Overwhelmed

I can't speak for LDR (surgery here) but wanted to let you know that there will be someone out there responding. Take a look at the locked threads at the top of the forum message list and look them over.

You came to the right place.

Don
_______________________________________________
Age 61 @ DX, 62 Now
DRE: enlarged w/"ridge"
Pre-Op PSA: 6.8
Biopsy: 5 of 14 positive, 12%(3+3),11%(3+3),20%(4+3),5%(3+3),4%(3+3)
da Vinci: 10/17/2014 Both Nerves Spared
Cath: 17 days
Post-Op Path:
Histologic Type: Adenocarcinoma
77gr - 4.5cm x 4.7cm X 4.2cm - 10-20% Involved by tumor
Largest module: 1.6cm Bilateral Lobes
Gleason Grade: 3+3=6 (down from a 4+3=7 in biopsy)
TNM Staging: pT2c pN0 cM0
EPE: Absent, SMI: Absent
Margins: uninvolved, Lymph Nodes all benign
Bladder Neck Negative for Carcinoma
Perineural Invasion - present, Vascular Invasion - present
PSAs: (Roche ECLIA Meth.):
01/22/15 - <0.1 (Three Month test)

Windsor,

I know the diagnosis is a shock. But step back and take your time before making any decision. Yes, the bad news is you have been diagnosed with PCa. The good news is it is Gleason 6 and pretty low volume. Therefore, you have plenty of time to research and consider your options. One of the options you mentioned is short term active surveillance. In your situation it would be my first choice at least for the short term while doing research and having a couple of more PSA tests at 3 month intervals, before consenting to anything more drastic. It is entirely possible that your "short term" active surveillance could become "long term" active surveillance. You could very well go for years or may never need more aggressive treatment. My second choice if I were in your situation would likely be brachy because it would hold a very high probability of cure or long-term remission with less probability of unwelcome side-effects (e.d.., incontinence) that can come with surgery and/or radiation.

These are just my observations. I'm not a doctor. But you should consider both risks and benefits. And ask your doctors to help you evaluate whether the risks of surgical or radiation treatment right now outweigh the possible benefit of waiting until when or if ever, your clinical signs become more problematic.

Jim

Thanks for the support. Having never had any serious health issues (never even spent a night in a hospital, other than with my wife during labor), this has come as quite the shock. Just trying to figure it out.

logoslidat,
I was treated for prostatitis around 2007-08, treated with Cipro, and everything seemed fine after a while. My PSA at that time was around 2 something, but I knew something was wrong as I had some discomfort when urinating. Never treated for BPH. Had a PSA done in January, and the number was significantly lower than my two previous tests. The last three tests are 7.41., 8.3, and 4.6. So it went up and then down.

I'm sorry you have to be here. But I think it's good you're reaching out. I was also diagnosed at 52. Here's my thoughts:

You've been diagnosed as a G6. While there are no guarantees, you've got excellent odds that ANY treatment will give you a lasting cure. That means you need to decide which side effects you can most likely deal with. It sounds like you're already thinking along those lines.

Arguably, the least side effects come from AS. At the same time, I know that everyone is not cut out for that. And unless you're in an AS program, you're unlikely to get that advice from doctors that are trained to do something. But knowing what I know now, if I had been a G6 I would have considered AS for as long as I could stay on it.

Even if you don't do AS, you have plenty of time to make a decision about what you want to do. So talk to some of the best surgeons and ROs around to help you decide. Of course, you already have great access at Johns Hopkins! (Although I'm not sure of their expertise with either SBRT or HDR brachy....)

I do have to point to two comments above that I don't agree with:

1) that you can have radiation as a back-up to surgery, but not vice versa. While that's (somewhat) correct, it's also very misleading as it implies there's no back-up for radiation and that's simply not true.

2) that surgery "gets" all of the cancer while radiation "hopes" to. To the extent that the cancer is in the prostate, surgery *should* get it all. But in the event that it's spread beyond the prostate, radiation actually casts a wider net and should "get" more cancer. (Assuming it's beyond the prostate.) And is anyone on your team suggesting that for your G6 diagnosis that surgery has a better success rate than radiation?

Again, sorry you have to be here. But in my opinion you have the kind of diagnosis where you can control the timing and choice of your treatment. If we can help, let us know. Good luck!

BillyBob,
Not sure why the PSA dropped. Between tests 2 and 3, I read that activities such as sex or riding a bike within 48 hours of the test may affect the PSA. I don't remember if I had sex within 48 hours of tests 1 and 2, but I probably did ride my exercise bike. I made sure I didn't do any of these things within a week of test 3.

