Newly Dx and searching

Dx 2/12/14 with Prostate cancer. I am 55. I have had an enlarged prostate for 10 yrs with normal PSA. Size 76 cm. Ultrasound a showed to be long about size of a lemon. Father Dx in his 70's for Prostate Cancer. Radiation treatment used. Have read many posts since finding site today. Glad to find source of fellow Dx'sto read their experiences.

Jan PSA reading of 4.6. Urologist ordered Biopsy. Results are as follows:

T1C
Rt base- benign
Rt lat Base- benign,chronic Inflamation, Post Atrophic Changes
Rt Mid -bengn , Chronic Inflamation, Post Atrophic Changes
Rt Lat Mid- Adenocarcinoma 6(3+3) 10%
Rt Apex- Adenocarcinoma 6(3+3) 35%, Perineural Invasion Present
Rt Lat Base- Adenocarcinoma 6(3+3) 40%, Perineural Invasion Present
Lf Base-Benign
Lf Lat Base- Benign
Lf Mid- Benign, Chronic Inflamation & Post Atrophic Changes
Lf Lat Mid- Benign ,Inflamation & Post Atrophic Changes
Lf Apex- Benign
Lf Lat Apex-Benign

surgery suggested
going to Radiologist on 20th for sec opinion of treatment

Hello Mr. Bottom,

Welcome to the forum. Sorry you have to be here but glad you found us.

Yep, you've got it. With your biopsy results you are somewhere between low risk and very low risk. If you shop around you can probably find doctors who will admit you to an active surveillance program (where you watch the cancer vigilantly but don't treat it until it is clear you need to do so.) But you also have enough cancer that most doctors will be glad to treat you. Your urologist (who is a surgeon) has already volunteered to do so. Most likely your radiologist will too.

When you see your radiologist ask him about brachytherapy (seeds and other internal radiation).

Since you have an enlarged prostate the radiation oncologist may talk about a brief session of hormones first to shrink the prostate so the amount of tissue needing to be dosed can be reduced and the surrounding tissues will be less likely to be damaged. I dismissed radiation out of hand since I was eager to skip the hormones. In retrospect that may have been a mistake since it would have given me more options. A young man such as you will probably snap back pretty quick after a couple months of androgen deprivation.

Again, welcome to the forum. We have a lot of guys here who have been where you are. The main advice we will all give you is that you have time to calm down and look at your options before you commit. Gleason 6 cancer (the kind you have) is slow-moving and you can (and should) talk to a lot of doctors.

You might want to talk to a brachy doc about the shape of your prostate. Sometimes the surgeons and the brachytherapists have different ideas of what is feasible. We don't get a lot of cryotherapy guys here. I seem to recall a couple of them. With your cancer in the apex I'd be a bit leery, I think. Cryotherapy isn't alwasy as targeted a therapy as one might wish and there is a lot of stuff nearby you are going to want to keep.

The guys here who are fans of radiation (and there are lots of reasons to be fans) will be here in a minute to tell you that what your surgeon said about surgery after radiation is irrelevant. Personally, I think it is semi-relevant. There are more salvage options with surgery as the initial treatment than there are with radiation but... surgery can have worse side effects, especially if your surgeon isn't the hot shot he thinks he is...

Rock bottom
Your stats look good. You seem to have lots of options but the large prostate could rule out brachy. You may need no treatment. Ask about finasteride to shrink that bad boy.

I had no choice as a GL 9: I elected to go for a cure: get it out and rt is a fall back whereas rp is not a fall back after rt. Your call. Good luck!!
Bob

Read this and other places heavily. Plenty of time. 6 month no matter but you will need to do something. U r young with 25 years to go god willing.

Once u pick a path forget any alliance to any doctor and get the best one u can. Mine had done 50 or so radicals. I did a bit of an upgrade even though he was confident he was a great option. Its your life use everything at your disposal.

