. Very effective with fewer and less severe side effects than surgery. Your large prostates makes permanent seeds difficult but is not a problem with HDR. The best information is from Dr Jeffrey Demanes at UCLA. He is the HDR pioneer and has used it for prostate since 1981. Website is www.cetmc.com. He has long term results for monotherapy which you could do.

Also check a recent comilation of thousands of studies on the effectiveness and side effects of all the different treatments in the current issue of "Insights" at www.prostate-cancer.org. Click on Insights at the top. Look at the current issue for the article about all the different treatments. Very informative and I wish I would have had it last year when I was diagnosed.
Posted 6/26/2011 5:08 PM (GMT 0)
Frack,

With a 90cc prostate your psa should be about 7. Your low and stable psa along with your low pca3 all indicate you have a very low grade cancer. You might consider just waiting for a while to see what it does. It may never turn into anything. Psa density at .3 is well below the 1.5 cut off. With just one core at less than 5% is also an indicates low grade cancer. You do not have even one indication of anything that would require immediate attention.

JT

Posted 6/26/2011 5:32 PM (GMT 0)
Another thought for you. A prostate of 90cc usually will not qualify you for seeding, as the size in most programs are restricted to 50cc or less. Maybe a talk with the doc to see if there is a possibility of taking some of the drugs that can shrink the gland, with the goal to reduce it to a size that would be acceptable for whoever you might be considering doing the seeded brachy. As JNF says, 'usually' size doesn't matter as much with 'most' HDR providers. Just another thing to think about.
Posted 6/26/2011 5:56 PM (GMT 0)
This is all good info. Thanks very much. Two doctors have mentioned the possibility of surveillance, but I don't think it's for my personality type. And the risk of not catching it in time seems too much of a gamble. I have lots of LUTS as you might expect from the size of my prostate, so thatbmight complicate things too. Think I'd need a TURP before seeds.
Posted 6/26/2011 6:24 PM (GMT 0)
Frack,

I completely agree with JohnT's response above. With what you have posted, you would be an ideal candidate for AS. Many of us wished we had had numbers that would have allowed that as a choice. Seeding would be a good option if you decide for immediate treatment, and they can help you "shrink" that larger prostate gland to a more treatable size, if that is what you choose.

You are fortunate that you have both time (due to the small amount of cancer showing) and primary treatment choices.

David in SC
Posted 7/14/2011 2:53 AM (GMT 0)
Frack,

Sorry your here, but you're with friends. Where are you from? I have similar numbers to you and I opted for surgery.

Two biggest reasons for me:

1) Like English Bob said - it's cancer, cut it out and without rushing the sooner the better.
2) Sometimes you need a secondary treatment after surgery and it's easier to do surgery first on so called "virgin" territory.

I opted for surgery and I'm glad I did. At one point even though I caught it early the surgeon thought the cancer might have escaped the capsule and I was devastated by the idea. In the end, I was lucky and it had not escaped the capsule.

It was explained to me the philosophy for my docs at Sloan Kettering is they don't want to be some years down the road with a patient wishing they had cut it out years earlier. You have some time on your side to decide but to my way of thinking you don't want to wish you did something else years down the road, wishing you could turn back the hands of time.

I'm cancer free. I miss the old days with a prostate but I don't have to worry that my cancer is growing inside me and possibly getting worse. I can send you the link to my first post is you'd like to see where my thinking was at almost 2 years ago.

Good luck,

Mike
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