Sorry you have to be here Windsor, but you found the right place. Your numbers and age are similiar to mine when I started out on this journey. You have time to do research and talk the other doctors. I would talk to a surgeon, radiation oncologist and a medical oncologist. Like you, I was in my early 50's and was being pushed toward surgery, because I was a good canidate to recover quickly. I didn't like the idea, and the side effects of any of the treatments were VERY important to me. I chose SBRT based on what I had learned and having a great facility nearby. I would have done LDBT or HDBT if I did not have the SBRT option. I'm going on two years out and doing fine, with no side effects of note. Not trying to tell you what to do, other than to make up your own mind based on your own research. We are always here to answer questions from a patient's point of view (which is much different from a doctor's). You can check out my story in the thread on my signiture line. Good luck and keep in touch with any questions you have. No reason at all to panic with your stats. Do your homework!
Mike

Windsor,
Sorry you have to be here, but welcome.

You've received a lot of good advice. I would like to add to this advice.

My observation is that the treatment option you select will be highly dependent on your temperament. Some guys are very conservative and want to hit their PCa with everything they can. On the other extreme their are guys who can live with knowing they have an indolent Cancer and can watch it forever. For some quantity of life is more important then quality of life (and vice versa). None are right, none are wrong, To each his own.

You only have one chance to make your initial treatment choice. I recommend you do your homework and make a choice you can live with. Once you pick the methodology, look for the best doctor (Surgeon, Radiation doc, etc.), you can afford.

Best wishes as you move forward.

Post Edited (RCS) : 2/11/2015 7:11:56 AM (GMT-7)

We all have walked in your shoes with the range of emotions after diagnosis. The news for sure is a shock but the overwhelmed feeling should dissipate soon as you become more educated about your situation. With your Gleason numbers there is no urgency to act/react so take your time as you become informed. The standard recommendation is to have a second reading of your biopsy slides at one of the recommended facilities (Bostwick Labs, etc.)

Hi Windsor, and welcome. You have come to a good place with immeasurable help and knowledge from those that have "been there, done that" with respect to being told we have PCa, learning about the beast, deciding on a treatment path and moving on. Please keep in mind that with your statistics you do have time - time to learn about PCa and the various treatment options - so don't panic!

Good move on getting the 2nd read on your biopsy slides!

Along with forums such as this where you can learn from people that have and are going through what you are, do as much internet research as you can. When I was at your point in my journey I encountered the "paralysis by analysis" syndrome as I was spending several hours a day doing all of the research and reading as much as I could - but that's o.k. as it will put you in a better place in terms of deciding your choice of treatment - that may include AS.

There are a number of great books out there as well - Dr. Patrick Walsh's "Guide to Surviving Prostate Cancer" and Strum and Scholz' "Invasion of the Prostate Snatchers" are two that I found incredibly helpful during that part of my journey.

You will also want to talk to and if possible meet with as many of the medical experts in the different treatment approaches as you can. When you do, be sure to ask for their specific outcomes post treatment - % regression free, continency (and have them define what "continent" means - to you and I it means NO issues, while others may qualify that with "only one pad per day" or "only when straining") - same goes with ED. They all have these statistics and if they say they don't or are unwilling to share that would be a cause of concern for me.

At my young age and excellent health (age 55 at Dx), and with no symptoms or issues - while curing the cancer was / is my top priority, at the same time preserving my quality of life ran a very close 2nd. Be aware of this by doing your research and getting these statistics from the practitioners/treatment modalities you may be considering going with.

As part of my journey to learn about the various treatment options I downloaded, purchased, and copied a number of studies and results that I would also be happy to share with you, so again if you are interested shoot an e-mail my way and I'll reply right away.

I would also add a "LIKE" to what Michael T posted, particularly the two points he counters.

We are all out here to help - my very best wishes to you in this journey.

You were just diagnosed last month with what's called "very low risk" prostate cancer, and if you're like most of us, you're still in the throes of the initial shock. Time helps. And with your diagnosis you have the luxury of taking your time, and I strongly recommend you do just that.

Active Surveillance should be your first option, because it has no side effects, and is very safe (only 1.7% died from prostate cancer during the 20 years of f/u). My feeling is that it makes sense for younger guys because you have the longest to live with the side effects of any treatment - and they all have some side effects, even if it's just loss of ejaculate. More than half the men on AS remain untreated after 20 years. Most often, prostate cancer is indolent and insignificant, and it's a shame such cases get diagnosed at all.

Other options are focal ablation, SBRT, HDR brachytherapy and LDR brachytherapy. I didn't put proton or IMRT on the list because SBRT is a lot less bother (only 5 treatments), at least as effective, lower side effects (especially sexual), and a lot less expensive. Surgery is a good option, but not for the reason you mentioned (salvage radiation) -- in fact, that's probably the worst reason to have surgery. It has a unique side effect profile, but you do get a path report card, you usually don't have to wait long to learn if it worked, and if you're lucky, you'll get a Trifecta.

I hope you take your time - you may find that it becomes easier to live with.

Thanks for catching my error RCS, yep you're correct! I will edit my post and thanks again.