New member with high volume question

Welcome Dwight. Sorry you had to find our little corner of the world though. Others will chime in with their thoughts, especially regarding treatment choices, but I'll just say that I was 18 days shy of my 52nd birthday when I had 'open' (non-robotic) surgery, and at 7 1/2 months out, am doing well. My continence is mostly back and I can get useable erections--which I hope will improve even more--with which pills help, but I can manage without, too.

The reasons I chose that option were several. While I had small volume, compared to you and many others, and all was G6, it was found on both sides of the gland in the biopsy cores, which concerned me a bit, and I wanted to be sure that a G6 was all I had, as it's often upstaged (as mine was) after the pathologist gets a look at it. I also wanted more options if it came back in the future. The thought had been that surgery after radiation isn't an ideal situation, but surgery before any radiation has been the standard. I'm sure others will give you advise and guidance on other treatment options that have become available recently, but I can't comment on those. I wanted to give you a perspective of how surgery resulted, though--at least with me, thus far.

You do have quite a bit of volume in your cores, so it certainly makes sense that you get some type of treatment. Has your doctor mentioned anything abut imaging, like a 3T-mpMRI? It can be useful in determining if everything appears to be contained withing your prostate, as well as the condition of seminal vesicles and surrounding tissue. This is something that can also affect your treatment decision.

One more thing. Where are you located? This helps the good folks make recommendations and /or suggestions that may know of options in your area. You can add your location to your profile if you'd like.

Best of luck!

Yeah, all things considered, surgery is probably your best choice...The G-6 Gleason bodes well for the future..Virtually nobody dies from G-6 PC.......

Welcome Dwight,

I'll just second what Jim said. It is so important that you make the effort to talk to experts in each kind of therapy he recommended to you (see the end of the sticky for suggested interview questions). I'd also very much want a second opinion on the slides from Bostwick or Epstein.

You might want to discuss a 3T MRI with this kind of high volume - if the cancer is already growing beyond the capsule, surgery might not be your best option. Only radiation can reach areas outside of the capsule. Radiation after surgery is not a good idea when you suspect that from the start - the side effects are worse than if you did either alone.

There are several salvage treatments after radiation. I agree that salvage surgery is difficult, but salvage focal ablation, salvage brachy and salvage SBRT have all proven to be effective.

The thing that really sucks about PC is that there are so many unknowns. And the unknowns are a moving target depending on your age and change over time. You are a G6 but will a post op pathology find that is really a 3+4 or 4+3? What will be you side effects and will they improve over time. At a young age do you need to worry about secondary cancers from radiation 10-20 years down the road?? What is more important to you the near term or long term. There is no real precise way to evaluate it. Just take your time (you have plenty)absorb all the info you can. Think about the road ahead over the next 25-30 years, decide what is important to you. Good luck with whatever you decide.

Lots of support for radiation here but at age 52, the long term and likely side-effects of radiation treatment must be considered more closely than need be in an older man....A good R.O. will level with you about side effects down the road..