New Diagnosis - 38, Gleason 3+4=7

I'm 63 and was Gleason 8 at biopsy. That raised the urgency to do something. All the scans came back ok, but the normal scans frankly cannot answer the most important question relative to the best surgical outcome. Has it escaped the capsule? The odds were that it hadn't, so I went for surgery for the same reasons others have already discussed. I had one of the best surgeons in the business - Catalona at Northwestern in Chicago. My pathology report came back with good news and not so good news. Gleason was downgraded to 3+4. But the cancer had escaped the capsule. Surgical margin was clear but "within 0.1mm of the left apical margin". When I went back to Catalona after the surgery to review the path report he said it was "not bad". From my perspective that's a lot worse than "great" and I knew what he meant. Now, almost 9 months post surgery, my PSA has crept up from 0.02 to 0.10. Indications are we didn't get it all and I'll need secondary treatment.

There are other scans that might have provided a better answer to the question, or at least provided better odds that the answer was correct. My brother just had feraheme and PET scans done under Dr. Myers care at Sand Lake for his GS9 with lymph involvement. I don't know if insurance doesn't cover these or why the best technology isn't the standard method. Would my decision have changed if the scan showed (or could have shown) what the pathology report showed? I don't know. If surgery, it might have meant cutting wider to get all the cancer but losing any hope of erectile recovery.

I'm not trying to persuade you one way or the other, but to "second the motion" that at your young age you investigate all options so you have a clear understanding of each before making the decision.

ericg said...
Doctor gave me every reason to believe we caught it in time. My prostate is the normal size and doctor felt nothing in the rectal exam. The PSA is the only reason doctor recommended a biopsy. My dad had his prostate removed three years ago (63) for prostate cancer. That is why I decided to check my PSA before 40. Glad I did! But now what?

I was only two years older than you. Welcome to the "this ain't right"club.

It's a good thing you were proactive with your testing.

I was told that both surgery and radiation would cure me. But given my age, almost every expert I spoke with leaned towards surgery.

You will be fine and get over this but expect a 1-3 year physical and emotional battle.

Whatever you do, select a superstar doctor if you have that option.

As for potential side effects, you need to prepare for the potential for these regardless of treatment. I am sexually active like most people here but eradicating the cancer, finding a cure, getting a full pathology, not risking potential long term side effects of radiation were my concern. And also, to a very large extent, I did not want to go through 35+ sessions. No, I wanted to go into battle and move on. My surgeon told me that given my age, fitness, sexual fitness, degree of my disease and his skill I could be assured that I would be fine. HE was right, never a single issue with incontinence and was having sex again within a month. But it's a risk for sure so pick wisely. My inclination was for surgery and experts, including well know oncologists confirmed my feeling given my age. But they all stressed that radiation would also cure me.

The only guaranteed side effect is dry orgasms. Wife prefers them, I miss the good old days in that regard.

Best of luck.

ps - would you be willing to travel to Chicago or Detroit? There are some superstars there.

Post Edited (davidg) : 7/28/2014 10:11:29 AM (GMT-6)

I felt like I was given a sales pitch rather than medical advice with when I met with a doctor at a "cyberknife" facility. The doc said every method for treating PC was equally effective in curing it and emphasized that this was painless and only took five 70-90 minute treatments and is less expensive than surgery. He did emphasize the 30-35% chance of impotence, which I appreciated.

The doctor really rubbed me the wrong way by joking that he didn't have anything else to talk about because I checked "no" on every box related to other health conditions and I take no other medications.

Your thoughts on cyberknife?

I found this article as I was researching cyberknife: http://www.forbes.com/sites/marcsiegel/2012/04/06/the-new-world-of-prostate-cancer/

Eric,

Making the choice is hard. Now that it is behind you, focus on the path ahead.

There are good threads here on HW regarding how to prepare for the surgery (what things to have available in your home to make you more comfortable, etc).

You may want to visit the link in my signature below where I describe play-by-play of my surgery experience and recovery. Yours may be different, of course. But, since our ages are similar, perhaps it will be a similar experience.

Remember that after surgery is over, walking and drinking liquids will help your body to heal. Do that as soon as you are able (a few hours after surgery), and as much as you are able. But, listen to your body and don't overdo it.

Post questions here before the surgery, and please post afterwards to let us know that you are doing well.

-Gedman