New to all of this

Hi,

PeterDisAbelard is giving you great advice in getting a second opinion, including having your original biopsy slides taken to a different (and highly renowned) lab for independent analysis.

To answer your question about whether brachy treatments may not be best in your case, I can refer you to my own situation. In my case, the prostate was 3-4 times normal size at 98.3 grams. This was causing me very frustrating urination problems -- weak stream, interrupted, stopping/starting, etc.

When I went to Mayo Clinic for a second opinion (including my biopsy slides), I met with one of their radiation oncologists who explained that brachy would not be recommended in my case because of the size of the prostate. Such a huge prostate will tend to "hide" behind bony structures, etc., as it slowly expands outward. The doctor explained that this would make it impossible to get the seeding needle in all of the angles required to seed the entire prostate.

He did not mention anything about shrinking the prostate and then giving it a try. Perhaps the sheer volume of my prostate could not be reduced enough to satisfy requirements for brachy. Since your prostate is not as huge as mine -- or others who have talked about reducing the size -- maybe it is something feasible for smaller "large" prostates. Unfortunately, mine was beyond that limit.

Although he specializes in radiation, the Mayo radiation oncologist actually recommended that I have a DaVinci prostatectomy performed to kill two birds with one stone -- the cancer AND the urination problem.

I'm glad that I did this. They say I am almost definitely cured (knocking on a pile of lumber here) and my urination is like when I was a teen.

PeterDisAbelard was also right that sometimes the original biopsy report can differ from a second biopsy opinion. In fact, the biopsy report is only an educated estimation of the state of the prostate. Only by removing the prostate, and examining the entire prostate under the microscope, can the true state be determined. about 30% of the time the actual post-op pathology either upgrades the cancer or downgrades it.

This is just some statistical stuff though, not intended to worry you. Your elevated PSA is probably, in part, explained by BPH. The odds are probably heavily in your favor to be cured if you select some form of treatment. If you choose AS, you should definitely keep up with those PSA readings to stay on top of it.

Wishing you the best of luck in whatever treatment you eventually choose.
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-firm erections now happening 14 months post-op & slowly getting a bit stronger.

Take your time and do your research. Each specialist will probably recommend one of their own techniques, because this is how they make a living. All methods generally have pretty good success with your grade of cancer. If you are like me, the thought of living in a diaper or not being able to have an erection scared the heck out of me, side effects are important for quality of life. Good Luck in which ever treatment option you choose. I am very glad that I chose proton therapy.

Regards,
Kris

Pakeha,

As has been pointed out, don't dismiss BT as an option due to the gland size just yet. I took Avodart for 2 months to shrink the gland prior to having my seeds inserted. May be possible for you too if you decide you want to go that route. Regards,

Joe

It seems likely to me that you would be done with the hormones once the seeds were inserted. When your testosterone level recovered your prostate might start to regrow somewhat but wouldn't get a chance to grow very much before the treatment effect was complete. Radiation tends to shrink the prostate a bit and it might not regrow at all.

Concurrent hormone therapy seems to make almost all prostate cancer treatments more effective. Surgery plus hormones works better for disease control than surgery alone. Ditto for the various forms of radiation including brachy. But since the cure rates for Gleason 6 guys is so high already hormones aren't generally needed because it is hard to improve on 100 percent.

That's my shoot-from-the-hip guess. For what it's worth.