im torn between treatments

Sorry to find yourself in this situation. Treatment decisions are perhaps the most difficult thing. While I don't want to tell you what treatment to choose, based on what you've told us: Gleason 6 with only one positive core and being age 48, I think you should *consider* Active Surveillance. This is very different from "wait and see." You're on a program, you're tracked and if the cancer ever worsens--or maybe a future biopsy finds some cancer that has previously been missed--you can always have treatment then. Some will tell you that you don't do AS with younger people, but IMHO I think it's best for younger people since it puts off potential SEs at an age in which you're more likely to be active.

Surgery is generally not a good option after radiation, but that doesn't mean there are not any other treatments available if radiation failed. That said, with such a low level of cancer ANY treatment is likely to take care of it, so I wouldn't even let that work into your decision making process.

Lastly, don't put an arbitrary three-week limit on making your decision. You have a very UN-aggressive cancer and PC in general is very slow growing. If you are going to decide between surgery or brachytherapy, you are going to want to talk to several doctors to make your decision. You have LOTS of time.

Good luck and do keep us posted!

My oncology urologist (fellowship at MD Anderson) and his partner told me that if I had Gleason 6 that they would not operate, but instead do active surveillance. With your diagnosis your a great candidate for active surveillance. That will buy your time to make an inform decision and also time for medical science to improve.

Agree with the several posters who advised take your time deciding by doing Active Surveillance (as opposed to passive do nothing).

Once you self educate and meet with at least a seocnd opinion urologist and a radiaiton oncologist or two, you can make an informed decision, but you have some time.

If you update your profile or advise in a post what area of the country, others here can point you to doctors they had a good experience with.

I appreciate all your advice and comments because this is all new to me and I am still in shock. No matter how low grade my cancer is it is still overwhelming. I know there are SE's to both options but if I "did" decide right now to do something I am leaning more toward the seeds. As I said however my concern would be how good long term is this kind of treatment. Leaving the prostate in and after the radiation runs out I would be afraid that 5 to 10 years down the road it would come back and maybe even stronger.

habhammer,

You didn't sound ignorant at at all and no one here judges you. Pretty much all of us freak out when we first find out, myself included. No need to apologize.

That said, since it's almost Father's Day, let me share with with you one of the best things he ever told me. "Don't make a decision when you're upset." You say you're in shock and that's understandable. But take a step back and think about the fact that as a Gleason 6 with only one biopsy core positive, you are on what would be considered the safe end of the PC curve. That gives you the luxury of time and you should use it to get smart on your options. I'm glad you're asking questions about treatments. Very smart move. Keep asking us and we'll give you our thoughts.

So let me take the opportunity to ask you a few questions: where are you located? We might be able to recommend some local resources for you to check out. And is there anything you're scared of? Incontinence? ED? The thought of radiation in a sensitive area? All valid concerns. Let us know and we can give you our thoughts on that.

Han,
Pick up a copy of "Invasion of the Prostate Snatchers" by Dr Mark Scholz, it will explain low risk prostate cancer and your options. You have Years to make a decision without much risk, so don't do anything until you understand all your options. A G6 will not matastize or spread.
As for seeds, it is very unlikely that the cancer will return as G6 cancers are easy to kill with radiation and the prostate is fallow, which means that cancer can't grow in a radiated prostate.
Your best option is to monitor and only treat if the cancer shows progression; delayed treatment has the same effect as immediate treatment for low risk. There is a 70% chance that you can go a lifetime without treatment.

G'day Habhammer,
I am post Robotic Prostatectomy 6 weeks. Happy with my decision, however as people are advising, research, talk, post, question and make your own decision and be confident in whatever you decide.
Stick with this forum as I can guarantee you will get a lot from it.
It is a shock when you are first diagnosed, and if you are anything like me you just want support and to read and devour as much info as possible.
Good luck, I know you will make the decision that is right for you.
Cheers
Greg

I would seriously consider Active Surveillance with the stats you've provided. I have been on AS for six years now and it was the right choice for me. I got a lot of opinions from many doctors and every doctor I talked with advocated for the treatment he was well-versed in and discounted all others. Get some more opinions from other doctors and make a well-informed decision. Good luck.

Habhammer,
you definitely have low risk disease at this time so active surveillance seems like a logical action given your age and extent of the disease. But it also sounds like you have real concerns about the long term effect of seeds or surgery. It all really depends on what you are willing to risk. There are side effects of each option.

With surgery, you could almost be 100% assured that the surgeon removed all the cancer but the side effects you could be faced with are as follows; incontinence, erectile dysfunction, penile shrinkage. The last one is a very real phenomenon.

You may have all the side effects with seeds but later in life, or you may have none at all.

With active surveillance, you can defer all the side effects but may have anxiety knowing that you have cancer in your body. This may cause it's own emotional side effects, who knows.

But really, the choice is yours and yours alone to make. We can't make this decision for you and we shouldn't tell you what you should do. We are here to share our experiences and encourage to gather as many facts as you can to make an informed decision.

