Wish I didn't have to join - glad you are all here.

Prostate biopsy came back positive. Gleason 3+4=7.

I'm 71 y/o, diabetic and suffer from high blood pressure. I'm a Vietnam Vet, was part of the World Trade Center Rescue/Recovery and still work in passenger (bus) transportation. My career began in 1973 in the Bronx, NY (I'm a Bronx boy) as a bus driver. Moved up through the ranks to senior management. Tried retirement twice - not for me - yet.

I hadn't undergone a PSA for more than ten years. Frankly, I didn't know what the devil it was. I had a penile implant on 1/29/20 in Wellington, FL. When travel restrictions hit, I found a good urologist in Sewell, NJ. Two months ago I discussed a PSA test with im and he drew the blood on the spot. First test was 8.7. Two weeks later it was 8.4. Hence, the biopsy.

My wife's oncologist wants me to consult with a radiation colleague of his. Notwithstanding, my gut instinct is to just have it ripped out of me via surgery asap - - which would be about six weeks down the road.

Thanks to this site and friends who have been forced to walk this road, I am aware of possible side effects from either method.

I am not cavalier about this. I confess to being scared. I have always been a "darn the torpedoes" type - - that is why I am bullish on surgery. My treating urologist prognosticates that this should not affect my life span. In fact, he opined that my already having an implant is a bonus. I am hopeful I will still be able to ejaculate after surgery.

As a prelude to surgery, he want to go inside my bladder to make sure all is okay there. He says it is his SOP. Of course, the thought of having a thingy pushed inside me without being knocked out is quite distasteful. But he's the doctor and I'm not.

Am I missing anything? If anybody reading this thinks I am moving too fast, etc., please shoot from the hip. I assure you that I will be extremely appreciative.

Hope everyone (and your family) is safe and well.

Fred

So sorry to hear about your diagnosis and sorry you have to join our club. But hopefully we can be helpful while you go through this. A few thoughts:

First off, I recommend that you get a second opinion on your biopsy slides. This is easily done by having the slides sent to Johns Hopkins for Dr Epstein and his lab to review. There's info on that in the "newly diagnosed" sticky and you can google it as well. You want to confirm that you're actually a G7 (3+4) so you know what you're dealing with.

And I would recommend that you talk with one--or more--radiation oncologists. Particularly someone that practices SBRT or brachytherapy. It's pretty common when you're diagnosed to want to get the cancer out of your body, but radiation is equally effective and can have a different side effect profile. You owe it to yourself to look at the alternatives prior to making a decision. Some guys here in the NYC area can probably make a recommendation on docs to talk to. If you do have surgery, you want to find a doc that has done 1,000s of procedures--that may or may not be your current uro.

At the end of the day, you're highly likely to do fine. But in the meantime, you'll need to jump through lots of hoops to get there. Take things one day at a time and keep moving forward. Good luck and ask as many questions here as you need to.

Hi Fred,
This video from Dr John Mulhall of MSKCC at a patient conference a few years ago might be of interest to you in managing "expectations" following various initial treatment options.

"Optimizing Sexual Function Outcomes in the Prostate Cancer Patient"

https://www.youtube.com/watch?v=4ELsojPFNV8

Charles

Welcome to the forum sorry you had to find us, but you landed in a good place for both knowledge and support.
First slow down. I know the feeling of wanting to just get it out. I felt the same way
And I know the feeling of being scared I felt the same way in that regard as well. I ultimately did surgery but not until I explored my other options and you should be the same as well. Once you do that you’ll have made an informed educated decision based on the knowledge and data that you have. And as a result no matter how things turn out you will never look back and say should’ve would’ve could’ve.

First, for sure send your slides to Jonathon Epstein Johns Hopkins. Here are instructions, https://pathology.jhu.edu/department/services/secondopinion.cfm but you can probably just instruct your urologist to send the slides to JH Pathology and he’ll know what to do, believe me, he’s gotten this request many times before.
Second, you are in the NYC area as I am. Take advantage of it. Whatever treatment you choose you want to be treated at a major cancer center like Memorial Sloan Kettering. You can also consider NYU Perlmutter Cancer Center, or Mount Sinai, particularly if toy end up choosing surgery.
Third, when you I want to speak to somebody who is an expert in radiation I would recommend you contact Dr. Michael ZELEFSKY at Memorial Sloan Kettering Hospital. He is vice chair of the Brachytherapy service And can also talk to you about SBRT otherwise known as cyberknife. With that said you should also talk to someone whose focus is SBRT/cyberknife. I would recommend Dr. Jonathon Haas add Winthrop/NYU Perlmutter.
By the way if you have a hard time getting an appointment with Dr. Zelefsky, which is very possible, there are many other talented radiation oncologist at Sloan Kettering. One name that comes to mind is Dr. Gewanter. There are others.

