New Member - Intermediate Risk

PSA level and history? Lab findings from the biopsy?

robot - I'm pretty new here, too, so I can only add a bit of info for you. Your pathology is what is now called "favorable intermediate risk," which means that probably any of the mainstream first line treatments will have the same results for you. Your PSA doubling time is fairly short, but your tumor statistics are favorable. The only factor of your situation that greatly differs from mine is age. You are a lot younger than I, and many of the traditional docs would recommend surgery for this reason. Their logic is that PC can sometimes be forced into long-term remission that often "looks" like a cure, but isn't. Their logic is that if you have surgery and then in 20 or 30 years have a recurrence, you can explore all of the other treatment options. That may be statistically correct, but what are the odds of recurrence? I don't know those odds, but someone else here might. That info would be, to me, a critical piece of the decision tree.

The other piece of info that I'd need is the side effect profiles of every type of treatment you are considering. If all of the modes of treatment have the same disease control (as we are told they do), which side effects are you most likely to find tolerable?

Above all, though, remember that PC is a very slow-growing cancer. With your favorable pathology, you have the luxury of time to do your homework on the pro's and con's of all the different modes of treatment. Even if you take a few months, as I did, to decide, it will have no meaningful impact on your chances for a cure. Remember, too, that we only get one chance at "first-line" treatment. Make sure you are comfortable with your choice. Don't let any doctor just walk you down to the scheduling desk until you have explored all of the treatments that may apply.

Also, with your favorable intermediate risk profile, you probably qualify for some of the Active Surveillance programs. These programs are not just "hopeful waiting" programs. They monitor patients closely and set trigger points for each patient at which the patient needs to consider entering treatment. The benefit of AS programs is that while you don't lose sight of your PC, you do get to delay treatment until it is actually needed, thus delaying the potential impact of side effects. All treatments have side effects. The longer you can delay them, the fewer years you must endure them. Also, if you can wait for treatment, there can be newer treatments developed with even fewer side effects than today's treatments.

Sorry for the rambling response, but so much comes to mind. I'm not going to try to sway you toward one sort of treatment or another until you've done some research. That wouldn't be fair.

Sorry you have to be here with us, but since you did win that lottery, you are at the best place to learn how to deal with it.

Hi robotguy and I'm sorry to hear about your diagnosis--particularly at such a young age. I remember very well my first post here as I tried to get started and yes, it certainly is like drinking out of a fire house. A few thoughts for you.

First off, you have plenty of time. PCa is very slow growing and you literally have months to make a decision. Use that time to get smart and talk to as many experts as you can. (It seems like you're off to a great start there, but I'd throw someone that specializes in SBRT into the mix.

The other thing you should do is get a second opinion on your biopsy slides from Johns Hopkins where they specialize in specifically reading PCa slides. The newly diagnosed sticky at the top says how to do this. It's quick and easy and perhaps the best thing you can do while you're making a treatment decision.

I also would not eliminate AS. While that's typically done with Gleason 6 cancer, a single positive core of G7 would still be considered by many AS programs. (Pending your biopsy second opinion, of course.) You say you don't necessarily like any of your options--keep in mind that the only treatment that doesn't have SEs is AS. BTW, some will tell you that AS is more appropriate for older patients--personally, I think it's well suited for younger guys like you that can put off any treatment for a long time. Hopefully, years at a minimum and maybe even a life-time.

Lastly, I would also take a look at focal treatments. This is an area that I don't know much about, but as I understand it's well suited to a small amount of cancer like you have. Hopefully, one of the smarter guys here can provide more info for you.

At the end of the day, you have every chance of doing great. Good luck to you.

On more thing...with your PSA and single core of G7, a scan would be extremely unlikely to show any cancer and is generally not recommended. You should be counting on a cure from primary treatment.

If you want minimum side effects then you use the HDR. Simple. Martinez is as good as it gets as he is one of the HDR pioneers.

I used HDR six years ago and am side effect free and undetectable PSA. Totally successful. I too was a G7 but higher risk than you. I also had IMRT including the pelvic lymph nodes and three years of ADT.

As to HDR risk of secondary cancer, it is essentially the same as dying on the operating table during surgery. Not something I would lose sleep over. The other side effect issues (urinary and bowel) have been shown in numerous studies and reports as far less probable and less significant than the urinary and ED issues of surgery.

I like your optimism of 30-40 more years on earth. Your dx looks like you will likely beat this and the combo of HDR and IMRT provides better cancer control than surgery alone and with less side effects. If you choose surgery and then find out (after it is too late) that nerves couldn't be spared and/or that you also need IMRT than you have chosen to take on the combination of treatments that most always result in the worst and most significant dies effects with no better cancer control. Why take the additional risk when there isn't any better rewards?

Robotguy, welcome to our club. It sounds like you're asking the right questions and searching out real experts. Here are a few things I used in the weighing of options...I chose surgery 18 months ago and have essentially zero side effects. (daily 2.5 mg cialis does wonders)

If you're in good physical condition, and don't have any issues with ED or urination, then you'll probably do well. My surgeon put it this way: whatever grade you give yourself on those two today, chances are you'll go down at most 1 to 2 steps, for the short term. So, if on erectile function you were a 10 at 18, and you're at 8 now, you might drop to 6 or 7. Now, there is a non trivial chance that you'll loose it all. How do you feel about that prospect?

For me, there were time and space issues that mitigated against the external radiation options...mostly being 100 miles from where I'd have to get treated. Daily drives back and forth didn't sound practical. And, I'll admit to having a creep factor against either HTBT or LDBT. The idea of having radioactive pellets inside me for life creeped me out.

In the end, you have to choose based on your best understanding of both risks and benefits. Whatever you choose, we won't second guess you..and we'll be rooting for you as you walk in the door for treatment.

Hi.

I was also "moderate risk", my choice of treatments is below in my sig. You will note the last 2 PSA readings. I take those (almost 300% PSA increase in 3 months) to mean that it sorta didn't work.

Note: Sometimes things are a tad worse when the surgeon gets in there than when he/she is looking at the tests and you have no choice but to deal with that after the fact.

My radiation oncologist told me that the increased chances of urinary tract, colonic or rectal cancer total 1%. I balanced that 1% against the 96% chance of a 'cure' from the Intensity Modulated External Beam Radiation Therapy (Cyberknife). I can do the math.

I am very frightened by just 1 little Gleason 4 cancer cell because I know that it can - given a bit of time - eat me alive. You possess a bunch of those G4s. What you do about that is your choice, but for myself, I put getting rid of those above any possible side effects. I got the side effects bigtime, but would still rather be alive than inconvenienced.

Hey robotguy -

I see you are in Michigan and have robot in your name.
Are you a part of FIRST?

I am a mentor on an FRC team.