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50 years old and newly diagnosed

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Posted 8/8/2014 4:23 PM (GMT 0)
Hi. I have just found out that I have prostate cancer. I am almost 51. PSA at age 46 was 3.1, at 50 - 5.1, and 12 weeks after my biopsy it has jump to 8.9. Biopsy results we 12 core, 1 positive with 7%. Gleason was 3 + 3 = 6. I have asked for a second opinion after being told I should do active survellience. I am schedule for another biopsy in 3 weeks by another urologist. I am leaning very hard towards surgery to cure this thing. Any comment or advice would be so appreciated right now. I have a wife and 2 children that I want to spend a lot of years with. I am so scored right now. Please help me get the stress under control
Posted 8/8/2014 4:50 PM (GMT 0)
Wade,

First, take a deep breath: you've got time to make any life-transforming decision.

Second: get a second opinion with respect to the biopsy. I myself had my biopsy slides sent to Dr. Jonathan Epstein at Johns Hopkins University.

Third: get a 3T-mp-MRI image to check whether higher grade cancer (Gleason 7 and higher) is lurking in your prostate. In conjunction with this, I would prefer to use a MRI/Fusion targeted biopsy instead of the customary blind 12-core TRUS biopsy: the targeted biopsies are more accurate.

Good luck.
Posted 8/8/2014 5:18 PM (GMT 0)
Welcome Wade,

I was you 8 mos ago and with the same mentality. To cut it out and move on. Luckily your Gleason is a 6 so you have plenty of time to shop around for various doctors as well as weighing all your treatment options. If you state your city and state folks here can give you recommended physicians in your area.

You have the best possible path report you could have for PCa.

Prognosis calculator
http://nomograms.mskcc.org/Prostate/
Posted 8/8/2014 5:38 PM (GMT 0)
I am in Nova Scotia Canada. THe eurologist I am seeing is supposedly the best in Eastern Canada from what I am told. I think I am in good hands there.

Tdubb: This comment from you has made my day. All I have been able to find is doom and gloom and far out unproven treatment theories. Hopefully I have finally come upon a site that can help me and give me some reassurance
Posted 8/8/2014 5:45 PM (GMT 0)
Wade, I was in your spot 2 1/2 years ago. Don't rush into anything. Do as much research as possible. Be careful not to be one who is overtreated. You'll understand what I mean after you've done your research or you can Google "Overtreatment of Prostate Cancer. If you are going to have another biopsy definitely push for a 3T MRI guided biopsy. Best of luck
Posted 8/8/2014 9:07 PM (GMT 0)
Unless you absolutely cannot stand the idea of having a known cancer core in your body, one that will likely cause you any mortality risk, you seem to be an ideal candidate for pro Active Surveillance. It is almost certain that when you eventually die wit will be from something other than prostate cancer given your stats, the classic die with it rather than die from it.

Don't let the first surgeon you encounter talk you into doing surgery until you have done your homework. With your metrics, time is definitely on your side to study up and decide later.

LupronJim
Posted 8/8/2014 9:22 PM (GMT 0)
Wade, 7% of 1 core out of 12 with Gleason 6 is almost non existent.

Slow way down, your options are plentiful. Quite a few guys here have come in with your numbers and settled into a life of Active Surveillance.

The bigger part of the picture for you should not be worrying about such a small amount of non aggressive cancer, but rather the side effects that are possible with any form of treatment.

At your age, worrying about incontinence, erectile dysfunction and the other possible side effects from surgery, radiation or whatever, should be the bigger issue.

You have soooo much time to research, watch, and learn that there is indeed no rush to make any decision.

You have been given some great advice about additional tests, 2nd opinions, etc., so take the time to gather more information.

Give this crap the due diligence it is due, when it is required and the rest of the time go back to enjoying life and living.

Sonny
Posted 8/8/2014 10:15 PM (GMT 0)
I was also in your position a couple of years ago, but your stats are more favorable than mine.

The one thing you should realize is that with small amounts of with Gleason 6 that there is no rush to make a decision. I decided to give myself a year and then after tons of research I opted for active surveillance.

Aside from this site (which offers excellent support and advice), I would check out the following:

http://www.yananow.net/

http://askdrmyers.wordpress.com/

The second has a series of about 10 minute video logs by a well-know urologist who has prostate cancer. If you search through the older videos you will see topics such as active surveillance, surgery and radiation.
Posted 8/8/2014 10:26 PM (GMT 0)
Hello Wade, My husband was diagnosed at 49 and we have 2 children so I understand what a massive shock this is for you. Keep in touch with the guys here as you consult on the best course of action As others have said, you have a really good option to go the active survaillance route with your numbers. My husband had a higher Gleeson and he is fine after 7 years.