For surgery, I would recommend you speak with Dr. Ash Tewari, at Mt Sinai, and for a second view, dr. James Eastham, at Memorial Sloan Kettering. These guys are tops in our field although Tewari has more experience with robotic surgery. Full disclosure Dr Tewari did my surgery, I think he’s great.

My personal opinion and others will disagree, if the recent 7(3+4) holds, After Dr. Epstein’s second opinion, I would not consider active surveillance. If there’s any grade four in there I think it’s chancy. But that’s me, I’m conservative, some hospitals and doctors under certain very strict circumstances will except g7 (3+4) patients for their active surveillance program.

Others are going to chime in here and tell you how horrific the results are with surgery from the side effects standpoint. Some do have that experience, others don’t. Four weeks after my surgery I was fully continent, and very shortly after that had no problem achieving a more than satisfactory orgasm and erection. But you will have no ejaculate. With that said from what I have read here most guys who have some form of radiation treatment instead of surgery do experience a reduction ejaculate over time, but they don’t lose it completely

Regarding the comment that 35% of surgeries fail, I’m not sure if it’s quite that high but it could be. However what’s important, is that this points to how absolutely important it is to choose, the best practitioner with as much experience as you can find in whatever area of treatment you do choose.

You’ve got some time but get things moving. Stick around many others will chime in shortly, With many different opinions at the end of the day the right decision for you is only the one you choose. Get educated make your decision and move forward. You are going to be OK.

Keep asking questions and please keep us posted

Hi Fred,
Glad you found us. Any decision made without fully understanding the options is likely to end with some regret. Each treatment choice comes with advantages and disadvantages and I recommend you explore them all. Unfortunately a prostate cancer diagnosis is with us for the rest of our lives. No matter what treatment choice; you’ll need to monitor PSA for the rest of your life.

Because radiation (SBRT) was best for me doesn’t make it best for you. I had no urinary problems prior to treatment and maintaining sexual function was high on my priorities. My cancer was low risk and all the treatments offered a high probability for a cure.

Having your prostate removed is a big deal and takes a great deal of skill to remove without damaging other organs. My wife is an RN who has assisted in a lot of surgeries and tells me that it’s very difficult to distinguish between cancer tissue and healthy tissue. That’s why following surgery they do pathology on the tissue removed. Any cancer cells left behind don’t see the pathologist and is why surgery guys continue to have PSA’s checked. Surgery offers no better cure rates than radiation and can lead to significant side effects as well as an unpleasant recovery period. On the plus side surgery can help those guys also suffering from enlarged prostates (BPH).

I’m a radiation guy and can tell you the only treatment side effect is a very significant reduction in ejaculate. Although the wet spot is smaller, sex is as pleasant as prior to treatment.

Getting a second opinion on your biopsy slides is easy and maybe the best $200 you will ever spend. Epstein is the gold standard and a second opinion on your slides is very important. Keep asking questions and learning and I always tell guys to seek out the very best practitioner they can find no matter what choice of treatment they may decide on. Keep us posted.

Gentlemen,

Merely saying "thank you" seems woefully inadequate. I am grateful beyond those words.

I spent the bulk of last night reading. The consensus, given my age and underlying conditions, points towards radiation. Perhaps my "enthusiasm" in wanting carved out asap was due to fright. My eyes have been opened. Your patience and fraternity were of immeasurable value.

My former GP is retired. He treated me and my family for some 25+ years. He is my friend and he can be monosyllabic and matter-of-fact when I need it. Last night, he was just that - brass knuckles and expletives ruled.

I am, this very morning, moving expeditiously to secure appointments with radiation oncologists. My wife was treated (successfully) for breast cancer 13 years ago and has no recurrence to-date. Unbeknownst to me (I love this lady!) she called him yesterday whilst I was still stunned and he offered-up two names in Monmouth County. NJ. Overnight, I looked at their respective pedigrees and they passed muster.

I meeting with the urologist this coming Thursday. I plan to put the brakes on and pickup copies of the pathologist's report. Now that my haste is bridled and I accept the time urgency is no what I thought during my panic, it behooves me to move carefully and thoroughly.

