rushing into treatment?

6 weeks is rushing it. Not nearly enough time to get 2nd opinions from specialists other than surgeons and other surgeons. Delays of 6 months are not uncommon and have little effect on outcome. Your PC has been in you for at least two decades and a few more weeks is nothing. Any cancer takes 44 doubling from cell formation to death. It takes 30 doubling for a cancer to be detected by advanced imaging, when it is the size of a pin head. There is no danger in waiting a few months.
When asked if they would do anything different, members of this forum have consistently ranked the highest. "I should have waited longer to make a decision". Second ranked was "I should have looked at other options".
Take it from the thousands of men that have been in your position and listen to their advice.

John T.
You are correct that 6 weeks is not enough time to get second opinions. I should have been more specific.
I think 6 weeks is more than enough time to decide if you need treatment that soon (almost never), or if you want a second opinion (always a good idea) etc. But mostly, 6 weeks is definitely enough time to calm down and start asking more questions.

Cancer is frightening. You have cancer! Oh my god, I am dead. How much time do I have? I want to bang some more. So we panic. Doctor, help me please. I don't want to die. Do anything, fast. Please. So we rush into things with our eyes shut. Some PC do not even need to be treated.

Dan0 said...
M

I guess I don't really buy the whole "rushing men into unnecessary prostatectomies" line, at least in this more educated era.
,

Actually, I DO buy it. I can't possibly count the number of times new members have shown up in HW within a few days or weeks of diagnosis saying "I need to get it out because my doctor said so". As Halbert has said on other threads, one of the best pieces of advice we can give newbies is to slow down, get educated and get multiple opinions.

Jim

Annie, yes it's draining to do the due diligence. I guess the collective experience of this gang here is that we all get one chance to treat this beast, and it's critically important to get it right. The time it takes to do the research and the consults is time well spent. I hope, at least, that you're getting treatment at a major center by a highly experienced surgeon and team.

It's not just time for information gathering. It takes time to get out of the initial cancer panic and into a frame of mind better suited to making a life-altering decision.

I often hear patients use the kind of "what if" language that Annie is using. The answer is that we can only deal with what we know, and all those "what ifs" are both the cause and perpetuators of useless anxiety. Here's what we know about delays between biopsy and surgery:

"In this study we examined the effect of delay from diagnosis to surgery on outcomes in men with localized prostate cancer and found no association between time to surgery and risk of biochemical recurrence, even for patients with longer delays and high-risk disease. Men with localized prostate cancer can be reassured that reasonable delays in treatment will not influence disease outcomes."

Effect of delaying surgery on radical prostatectomy outcomes: a contemporary analysis

And here's what we know about delays between biopsy and radiation:

"There were no differences in 5-year biochemical failure, distant metastases, or overall survival depending on whether patients started treatment sooner or later than the median time to treatment. This was true for every risk group.
This was even true for high-risk patients who did not receive any ADT in addition to their radiation."

Time from diagnosis to initiation of primary radiation therapy: does it effect outcomes?

I very much agree with Annie that there is a real danger of information overload in trying to reach a decision too fast. It takes time to let the info sink in, to consider the implications of that info, and to evaluate it all. Finding specialists and getting appointments takes time. Sometimes we travel large distances to meet with them. Unlike other cancers where time is of the essence, we have more time. Unlike some cancers where there are no treatment choices, we have many, and there is no such thing as "one stop shopping." We have time, and we should be taking it.

- Allen

Shuddering Thud, Alephnull - wow, 4 weeks. I was told 8 weeks, and I had surgery 8 weeks and 4 days after diagnosis. And I thought I was quick.
In that 8 weeks, I found that it was plenty of time to do my due diligence. Partly thanks to the guys here, I was already quite educated. As far as being in a frame of mind to make a decision, I was never going to be in that frame of mind until after it was treated. Tall Allen was recommending Mindfullness to help me, but I was more aligned with mindlessness. I think a lot of people are like that. And so we want to get treated quickly, the population here is truly exceptional, I doubt the vast majority of patients are anything like the folks here.
As an aside, in the 8 weeks I waited, I saw 2 radiation oncologists, specializing in 2 different techniques, and 3 robotic surgeons. In addition to my diagnosing urologist, and 2 visits to my PCP to talk things through. And a phone consult with an MO, Dr. Mark Scholz. And spoke to a lot of people both here and elsewhere who've been thru it. I sprang into action immediately after diagnosis, seeing the first Surgeoon 2 days after I got the call. I think it was my way of trying to take control.

Annie,

I trust that you have had consults with other practitioners that can use the various radiotherapy methods of treatment, notably HDR and LDR brachytherapy. The risk factor you present indicates you have ample time to investigate the different treatment methods and choose the one that provides effective cancer control with minimal side effects. Surgery may not be best in your situation.