I can see you there well into the future sharing a long life with your family, so breathe, and as others have said don't rush into anything. Get the best advice here and you will find a range of options and opinions which will help you sort through the maze of information and make the best decision for you.
Take care and welcome to HW.
Posted 8/9/2014 12:20 PM (GMT 0)
Hi Wade,

Shocking news isn't it?  No one wants to hear that they have cancer, however mild like it sounds in your case.  Cancer may have affected several loved ones like myself or it may be the first time you are dealing with it.  The good news is, as others have said, you have been diagnosed (so far) with one of the least aggressive cancers.  I would say to educate yourself as much as possible before deciding to do anything.  I like Dr. Patrick Walsh's book, he was one of the leading physicians on modern surgical treatment and has a lot of researched data compiled in his book and covers all aspect of prostate cancer and its treatment options. You have time, as others have said.  There are also some new prognostic tools like genomics testing that can help give you more information to help you decide what you will do.  What I think you will learn is that prostate cancer is a very uncertain animal as are its treatment options.  Whatever course you decide there will be risks.  As TurpT1a mentioned, get a second opinion on the biopsy and MRI and possibly a bone scan.   What is important, I think, is that you make a decision that you are totally at peace with.  All of us are different and have different priorities and things that are most important to us.   It is a tough decision, good luck, I have found this forum will support you whatever your decision.

Posted 8/9/2014 12:22 PM (GMT 0)
Wade, your numbers are the same as mine were 6 months ago. I was told to take action over the next year to eliminate the problem. I researched everything I could read for three months and started to rule out therapies. The very first was surgery. Most people's reaction is to jump to surgery and looking back this is the most invasive and has the most negative after effects. In addition not all tissue can be removed and if any cancer cells remain they will continue to grow and you will be faced with the problem again. To make a long story short I opted for Proton Radiation therapy at the Univ. of Florida. For you and your numbers they claim 99% remission at 5 years. I completed radiation 3 weeks ago and have no after effects other than minor urgency issues at times but never a leak. I have retained full sexual functions. I cannot say enough good things about the facility I was treated at. It is painless with very small effects on the body. I just cannot understand why men subject themselves to brutal prostate remedies when there is one that is effective and non invasive. about 10% of the fellows in my program had surgery and now are being treated for the return of cancer since some tissue was left behind. Talk to a proton center before you make up your mind. I do not know where you live but I can recommend one if you want to tell me where you are located.
gbiers
Posted 8/9/2014 1:05 PM (GMT 0)
Wade, welcome to HW but sorry you have to be here. You have already received some excellent advice....namely slow down, take a deep breath and take your time making decisions. What you have diagnosed is barely cancer and, in fact, some recent thoughts by noted doctors would not call it cancer at all.

Nevertheless, I understand your angst - we have all had it - and you need to deal with it. I recommend you start by reading the sticky thread at the top of our forum that is designed for newly diagnosed patients: www.healingwell.com/community/default.aspx?f=35&m=2652250. You want to get educated on our cancer so I would also recommend several books, including Dr. Walsh's, "Guide to Surviving Prostate Cancer" and Dr. Scholz', "Invasion of the Prostate Snatchers". You should also proceed to get a second opinion on your biopsy results from a noted pathologist like Dr. Epstein at Johns Hopkins or Dr. Bostwick at Bostwick Labs. It's really important that you have a good understanding of your pathology and reading these slides is an art as well as science.

BTW, your big PSA jump after your biopsy sounds like you may have gotten an infection. Has your urologist suggested a course of antibiotics to see how that affects your PSA? He should.

TurpT1a suggested a multi-parametric MRI. That would be a good idea IMHO so that you can more comfortably rule out more aggressive cancer and can perhaps settle into a course of Active Surveillance.

Good luck and keep us posted.

Jim
Posted 8/9/2014 4:13 PM (GMT 0)
Wade,
Psychologically you have every reason to be scared; the word "cancer" does that to you. In reality there is little to fear and your biggest risk is making an emotional decision that may affect the rest of your life.
First, you have a very small amount of a non-aggressive cancer.
Second, a G6 is rarely deadly as it does not metastasize. Only cancers that metastasize can kill you and as long as it remains in the prostate it will do no harm.
Third, about half the men your age have exactly what you have, small amounts of cancer in their prostate that usually go undetected for a life time.

