Newbie here

Hello all. My 42yo husband was just diagnosed with PC last week. We're still reeling from the news.
His story...His uncle was dx with PC in 2014. His father was dx with PC in 2015. Both had Davinci prostatectomies with Gleason 6 scores. Within the last year his uncle's PSA went back up so he is undergoing more treatment for that. Because of his family history his Dr did a DRE that was neg and ordered a PSA test on my husband in August 2015. It came back at 5.3. He did the 2 weeks of cipro and was tested again in October 2015 and it came back at 6.2. His Dr referred him to a urologist. The urologist did a TRUS w/bx in January 2016. 1 of 12 cores came back as a HGPIN and that was all the info we were given. They recommended monitoring for the time being. In May 2016 his PSA tested at 6.8 so they did another TRUS w/bx a couple of weeks ago. 7 of 20 cores came back pos for PC and he was given a Gleason 3+3. I am still waiting on a hard copy of the report so that is all the info I have for now. I do know that both bx were done at Dianon. Because of his age they do not recommend radiation. Currently he is scheduled for the Davinci radical prostatectomy in August.
My question for the veterans out there, I was reading and saw that it was highly recommended to have the slides sent to an expert lab for a second opinion but they were done at a lab that specializes in uropathology. At the same time I question just how quickly his results changed and think maybe it wouldn't be a bad idea to go ahead and get a second opinion on the slides. We are in a position right now where we do not have any extra money because we are having to save so that we can survive while he is off work after surgery since he does not have any short term disability coverage through his employer. Would getting a second opinion be worth paying the extra money for? He does have health insurance but I don't think they would cover a 2nd opinion.

Welcome to HW.
At this point, the only reason for a second opinion on the slides would be to see if he qualifies for AS (active surveillance). If you're going for the surgery anyway (which seems reasonable in this case), I'd skip the second opinion. You'll get an extensive pathology report with the surgery that will give you better info anyway. Save your money for surgery.

Hang in there,
Andrew

Tall Allen posted "If confirmed, he is an excellent candidate for active surveillance (AS). AS will give him the best chance at symptom-free living for as long as possible -- something that is especially important to a 42 yo man who is in his prime sexually and probably has no urinary symptoms. After 20 years on AS, about half the men had no need to have any further therapy."

TA, There are very few instances where I am not in awe of your knowledge...but, I ask that you consider that he is 42, with father and uncles having PCa, and with seven positive cores.

Sure G6 is G6, and waiting means living a normal life, and maybe some less-damaging type of treatment will be approved during that time. But, IMHO, any AS regimen for him would need to be very frequent and strict.

ASAdvocate -

I very much acknowledged that he is 42. To me, that means he has more time to live with the symptoms of any treatment he chooses. At 42, my potency was very important to me -- it still is! Maybe at 72 I will not think of it as that important. Maybe at 72, it would bother me less that I have lost an inch in the length and girth of my penis, or that I shoot urine at orgasm (climacturia). Maybe at 72, I will not be as continent as I was at 42, and will be using Depends anyway. Maybe. But I have seen a man cry in my PC support group who experienced those things after RP in his 40s. That makes an impact.

It is because these are his prime years that it is the best time to defer treatment. I surely don't have to tell you that AS involves very close monitoring, so the moment that the cancer goes from insignificant to significant, and from indolent to aggressive - if such a moment is ever reached - one knows it in plenty time to deal with it THEN. You may have noticed that I am very big on living in the present moment and dealing with things as they are NOW, rather than what one imagines they might be. We have enough data to get some idea of the real future probabilities (based on facts as they are now), so that we don't have to assume unlikely scenarios.

Heredity is a risk factor, but not a very big one. I've read that the influence is up to 20% but not more than that. If he said he were African-American, AS would be more concerning. Also there are 2 pretty good (albeit expensive) genetic tests - Prolaris and Oncotype Dx - to help one gauge the degree of genetic risk.

As for biopsies, the first f/u biopsy should be mpMRI-targeted and/or transperineal mapping biopsy. After that, what happens next depends on what happened before. If there were no signs of any progression, the next biopsy can be two years later; after that, maybe 4 years with just an imaging study in between, etc. I know that even Johns Hopkins, which had the strictest AS protocol, relaxed their stance on annual biopsies.

Don't forget too, that the longer one is able to stay on AS, the higher the probability a cure will emerge from all the research now in the field. Already it seems that 5ARis may delay or even reverse progression in low risk PC. There are a number of hormonals and immunotherapies already being tested that might prove to be even more potent.

