Take your Time???

Mel,

Once I was diagnosed with a Gleason 7 (4+3), I knew there was the possibility of a more agressive cancer. The problem with waiting any longer period of time, is that you don't know when and if the cancer goes outside the prostate. Some people will make it sound like it will take years for that to happen, my own doctors told me that it can happen in months, and even weeks if the cells are real close to the edge. And one has to remember too, that the biopsy is but an estimate, it is only based on the cores sampled and the grade, quality, and quantity of cancer found there. It's always possible that the cancer is more developed, but unless one's prostate is removed by surgery and then analyzed by pathology, there is no accurate way to know the fuller extent of the cancer.

I am not advocating for anyone to race out and react on fear or lack of knowledge, not like that at all. But there are schools of thought among cancer experts, that Gleason 7 are very unpredictable creatures, its that "4" component that can make it turn ugly in a hurry.

I was not rushed into anything by anybody, doctor's included. With the span of 3 biopsies over 18 months, I researched extensively, and pretty well knew my options and odds. Once my Gleason 7 was fully discovered, I was prepared to make my choice, and I did.

Each man here has to come to his own conclusions, and there is always risk in waiting when dealing with any cancer.

David in SC

Mel,
If it any consolation you have most likely had the PC for 15 years or longer, Given this time period two or three months longer isn't a lot of time in the scheme of things especially if you need to nail things down.
I was a G4+3 and waited 8 months from 1st DX to treatment. I went on a no meat and no dairy diet which I think helped slow my PC growth. The extra time I felt was well spent in gathering enough info to make an informed decision. You can also take Casodex for a few months if you are really worried and this will stop anything dead.
JT

Just a note:
Casodex will not stop anything dead. It is an anti-androgen and blocks absorption of testosterone in androgen dependent cells. However, any cells that are not dependent on androgens will not respond to Casodex. PSA may be masked with Casodex, and indicate that the drug is working. And it is but only in androgen dependent cells as long as they respond to this therapy.

Tony

I’m with Mel. Got my biopsy results on a Monday and I would have had my prostate taken out on Tuesday if I could have found a surgeon to do that. The recovery period of biopsy to surgery was excruciatingly painful to me and my family. I would say that during the period of time between PSA and Biopsy I became as informed as I needed to be. I still today pick up interesting facts… but nothing that is significant in choice. “Take your time” wasn’t a consideration for me. I actually understand the need to have the healing time between biopsy and surgery. So I may have been embellishing above when I said I’d have the surgery the next day after results. I really would not want a complicating factor like a colostomy but …that time was just a killer for me!  jnm

Mel,I don't know if this is helpful but I had 6months between biopsy and surgery.after they found out i needed radiation my Dr. said something to me that put me in a tail-spin.He told me there is never a need to rush.And I still wonder about that.Well as always take care of your self and try to relax as much as possible.

Zach

Empirical type question maybe Tony-TC or John T or other(s) could put a spin on this. Why is it that many or most uro-docs do not tell a patient you could take casodex or other control drugs while you wait upon your surgery or decision processes????

Now is it that the drug may shrink the gland and I know it would make surgery more difficult, but is that the reason? Plus I know that surgery is still possible and some folks have done just this path anyway and got their surgery via various methods.

Is it that the patient may change his mind about the major treatment that is proposed to him?

Then why not offer this option straight up to patients whom are worried 'sick' about a their own PCa scenario, especially with higher gleasons or higher psa's? Seems it would be very comforting to the patient, to hear...hey...we can prescribe x,y,z while you wait and decide or prepare for whatever. My curiousity on this and to compare and contrast opinions.

Post Edited (zufus) : 12/13/2009 6:42:43 AM (GMT-7)

I am just posing what I think is a reaonable question to ask just as compiler and others have done ?  Looking at any inputs from any angle, we know PCa....many angles.

I was on Casodex and Lupron for two months prior to my surgery, I had originally settled on HDRT and an IMRT follow up so I started the Casodex-Lupron thing.  The onco. who gave me the Casodex-Lupron assured me that the medication would not preclude surgery.  I then met with one more surgeon and decided to go that route.  The surgeon was up front saying that it may be a little more diffucult to peel the prostate away from the nerves but he would just have to see.  I got a copy of his surgery notes and he documented that it was tough peeling the prostate away.  The surgery took about 1 1/2 hours longer than usual because of it.

The upsdie to the meds were my peace of mind during the wait for surgery, I knew that the cancer was shrinking and my PSA was undetectable.

Would I follow the same path? That's a hard question and I'm not looking back or second guessing myself.  This is just information for peopletrying to make a decision.

David

I have heard that taking Casodex will shrink both the prostate and the tumor moving the smaller prostate away from some of the major organs and enabling better margins. It also may kill small amounts of PC cells that may have escaped into the blood stream. It definately will slow down any androgen dependent PC cells. I know that most surgeons don't agree with this and as pointed out the surgery becomes more difficult. I don't know if there is a difference in taking Casodex or Lupron in it's effects on the surgery.
Again, this is another area in which there is a lot of disagreement among professionals when it comes to treating this disease.
There is also disagreement as to whether adjuvent HT helps in radiation. It seems logical that anything that can make the prostate smaller would be a huge benefit because you are giveing the same dose to a much smaller prostate and tumor, so the targeted area is getting 100% more radiation if it is 50% smaller. It also is logical that HT would make the PC cells weaker and easier to kill.
JT

Wyatt Earp's advice about gun fighting applies, "Take your time but do it quickly."

Herophilus said:
"Got my biopsy results on a Monday and I would have had my prostate taken out on Tuesday if I could have found a surgeon to do that."

I felt exactly the same way. I went to Moffitt Canceer Center in Tampa on a Thurs. to meed with Dr. Pow-Sang. He told me they were scheduling surgeries out six weeks. Well, OK, but if you could take it out tomorrow I'd do it. So he immediately went to his scheduling nurse and came back to tell me they had an opening the next Tues. I got in all the golf I could over the weekend, which keeps me from thinking about anything else (Boy did it help last year during the stock market collapse!), went up Mon. for the pre-surgery tests and Tues. afternoon my (&%4@ betraying prostate was gone. I did research on the seeds and radiation but the decision was pretty easy for me. Since then I found HW and thanks to the intelligent people here I have learned more about Pca than I ever knew before. Nothing I have learned here however has made me second guess myself.

Mel, this is just my experience and in no way a recommendation for your case.
Best of luck, You have gotten so much good advice here am sure you will do what is right for you.

Steve

I was diagnosed with PCa in January, a not unexpected result given family history. I decided on surgery after a bit of research, consulting with a radiation oncologist, and a prayer or twenty. I could have had surgery as early as mid-February. However, I'm an accountant with my own practice and February surgery would have made me miss a major portion of the tax season and, quite possibly, put me out of business. I laid that out for my urologist and he told me he had no problems giving me a shot of Lupron to slow things down and get me safely to the end of April. I was afraid any meaningful delay could be enough to get past the possible cure/palliative care tipping point. Even if the Lupron had no PCa effects, which I don't believe, it did give me peace of mind to stay in business. It also meant I was doing something.

35 years ago my father had to decide surgery or not for PCa. He chose surgery and enjoyed life with my mother until the week before my surgery. A friend of theirs chose the chance of sex over surgery at about the same time (this was pre-nerve sparing days) and ended up dead in not so many years. That sex thing didn't work out real well for him as a long term strategy. My parents both think he was an idiot.