Well, here I am for good I guess

Hello, Larry. Sorry for the news. As I'm sure you know, G6 is the lowest graded cancer so that is your silver lining. Now take your time and get fully educated so you can make some great decisions that will affect the rest of your life.

Of course you should get another reading on your biopsy slides from Dr. Epstein at JHU. Look at our sticky thread at the top of the forum for directions. Reading these slides is as much art as science so you want to make sure you know what you have -- at least as far as the biopsy slides go.

AS seems to be a reasonable alternative for you to consider. We have a number of HW guys on AS and I expect many of them will chime in on your thread. You may also want to email some of them. If you do choose AS then make sure your doctor has experience administering it and a standard protocol to follow. Studies have shown that patients who pursue AS and then later have treatment have just as good results as those who treat immediately so that should give you some comfort.

It's not surprising that your uro suggests surgery...duh...he is likely a surgeon. Most of us had the same experience. Some of us did choose surgery but others chose other paths after doing our research. The flip side of doing surgery "because you are young" is that you likely have a long lifetime to live with the possible side effects and you should consider that as well. Also the oft-promoted (by urologists) statement about having surgery so radiation can be used later is pretty much BS. You should choose a treatment based on its best chance to cure you plus your personal assessment and willingness to chance side effects. Besides, there are just as many options for salvage treatment after a failed radiation as after a failed surgery.

So now take a deep breath, get your slides re-read and get educated about your options. Stick with us; we will help you thru this.

Jim

Sounds good. Grade Group 1...that's the very lowest grade of PC, as I guess you know now.

Yes, Active Surveillance is absolutely sometimes called "deferred treatment." Said another way, treatment is "deferred" until it is needed. For many, many men who are eligible for AS, that means that it's never needed. They monitor their low-grade PC, and never treat it...and never subject themselves to unnecessary (and onerous) side effects of treatment. For those who's case changes enough over time to trigger a decision to treat, they move forward at that time...perhaps at a time when treatments have advanced, outcomes improved, and side effects have been reduced through the ever-evolving, ever-improving techniques. Outcomes are no better, and no worse, for men on AS who have deferred treatment.

So yes, think of it as "deferred treatment." Deferred until (and if) it is needed. For a younger man, this simply means that he's got more years of monitoring, and while the % probability that future treatment is needed goes down after each year of AS, the younger guys just have more years that it might change. No biggie.

Now it's time to get your "Movember" going...!

Post Edited (Blackjack) : 11/1/2018 2:08:03 PM (GMT-6)

I shaved this morning. We will see how far my wife and boss will let me go. I am not planning on telling anyone at work about it until I have to. I let some know I was getting test results today but did not tell what it was for. I don't want that to possibly stand in the way of promotions to higher pay grades if they think I may be taking a long time off for treatment should it come to that.

Funny thought, The URO did not really seem against AS since he told me how he would plan it. He did say if I got hit by a but in 7 years that the surgery would have been a waste because the cancer would most likely not kill me by then. I found that humorous.

ps: I guess I need to go back to work on my signature.

Larry

Sorry for your news. If you are feeling down just think how many hundreds (thousands?) here would love your diagnosis. AS is great. And yes I'd get a 2nd read on the slides.

The NP said the DRE was normal and the URO said everything looked good after the biopsy.

To all, I did say I was going to check with RO just to see what the options would be, but at the moment that would most likely be my last choice. I know things have probably changed a lot since my dad had it done, but just from the reading I have done here it seems like a lot of the side effects are similar.

My wife and I have not had time to talk since this mornings visit since I had to go back to work. I am sure we will sit and talk some this weekend as we read the book and get more questions. I am in no rush.

Honestly, most anything should work for you: AS, surgery, RT ... it will be a difficult choice.

Talk to all the experts first - URO, RO, etc. Gather your info, sleep on it, discuss it and then make your best choice on what you feel the best thing to do is.

I am biased towards RT (SBRT in particular) as based on what I read it's good, fast and lower on SEs. Recent reports on it are good.

But, it's your body, your choice.
Andrew

Definitely get yourself educated.
That "old" idea that if you have RT as a primary TX you are done and there are no options if the PCa returns is just ABSOLUTELY wrong. Also the idea that with a small tumor RT is not a good choice is actually bass ackwards.