Your first steps should be to confirm what the biopsy found by getting a 2nd opinion of your biopsy slides. An MP-MRI would be more useful than a 2nd biopsy so close to the first. The MRI will confirm both the size and location of the tumor and possible spot other areas that the biopsy may have missed. This information is critical for good decision making.
Pick up a copy of "Invasion of the Prostate Snatchers" by Dr Mark Scholz as it is the best reference on "low risk" PC.

JT
Posted 8/9/2014 4:16 PM (GMT 0)
I'm in a similar situation as you can see from my signature. I wish you the best. Ditto on turpT1a's advice.
Posted 8/10/2014 7:25 AM (GMT 0)
Sorry Wade, the news sux... Luckily you caught it very early and have many options and time. You have received good advice here, another book to look at is by Dr Peter Scardini. I was 48 when diagnosed with an enlarged prostate and a few more positive cores. In hindsight I wish I could have waited. Get educated and make the right plan for you

Best of luck
Posted 8/10/2014 11:38 AM (GMT 0)
Wade,
I can relate to the scared part. In my case it was pretty close to panic. Truthfully, I was more frightened by the possible side effects of treatment: especially surgery. I did the 'watchful waiting' aka active surveillance for as long as I could which was right around 2 years. I had no problem with it...and no side effects. I would have continued to do AS indefinitely if the circumstances would have permitted it. As it is, it became pretty clear that I needed to choose a treatment path when I had 15 instances of G6 and one G7 out of 60 samples.
I chose LDR brachy because my research indicated that brachy would offer me an excellent chance of beating the disease and a lesser chance of life-changing side effects. My research was correct. It truly was the best decision of my life.
Point being, your fear is very natural, but understand that pc, when caught early, is very treatable if you even need to be treated. Equally important, you do not have to give up your quality of life. My oncologist actually uses the 'cure' word. I'm reluctant to use it but I sure as heck like to hear him say it, and my sex life has never been better.
Try to relax a bit as you educate yourself about pc, and be confident in knowing that many of us have been very successful in our pursuit.
God Bless.
Posted 8/11/2014 1:43 AM (GMT 0)
Wade
You've received good advice here. Gl 6 is completely curable and may not need any treatment . Take you're time and just watch it . If it progresses then take action. Good luck!
Bob
Posted 8/11/2014 3:20 AM (GMT 0)
Wade:

you'll be okay. You've caught this early.

Before I was upgraded to a G7 my numbers were nearly identical to yours. After speaking to several experts, oncologists, surgeons, and a radiologist I decided to treat it because of my age. That was their expert advice.

Best thing you can do is to find experts in various fields who can advise you. It'll be a whirlwind of information, perhaps conflicting, but at least you will have done your due diligence.

you'll be ok with the cancer part but the experience and stress may require further attention after you've done something about the cancer itself. Best of luck.

Post Edited (davidg) : 8/10/2014 9:23:53 PM (GMT-6)

Posted 8/11/2014 3:33 AM (GMT 0)
Wade, welcome here, sorry you have the need to be here.

If your 2nd opinion confirms a single low grade Gleason 6 core, I would strongly urge you to consider AS as your "Primary" treatment at this point.

Why risk ED and/or incontinence issues over a microscopic amount of cancer, that probably would never hurt your the rest of your life? Much of what is at HW PC has to do with men dealing with both issues, or at least one, and some, very long term serious issues.

If your 2nd opinion indicates a stronger grade of PC, or more cores, or more cancer within the core(s), then that is a horse of another color.

But if confirmed as you know now, you really need to think through what is best for your body. Don't let the word "cancer" in this case, be the sole determining factor in choosing a very invasive treatment, that you may not ever need.

With AS, if you are qualified, would still allow you future invasive treatments if it worsens over time. But if you are truly a Gleason 6 with a single low grade core, you are highly likely to live the rest of your life without fear of that cancer doing you in.

Just something to think about. Of course, its your choice, and its between you and your doctor(s) to make. But don't let the "C" word scare you of proportion to what your actual situation really is.

Best of luck to you. Once you take on an invasive treatment, there is no turning back, and the outcome can not be predicted by any doctor or treatment method. It's like the roll of a dice at that point. Many men "luck" out in a good way, yet we have way too many here dealing with serious issues that could have been avoided simply by choosing AS when their criteria safely warranted it.

