Official Diagnosis Interpretation

If it was me, knowing what I know now, I would not do anything right now. There are a lot of way smarter guys on this site, and their opinions are probably more valid. But if that was my diagnosis today, I would resist the get it out mentality and enjoy dry pants, erections & ejaculate. I would watch it, but wait until it gets to the point where you need to act in the next few years before you do anything drastic. I am in no way saying ignore it, but have it be a minor life changing event rather than a major one. As the doctor's liked to say to me "If you were my brother I would...." do nothing except be vigilant.

you have found the best possible place to be right now. sit back and wait and you will get a whole lot of real good advice. I was DX at 49. Like you my Dad had it. He is 92, and still kicking. Chemically castrated, like a lot of the smart guys on this site. You are a low risk guy, and it's not worth the side effects until it gets to the point where it is worth it. Take your time, do the research, and listen to these guys. I wish I had that option. I was totally of the mindset of "get it out." I found this site a few years later while dealing with the side effects. I wish I had been here at the beginning like you are.

PC Legacy,

You haven't told us anything that sounds like you need to do something in a big rush. With your family history you really need to keep an eye on things but you owe it to yourself to find out at least a little something about every available treatment for prostate cancer because they have different side-effect profiles and almost any of them will cure the cancer you describe.

You are right that cancer at the apex can add a bit to the risk of incontinence and impotence with surgery. Things are kind of tight there and the surgeon doesn't have a lot of room to cut wide without getting into stuff you'd rather keep.

There are several kinds of radiation that would work for you and, while they have their own risks, they can often treat cancers in the Apex without as much risk of incontinence or impotence.

Welcome to the forum, by the way before I forget. Sorry you find yourself here but glad you've found us.

PC
The bladder neck is at the base of the prostate not the apex so migration to bladder neck is unlikely. I would definitely get another opinion from Epstein or Bostwick on you're gl6 reading. If you're still gl6 and have such low volume, then AS is definitely a good option. You are not at the point where get it out now is necessary and you may never be at that point. Good luck!
Bob gl9 pt3b

PC,

Your concern is sensible but you did word it wrong. The apex is close to the "distal" urinary sphincter (between the prostate and the penis) and not the "proximal" urinary sphincter which is between the prostate and the bladder. The distal sphincter is the one they let a man keep after RP. The proximal sphincter usually goes with the prostate. If the surgeon has to cut too close to the distal sphincter it can cause continence problems. Men treated with radiation get to keep both sphincters and tend to have fewer issues with continence after treatment. So cancer in the apex is a reason to prefer radiation over surgery, all other things being equal.

Thanks guys. I am pretty sure that AS will be the treatment plan advocated by my urologist, as he has already stated that we will have to monitor this closely. He didn't even mention surgery or radiation in the conversation yesterday. However, a few weeks ago, before my biopsy when we were discussing the MRI results he did state that given my family history and the location of the "lesions" (before we knew it is now an official PC tumor) that he felt surgery would have to be considered.

I am however, pretty sure that he believes we will evenutally have to move to a 2nd phase of treatment after AS at some point during the next several years. The good thing is that I appear to be a candidate with options. Given the situation, I can't help but be very pleased with this initial diagnosis.

PC Legacy

Rule of thumb: anyone initially diagnosed with low-risk PC who undergoes aggressive treatment without the benefit of TIME and a second confirmatory biopsy has placed themselves at high risk of PC overtreatment.

PC,
I am you 8 yrs older. I chose to have the cancer removed. At my 3 mo post op visit last week to the Uro I told him I'm 97 - 98% continent. He said I will be 100%. My PSA is .01. Pretty short story.

I haven't heard of any problems with insurance and TFT. Actually one of it's problems in it not being more wide spread is that there isn't that much money in it. The only insurance denial problem you may encounter is for the mandatory 3 D mapping saturation biopsy. In my case once it was explained why it was approved. For normally a simple 10-12 core truss biopsy is done for radical treatments involve the complete removal or destruction of the prostate. But for TFT to best locate the PCa exactly many more cores are needed depending on the prostate size. In fact mine was shrunk over 2 months by taking avodart and it still required 45 cores.

Like all have said you can do AS which is what I would recommend now or consider TFT. A far less invasive treatment with my only side effect being maybe a 60% loss of ejaculant. In truth I and another here are the two most successfully treated men on this site.

