Diagnosed with prostate cancer and worried!!!

Dear all,

I was diagnosed with prostate cancer a few days ago and my urologist says, after introducing the results of the biopsy, that I need treatment. My last PSA was 5.76 and out of 12 cores, I have 6 cancerous cores. All are grade T2 and their Gleason scale score is 3+3=6. My urologist says all these cores are located on the right lobe of my prostate gland and they are confined to prostate gland. I requested a CT scan, MRI scan and bone scan to make sure that there is no spread, but the doctor says there is no need for MRI and bone scan and only CT scan is needed. I am extremely worried and confused because I don’t know what to choose for treatment, radical prostatectomy, radiotherapy (external beam, brachytherapy) or cryotherapy. Please help me, I want to hear your opinions. Any comment or advice will be highly appreciated. I'm 67 year old and located in Montreal, Canada.

Post Edited (John-Can) : 5/19/2018 11:48:31 PM (GMT-6)

Hello John and welcome. Sorry you have to be here but we WILL help you get thru this.

First of all, you have been diagnosed with the "mildest" form of prostate cancer, i.e. G6. Many men with that diagnosis opt for "Active Surveillance" wherein you do not actually treat the cancer but rather watch it actively to see if it changes. That way there are no side effects and studies show that if watched properly then any needed later treatment is just as effective as if you do it now. I would recommend that you read the sticky thread at the top of our forum that is designed for new patients and also search "active surveillance" in our forum for a lot of good info on that option.

Next, you really need to get a second opinion on your biopsy slides. Reading PCa pathology is as much art as science. Get your slides sent to Dr. Epstein at Johns Hopkins so you know exactly what you're dealing with. Info on how to do that is in the above mentioned sticky thread.

If the G6 holds up I would recommend that you find a program that is expert in working with AS patients. If you'll let us know where you are located we can help you find such a program or doctor.

Finally, try to relax and take your time. Our cancer is slow growing and you have time to decide what to do. Don't be hurried by your doctor, spouse, friends or anyone. You'll need to get educated and make a logical decision. There are many treatment options that will cure you including the ones you mentioned. If you decide against AS but for active treatment, then you will want to consult experts in several fields so that you can determine your course of action. You will need to be your own advocate. Curing treatments if you don't do AS are surgery, LDR Brachytherapy, HDR Brachy and SBRT. IMRT is probably overkill and cyro has nasty side effects that you don't need to chance. In fact all of the treatments have some SE's but some more than others. We will help you thru an assessment of those as time goes on.

Take a deep breath; you have the time to get this right. And, BTW, your doc is likely right about the lack of need for those scans.

Jim

No fun to get that report, but like others have said a 3-3 is good and gives you options. The question will most likely come down to if you are the type of personality that can watch and wait, or are you the type that watching and waiting causes too much anxiety and you opt for treatment. You will find there is not a perfect path through the maze of treatments with each having advantages and disadvantages. More than anything find a good Doc (or two) that you feel is providing you thoughtful advise. PS: This forum has a tone of great info.

Post Edited (Gear) : 5/19/2018 2:24:38 PM (GMT-6)

John,
A CT and Bone scan and MRI would be a major waste of money and any insurance company would be within their right to refuse payment. There is nothing a CT scan will show to add any information about your treatment decision.
First, no scan will show anything unless your psa is in the 20 range,
Second, a G6 will not matastize. In 17,000 surgeries at John Hopkins not one case of matastis was found on G6 tumors.
You have every reason to be confused and scared, and this is exactly why you must not make any decisions quickly. You have years to make a decision with your favorable stats and you need to talk to specialist about their treatment methods. Don't accept advice about a treatment unless the doc is a specialist in that particular treatment.

You need to post your age and location to get better information. I agree with all of the above. Remember your URO is a surgeon. He will push surgery. Look at all your options and read those books before you do anything. I jumped into surgery before I found this group. BIG mistake.

Sorry, you are here with us and this is the place to be to share your fears and questions. Our cases are not much different. I initially had four G6 cores and one was upgraded to 3+4 (G7) <5% of the core. Based on that I choose to get treatment and I took 6 months of study to select which treatment was best for me.