One thing I would like to leave you with is to BE YOUR OWN ADVOCATE!! This is your body and your life. Ask lots of questions, join a support group and question, question, question your doctor. Do not let this get away from you.

Take care,

Hammer,
As to your 'ignorance' about pc, let me say that I would have chosen to be ignorant about it for my entire life. Unfortunately, we have been put in a position where we have to learn more about it than we would like to. That's why you are here. You have gotten some good advice so far, and I would concur that AS (they called it 'watchful waiting' when I was diagnosed, but that didn't sound serious enough, so the term was changed to active surveillance) is the way to go. It is possible that you may never need to be treated. If, however, a time comes that you do, the 'seeds' that you mentioned are an excellent choice. I am a very strong advocate of LDR brachy (seeds), and from what I've learned, HDR brachy is also an excellent choice.
At any rate, it would appear that you have time to do your own research and make a decision with which you can be comfortable for the rest of your long life.
Best to you, Brother.

A good source of information is on the 2nd or 3rd page of topics called:

'Best Document For the Newly and not Newly diagnosed patient.'

The thread was started by Tony Crispino. A lot of great information in there that can help you understand your disease and educate you so you can further question your Drs. and hopefully get those 2nd and 3rd and 4th opinions.

Maybe you can post the full biopsy results because it is curious as to why your Dr. feels Active Surveillance is not for you. Maybe we are missing some information other then age as to how he is reaching that conclusion. Active surveillance does not mean you have to put it off forever, it may just mean giving you more time to explore more opinions from other Drs. and Prostate Cancer Centers and gather more information through other tests such as 3T MRI and targeted biopsies. It can mean taking some time calm yourself after such shocking news and fully educating yourself and moving forward with many educated questions.

I was initially diagnosed 3/19/15 as a low intermediate risk and I really had hoped I could choose A.S. because I am self employed in lawn service and landscaping and I really wanted to wait for next winter for any treatment. Plus I was in a state of shock over this and I really wanted time to absorb all of this and needed time to educate myself. I KNEW ABSOLUTELY NOTHING about MY PROSTATE. My first Urologist explained I was not a candidate because 7 of 12 cores showed up positive with up to 65% of the core, plus I was a 3+4.

Since then I have been on quite a ride seeing 4-7 different Drs and many tests to finally reach my treatment decision. Plus my diagnosis has changed from a low intermediate risk, to intermediate, to low risk, to very high risk, to high risk to finally settling on either intermediate or high risk which only will really be known post-surgery. With each step of the way my treatment options changed so it has been quite the roller coaster ride, but one I needed to take to finally reach a treatment choice that I am comfortable with.

I wish you all the best in your journey....Jim

Hello Hab and welcome to HW. Sorry you have to be here but as you can already see, this place is full of welcoming and smart people who will help you through this. You have already gotten some excellent advice on this thread so I will just summarize and emphasize:

1. Breathe and take your time to make a decision. This is one of the biggest decisions of your life so being pushed into a three week window is ridiculous, IMHO.

2. Get educated on our disease. The sticky thread at the top of our forum is designed for newly diagnosed patients. Read and absorb it then ask any questions you want. www.healingwell.com/community/default.aspx?f=35&m=2652250
There are some excellent books I can recommend. My two favorites are "Guide to Surviving Prostate Cancer", by Dr. Walsh (a surgeon) and the previously mentioned, "Invasion of the Prostate Snatchers", by Dr. Scholz (a prostate oncologist).

3. Get another opinion on your biopsy slides from a prostate pathology expert like Dr. Epstein at JHU or Dr. Bostwick at Bostwick Labs. Garden variety pathologists may not get it right.

4. Strongly consider Active Surveillance. Search for the topic on the HW search engine and you will find many excellent threads and links on the subject.

5. I understand you are considering seeds. That would be a good choice and I am biased in that direction (copy and paste the link in my signature to see my story). However, almost any of the main line options should cure you. You should seek out experts in surgery, LDR Brachy, HDR Brachy and SBRT before you make a decision. This is due diligence and will lead you to a good and confident decision.

6. The argument that says "you can radiate after surgery but not have surgery after radiation" is a bogus argument, IMHO. Yes, it is true that surgery after radiation can be problematical and should only be done by one of a handful of experts. HOWEVER, what is often left unsaid is that there are just as many and just as effective options after failed radiation. If you choose seeds, you can re-send with another isotope, use HDR brachy, use cyrosurgery or several other possibilities for salvage treatment. So...I suggest you generally ignore this "what happens if I need more treatment" argument and focus on finding your best initial treatment for now.

7. If and when you do choose treatment, go with an expert. Experience counts in this world; let the beginners work on someone else but not you.

Good luck and let us know how we can help.

Jim

P.S. Oops...here is another excellent document for your background: http://www.nccn.org/patients/guidelines/prostate/index.html[url]