I will keep you posted. I wish all of us Godspeed.

Fred

Hello Fred and welcome. Sorry you have to be here but we will help you through this. The change from your original post to your most recent post shows that you "get it". Slow down, get educated, get a second opinion on your slides and look at multiple treatment options so that you can make a good decision. You sound like you are heading in the right direction. Hang in there.

Jim

Fred, I add my welcome and assure you that you've come to the right place for advice and support. I am treatment naive for PCa but am trying to keep up with the subject. All the advice you've been given by more experienced hands is spot on. A second reading by Dr. Epstein would be my suggestion as well. I'm glad you're meeting with an RO as you will get a different perspective than from a urologist.

As others have said, take your time - you have a bit right now - and do some diligence. There's a lot of info out there (the Scholz book is excellent; if you have time "The Invasion of the Prostate Snatchers", a catchy title and written by Dr. Scholz and one of his former patients, is another good one for perspective).

Keep us in the loop and have faith. Sorry you've had to join us, but compared to many other maladies that we face, this one is treatable and leads to generally good outcomes. I'm no doctor so can't comment on your precise stats. But I will say that a cystoscopy is really no big deal - I've had two. The anticipation is far worse than the event!

David

Fred, another voice of welcome here, from a relatively recent new member of this piss-poor club; Pun intended. And of course, just kidding, the club here is awesome and has helped me enormously—it’s the reason for membership that bites the big turd sandwich.

You’ve gotten great advice and it sounds like you are already tapping the brakes appropriately. Definitely take the time to learn about all your options, so that you can own the ultimate decision. Sounds like that’s exactly what you’re doing, so good on you for that.

Keep checking in, and know that you’ve got of support here.

Cheers,
FW

Fred,
Here is Curious Charles recommended video :
"Optimizing Sexual Function Outcomes in the Prostate Cancer Patient"
in a clickable link:
https://www.youtube.com/watch?v=4elsojpfnv8

Wings aka Dan in So Cal

I begin by thanking (loud applause) Wings of Eagles for providing the link to Dr. Mulhall's video. The impact on me was significant.

Sometime this coming week, I will be scheduling an appointment with Drs. Mitchell Weiss and Sang Sim. These gentlemen are currently practicing radiation oncologists at Monmouth Medical Center in NJ. Both are alumni of Memorial Sloan Kettering in Manhattan. They were recommended by my wife's oncologist, and that is weighty.

This Thursday, I return to Dr. Tom Mueller at NJ Urology's Sewell, NJ office. Tom did the biopsy. He is a surgeon and, as one would expect, the robotic scalpel is his strong suit. I have questions to ask him. When Tom delivered the verdict, he did, in fact, touch on the option of radiation. My zeal to have it "carved out" asap has been bridled thanks to the salient advice you good gents have taken to time to provide.

It would be absurd for me to state I have made my final decision at this point. However, given my age, diabetes and high blood pressure, my leanings are towards radiation. My partiality is forming, in great part, due to the counsel of my now-retired GP (a close friend of some 25+ years). He, too, opines radiation is the best route to travel.

A Saturday get-together in the Philly vicinity has been mentioned. Count me in. I live in Ocean County, NJ. The trip to Philly is no biggie. In fact, my office was in Philadelphia so my "horse knows the way to carry the sleigh."

I am a Vietnam Veteran. I flew air rescue/evacuation missions galore. I served in the United States Air Force enlisting fresh out of high school when I was 17 1/2 y/o (no college for me at that time - later, yes); active from 11 Oct 66 to 10 Oct 70. It was my honor to wear the uniform of my country. I know what it felt like to be called a "murderer" by some ignorant and cruel *****es and ******s. Hell, that was the way-of-it in the sixties. But my Honorable Discharge hangs proudly on the wall of my study. I would do it all again.

As we honor those who served on Memorial Day 2020, I raise my arm in a salute and say God Bless. Thank you for my family's freedom.

Fred

Post Edited (NJFred) : 5/24/2020 6:48:03 AM (GMT-6)

Fred, and others...I was the one who mentioned a Philly area meetup. Perhaps later this summer when the Covid dust settles a bit we can figure it out. I live in Bucks Cty (just north of Philly). I'm sure we can figure something out.

Also, Fred, most important--your plan of action sounds good. With your other health concerns, one of the radiation methods is good, much less invasive. I'd suggest you ask about SBRT/Cyberknife, as well as HDR brachytherapy--both are done with a lot fewer visits that standard external beam.