I had a PSA draw in mid August 2010 and it was 59. Definitely a big problem. I had a biopsy a couple weeks later and my uro said three months to get started. I did a lot of concentrated research, saw two other surgeons, two radiation oncologists, and two medical oncologists in a four week period. All said no to surgery and all said I would need hormone therapy. So I had an Eligard shot the first week of October and started two forms of radiation therapy a month later. It has all worked ou wonderfully.

The key is to not decide on any treatment until you have investigated all treatment options. You can easily do that in six to eight weeks and with prostate cancer that is not a delay that will ever make a difference. Rushing to the wrong treatment out of fear of the cancer can make a huge long term difference in side effects. Be deliberate and make sure your decision is one that gives you a maximum of confidence. There are no do overs.

Dan0 said...
I guess I don't really buy the whole "rushing men into unnecessary prostatectomies" line, at least in this more educated era.

As you can see from many cases right here at HW/PC, "rushing" remains commonplace even in the contemporary period.

You have, by the way, made the proper delineation by clarifying the subset of men who quickly seek unnecessary treatment, which is most frequently an "elective" surgery but may also include BT or other treatment modes. A unfavorable-risk case, on the other hand and very important to differentiate from, is typically appropriate to move promptly to treatment mode; HT often begins right away.

However, you have mixed-up the interralationship between TIME and PATIENT EDUCATION. You see, the whole thing with favorable-risk cases is that they DO have the time necessary to become well educated about the disease, the risks, the harms and the benefits prior to making a decision. Those who rush to not take the time--and there is no shortcuts--to become well educated about the reality that there essentially are few if any benefits to aggressively treating low-risk PC, only harms. The rush is all about the panicked, emotional response.

Also, I didn't read every reply here word-for-word, but I did not see mention of the second biopsy reading by a prostate-expert pathologist, which should be done prior to discussing any treatment modes. One of the rules-of-thumb for favorable-risk men is this: anyone who is initially diagnosed initially with favorable-risk PC and moves to an immediate treatment without getting an expert second opinion on biopsy slides is at increased risk of being overtreated.

BTW, the medical field generally looks at "immediate treatment" for favorable-risk men with PC as anyone seeking treatment within one year from the time of the initial diagnoses from a prostate biopsy without a follow-up biopsy. In general, men with favorable-risk PC who move to AS/deferred treatment will have their second, confirmatory biopsy in the 12-18 month timeframe.

Post Edited (JackH) : 4/30/2016 2:12:33 PM (GMT-6)

I just finished pro-treatment planning and scheduled to HDR Brachy on May 11. My and my fiance have been struggling with whether or not to bank sperm. My Uro told me we could take till September to make a decision and maybe even a baby.

I was pretty surprised by his comments. I thought six months was the max period to wait after biopsy. But in my case he feels it will be safe. I am still going with May 11 because I just want to get it over. I am just rushing on making a deposit.

My situation is very much like Halberts. A few years of rising PSA, a family history (dad), one (false) negative biopsy that did show hi grade PIN, all leading to the feeling that eventual diagnosis was inevitable. So I was doing some casual research prior to diagnosis. Although it started in earnest after diagnosis. And upgrade to low intermediate risk like Halbert, after surgery, so treatment was not unnecessary

The only difference worth noting, was that I WAS rushed to treatment by one very high profile NYC Doctor. I saw him, literally two days after getting the news that I had cancer. Exactly 48 hours. Before I walked out the door, he had me scheduled for surgery 5 weeks later, and had already begun the insurance approval process.

The more I thought about it, as I regained my footing, and with the help of many guys here, I regained my senses and realized it just wasn't right. I cancelled and never saw that high profile, well known (well marketed and advertised) Surgeon again

I had my surgery about 7 weeks after dx. But there is more to that story.
Having years of a slow but steady rise in my PSA (and a bad PCA-3 result -- that's a blood test), I had a bad feeling about what was coming up.
So, I started doing research and reading HW about 6 weeks BEFORE my biopsy (I think Halbert did the same thing).
Knowing my own psyche, I knew I would not be able to think straight upon a PC dx. So, I did the research in advance and had a very detailed plan. When I got the dx., I immediately had the samples sent to Dr. Epstein at Hopkins for a second opinion. I also scheduled appointments with Dr. Menon, a distinguished surgeon at Ford Hospital, Dr. Hamstra, a top-notch radiation guy at Univ. of Mich., Dr. ?? (can't remember his name), a well-recommended surgeon at U. of Mich., and Dr. Hussain, a world-renowned PC oncologist/researcher at U. of Mich.
The Umich appointments were all scheduled on the same day.

I found it tremendously useful to have a plan in place.
I also got a few books that were well-recommended (one was the Walsh book).


Keep in mind you will also be reading posts on HW from folks who have strong opinions about particular txs. There is no sure answer, although specific biopsy results might make one tx. of another less advisable.
Try and research various txs. There are plenty of arguments pro and con about each tx., especially with regards to SE profiles. You know your own self and psyche and you have to be true to yourself.


I had some very definitive reasons for my choices and have no regrets.

I'll leave it at that.


Mel