New 45 year old member recently diagnosed prostate cancer. Options?

Welcome Peter,

It would help to know a few stats from you before anyone could really offer an opinion. What was you PSA at diagnosis, and your Gleason and Staging if known from your biopsy? How many cores were taken and how many were positive, etc.

Wish you luck in your decision, it will be one of the most important ones you will ever make, and there is no re-do button of course. Some more info would help.

Keep us posted

David in S.C.

Peter,
Welcome. Sorry you joined our club but this is a great group of folks. i was 44 when I joined the party five years ago. I am doing well and have been on the fortunate side of things so far. I don't think I would agree with your urologist that your are too young for radiation, but I do agree the concerns later in life are always in the back of my mind as I had radiation after surgery. Still techniques have improved greatly and I'm banking on that. As far as HIFU, I have read quite a bit about it over the years and if it were me I would stick with the more common approaches of surgery or radiation. Still others would disagree.

Stay positive. It's important. And do your very best to educate yourself.

Tony

I highly recommend the recent popular book The Invasion of the Prostate Snatchers by Dr. Scholtz and also visit www.prostateforum .com of Dr. Charles Myers who is my consulting MD

I am  60 with my first biopsy gleason 7 (3,4 ) in February 2011PSA 9.0 and July 2011 second biopsy 6 (3,3 ) PSA 6.9 and 2 out of 12 cores positive PSA . Surveying and researching all the options my choice , and three other men ages 53 to 58 with Gleasons ranging 7-9 here in Toronto recently decided to go to St. George Hospital in Bad Aibling Germany to be treated by Dr. Douwes who uses Radiofrequency Transurethral Hyperthermia ( oncothermia ) + 6 months Hormone Therapy Two months aafter treatmentt I am now .2 PSA and expect this will go down further Most Doctors here in North America consider Hyperthermia experimental but it combines two proven FDA approved treatments to kill cancer and the main benefit is that this treatment has NO significant long term side effects-and if the concer does return you can still have surgery or RT. This clinic has been successfuly treating PCA for almost 20 years and they treat about 200 men a year from all over the world - Cost is about $10,000 - half of HIFU This a viable alternative for those with low to Intermediate risk Prostate Cancer seeking an Intermediate level of Treatment ( with potential full cure ) rather then the all or nothing approach here in North America Ezra

 

 

What davidg said.

I was diagnosed just before my 42nd birthday this past August 2011 and had the sucker removed at Johns Hopkins 11/5/11. Saw no use in waiting. Already have kids with one on the way, so fertility was not really an issue; altho we did bank some sperm just in case we wanted another in a year or two. My PSA at surgery was 3.8 and I was G6 both pre and post op. Had no seminal vesicle or lymph node involvement and the margins were clear with the cancer completely in the capsule. I had nerve sparing too. Dr. has said numerous times that I couldn't have asked for better numbers or outcome. Used the word "cured." ...altho I won't lie about having some doubt regarding the use of the term... Still awaiting first post op PSA in Feb 2012.

Other than the catheter being a pain, once it came out, I've been virtually dry since day 3 or so. And have since starting using the ED meds with some regularity over the past 3 or so weeks with excellent results, for the most part. Other than the orgasm being a bit different, all parts seem to be working with the help of the ED meds and I've started with some spontaneous partial erections mainly at night.

To me, it boils down to the skill of the surgeon and the institute where the procedure is done when opting for surgery. Living 15 minutes from Hopkins made treatment there a no-brainer.

Good luck with whatever course you choose.

Peter,
I understand your dilema I am 47 and recently was diagnosed with prostate cancer. I had a choice to make concerning which treatment option. My urologist (which happen to be a surgeon) suggested surgery. I talked to a radiologist oncology he told me with my numbers I was also a good candidate fo radaition therapy. My Gleason score was 3+4 7 I had 8 of 12 cores positive. You need to make your decision based on what YOU believe will give you a better quality of life after the procedure is complete. I chose radiation, and started my treatments last week today will be my 6th. With all the complications involving surgery, ED, incontinence plus I am prone to blood clots. After external radiation I will go in and have the seeding procedure. Do your research online etc, Now if the radiation oncologists had told me surgery was a better option for me then by all means I would have opted of surgery. Good luck and GOD bless....


CED

Peter, Decisions are the worse part. Do the research and the make the decision you and your family think is best. Will you second guess it? probably. After you start down the path you pick, don't bother to look back. It has no value.
All the best in the days and weeks ahead with your research.

I'm fairly new here but there are alot of 40 somethings hanging around if there are any questions or you need to vent.

Hi Peter!

First off, sorry you have to be here!! Secondly.....LOVE your login name!!!

We are also in Calgary. My husband was diagnosed at 45 with very early stage, low grade disease. He opted for AS for a couple of years, then had brachy at the Tom Baker at age 47, Nov. 8, 2011. The reason he opted to proceed with treatment wea that his prostate was getting larger, and had he delayed further, he would have had to have had hormones to shrink his prostate.

I agree that you are too young to have EBRT (external beam radiation therapy), but I DO think that HDR Brachy would be a fantastic option for you! Calgary is in the process of bringing HDR brachy on-line. All the Rad Oncs have had training, and the equipment is in place, and ready to go. The only holdup (as far as I'm aware) is political, but things should be rectified in the not-too -distant future.

