Reasonable wait time

Denial seems to be the primary tx. at times!

Don't be rushed into anything. Your situation is not dire at all.

Take a couple of months -- maybe you need to get some other opinions.

Mel

It is hard to say if you really can wait a couple years to decide or if you should make a decision within a month or so, as the surgeon suggested to you. A Gleason 6 is not a very aggressive cancer. But I would also remind you that the clinical pathology (the biopsy report) is just a prediction and estimate.

There are numerous times when the post-op pathology, after the removed prostate has been directly examined, revises the original assessment to a higher Gleason score. And, of course, sometimes the post-op pathology revises it downward also.

But with the hard spot on your prostate, I would think that you would NOT have a couple years to wait, as the RO said.

*****Edited Addition: This is particularly true since you had 6 of 12 positive cores. And, with that hard spot on your prostate, it seems quite likely that the tumor(s) are near the edge and, as you said, large volume. This is nothing to fool around with.*****

In my humble and highly uneducated opinion, I would think that you should be thinking now about treatment in the very near future -- whether it is radiation or surgery.

As you suggested, the time to get it might be now -- before it has a chance to escape the prostate capsule.

Anyway, this is just one of many thoughts that others will be sending your way.

Good luck with whatever you decide!
Chuck

Resident of Highland, Indiana just outside of Chicago, IL.
July 2011 local PSA lab reading 6.41 (from 4.1 in 2009). Mayo Clinic PSA Sept. 2011 was 5.7.
Local urologist DRE revealed significant BPH, but no lumps.
PCa Dx Aug. 2011 at age of 61.
Biopsy revealed adenocarcinoma in 3 of 20 cores (one 5%, two 20%). T2C.
Gleason score 3+3=6.
CT of abdomen, bone scan both negative.
DaVinci prostatectomy 11/1/11 at Mayo Clinic (Rochester, MN), nerve sparing, age 62.
My surgeon was Dr. Matthew Tollefson, who I highly recommend.
Final pathology shows tumor confined to prostate.
5 lymph nodes, seminal vesicles, extraprostatic soft tissue all negative.
1.0 x 0.6 x 0.6 cm mass involving right posterior inferior,
right posterior apex & left mid posterior prostate.
Right posterior apex margin involved by tumor over a 0.2 cm length, doctor says this is insignificant.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, PSA <0.1.
Semi-erections now happening 14 months post-op & getting stronger.

Post Edited (HighlanderCFH) : 1/26/2013 2:07:46 AM (GMT-7)

I will join the take your time do not get rushed into anything crowd. You have plenty of time and a month or two waiting will not change your outcome. Look at all options and what they can offer in QOL. There are several new radiation treatments like proton and CyberKnife to look  into as well as seeds.  Remember the decision you make is the only right decision as you are the one who will have to live with the treatment you choose.

Terry

MrAnx, I too would absolutely agree with the take time approach! To qualify that I'm not sure I would wait the 2 years that was suggested, which sounds like AS.

Regarding your question about HDR vs LDR Brachy - ultimately I chose LDR, primarily because it has a longer track record, only involves one treatment (if monotherapy), and also that I felt I found 'the best' practitioner. If you've been on this site at all you have probably found that there's a fair amount of guys that have done both very, very successfully, and I believe both are equally effective - it then becomes a matter of personal choice.

As far as palladium or iodine - the main difference between these sources is the time in which the radiation is delivered. Both isotopes are short-lived or decay rapidly, meaning they deliver the required dose in a short amount of time. So far, the cure rates within these isotopes appear to be equal. A good/experienced radiation oncologist will choose the optimal plan for each patient, taking into consideration many factors including the size and shape of the prostate gland, Gleason score, age, other health conditions, etc.

At the end of the day IMHO you couldn't go wrong with either choice, LDR or HDR.

Best to you.

Take your time and feel comfortable in your decision and not rushed. There is little difference in LDR and HDR outcomes and side effects. The biggest variable is the skill of the doctor, so choose the best doctor and accept his speciality for the best outcome. The isotope used is not critical. Paladium is used mainly on larger tumors and when combining with IMRT. The short term SEs are greater, but go away sooner, 4 to 6 weeks vs around 8-12 weeks for Iodine.

Hi MrAnxious,

I am taking time to decide after education. One of the surgeons at my hospital was like yours: decide by the end of January. Two radiation oncologists at the same hospital told me I had time (they quantified that into several months) to decide on what course of treatment to do.

For me it is proving to be a very tough decision. My mind has changed several times. I think it is par for the course given there is no real gold standard and each treatment comes with side effects, some potentially permanent.

I've learned a great deal just reading the stories of others who came before me on this site.

Good luck!

MrAnxious – It’s a hard decision and I went back and forth between surgery and seeds and even considered AS. My biopsy results: Gleason 6; 50% in 1 of 12 cores; 2 cores with high grade PIN. I was told that I would do well with surgery, brachy, or IMRT-- and possibly AS. The rad onc recommended AS. The surgeon said if the amount of cancer was below 50% he would be OK with AS, but since the core had 50% he thought I should have either surgery or seeds; and that I should get treatment sooner rather than later - within a couple of months.

I went with surgery and my post-surgery pathology confirmed the G6 score, but contrary to what the biopsy suggested, I ended up with cancer on both sides and the cancer had escaped the prostate, but not the capsule. The surgical margins were clear, the SV and lymph nodes were clear. My surgeon told me, in his opinion, my cancer would have gotten out within 6 months to a year and that my surgery was “timely”.

I believe you can take your time and explore your options. G6 is a slow growing cancer. It took me 6 months to go from diagnosis to treatment. You only do this once; there are no do-overs. You need to be comfortable with your decision.

Best of luck -- Tigerfan

Thank you all for your opinions and insights.  They are very much appreciated.  I will try to make my decision within the next month and get it taken care of within a couple of months.  I will never feel even 80% comfortable with my decision but I suppose the unknown affects us all similarly.

Thanks again.  You are all very much appreciated.

I did HDR. It has been around for more than 30 years and many doctors in the US have done more than 1,000 procedures. Technically speaking it uses better technology than LDR and should result in potentially less side effects, though no direct studies have been done. Each have relative advantages and disadvantages.


HDR is just as effective for monotherapy as LDR, so be suspect of whomever told you it isn't as good, they are incorrect.

The best HDR website is www.cetmc.com by Dr Jeffrey Demanes the HDR pioneer and currently Chief of Brachytherapy at the UCLA Medical Center. Unfortunately some LDR only rad oncs will run HDR down (the two I consulted with did) without basis. So it is imperative you do your homework independent of the practioner.

JohnT's point is excellent....both protocols are as effective as surgery and with fewer and less severe side effects. The real key is to find the practioner with the best overall operation and level of experience. In other words, it is the singer, not the song.