Places like this r great. You will likely also find your male buddies highly receotive cause we all worry about this as we age. Unfortunately many here are on the wrong side of the worry

rockbottom said...
Dx 2/12/14 with Prostate cancer. I am 55. I have had an enlarged prostate for 10 yrs with normal PSA. Size 76 cm. Ultrasound a showed to be long about size of a lemon. Father Dx in his 70's for Prostate Cancer. Radiation treatment used. Have read many posts since finding site today. Glad to find source of fellow Dx'sto read their experiences.

Jan PSA reading of 4.6. Urologist ordered Biopsy. Results are as follows:

surgery suggested
going to Radiologist on 20th for sec opinion of treatment

I can speak from my own experience which is somewhat similar to yours. First, with 3 positive cores, you would generally not be considered appropriate for AS. Some sort of treatment -- radiation or surgery -- is most likely something to consider in the future.

Also remember that 20-30% of biopsies miss other tumors present with a prostate. There tend to be between 3 and 7 individual tumors within cancerous prostates. In addition, about 28% of surgery cases reveal that the Gleason score, as estimated by the biopsy, is upgraded to a higher grade.

In my situation, they told me that my enlarged prostate made me unappropriate for brachy. This is because a huge prostate (mine was almost 100 grams -- about 100 ccs) tends to sprawl out into any space it can find, including beneath the bony structures, etc. This makes it difficult to angle the seeding needle to all positions needed to property seed the prostate. This is what I was told by a Mayo Clinic radiation oncologist.

However, he went on to say that external beam radiation (EBR) COULD cure my case as easily as surgery.

But he added that the EBR could NOT solve my urination problem (severe BPH was making my urination problems progressively worse). So the Mayo radiation oncologist actually recommended that I go with da Vinci surgery.

I ended up doing this and have had zero PSA readings over the 2 years since surgery. I also have 100% continence.

So, for whatever this is worth, I thought you might gain some insight from a case that is probably similar to yours. You'll see additional info in my signature below.

Good luck in whatever choice you make! :)
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.
Pathology showed Gleason 3 + 3, pT2c, N0, MX, R1
adenocarcinoma of the prostate.
Prostate 98.3 grams, tumor 2 grams. Prostate size 5.0 x 4.7 x 4.5 cm.
Abdominal drain removed the morning after surgery.
Catheter out in 7 days. No incontinence, occasional minor dripping.
Post-op exams 2/13/12, 9/10/12, 9/9/13 PSA <0.1. PSA tests now annual.
Firm erections now briefly happening in early mornings, 2 years post-op.

get it out and rt is a fall back whereas rp is not a fall back after rt.

i wish you guys would quit repeating this tripe. your uro is a surgeon who wants your business. when BT fails the failure is very rarely local so what good would surgery do you?

ed

F8 said...
get it out and rt is a fall back whereas rp is not a fall back after rt.

i wish you guys would quit repeating this tripe. your uro is a surgeon who wants your business. when BT fails the failure is very rarely local so what good would surgery do you?

ed

Respectfully, you radiation guys need to stop being so snippy and sensitive over this. It is growing tiresome. None of us are doctors. But there ARE doctors who discuss things in this light. And not all are surgeons. THEY are the doctors, not us.

Whether it is rare for radiation to fail, or not, the fact remains that surgery is seldom an option IF radiation should fail. But the reverse IS true.

So please try not to be so thin skinned over this. Surgery proponents seldom attack when the frequent negative remarks are made here regarding surgery. So why not extend the same courtesy?

Just allow new patients/readers to absorb ALL of our opinions & comments -- and let them combine it with their own research so they can make informed decisions for themselves.

These constant attacks are not doing anyone any favors.

LOL.

Tudpock puts on his moderator hat and tells us not to turn this into a radiation vs. surgery argument thread.

He then does exactly that, with his predictable radiation choice. I think such a discussion from time to time, although old for many of us, is good as new folks (unfortunately) join this Forum all the time.

The fact remains that IF surgery fails, then there is STILL a possible cure with salvage radiation. The reverse is not true due to the surgical difficulty, although there may be other salvage strategies.

To use hindsight and say that if surgery fails and salvage radiation works, then radiation should have been the first choice is disingenuous. Hindsight is great. Having a crystal ball is great.

Heck, if radiation fails and then HT works for 15 years, I guess it was foolish to use radiation, by that logic!