Surgery is an option for some men.
Various forms of RT are options for some men.

I do believe, as others have also said, that AS is a great option for you. Do the AS thing and use the time to become VERY well educated and only IF you need that you will be prepared.

In the spirit of full disclosure I will admit I am a RT guy with some bias against surgery. My advice is get educated and make your own best decision.

You have a lot of time to do what needs to be done and if anyone tries to rush you they are someone you do not want to listen to.

Roger

I vote for AS as long as you’re not an anxious person. I was just a nervous guy, no need for you to be as long as you have a urologist with experience with AS.....

I have been on AS for nine years. about 55 percent of the men in the JH, Sunnybrook, and MSKCC AS programs have not needed treatment in twenty years.

The AUA and four other organizations that represent the spectrum of the American medical establishment that deals with prostate cancer ALL specify AS as your default treatment.

But, “active” is the operative word. So, get a second opinion on the biopsy slides from JH, and be prepared for an mp-MRI and a confirmatory fusion biopsy within the next year. That protocol will greatly reduce the chances of a higher grade cancer being missed.

Greetings BBQ: Welcome to this merry band. Could you explain what happened with your father and his radiation that has you thinking negatively about RT? Was it for prostate cancer? How long ago? Most guys getting RT for their PC have a pretty good experience. Mine was quite uneventful. But in your case it may be that no treatment is the best treatment.

BBQ, you might want to check out the team at Vanderbilt--definitely one of the premier prostate programs around. If your Uro is affiliated there, that would be even better.

Allright, you're getting "mostly" good feedback. Yes, the professional medical societies all primarily recommend AS for cases like yours, but yes you will need a 2nd confirmatory biopsy in about 12-months to really validate that your AS candidacy is appropriate. Yes, you should strongly consider getting a 2nd opinion of your biopsy slides because when read by the local hospital pathologist who just read a breast cancer sample and has a kidney cancer sample next is not as precise as someone who only reads prostate cancer samples; contact LINK. It's important because you want to make your decision based on the best, most accurate information. Yes, when you start out down the AS path, a common step is to get a detailed mp-MRI...lots of new tools are becoming available to help confirm your choice. Someone here said something (rule 3 violation removed by moderator) "most anything should work for you: AS, surgery, RT." Yeah, surgery and RT work great for men who don't need treatment (rule 3 violation removed by moderator). Yes, once on AS if your monitoring thresholds are exceeded sometime down the road, the recommendation will likely still be as it is today (although treatment effectiveness will likely be better): either RT or surgery because cancer outcomes are (statistically) the same, and those outcomes are no different whether you defer treatment or not. Someone said to "get your AS protocol in writing;" well, even in AS protocols there's usually not any one-size-fits-all solution, but merely starting-place guidelines...so start gathering ideas from several sources to have a good, on-going dialogue with your care provider...that's the important point. Yes, side effect profiles are different for those two most common treatments; surgery has immediate side effects which most men recover from over time, RT has not much affect immediately, but delayed late-term side effects (which is why RT is generally not recommended for younger men). No, you don't need Walsh's (long retired) "Surviving Prostate Cancer" book; it's outdated and very heavily slanted towards surgery. Instead, you need the book by Dr Mark Scholz (PC doctor to many here at this site) "Invasion of the Prostate Snatchers" (LINK)because it is written for cases like yours. I've read both; Walsh essentially ignores AS...which is your recommended path (every professional medical society). Common sense...all of it.

OK, we got all that. No hurry. Now on to important stuff...so you like to barbecue? What do you do? I have three favorites: (1) ribs, but they're super easy, (2) pork shoulder/butt, which I do on a bullet smoker but I'm not a great fan of getting up before 5am to start the coals...and even then I usually end up finishing it in the oven, (3) I do a wicked bbq chicken that I learned from a country friend in North Carolina...shredded cooked chicken, stick of butter, cup of vinegar and lots of red peppers. What do you do?

Post Edited By Moderator (Tudpock18) : 11/2/2018 12:01:02 PM (GMT-6)