3+3 gleason 6

IMRT

my first choice would be seeds (based on what you've said).  second would probably be IGRT.  see, three responses and three different recomendations .

ed

 

....then you meet the strict requirements for Johns Hopkins Active Surveillance protocol.

even with a psa of 9?

ed

the OP has already said that he has made up his mind to have surgery.

ed

 

I feel that you should wait until after you get your full biopsy results before you make a decision. Like Jazzman correctly points out it is a highly personnel decision, and right now you probably need more data on your DX before you make a decision ... you only get to make the decision once .... No Mulligans. Therefore, do all of your research; read books by Walsch and others; get a second lab to verify your biopsy slides; get a second opinion on treatment choices from another doctor; look into Cyberknife, Proton Beam Therapy, AS, etc..

I chose surgery and had pretty good results; however, treatment that fits my case may not be the best for you.

Best wishes in your fight against PCa.

with a psa of 9 your prostate would have to be very large, 135 cc, to have a psa density of less tha 1.5 which is the cut off for AS. The fact is that with a true gleason 6 any treatment will have just about the same results with seeds slightly higher than surgery and IMRT. The difference in treatment effectiveness is in the probability of permanent side effects with seeds have the lowest and surgery the highest.
Regardless of the facts it is a personal decision that will be determined more by your belief system than any published data. If you believe that surgery is the most effective cure, by cutting it out, then you will choose surgery. If you believe that there are many other ways to cure cancer and are more concerned with the side effects of surgery you will most likely choose seeds.
JohnT

Almost,

Since no one has done so, welcome to our forum but I am sorry you have to be here.  None of us are experts and I do not think doctors so all we can give are opinions based upon our experiences or information we have gathered as you have when we were diagnosed.

One thing for sure you do not have to make a decision today next week or next month, so do not rush into anything and look at ALL available treatment options. The first thing you need to get is a copy of the lab report from your biopsy. I recommend you also get second and third opinions and/or find a Urology practice that has not only surgeons. but radiation and medical oncologists that all have extensive experience in treating PC. My URO was part of such a practice so I was able to get opinions on all treatment options that were unbiased and I made the right decision for me as it was my decision (with a lot of input from my wife). I did not find this forum until a month after my surgery but after all I have learned here I am still convinced that I made the right decision. Given my post pathology I also feel surgery was my best choice as my prostate was 60% tumor at G7 but was prostate contained 100%.

My first choice was proton RT and my URO concurred that it was a good choice. I ran into the obstacle of not being close to a proton facility ( Jacksonville FL was 300 miles away)and not able to be away from my business for up to 8 weeks. Then I got stonewalled by my insurance company when they refused to cover the $80,000 cost as they still consider PBRT as experimental which isn't true at all. I then chose surgery over seeds and EBRT because of possible long term side effects of radiation over short term effects from surgery.  One thing I was told by my URO team was that with surgery you can still do radiation later but with RT first surgery is not an option if the radiation fails. Again this is all just my opinion as you will find no 2 of us are the same when it comes to PC.

Good luck on your journey,

Terry TWG

BTW Skeeter, I disagree that proton gets beat up on in this forum, just for many of us who do not live close to one of the 10 PBRT centers in the US and/or have insurance which will not pay PBRT is not an option.

no side effects whatsoever from surgery so I can safely say that I would recommend surgery. So far am where I was before surgery. I know things can change over time, but the notion that surgery has terrible side effects is not so accurate. There have been great advances and one needs to select a very good surgeon. there are a ton of people who have come out of surgery and within a short time are doing great.

I was also told by one urologist and one surgeon that radiation would be as effective, but that given my young age I could suffer from long term side effects there.

My boss did seeds and hormone treatment and is doing just fine now although he had a rough 3-4 months at the beginning of his treatments wetting himself and with hot flashes.

You should talk to the best people in these different fields and then go with your instinct.

I had radiation, but my suggestion is to make an informed decision.  Someone else said that it is a personal choice.  I looked at all my options before doing radiation.  I have been finished for about 5 months now and have no lasting side effects.

During treatment I had irregular bowel movements, gas, and had to watch what I ate.  All these were minor compared to what some people have talked about.  BUT it really depends on what type of radiation treatment.

Good Luck with whatever your decision.

Frack,
You are correct.
JohnT

Take your time and don't rush into anything. I had seeds and I am happy with the SE (which are very few). You can see what I went through making a decision by clicking on the link in my signature.

Good luck to you.

Dear All:

Welcome to HW...sorry you have to be here.

It's tough for any of us to make "recommendations" without seeing your full history and stats.  Having said that I can suggest to you that you send your slides out to a PCa expert (e.g Bostwick or Epstein) so that you are more confident about what you are dealing with.  You also certainly owe it to yourself to seek out an experienced radiation oncologist who can provide some balance to what you have heard from your surgeon.  Finally, for what it's worth, I would be a bit baffled as to why a healthy 56 old man would choose surgery if he is candidate for seeds.  The cure rates are likely to be the same, the seed procedure is much less invasive and the seed SE's are likely to be much less onerous.  Of course I'm biased by my own research and my own choice so you have to take than into account.

For a first hand lengthly look at my "journey" feel free to copy and paste my story at the end of my signature.

Tudpock (Jim)