Prostrate Cancer

My father is diagnosed with prostrate cancer. Doctor has suggested Robotic Radical Prostratectomy.

His PSA is 23.

Core Biposies right lobe - Gleason's score is 3+3 involving 1/7 cores - 9% area of the tissue
Core biopsies left lobe of prostrate - Gleason's score is 3+3 involving 1/4 cores - 8% area of the tissue
Core biopsies targeted site - Gleason's score is 3+3 involving 1/2 tissue cores - 25% area of the tissue - perinerual invasion is not seen.

Kindly suggest me whether I should go for robotic surgery and also share whether after surgery my father will be fine.

Thanks

Anthony

Anthony,

Sorry you need to be here for your father. It sounds like he will be fine and he has many options available. His PSA is rather high but Gleason score is low. He may want to have a second opinion look at his slides from his biopsy.

Surgery would be a good option if it is contained, as long as he uses a surgeon with a lot of experience with DaVinci. There are no do overs. Remember, urologist are surgeons so they usually suggest that treatment.

The radiation guys will be along shortly and it looks like he would be a good candidate for radiation also.

It would help to know his age. If he is over 70, that may change things. Also his overall health.

Bill from Florida

I suggest that you also research various forms of radiation therapy including brachytherapy (either permanent seed or High Dose Rate). These treatments are as effective for cancer control as surgery and generally lessen the side effects of treatment.

His G6 low risk is complicated by his high PSA. But, you should be in no big rush to initiate treatment. You have time to do research. My doctor required that I get multiple opinions from other doctors before he would accept me as a patient. For me that was very effective. Even if your father is 100% that surgery is best treatment, he should at least research surgeons to ensure he is with the very best. Results vary widely among surgeons and it is advisable to know you are with one of the best.

Questions to ask include how often the surgeon performs the surgery and how many have been performed. What is the surgeon's statistics regarding positive margins, incontinence, ED, etc. If the surgeon can't provide objective evidence, you should be suspect. Get referrals to other patients to learn of their experiences. Get potential insight into practitioners in your area from members of this forum. Also check in your area about any USToo groups. These are PCa patients that can provide information based on their experience.

Hi.. I am sorry about your Dad. As you are finding with this board, there are lots of us with PCa .. and many of us have taken different pathways for intervention with success. His opportunity for success is very good these days -- first with "beating" the cancer, by eliminating it and second with achieving control of side effects sufficiently that he won't be significantly impacted in quality of life.

My first thought is that your dad (and you!) have time to really check this out .. consider all of your options and meet with multiple doctors (surgeons, radiologists, etc.) to feel highly confident in your choice of treatment, and which doctor to do it. PCa is quite slow growing, so you have time .. at least months, not weeks. Higher Gleason scores might prompt more immediate intervention... your dad is G6 so far.

My case as an example... I had a PSA jump at age 56, and had a subsequent biopsy in Jan 2012 that indicated G6 in 2 of 12 samples, 5% and 20% respectively. After MUCH deliberation, I chose Active Surveillance through a formal program at UTexas Health Sciences Center in San Antonio and participated with that until a repeat biopsy (part of the program) in Jan2014. This 2nd biopsy was positive in 5/12 samples, and 3 of those were G7 (3+4).

I (actually we, my wife and I) decided last spring (again, much deliberation and evaluation with multiple drs.) that based on progression of disease status, we would pursue surgery (RALP) which I completed last month (Sept 8th). Final Pathology report confirmed G7, and everything was contained within the prostate -- this is the pathology report we were hoping for. So far (6 weeks) I'm doing well with both incontinence and ED which are the major side effects. I attribute this fully to choosing the right surgeon, and surgeon had a good day....

Overall, my timeline from initial diagnosis (Jan12) to surgery (Sept14) was 32 months, and my cancer progressed from G6 to G7 but was still fully contained. We are all different and will all have different experiences, best not to ignore anything but you have time to fully evaluate options and make the best choices for your dad.

Keep us posted on his and your progress.

Anthony, pick up a copy of Dr. Pat Walsh's book "Surviving Prostate Cancer" and learn exactly what you are facing here. Have Dad read it too...

While the biopsy did it's job, it discovered the cancer, it may have missed a more aggressive tumor. Prostate cancer tends to be multi-focal..There are usually more than just one tumor and the needle biopsy can not be relied on to uncover them all...So I would second John T's suggestion to carefully investigate the reason for the PSA 23 so his best treatment options can be determined...Again, read the book, the knowledge gained with be a big help on this journey...

To me, it says he has a little arthritis here and there but because of that PSA 23 number, the word "however" suggests there is a possibility of bone mets.....But they are not 100% sure...Typical CYA doctor talk....

I know you and your dad are tired of tests these days Anthony. But, as others are saying also, there seems to be discrepancy in the results you have so far, that really should be evaluated further.

My (non-medical) read of the bone scan is that it's a pretty good report. And, biopsy showing 3 spots of Gleason 6, while a positive result for cancer, is lower risk and doesn't seem highly troubling. But, then there is that pesky high PSA level... hmmmmm.

Hi PSAs can be caused by a number of different things, including prostatitis (infection) that can be cured with antibiotics or time. Then, repeat the PSA in a month or two, and it will hopefully be a much lower number and you and your dad can sleep much better.

I second John T's suggestion that another test called a multi-parametric MRI (mpMRI) could be helpful for you. This isn't like biopsy in that it is non-invasive and you only lie on your back with the machine. I remember that they use a dye though, which goes in through an IV line .. so you get a needle once again in your arm.

This test is relatively new on the PCa scene, and it can effectively identify higher grade tumors in the prostate. It is less reliable in finding lower grade (G6 or even G7) tumors .. but can be very good at finding most G7 and G8+ foci. In your dad's case, the high PSA number might (?) mean a location of aggressive cancer that was missed in the biopsy, and the mpMRI can help you rule that out. If mpMRI findings are negative, then this supports the biopsy findings of couple of spots G6, which is lower risk and means that you and dad havw much more time to figure out his choices and next steps.

One important thing with mpMRI -- the newest MRI machines that do this well are called "3T" models. If you choose to do this, make sure with your lab that MRI unit is a 3T.

Good luck...