Take time to learn all your options, below is a link to where I had my TFT.

http://www.precisionprostatecare.com/

Hi there, and welcome

I too was diagnosed at 48 with a Gleason 6, and that age aspect was what the uro saw as important in making a decision about whether or not to do anything as he felt I shuld be going to live for say at least 35 years and that was long enough for the PCa to get worse, thus at some point we would need to do something about it. MY choice was to want to find out that I had perhaps acted too early rather than too late. And as it turned out I was perhaps wise to act too soon as after surgery it turned out I was actually a GEalson 7, and the PCa had "escaped" into the seminal vesicles, and within a year I ahd also had SRT as my PSA went up soon after surgery. Now I emphasise that that is what happened to me and is not necessarily what happens to other folk.
However one importnat thing my uro siad was to take plenty of time to think abotu what wanted to do, I had for instance had a vacation planned and he said that it would be a good idea to go ahead with it and make decsions when I got back, or later. Ineed my second uro that actually did the surgery said it would be fine to rethink my decisions right up to the last minute, even on the morning of surgery I could change my mind and opt to wait a bit longer.

A couple of points:
I'm not an expert, but I was under the impression that the Apex of the prostrate was actually the end nearest the penis. When you hear the word apex, you think it means "top", so that makes you think it's the end nearest the bladder, but it really means the pointy end and the pointy end is at the bottom, if you see what I mean. But check with the uro. It's the fact that the apex is right down in the hard to reach place that can make the apex area problematic as it were, not the fact that it is close to the bladder neck.

Secondly the fact that your dad is also "one of us" is bad news in one way as it means you have a higher risk of getting PCa, but you're actually past that point. I think the important thing is that he has already survived 21 years, and has done so despite his PCa being stage 4, suggesting to me, as a non professional that he had a less aggressive form of PCa and that there could be a chance that you have a non-aggressive form too. Not sure it's possible to tell yet what type it is, but IMO I think what you need to do now is to continue to assemble as much info as possible and not rush into anything. PCa is not like other cancers in terms of the time scale in the immediate aftermath of diagnosis, so although we all tend to feel bad about what is happening to us we have time to assess things quietly.

All the best
Alf

PC Legacy said...
Tdubb,
How has your recovery progressed? Any ED? If it were not for this potential complication, I would be very inclined to follow suit and have surgery myself. On the other hand, if my Urologist, who happens to be the Chairman of Urology at an incredibly well respected program in UTSW in Dallas, says active surveillance is the right path even though he has done almost 2000 RALP procedures, I can't help but believe him that AS is the right path. I have already resigned myself to the fact that a next step of treatment will eventually happen and that likely will be surgery. However, should my G6 really continue to grow slowly and I find myself 10 plus years down the road (doubtful), surgery may not be how I decide at that point. If my PSA continues to rise and is a point or so higher within the next 6 months I will likely exercise my option to have surgery. Just hoping I actually get a longer time frame to make that decision.

Thanks,
PC Legacy

PC,  My recovery from surgery is going well.  I am a marathon runner so was in good shape and weight before surgery.  ED goes hand in hand with surgery.  At 3 mos post op I am getting sensations in those nerves and doc says that is very promising in recovery of ED at this stage.  My personality didn't allow for active surveillance.  My Uro says his patients on AS jump to surgery at the first sign of PSA increase.  That would have been me.  My train of thought is I want it out and if I ever need salvage treatment I could fall back on radiation.  My GL was 7 (biopsy path report) and was downgraded to a 6 (surgical path report).  I couldn't stand to go through another biopsy, I just wanted this over and done and move on.  I do believe people's personalities play a strong role in final treatment choice and ultimately the comfort level of one's decision.  All the best, it sounds like you're in good hands.  Tdubb

PeterDisAbelard. said...
PC,

Your concern is sensible but you did word it wrong. The apex is close to the "distal" urinary sphincter (between the prostate and the penis) and not the "proximal" urinary sphincter which is between the prostate and the bladder. The distal sphincter is the one they let a man keep after RP. The proximal sphincter usually goes with the prostate. If the surgeon has to cut too close to the distal sphincter it can cause continence problems. Men treated with radiation get to keep both sphincters and tend to have fewer issues with continence after treatment. So cancer in the apex is a reason to prefer radiation over surgery, all other things being equal.

You are generally correct about keeping the distal sphincter after RP but many robotic surgeons were also able to keep the proximal sphincter. See this article:

http://onlinelibrary.wiley.com/doi/10.1111/iju.12206/abstract;jsessionid=A7287F88FC8CE64F5958BD6BEA69E582.f01t03?deniedAccessCustomisedMessage=&userIsAuthenticated=false

In fact the surgeon operated on me used this technique and I have no incontinence issues from the moment the catheter was taken out.

Regards,