Introducing myself and my prostate

So sorry you found the need to find us but welcome Gedman.
I will leave others with far more knowledge than I to chime in, as I am sure they will do shortly, with a flood of great advice and information.
Stay calm and learn all you can about the various treatment options available to you.
Sending you and your wife a hug and wishing you all the best from over the pond.
Susan
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Hey Gedman,

 Welcome aboard and it looks like you're on the rigth track(staying calm, good health and coming here). I'm sure you'll have many questions on your journey, so ask away.

Foxrun<!-- Edit -->

Welcome to our fraternity no man rushes to join. Your case is a great reason why I tell all men I know that they should begin PSA testing at age 40. As you now know this is not an "old Man's disease" and we have way too many guys like you in their 40's in this forum. With 5 positive cores and the 9 PSA with the G7 rating if you had waited until you were 50 to have that PSA test your outcome could have been a lot different.

Now the good news, you still have plenty of time to do your research and find the best treatment for you and your life style situation. With a small prostate you should be a good candidate for almost any treatment including RP and several radiation options. I would definitely talk to a radiation oncologist who specialises in prostate cancer treatments. In addition to Brachytherapy (seeds) you should look at proton beam radiation and a new and upcoming treatment call CyberKnife radiation. If you decide to go surgery at your age you will have a much better chance of success with side effects of continence and ED. One thing to remember in doing consultations about treatments, Urologist who are also surgeons will push surgery and Radiation oncologists will push RT. The best thing I recommend is to find a prostate cancer treatment center that has both surgeons and radiation oncologist on staff so that you hopefully will more non biased recommendations from them.

Also you may get some biased opinions from members in this forum as most of us like to think our treatment which may have worked great for us will work just as great for everyone. If that was the case there would only be universally accepted treatment for PC. PC is a very unpredictable cancer and it seems to not affect any 2 men the same so we are all in a way are unique. The treatment decision you will ultimately make is the only right decision as it will be the one you make and will live with.

Terry

If you should decide to go the RP route, I know two people who used Dr. Tewari, and both had very good results. I was planning to use him, but I changed my mind and used my own urologist instead, also with very good results. The surgical route is not without its own set of issues, but time does heal all wounds, and, if done properly, everything eventually heals. Another friend of mine recently used Dr. Samadi, also in NY. He was also very pleased with the results. I wish you the best in whatever treatment you chose.

Gedman, email me if you would like feedback on NYC surgeon (good feedback). My husband recently had surgery in NYC, and we did a lot of research on surgeons and radiation oncologists in NY.

Hi gedman, and welcome to our little corner of the world. You have come to a good place with immeasurable help and knowledge from those that have "been there, done that" with respect to being told we have PCa, learning about the beast, deciding on a treatment path and moving on. Please keep in mind that with your statistics you have time - time to learn about PCa and the various treatment options -so don't panic!

One of the first questions many will pose to you is have you gotten a 2nd read on your biopsy slides yet? Labs such as Bostwick and Epstein are two of the best and a 2nd opinion is usually a good thing to add to your dossier. Also if you could share more of your stats with us, that too would help us understand better. For example, what is your DRE's results/history, of the positive cores what were the respective percentages of carcinoma present, and what is your cancer stage.

Along with forums such as this where you can learn from people that have and are going through what you are, do as much internet research as you can. When I was at your point in my journey I encountered the "paralysis by analysis" syndrome as I was spending several hours a day doing all of the research and reading as much as I could - but that's o.k. as it will put you in a better place in terms of deciding your choice of treatment. There are a number of great books out there as well - Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" and Strum and Scholz' "Invasion of the Prostate Snatchers" are two that I found incredibly helpful during that part of my journey.

You will also want to talk to and if possible meet with as many of the medical experts in the different treatment approaches as you can. As Water Guy / Terry mentioned, find a prostate cancer treatment center that has both surgeons and radiation oncologist on staff so that you will hopefully receive non-biased opinions. And when you do, be sure to ask for their specific outcomes post treatment - % regression free, continency (and have them define what "continent" means - to you and I it means NO issues, while others may qualify that with "only one pad per day" or "only when straining;" same goes with ED. They all have these statistics and if they say they don't or are unwilling to share that would be a cause of concern for me.

As part of my journey to learn about the various treatment options I downloaded, purchased, and copied a number of studies and results that I would also be happy to share with you, so if you are interested shoot an e-mail my way and I'll reply right away.

We are all out here to help - my very best wishes to you in this journey.

Hi Gedman...I'm a relative newbie on the forum, but let me welcome you as well.

Regarding the transrectal prostate MRI, I had one back in October and it's (unfortunately) nowhere close to having the transrectal ultrasound. Basically, I spent close to 90 minutes in the MRI tube with a coil stuck up my butt. But apparently it gives an excellent picture of what's going on inside and my oncologist (Dr Lam) considered this an essential part of staging my disease.

