Just diagnosed with PC - what is the best option

Hey DG, welcome to our club that none of us really wanted to join.

With half your cores, with targeted biopsy, you do have a high load. I'm not sure you'd qualify for AS even though it's all G6. To try to answer your question....and none of us will tell you what to do, that's up to you, but we can lay out the options and our own experiences.

First, a couple of questions...

How old are you? Where are you located? With that info, we can more easily aim you towards the experts near you.

Up at the top of the forum page there is a "sticky" thread titled "for the newly diagnosed", I do suggest you read that, there is a lot of basic information there that will help you.

As far as options, either surgery or any of the common radiation packages will cure you. Yes, cure is a real word. To explore your options, you need to talk to specialists in each of the various modes. You urologist is a surgeon, that's what he knows, and that's what he recommends. He's not going to recommend radiation because he's not an expert radiation oncologist.

The most important thing is to find the specialists who have treated a great many patients. Experience matters, in a big way. Don't be afraid to ask them how many surgeries or radiation procedures they've done, and what their particular 'record' is.

And, keep hanging around here, keep asking questions, and don't forget to breathe. Slow down, you actually do have time to explore your options and make an informed decision.

Hi, DG, and welcome. We know. . . none of us wanted to be diagnosed, but we are here. We're glad you found us.

It sounds like halbert and Bobby Mac are starting you out with some great information. It would help, though, if you create a "signature" to show at the bottom of your posts, showing the basics of how you got here. Look at some of the others, then create your own in the "My Profile" tab. I'm sure you will get even more good advice once we see that.

I'm still pretty new at all this myself, but the one thing, aside from reading the "Newly Diagnosed" stickies, is that you owe it to yourself to learn about all of the potential treatments for your particular disease status. Learn enough that you can make a comfortable decision about the best direction for you to take. As halbert so politely noted, urologists are all surgeons. They may simply state your diagnosis and ask you when you want your surgery, assuming that this is what their patients will want. (Sales people call that the "presumptive close.") There may, though, be other treatment options that you feel are better for you, and you have the right to choose. I read that you have family "experience" with PCA, but also remember that the treatment that was right for dad or uncle Joe may not be right for you. This one is your choice.

DGS--Welcome and best wishes.

Budreaux: ASAP -- probably 'atypical small acinar proliferation.' Unusual cells, but not clear if they're cancerous or not.

AS MDNative said, ASAP cells do not appear normal, but they fail the tests to prove that they are cancer. Technically, they are not considered cancerous.

The tumor load is relative but may not be as prognostic as others here have stated...since it was an mri guided biopsy ...the needle cores hit the tumor directly{that was the intent of the guide biopsy} so the cores were "loaded"{ oh my... tigers...lion and bears...oh my}... the position of the tumor...the true Gleason score{do get a second opinion on that} and the other data gleaned from the mri...low psa score...all positive prognostications of of possible indolent cancer are much better indicators of where you are....Your urologist knows this and if you press him on it watch his reaction...He wants that prostate in a bag along with a bag of silver...cynical...ok...doesn't mean it aint true...You very much are eligible for AS...Its interesting to me that the folks who who do't provide you with this information are "usually those who either did not have it{the info" at the diagnosis...or refuse to accept it in fear of a silly self indictment. Get the slides to Bostwick or Epstien for second opinion...Your Uro is puposely withholding your options...the most important one being AS......It is also interesting to me that you are 4th newbie {now with boudreux checking in} that have very similer concerns...but were not given much but a rehash of information that they received in a deadly game of Telephone...Think about it men...it is your responsibility to make the informed decision...not ours... regards and good luck...aint any of ya... if gleason holds...gonna die of this...treatment Side/Effects can be life changing...

Wow, this thread has become a twofer of newly diagnosed. Sorry to both DGS50 and Budreaux on your diagnoses. The best advice I can give both of you is: 1) get a second opinion on your biopsy slides from Epstein at Johns Hopkins as per the newly diagnosed sticky and 2) talk to experts in various treatments to explore your options.

Re #2, there's no "one-stop" shopping and uros are helpful about learning about radiation and ROs generally are only expert in their particular type of radiation, such as SBRT or brachytherapy. Neither of you have aggressive cancers so you have the luxury of time to learn about your options. Hope we can help you do so--and ask any questions you'd like. Good luck to you both!

Thanks all for your feedback and support - it means a lot! In response to your questions, I am 59 and currently work in Singapore, although my home is Scotland. The healthcare in Singapore is luckily world class and I have good health cover.

I am T2c as there is cancer on both lobes - seems I have a multifocal tumour rather than a single tumour that has grown?? Perhaps thats down to family history. I understand that because of my tumour load I need treatment and AS is not an option as I have already met the criteria for intervention had I started out earlier with AS.

I will seek a second opinion from a radio oncologist as suggested. My pathology was validated already so G3 +3 it appears to be. If I do opt for Robotic Prostatectomy the pathology report may show something higher grade, I guess.

This is a great source of support and info - so glad I found you all.

Thanks Halbert for the insight and reassurance that I am in good place for treatment. In terms of clinicians I have currently seen a Urologist who has done hundreds of Robotic Prostatectomies and is one of three guys in Singapore with a "golden" reputation.

Agree I should explore other options with a Radiation Oncologist - will look to do that. I can't do anything in the way of treatment just now, as my prostate has significant inflamation post the 23 cores! 6 weeks to do due dilligence and take dutasteride to shrink my prostate and potentially slow down tumour growth.
- been told that the drug will lower my libido etc - frankly lost that totally at the moment! Least of my worries.

I am in Atlanta and can provide you with information on practitioners and clinics here.

Budreaux, You'd do well to google "NCCN centers of excellence", these are hospitals that meet a rigorous standard for cancer care, and generally have specialists in all the various cancers. You didn't tell us where you're located yourself. CTCA has mixed reviews in this forum: we've had some guys who praise them to the hills, and others who had poor experiences...but that's life. If Atlanta is in your sights, Emory has a great reputation.