In the end, the OP must decide what he is most comfortable doing. Maybe it will be AS, maybe SBRT or brachy, maybe surgery. What I am uncomfortable with is his doctor making those life-changing decisions for him, and ruling out any options without evidence. He certainly has plenty of time to investigate all options thoroughly for himself before coming to a decision. I think leaving options open until one is ready to decide is the best stance to take. I have only seen treatment regret in men who didn't take the time to do that.

Hmmmm... Both good arguments on both sides. So long as the OP can live with the mental aspect of having PCa and being on AS, I would vote for that. The SEs of the treatments suck. Good luck on your research, discussions and journey Cyndiane. Keep us posted. -JR

For him I think the thought of having cancer has him a bit on the edge. He is still in the mind set that he wants it out and the sooner the better. His urologist went over all the the possible side effects and complications of both surgery and radiation. She said there was an option for AS but it would be her least recommended treatment because with his family history (his uncle had a gleason 6 and a RP with clear margins and nodes but still ended up with bone mets less than 2 years later.) he would be getting bx quite often and he was definitely not fond of that idea. The first bx for him he said was the most traumatic thing he had ever experienced. The second one they drugged him up so it wasn't near as bad. His reasoning for choosing surgery is that he can just get it done and over with and he wont feel like he has an axe hanging over his head all the time and also having blood drawn and tested isn't nearly as traumatic (or costly) as a TRUS w/bx for him.
As far as the surgery, both his uncle and father had no complications, were both continent within 6 months and were able to achieve erections within a year. I think he is counting on being able to do the same

My husband (49) has a slightly similar situation as yours. While we don't know his medical family history (he's adopted) his Gleason scores were the same as your husband's. His PSA was 6.8 when he had his biopsy and his urologist, radiation oncologist and internist all recommended AS. That was over 6 months ago and his PSA a few weeks ago was 1.9. We were both hell-bent on surgery when he was first diagnosed but now are so glad we chose AS. His doctor did not recommend routine biopsies either. It seems that he has some time to do research before he jumps into anything drastic. Maybe a second opinion from another urologist might be a good idea?

7/12 positives at age 42 seems like a lot. Especially the jump from 1 HGPIN core to 7 cores in a year. I'd agree with the saturation biopsy to really get a clear idea of what is going on in there. After that, the treatment decision is highly personal, and the factors are unknown to all of the rest of us. And, AS is a treatment, particularly in this case.

There does seem to be some anecdotal evidence (which isn't actually evidence) that the PC that shows up in younger men under 50 is more likely to be ugly and nasty--perhaps because it has a lot more years of future play time to manifest itself. I'm thinking particularly of our friend Todd1963 as an example.

I, too, get the family dilemma. Maybe it is only a 20% increase in true probability...but when you're IN a family with lots of history, it plays differently. I started getting PSA and DRE in my mid-40's, and I'm glad I had 10 years of zeros before it started to move. I knew what I was looking at.

All we can say, Cyn, is to keep digging and do your due dilgence by talking to experts in all treatment modes. Do that, and you'll know you made a truly informed decision. And THAT is where peace comes from.

The questions TA poses are the ones we all faced. They are easier to answer at age 70 than age 42 at one's sexual prime. The issue of SEs is more of a fear than fact. Excellent practitioners usually don't have bad outcomes. To me it comes down to the person's ability to live in the present as TA says. If one tends to be anxious and impatient, AS would be tough to handle.
Bob

When I was diagnosed, my children were in shock and so was i. "Just get it out, Dad" was the concenses and mantra at home; but then again I did have a G9. Four weeks later, post biopsy, I had Da Vinci. PSA is < .01 almost three years post op.

I dont have a family history of PCa, but given the grading of your cancer G6, I would postpone the surgery for a few weeks even months, whilst I find out what ALL my options are.

I must admit during my Fear, Uncertainty and Doubt (FUD) period, I found myself in a Urologist Bubble - the focus was surgery and surgery only. If I had known about this Healingwell forum and the good information present here, I might have taken a different route.

All the best with your decisions!
.

AS isn't a decision everyone can make. Emotional and psychological facts do weigh in.

Still, surgery isn't horrible, but it does have side effects and normal will change in many areas of life.

Hang in there,
Andrew

He is 42 and decided surgery. I don't think that is a bad decision. Radiation and surgery work equally well. The younger you are, the more likely it is that the SE is mild. Radiation is sometimes not selected by younger men because of concerns that the prostate is still there and could get cancer again.

I am thankful to this thread for prompting me to research and write an article about the rational basis for choosing active surveillance in younger men. I also recognize that the choice is not a wholly rational one and emotions do enter into it. Whatever one's choice, the available medical evidence should be understood, even if other factors carry greater weight. I'll post a link when it is published in the next few days.

- Allen