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Posted 2/27/2011 2:14 AM (GMT 0)
I was about to loose my insurance coverage so I had my doctor do an overall physical. In my blood work I had a PSA reading on 7. My doctor urged me to go for a consult with an urologist. I visited the urologist and after a rectal exam he confirmed the need to do a biopsy. My biopsy result came back positive for prostate adenocarcinoma in 4 of the 12 samples with ranges between 30% to 85% of sample ( which I still do not understand what that means).
In the glean score of 3+3=6 in all the samples obtained.
My urologist recommends surgery due to my young age and the "amount" of cancer present.
I chose to have a second opinion with another doctor, more specialized in prostate cancer treatment, urologist oncologist, and he confirmed the same treatment option.
He cited age and the fact that by removing prostate could we be more knowledgeable of the cancer and be able to predict recurrence of cancer down to year by studying the gland.
I have read and read and felt more inclined to take the approach towards proton radiation, though I am concerned about the potential treatment options if the cancer returns in a few years.
Any thoughts, advise?
Posted 2/27/2011 2:18 AM (GMT 0)
>>My urologist recommends surgery due to my young age and the "amount" of cancer present. <<

sorry to hear that.  my uro recommended a combination treatment because of the high volume of cancer, my age and general good health.  his thought was we should hit the cancer with everything the first time.  he said that since there is a 60% chance that the cancer jumped the capsule surgery was not the right choice. 

ed

Posted 2/27/2011 2:31 AM (GMT 0)
Hi F8
Did you have scans done? On what basis did your urologist assume 60% chance cancer had jumped or spread?
Posted 2/27/2011 3:03 AM (GMT 0)
Carlos -- i had a bone and ct scan, both negative.  my biopsy showed 12 of 12 cores positive.  one core was 70%, two were 60% and another was 40% and then smaller amounts.  based on cancer volume, gleason score, PSA,  negative DRE and smallish prostate my doctor said there was a 2% chance that the cancer was systemic and a 60% chance of local spread -- i.e., in the prostate bed.

so i started with lupron which was continued for 9 months.  about 10 weeks after the first shot i had BT which was followed by IGRT.

sure i'll never know what the actually pathology was but it doesn't really matter since we threw everything at the cancer.  we do know there is a 40% chance that the actual pathology is worse than what the biopsy shows and that adjuvant treatment is more effective than salvage treatment.

the comment you made about having surgery to better gauge recurrence doesn't sit well with me.  but maybe i'm misinterpreting what you or your doctor said.  whatever you decide i wish the very best outcome for you.

ed 

Posted 2/27/2011 6:52 PM (GMT 0)
Carlos,
Your biopsy and psa indicate that you have a moderate to large volume of low risk or non agressive prostate cancer. Most patients with these characteristics do very well long term and all treatments have similar results.
Proton, surgery, seeds and IMRT radiation are all options that would work well. They all have different short and long term side affects that should play an important part in your decision making.
Surgery will give you a good idea of the extent of your cancer involvement, but comes with a price. Scans like MRIS or color doppler can give you almost as much information about involvement without the side affects.
There are salvage treatments for failed Proton and radiation that work at the same effectiveness as salvage treatments for failed surgery, but your decision should focus on the best primary treatment for your condidtion.
To achieve the most favorable outcome:
Know the biology of your individual cancer. (is it agressive or non agressive; what is the size and location of the tumor; has it excaped the capsul, how fast is it growing)
Fit the treatment to your cancer's biology.
Pick the absolute best doctor that specializes in that treatment option.
JT
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