David
Posted 8/11/2014 3:52 AM (GMT 0)
it is not even close to being a roll of the dice, David. There are several factors, including Wade's general health, sexual potency, location of tumor, skill of doctor that will play a significant role in his recovery. Calling it a roll of the dice injects a lot more fear into an already scary situation. It's not a game of Russian Roulette. We have the power to make sound choices although there are no guarantees. This thread is just about scare tactics. You should also consider the nature of Internet board sin general, the vast majority of those doing well unfortunately (or not) decide to move on with life and not linger on boards playing doctor.

Wade, many radiologists, surgeons and even AS specialists will have statistics that can give you an idea of their metrics outside of basic standard industry ones.
Posted 8/11/2014 4:13 AM (GMT 0)
davidg - its my personal opinion, and my personal choice of words. there is an element of "chance" once you choose surgery. doesn't matter if you have the "greatest" surgeon in the world, your young age, etc, no one can guarantee an outcome, let alone a particular one.

we have too many men here, with nerve sparing ops, that are still dealing with major ED issues years later. and those too with long term or perm. incontinence issues, and unfortunately those dealing with both.

surgery, whether it be robotic or open like I had, is invasive. and the risks are even higher if the goal is to remove a microscopic amount of a Gleason 6 cancer, that is highly unlike to turn to mets or ever harm the patient in a normal lifetime.

not trying to scare wade or anyone else new to PC. not saying anything any different than the majority of those that have responded to wade in a similar manner. so my words stands as I wrote them, my post, my choice.

none of us are doctors or pc experts, so I can only answer based on my personal experiences and knowledge that I have gained the past 6 years since being diagnosed

thank you though, but I disagree with your perspective of my "word" choice.

David in SC
Posted 8/11/2014 4:26 AM (GMT 0)
sure, there are no guarantees. But we know that depending on several factors, and luck if you like, Some docs reach metrics in the 80-90%. There are also no guarantees with AS, even assuming you can get on a super program (most don't).

It's like radiation. I didn't want radiation for 3 reasons. One of them was my fear of damage form the radiation. I was told that the chances of this happening, although most data wasn't on 40 year old men like me, was miniscule. Yet here we are talking and look at what radiation did to you. I think you'll agree that you were an exception tot he rule and that most men who undergo radiation do not suffer from such side effects.

I know you meant well. Sorry if I came across to strongly. Just that Wade opens up saying he's thinking about surgery, and you're basically telling him it's a roll of the dice. I think Wade will do fantastic whether he chooses surgery, radiation, or a good AS program and that done properly, none of them are a roll of the dice.
Posted 8/11/2014 5:03 AM (GMT 0)
Not saying that surgery wouldn't be his answer, and for many men, especially those with a low grade case which he appears to have, it very well could be curative on the first attempt, and he might "luck" out on the negative aspects. As you well know, I am one of the rare lucky ones, who had a non-nerve sparing op, and to this day, have never experienced a single day of ED. Didn't make sense back in 2008 when I had the op ,and still doesn't make sense to this day. But I have always been thankful for that one golden cloud in what's been a very messed up PC experience.

But for each and every man that can safely meet the criteria of AS, I only wish upon confirmation via a 2nd opinion or even 2nd biopsy, they will at least strongly consider AS. As mentioned prior, if AS proves to be unsatisfactory in the future, that same man normally has all the same primary treatment options that he first had. In the meantime, if he can get a few or many years without needing the risks with a primary and invasive treatment, the better for that man and his quality of life..

David in SC
Posted 8/11/2014 1:43 PM (GMT 0)
I am in good health, a touch of diabetes but have it totally under control, after I found out that I have prostate cancer I changed my diet and have started walking about 3 - 4 miles (5 - 6 km ) per day. I have managed to shed 25 lbs this summer. and expect to get rid of another 25 lbs this fall. I weighed 248 in January 14 and now am down to 222 lbs. I am hoping these changes will have an effect on my treatment and decision. I have also consulted people about cannabis oil but am unsure if that is the route to go. All this information I am receiving here is the best I have found for the last 3 months.

Also I have ordered the 2 books that were mentioned in previous posts.

I really appreciate the time everyone is taking to reassure me I don't have to rush into anything at this point.

Thanks so far everyone
Posted 8/11/2014 2:08 PM (GMT 0)
the weight loss will not only be of great help in recovering from potential treatments, but even more so, great in combating the #1 killer for us, heart disease. Fantastic job on taking control. Well done.
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