I also had to jump through a few hoops to get insurance authorization (I have a PPO with Aetna)...presumably it's not commonly used for diagnostic reasons, but perhaps others can verify how typically it's used.

Good luck to you and learn all you can to get comfortable in your decision. It took me a couple of months to get my bearings, but I'm glad that I invested the time in doing so.

Michael

Hey Gedman

Nice to meet you. (My hand is out to shake your hand - not your prostate! )
Keep reading. In a couple of days you'll know enough about PCa to be dangerous. Knowledge is a good thing.
You made the right choice by coming here. The support is fantastic. Way more than you can imagine.
Jeff

Hi Gedman,

I would guess that the required wait for your MRI is to allow the prostate to completely recover from the invasive biopsy procedure. They want to get a look at the prostate in its normal state.

As others have said, you do not need to rush into any decision. With that said, I do think that some sort of treatment is needed in your case because of your high PSA.

As others have suggested, have consultations with 1 or 2 radiation oncologists and have consultations with 1 or 2 urologists/surgeons. Get the pros and cons of both forms of treatment.

Ask the radiation guys if there is ANY chance of RT's triggering a fresh case of cancer 15 years from now. They say that RT treatments are becoming more & more sophisticated, so hopefully this may no longer be an issue. But, as a young man with far more than 15 years in your future, you need to be sure about this.

Also talk to the radiation oncologist about surgery if the RT should fail. In almost all cases, surgery CANNOT be performed if external beam radiation should fail to cure a cancerous prostate -- because of the scar tissue built up by the radiation. I don't know about brachy.

With the urologist/surgeons, ask them how they would expect you to recover in terms of continence, sexual ability, etc. Another great thing going for you is your youth -- younger patients tend to recover more fully & rapidly from surgery than older ones.

As one of us posted, you will see some biases from us regarding treatment. I kind of favor surgery (DaVinci robotic) because it remains the gold standard to which ALL other forms of treatment strive to emulate. Removal of a cancerous prostate is also the only way to know, for sure, what the actual Gleason score was -- in other words, you pretty much know for sure how aggressive it was and if further treatment should be done.

Many prostates, after being examined under the microscope after prostatectomy, end up with final pathology stats that differ from the original biopsy report. The biopsy report is just an estimation/prediction. Sometimes the cancer is UPGRADED from the original report -- and sometimes it is DOWNGRADED.

When you select a radiation oncologist for treatment, or a surgeon to have it removed, be very sure that they are highly experienced & skilled -- especially for DaVinci surgery. The learning curve to master this technique is around 300-400 surgeries. Do not allow yourself to be part of someone's learning curve.

It is highly likely that your bone and abdomen scans will be clear. The staging of the disease refers to how advanced it has become. A stage 1 means it is still completely confined to the prostate & no bumps are felt during DRE. There are 4 overall stages. You can have great hope that you are still stage 1.

With some Gleason 4's in there and a PSA of 9, I would not panic toward scheduling your chosen treatment, but I also would plan on doing something within the next few months to be safe.

In closing, you would certainly appear to have a VERY curable case of PC and you will learn that radiation or surgery will both cure you. It's a matter of what you feel most comfortable with and confident in.

Good luck!
Chuck

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 vesicules, 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 grams, tumor 2 grams.
Catheter out in 7 days. No incontinence, minor dripping for a few weeks.
Post-op exams 2/13/12, 9/10/12 PSA <0.1
Only semi-erections so far, with continued improvement.

Gedman,
Welcome to your new cyber family.
I am happy for you to have found us so soon in your journey.
I found HW just 2 weeks before my surgery but it was enough time to catch up and prepare for the surgery.

As we say knowledge is everything.

Your attitude and exercise routine will help you greatly. I increased my exercise program greatly after dx. I prepared for my surgery like it was heavyweight fight, becuse it was going to be a fight for my life.

Sounds like you have time to make the best choice for you. You have many choices at your age.

Good luck to you.

Bill

I was forced to make the decision by myself. My other half at the time of diagnosis decided to leave soon after. I chose radiation due to what other VETs that had gone through the procedure told me what they had gone through as well as their recovery times. I have since found someone that will stand beside me no matter what comes along, and have married her for better or worse. I am a lucky man for finding her. Knew her for 35 yrs before we got married, and our first night together was after my first day of treatment. I informed her, and she informed herself of what may be to come. She hasn't faltered and has stayed by my side ever since. I do have some side effects of ED and inability to climax without pumps and pills. However, life is good and getting better. Wish me luck everyone.

My PC diagnosis has actually motivated me to work-out harder - mostly because I expect that post-surgery (assuming I go that route) I will have serious restrictions on exercise for awhile.
That was a concern for me as well.