diagnosed with pca today

Terry,

Welcome to the club nobody wants to join.

Obviously, with a Gleason 6, you have some time.. AS could be for 3 months, 6 months, or 3 years. You have taen the hard step, you know what you have, and need to keep an eye on it.

Many men cannot go on living normally, knowing they have a cancer growing inside. That will be something you, or you and your partner decide. If you can compartmentalize your life, and go on, you will avoid some potential side effects from treatments. If you can't ignore the elephant in the room, you may have to deal with it.

Second opinions are advisable, even on your biopsy slides. Talking to a medical oncologist might be appropriate.

Good luck. Life can still be great, even with PC. It doesn't end after the Dr. says those words, "you have PC."

Welcome to our corner of the world. Don't let the "c" word scare you - too much. PC is a different kind of beast and you've found it very early. You didn't mention your age but AS and Brachy are both good possibilities for you. On the whole, it sounds like you've got a reasonable couple of doctors on your side - both make sense to me.

In your place I'd be seriously considering my AS options. The trick is to be "active" and have in mind when you would want to start treatments and what treatment to pick. An option to consider might be something like, 'when my PSA gets to X.X I'll schedule the Brachy treatments' The exact value or what maker to look for is something to talk to you docs about. Keeping track of how fast your PSA is rising is a reasonable indicator of how fast the PC is progressing (you'll hear about the "doubling time"). At your PSA level, scans aren't likely to show much but now you've got a base line to look at later. You might go a long time on AS before getting into the side effects of any treatment.

Second opinions and getting your slides read by someone else are prudent things to do.

Sorry you have to travel this road with us. Keep us updated on your progress and ask all the questions you want. Time to start learning all you can.

All the best,
Andrew

So sorry you have joined our fraternity.

I remember the first time I posted here and was given great advice of "take a deep breath and you have plenty of time to read, research and gather the information that you will need to make the best decision for you".

On a positive note, you have G6 and intermediate and often slow growing prostate cancer. So you do have time to do your homework. I agree with the others that AS is a sound approach for you.

I would suggest you first obtain the book by Doctor Patrick Walsh-Surviving Prostate Cancer. It is viewed by many as the bible on prostate cancer. If you will give you great detail on the entire subject of prostate cancer, the treatment options, which options may be best for the various diagnosis we all have received, etc.

It has a great discussion on AS, surgery, brachytherapy, hormone deprivation, etc. I found it to empower me with enough knowledge that I could have better discussions with my urologist, surgeons, radiation oncologists, etc.

Another sound advice that was given to me was to make sure you have someone go with you to all of your appointments. You most likely are numb and in a state of shock. I wasn't in the proper state of mind to hear everything that was said, let alone process it. While I heard the doctors talk, I found that once I was home and we talked over what was said, i realized I missed quite a lot of the main point.

Do you have family history of prostate cancer? That and your age will help us all give you better advice.

I would suggest that after reading and learning about this cancer you may want to schedule appointments with surgeons and radiation specialists. You will find that surgeons will advocate surgery and RO's will advocate brachytherapy. I went back multiple times to the surgeons and RO's and kept asking better questions that helped me make the best decision for myself.

You will get to the point of knowing what is best for you and most fortunately you have the time to research, learn and discuss with many medical providers what will be best for you.

Best of wishes and come back here and ask as many questions as you need to. We are all here to help.

You have very enlightened doctors, and your only problem right now is that you know there's a tiny bit of cancer there, and you feel like you have to do something about it. You don't. Most prostate cancer is insignificant and indolent, as yours most likely is, and you are much more likely to die with it rather than of it if you leave it be. But now that you know it's there (and btw it's a really good idea to get your biopsy slides re-read by Epstein or Bostwick), you're going to be troubled by it, and you'll want to watch it with a plan to do something about it at some point. How annoying is that!

The most important thing you can do right now is to decide not to decide now. Wait until you've had time to process it. I learned Mindfulness, which really helped me get through the initial cancer panic. What you think you know about cancer is probably not true of prostate cancer. It's its own beast -- mild as a lamb for most guys, but fierce as a tiger in an unlucky few.

Yes, there are many treatment options beyond Active Surveillance if you find you can't live with that. Because both positive cores were on the same side, you may be a good candidate for one of the ablative focal therapies. That means that they would burn out only the cancer and leave the rest of the prostate intact. They use HIFU (high intensity focussed ultrasound), cryo (cold), laser, RF or photodynamic therapy (if you can find a practitioner). Focal ablation depends on excellent imaging to locate the cancer. A very few doctors are expert at color doppler ultrasound imaging which can locate it with fair precision. Multiparametric MRIs don't seem to have enough resolution ( about 8 mm last I checked). The other problem with focal therapy is that only about 20% of cancers are truly focal. That is, there are often small bits of cancer that are too small to find with any available imaging that might eventually grow, so it will have to be monitored like AS anyway, and might have to be re-done at some point. The other skill necessary with focal is to keep healthy tissues from getting overheated or overcooled during treatment, which would be damaging. Other than that, it may offer a kind of midway treatment alternative between AS and radical therapy.

There are two kinds of brachytherapy (HDR and LDR) and SBRT (CyberKnife is the popular brand) all of which get very good results with not too many side effects. Pencil beam proton is the new kid on the block. IGRT/IMRT and old style proton are about equal and not as good as the others I mentioned, imho. Whole gland ablation (HIFU, cryo) are poor alternatives for many reasons in my estimation.

If your MRI imaging showed nothing, and your Uro felt nothing on the DRE, you are stage T1c, which is the most common stage at diagnosis these days.