Also, depending on your risk category, LDR brachy may still be an option. I know that they do LDR on some G7 patients, depending on what "risk category" they fall into.

I'd be happy to share info with you, if you'd like!!

Take care!!

Stay Hard said...
Proton Radiation with a shield?

Thanks guys, Peter

Peter,

I recently completed proton beam treatment at IU Health at Bloomington, Indiana. Not sure what you mean "with a shield" but I would be happy to discuss my experience and what I have learned about proton radiation treatment specifically, and radiation treatment in general. I spent several months studying my options before deciding on proton treatment. I felt it was the right choice for me, but I am older than you and that may make a difference in how you decide what is best for you.

Good luck with whatever treatment decision you make.

Steve

Wow! Thanks everyone who responded. Overwhelmed!

Kuls. I understand that there are still side effects (ED) with the HDR. Although I'm intrigued by the LDR combined with Hyperthermia. Is this offered locally? It's my understanding that there is multiple sessions?

Random. I feel the same in regards to post surgery side effects being temporary for someone my age. I'm 6'-2", 185lbs. at the gym a least three times a week. I will look into and start the kegels exercises immediately!

My surgery was scheduled for Feb. 2,'12 but I received a call yesterday postponing until March. A little more time to make a decision?

Peter

Given your Gleason score, number of cores with cancer, and stage, I'd be a little concerned that the cancer has already moved outside the gland a little. If true, radiation might be better than surgery.

Something that might be of use would be to check the Partin tables for your profile. Type "partin tables 2012" into your search engine and enter your data into one of the calculators you find. My cancer has similar PSA, same Gleason score, fewer cores showing cancer, and an earlier stage, and I have about a 38% chance that it isn't fully contained inside the prostate. There's 30% chance that the cancer has moved into the tissues just outside the prostate, 6% that it's gone into the seminal vesicles, and only 2% chance that it is in the lymph nodes and beyond.

I chose HDR brachytherapy because it can handle the 30% chance that the cancer is in the margins around the gland and it seems to give more radiation to the prostate itself and less to other tissues. It also seemed to offer the best longer-term side effects - but there isn't a lot of data out there past about 7 years. At age 60, my runway isn't as long as yours so I don't have as many years to enjoy before liftoff from this planet. Still, I plan to be here for at least another 20 years, and I tried to extrapolate what I could from the numbers I found on virtually every treatment type. Most of the side effects seem to reach a plateau at some point and don't get much worse after that.

My main concern about HDR if I were in your shoes would be that there isn't any really long-term data. However, this can be misleading because the long term data (15+ years) we have on any PCa therapy is looking at treatments done very differently from they way they are now.

Given your partin numbers, I'd think surgery might indeed be a good choice for you, but it's not the only thing I would consider. From everything I read here and elsewhere, surgery scares me the most. When I first started researching options, it quickly moved to the top of my list since it seemed so many men chose it, and I heard the term "gold standard" applied to surgery. However, the longer I looked, the lower it dropped on my list. From long term incontinence issues, dealing with urine bags during recovery, the chance that I could lose up to an inch of penile length, and more, it just seems "wrong" for my individual needs.

I've been somewhat irritated with the bewildering array of treatment options and lack of consensus, but now I'm actually glad to have this state of affairs. It forced me to learn much more and choose what works for ME. You get the same choice, and it's wonderful to have choices. Do the research and make the decision that works for YOU.

One more thought: Don't be too afraid of ED. When I first looked into this, ED was a major obstacle in my mind. This forum, more than anything else I've found, has eased my mind on this issue. ED doesn't have to mean the end of sex or orgasms - for either party. I fully expect to have some ED in coming years but it no longer scares me. There are lots of things available to make your sex life wonderful even if nature isn't helping as much as before. I'm diabetic and was already having some trouble in this area. This forum helped me decide to try something and I experimented with Viagra just before my first treatment and had a VERY good night - the flag was at full staff and the sensations were the best in many years. The PCa has opened new dialogue between my wife and I (we're a little prudish) and we're ramping up our sex lives, not down, as we deal with this.

Best wishes for a complete cure and good luck with your decision process.

Greg.

I agree with having the options - I was 50 - will be 11 yrs in June that had RP

Unfortunately, seeds were just being implemented and robots not on the seen.

I have ED as well as Incontinence - when I had the surgery, I knew that the percentages were me to have those.

Now, Surgery and other options are so much better.

I chose Surgery account of the options - Family history of 3 Uncles dying and Father having PC at end cemented that decision.

I still have Chemo, Radiation and HT.

Back then if I had Radiation, then only Chemo and HT.

Your family history is a big factor in deciding options.

Good Luck - thoughts and prayers are with you

tom west central ohio

50/50 for men in 40's means bad surgeon, best avoided, IMHO.

I didn't save all the research I did while deciding, but age-specific odds for 40-somethings were much better than that where nerve sparing was possible, assuming a competent surgeon. 70/30 or better, as I recall.

Speaking for myself, nerves are still healing based on how slowly everything now works, and it may never be exactly the same (can't really tell for a few more years) but less than 3 months out it's clearly able to function with or without chemical help.