We are all working with probabilities and very little certainty. When we are first dx., we really do not know if the PC is contained or not. Imaging techniques are just not good enough at that juncture for most of us. Choosing surgery because you have a backup cure possibility with salvage radiation is an extremely valid reason.

Note that there are other considerations, of course. If you are a G9 with extensive mets, there are no curative bullets and it's time to find a superbly competent medical oncologist to direct treatment that will hopefully put the beast to sleep for a good long time.

Mel

Mel

Ed,

you said...
i wish you guys would quit repeating this tripe.

The number 2 beside his name means that you are talking about his second posting here. Mr. Bottom hasn't been here long enough to have joined a clique. He is one guy. There are no "guys" in this case, unless you mean urologists.

Rock Bottom,

I think I promised that the radiation fans would be along in "a few minutes." It took 8 hours and 21 minutes for the fight to break out. You couldn't have known, but we do squabble over treatment options here on the forum and you unknowingly pushed a few buttons. Jim (the other moderator) and I used to go at it a while back. I was the surgery guy and Jim was the brachy guy. Jim and I are trying to stop. (Although I am tempted to rebut his last comment ... just a bit.)

We scold one another about fighting on a new guy's thread [ see my note to Ed, above ] but it is the new guys we fight over. Nobody likes to see the new guy given information we think is wrong or misleading. Sorry about that. The guys here are all good men (and women) -- even the extra cranky ones like Ed. Welcome to the forum, such as it is.

bUT mEL,

hE is CRANKIER THAN YOU. hARD TO BELIEVE, BUT TRUE.

pETER

compiler said...



The fact remains that IF surgery fails, then there is STILL a possible cure with salvage radiation. The reverse is not true due to the surgical difficulty, although there may be other salvage strategies.

l

Mel, you made my point more succinctly, thank you. The problem exists when posters ONLY discuss the salvage options after failed surgery without acknowledging the equally effective salvage options after a failed brachytherapy....that is what becomes disingenuous.

The fact is that there are many effective types of treatment. We just need to do our best to make sure new members have the full story and not just the sales pitch from surgeons or RO's.

Jim

Bob:

I'm not sure you can say what the main reason is for choosing surgery over RT as a first line tx.

For me, the idea of SRT as a second curative bullet was a very important consideration, and I think a very valid one.

Also, there was indeed the "get it out" mentality (but that was down on my list, yet still a consideration).

There was also the appeal of getting the SE early, dealing with them, and hopefully improving from that point, as opposed to SE creeping up in 2 years and maybe worsening. In my case, my incontinence resolved completely within weeks. I still have ED, but in terms of concerns that was third on my list, well after beating the cancer (failed) and incontinence.

Also, in my case, I do have intestinal issues, so I was worried more about those SE, which are a hallmark of radiation SE.

But, there was one more consideration and it was one of the most important: I had a truly world class surgeon, Dr. Menon, 2 hours away. I interviewed him and his team and I was very impressed. I was able to review data/statistics about surgeons. I was NOT able to do the same kind of digging with the radiation people. I just did not have a feel for the comparitive skills of the radiation experts.

In fact, when I did have to do SRT, I chose to stay local because it was so much more convenient and I liked the local RO. He was personable and very knowledgeable. It was only later that he made it clear to me that should I have issues I was on my own and would have to see other experts on my own (GI or urology). No wonder these RO guys can claim such great success. There is no follow-up. Meanwhile, I still get surveys from Dr. Menon for his follow-up stats.

I ended up failing surgery and SRT, but frankly I have no regrets whatsoever. Given the knowledge I had at the time, I made the correct decision. There are no guarantees.

For those who might recall when I first posted here, I agonized greatly over those crucial decisions. I studied it to death. Once I made the careful decision, I never looked back.

Incidentally, one other thing. I analyzed matters well before my biopsy. In fact, folks here felt I was jumping the gun. But I know myself. When I got that dreaded phone call, I was really not in the best frame of mind to think clearly. Fortunately, I had done my analysis and had a plan in place (who to consult, what to do). That helped TREMENDOUSLY.

Mel