It is critical for you to become your best advocate and to do that there is much to learn. Read all you can, watch the posts on this site, and join a support group if there is one nearby you. And most importantly, ask questions. I created a notebook to track everything related to my cancer. I also had a page of questions, every time I thought of a question I wrote it down. When I would visit with the doc out came the notebook.

I know how scary this can be and we are fortunate that our disease was caught in the early stage.

Hang in there! Denis

As all of the above. Slow down and take your time. After the 2nd opinion on the BX holds up you can really breathe a sigh of relief. You have a lot of time time to decide what to do. You also have all of the options on the table.

Just as you would not have a pro golfer teach you how to throw a football you want to talk to a specialist, and one who has done many procedures as in the thousands, in each field.

Stick with us here and you will learn.

Roger

If the 2nd opinion agrees that you’re gl6 you have very low risk PCa and Active Surveillance is a real option for you. Don’t opt for unnecessary treatment !
Bob

Thanks a lot for everyone who answered.
I met my radiotherapy oncologist today and we discussed the risks, advantages and disadvantages of radiotherapy. I wanted to make sure that the cancer has not spread outside my prostate. He performed DRE on me and said it is impossible for a G6, PSA 5.7 cancer to have extra capsular extension. I asked for an MRI to confirm his opinion, but he said there is no need for that. He said my cancer is T2a. As for my N and M stages, he said the biopsy report doesn’t show that, but we don’t need it at this time. I also asked him about the effect of radiotherapy on cells and tissues (prostate, bladder, urethra, semen vesicle) and he said radiation stops cell division and I wonder when a cancer cell stops dividing and eventually dies, it is ok, but what about normal cells and what may happen if they all die?

I’m also not sure if an oncologist can decide that my prostate cancer is T2a by just performing DRE?
Is an MRI really NOT unnecessary for me at this time?
Best wishes for all.

Get a second opinion on your slides and if that confirms a 3+3 then you are a prime candidate for active surveillance. Do not treat unless absolutely necessary.

Radiation treatment is planned to damage cancer cells, with as little harm as possible to nearby healthy cells. Radiation works by making small breaks in the DNA inside cells. These breaks keep cancer cells from growing and dividing and cause them to die. Nearby normal cells can also be affected by radiation, but most recover and go back to working the way they should.

How long it takes for all cancer cells to die varies. It's my understanding that the life cycle of a cancer cell progresses from one stage to another until it divides. If its DNA is damaged by the radiation it cant divide and dies. Some cells might be near that point early on after treatment and others may be months or years away from that reproduction stage and will hang around harmlessly until they eventually die. This is why it takes 3-5 years or maybe even a bit longer for all of the cancer to die.

Jon, since you asked....

The whole point of active surveillance is to keep an eye on things, and IF things change, THEN you treat. No, you're right, no one can guarantee that it won't change--but that is the point (and value) of AS: If it changes (and about 1/2 the time it does within the first few years), you treat then. If it doesn't, then you don't. The major value is that you avoid the stress, challenges, and potential side effects of treatment until it is truly needed.

Also, you have obviously heard one of the semi-truths of PC treatment, usually put out by surgeons: That if primary radiation fails, there are no secondary treatments available. Not true. Plus, with G6, your odds of having a primary treatment failure are miniscule--like less than 2% over the next 10 years.

If you're determined to have treatment--then don't let me tell you not to do it. Heck, I had surgery for G6, and my final pathology was G7--which happens about 10-15% of the time. I'm just trying to clarify some of your options. In short:

AS is there to keep an eye on things and discover if (or when) it changes, and treat then. There is NO apparent long term risk to AS: men who did AS have no statistically significant differences in long term outcomes compared to those who treated immediately.

Surgery or Radiation both have high likelyhood of cure for you. Focus on that and the potential side effects--not the very small chance of recurrence.

Just one option if Radiotherapy fails?? Not true....that is the "hard sell" tactic of the organ snatchers.

If you believe that then you have not done your research.

There are multiple options as "salvage" but you shouldn't even be considering that now. Now you should be looking at either AS or a TX that will cure the cancer.

Study some more and be kind to yourself.

Roger