PCa newbie, questions

Hello group,

Been Dx with PCa, age 54, G7 (3+4) on biopsy, PSA 4.5.

Seen uro and radiation specialist. Uro recommends surgery and radiation specialist recommends radio therapy IMRT. My uro has plenty of experience but so does the radiation doctor.

Another question, every since I can remember (since my teens) I have had pyronnies disease, this makes penetration possible only in the missionary position. I also have always had a somewhat of a little dribble problem a minute or two after urinating. I usually use a stall at work, and shake Mr Willy pretty well after urinating.

I'm afraid surgery will really mess these two problems of mine up much worse. Your thoughts? For now both problems aren't that big of a deal, wife is fine with missionary only. So in one sense, I would lean towards radiation or proton, as I'm afraid surgery will complicate my "issues" further and will leave me very incontenant and impotent, on the other hand surgery provides a path report and final stats, and age is a factor too, I'm 54.

Here are my questions. I have a HMO (Blue Shiled), can I go out of network to be evaluated by a top urologist and perhaps be treated? I'm not certain how that works if I'm in an HMO. What if I wanted to get Proton treatment? Can I be covered?

Prostate cancer runs in my family...father died of it. Dad had seeds and radiation, but it had already spread by then.

Thanks for your help.

Post Edited (Charlie57) : 11/2/2009 5:51:12 PM (GMT-7)

Hi Charlie,

As we say, glad you found us, sorry your here, and most of all Welcome.  You will find a tremendous amount of help here, from guys whom have alot of experience, and hopefully will be able to answer most of your questions.  I am a similar age to yourself  with a Gleason 7.  I decided that surgery was the way to go for me, and I am extremely happy with the results so far.  Just thought I would mention that I had a dribble problem myself before surgery.  No matter how much shaking I did, still had that little dribble after urination.  Well it must of been some sort of obstruction with the Pca, becasue now the water works is working great, no dribble any more and I am back to being a fire hose. 

Should you decide on surgery hopefully you will get the same result.  Good luck with your decision, but I am certainly happy with mine........Cheers Kev.

I think the best approach before making a decision is to get the best possible staging of your tumour. Usually, most decisions regarding the treatment of prostate cancer are based on fairly limited information regarding staging........at worse a PSA reading, DRE and maybe 6 or 8 core samples. CT and bone scan usually show very little if the tumour is not reasonably extensive. Take on board what other members have to say about various other scans and get them if possible. I think the best bet is to approach surgery with the thought that you will have some problems after.....both on the ED and incontinence front. This is not being a pessimist but rather realistic.......slow recovery of these functions is the norm and you will not be in a state of shock at what may well be somewhat temporary following the surgery. Keep your own copies of every report and test result. Most importantly, educate and educate yourself about the disease before committing to a decision and there is no better place to learn from than the great fellas (and some wives) on this forum. Good luck with whatever you ultimately decide and stay with us,
Bill

Charlie57, HMO plans usually have a PCP that acts as a "gate keeper". Th that case, all care must be coordinated through your PCP. Some HMO plans work similar to a PPO plan and do not have a "gate keeper" but do have a limited provider network. Best advise is to contact the customer service department for your plan and ask. If your plan PCP does act as a gate keeper, he / she can authorize you to go to an in-network urologist for treatment.