Good luck at not worrying about the elephant in the room! ;-)

Terry,

There's one thing that is usually said to he new guys to help them put things in perspective that doesn't seem to have been mentioned yet. I read back through the thread and don't see where anyone has told you that more than half of men your age will turn out to have prostate cancer if they are run over by a bus and autopsied. The rule of thumb is that your chances of having at least some prostate cancer present is approximately your age used as a percentage. Since you are 63 that means guys your age have a 63% chance of having some prostate cancer present if you really look for it. They never know. It never bothers them. It doesn't matter. So now you know that you are one of that 63 percent, not one of the other 37 percent who actually don't have it.

On the other hand most of those men have tiny little cancers and the chances of hitting them with a biopsy needle are small. They are very likely to have negative biopsies most of the time and the fact that yours came back positive is reason for caution. Your urologist sampled a tiny percentage of your prostate and found cancer. It's worth watching and worrying about but not cause for existential mortal terror at this point.

Hi Terry,

Welcome (odd for me to say as I am new here too!).

This forum is a great resource, comfort, and at times quite humorous. I read many of the posts and I post when I think I have something to offer. Just being a part of the community here is good for my health and I encourage you to be as active as you like - I think you will enjoy the results.

Sorry about your diagnosis, and happy for you that you have doctors and others to help you make the decisions as to how to deal with it.

I was/am about 10 years younger than you when diagnosed, and I could not rest knowing that I had cancer, so I opted for surgery. Great choice for me as my cancer had spread to my bladder. My doctors had offered AS and they also said a certain percentage of biopsies would under-report the level of cancer. So I had them take my prostate and for me that was the right choice.

You will find the right answer for you, and as I have come to learn from hearing others stories here, the right choice for you isn't the same as the right choice for me or others here.

Best of luck and welcome,

Pat

Hi Terry,
You have several pieces of information that all agree.
An MRI with a 3T,
A low psa
A biopsy with low core involvement
A confirmed G6
A psa density <1 (cut off is <1.5)
All of these are consistent with very low risk PC, a sub category of low risk PC.
Given this, you are an ideal candidate for AS and treatment for this class of PC at your age will not statistically extend your life for more than a few weeks.
I would pick up a copy of "Invasion of the Prostate Snatchers" by Dr Mark Scholz as there is a complete chapter on AS monitoring programs.
JT

I find a feeling of great comfort on this forum, the information is invaluable and suppresses fear and anxiety for me.
The thing that concerns me the most is (like Peter says) that the biopsy was only 10 samples and they were able to detect 2 samples less than 1mm in size, that leads me to beleive that larger cancerous
lesions may have been missed if more samples were taken. If I was 100% certain of the biopsy report, I would not hesitate to go the AS route, since nothing is 100%, and I have an appointment with my Uro next week, he will undoubtly present other options if I choose not to go with AS.
Thanks for all the input,
Terry

I'm glad you found the forum.

What were the dates and numbers on your previous PSA tests?

Dave

Welocme to the club.

I have a similar cancer and I just had brachytherapy. I am doing really, really well. I am not unchanged, but I am good. And i am pretty sure i will not die of prostate cancer, which is the main thing.

I did AS for 15 months and I probably could have gone another year, but I made my call. The cancer was growing (still Gleason 6, but more positive cores in the next biopsy) and that was a call for action for me.

I wanted to be treated as early as possible with the most effective therapy with the fewest side effects.

(Gee, how many guys have had that goal?)

It was time to act and I chose brachy. I had the procedure on Feb 21. It is minimally invasive and in my case, the side effects have been negligible. A little bit of a sore bottom for a coupkle of days, but I resumed mormal activity in 24 hours and the plumbing is working well. So I would agree with your doc in the preference of established therapies. I wholeheartedly endorse LD brachytherapy, but I also think there are other therapies that work.

The biggest problem with prostate cancer is that there are too many options and many more in the pipeline. The good news is that most all of them work for most men, so hold your head up. There is no reason this should kill you.

Photon therapy, high-dose brachytherapy, cyber-knife are all promising new therapies.

No one can make the call for you. My advice is: do your homework, get advice, pray and when you make a decision, do whatever it takes to make it work.

There will be changes, but isn't life all about adapting?

Be a survivor, like me. Best wishes.

Hi CT-Umpire
Like yourself, most eventually opt out of AS so what are the advantages of choosing it to start with?
Would it not better to choose treatment like brachytherapy (provide one meets the parameters) and avoid
the stress and anxiety associated with AS and the constant monitoring and biopsies. (Like Bill stated)
If you knew then what you know now, would you have just gone for treatment instead of AS? I'm in a very similar situation as yourself and if I can avoid a step in my journey I would consider brachy
or am I been simplistic?
Are your psa levels currently undetectable and did you have temporary or permanent seeds implanted.

Thanks, Terry

Post Edited (tak06) : 3/2/2013 11:54:04 PM (GMT-7)

If you knew then what you know now, would you have just gone for treatment instead of AS?

Terry, I would say that I still would have done the AS. I made it nearly 2 years, and those were two years with no possibility of side effects. I knew of a guy who did AS (they called it watchful waiting then) for 11 years. I wanted to be 'that guy'. I had very little anxiety because of the close monitoring. I figured that if it got worse, I would deal with it. That is precisely what happened, and I then chose a treatment (brachy) that offered both a very high chance of success and a smaller chance of the dreaded side effects. I couldn't be happier with the way things have turned out. I am very grateful. It sounds to me like you have a very good handle on all of this. You will be fine.
God bless.