Diagnosed with state 1 prostate cancer

I would need to know your age, your gleason score, your health besides this issue, your insurance options. Even then wouldn't be comfortable suggesting what you should do as a true professional should be the one advising you. Preferably one who knows you well.

Also, not sure why you list chemo with surgery. Chemo would be a last resort, not exclusive to surgery, and typically not necessary for folks who treat or monitor early stage PCa.

Best of luck on the PSA test.

I am not sure what a gleason score is.  I am 53 in reasonably good health - a bit on the heavy side (5'9" 205 medium build). I am not taking any drugs (legal or otherwise)  I have Kaiser insurance and my urologist gave me the three options.  She said that she could remove the prostate but that their might be side effects (erectile disfunction, incontinence, etc) She said the "seeds" might "melt" the prostate all together (melt is not the exact term she used but it sounds like this would be the ultimate effect).

What are your experiences with these types of treatments?

Semi,

A Gleason score is a number that a pathologist uses to describe what combinations of cell types he sees under the microscope when he is looking at your biopsy samples, or at your prostate after it has been surgically removed. As prostate cells get more and more abnormal -- more and more aggressively cancerous -- there are differences the pathologist can see. For each sample examined the pathologist will write down the Gleason grades (1 through 5) for the two most abnormal cell types seen. If he sees mostly grade 3 cells but also some grade 4 (worse) then he will write down 3+4 where the three comes first because he saw more grade 3 than grade 4 cells. If he sees more grade 4 cells than grade 3 he will write 4+3. He then adds the numbers together to get a gleason score which is usually written along with the grades. I am a Gleason 9 (4+5) which is pretty aggressive but not as bad as a Gleason 9(5+4) or a Gleason 10(5+5) which is the worst possible score.

Since your urologist is talking about waiting your Gleason score is probably Gleason 6 (3+3) but you should find out for us because it makes a big difference. If you ask your doctor for a copy of your biopsy pathology report we can help you understand it.

We have a thread that is just for newly-diagnosed guys. It is here www.healingwell.com/community/default.aspx?f=35&m=2652250. It has a lot of good information.

3 + 3. That is considered "low grade."
(according to my doctor)

Should I wait or should I act? 

Hi Semimba,

Welcome to HealingWell and I'm sorry to hear about your diagnosis, but the numbers you've given are very encouraging. You're going to be fine, but you can't ignore this.

It would be very unusual for someone with a Gleason 6 to get chemotherapy or hormone therapy; that's for more advanced cancers. The most common treatment options for someone with a Gleason 6 cancer are surgery, seeds and beam radiation. Your doc is right about surgery having side effects, and they can really affect your life. I'd suggest you talk to two or three docs who specialize in these treatments to get some perspective on them. It's something to consider very carefully because you don't get a do-over. I've heard good things about seeds, and I'm sure you'll be hearing from others who've had direct experience with that treatment.

You may be a very good candidate for what's called "active surveillance" or "watchful waiting." This essentially means holding off on any treatment, but watching the cancer very closely. It means quarterly PSA tests, annual biopsies and maybe more. If you can live with a little ambiguity about this, it might be a consideration.

Your biopsy pathology will have a lot to do with what options are available for you. During the biopsy they took maybe a dozen or so needle core samples of prostate tissue. The question is how many of those were cancerous, and how much of each core had cancer. If only a couple cores had a small amount of cancer, you may want to have a talk with the doc about watchful waiting. John T is right (he usually is); you should get a copy of your pathology report from the biopsy and find out what the numbers mean.

You still have time to make a treatment decision, although you've waited quite a while already. The fact that your PSA hasn't gone up is a good sign. I suggest you take a little more time to read a couple good books and scour the threads here. Dr. Patrick Walsh's Guide to Surviving Prostate Cancer is excellent.

Hang in there and don't let this stuff freak you out. A Gleason 6 is about as good as it gets, and you're going to be fine. Let us know if you have any questions, and let us know what happens. There are a lot of really great people here who can be very helpful. You landed in a good place.

Best,

Jonathan

semimba said...
3 + 3. That is considered "low grade."
(according to my doctor)

Should I wait or should I act? 

Semimba,  I was 53 when diagnosed with similiar stats to what you've provided.  My PSA was higher, though not through the roof.  I believe you have time to think this through.  You have what's considered "low grade" PCa, and that's good (at least for having it to begin with), so taking a few more months to make a decision should be ok.  I would suggest talking to a radiation oncologist about SBRT and "seeds", as well as a medical oncologist to get an overall view of your case.  You only get one shot at a primary treatment, so don't rush into it, is my advice.

I had SBRT and am very happy with the results.  You can read about it on the thread I've posted in my signature block.  It took me several months after diagnosis to come to that choice.  You may very well choose something else, but make sure you are confident in your choice and ask as many questions as you need to.  In the end this is YOUR decision.

Good Luck

Mike