prostate cancer time to think about what to do

Hope that every one of my brothers out there had a Merry Christmas and a Happy New Year. Well, I have another appointment with the doctor at the Mayo on Jan. 13 to do another PSA and of course the finger wave. PSA is now up to 15 and glenson is at 6, had a 2nd biopsy done the first one only 10 core samples were taken and the second one they took 25 and 10 of them showed cancer.

The doctor said that the readings were very small in numbers that at that point he wasn't to worried about it but wanted to put me on an active watch list.

So I asked him at what point should we think about doing something. He said that we should do an MRI and check to see what the prostate looks like. Well, thank GOD everything is still in the prostate area so he was happy with that.

So he said that if worst comes to worst that I would be better off to remove the prostate by using that Da Vinci which would allow the procedure to be a little more safer, he said that it would be the best bet with less harm.

So the other day I saw where my local hospital now has what is called the Cyber Knife where radiation is used and there is no cutting but that the rays are very small and only attack the cancer cells.

The other Doctor told me that if I start with radiation that I couldn't go back to have it removed so that is something to think about.

My question is are there any brothers out there who had the Cyber Knife done and are they happy with the results. How does the doctor know that the Cyber Knife did it's job? Do they use the PSA numbers to see if the PSA goes down? I guess I have a million questions to ask.

So if there is anyone out there that can pass on some information I would sure like to hear from you.

God Bless you all............

Hi art and sorry to welcome you to the club.

If you haven't already, you may benefit from reading the sticky:
Newly diagnosed with PC? – read this thread first

I think Mayo may have a dedicated prostate pathologist who reads biopsy slides - I seem to remember that Bostwick started there. If not, a second opinion on them from Bostwick or Epstein may be a good idea. It's possible to get misreads from even a saturation biopsy if the pathologist wasn't dedicated to reading only prostate biopsies.

I agree with JNF that you may want to understand why your PSA is so high for a GS 6. You may have a very large prostate, prostatitis, or urinary retention going on at the same time. A large prostate and urinary retention may preclude LDR brachy treatment.

In addition to SBRT and surgery, either kind of brachytherapy (as monotherapies) may be good options for you as well. I think conventional IMRT as primary therapy is outmoded, and there isn't any proven benefit to protons that justifies its cost.

I had SBRT - CyberKnife is one brand name for the linear accelerator system used doing SBRT treatments. I was treated with a different machine, but they are pretty much equivalent in the hands of an experienced radiation oncologist. See links in my signature.

As you've just learned, you have to talk to experts in each particular treatment specialty, and you can't rely very much on what others say who are not experienced in that specialty.

While surgery is not a good option if radiation fails, there are several other salvage options, including salvage brachytherapy, SBRT or cryotherapy. Local failures are rare after any treatment, surgery or radiation, for a GS 6, so that ought not drive your decision.

I think that experience is a starting point. How many procedures have been performed and how often are they performed. With most medical procedures there is no substitute for frequency. Next get information from other practitioners in the area. Look for information regarding professional reputation. Seek testimonials from patients. Check in on USTOO groups to see who has provided treatments and how they were judged. Look for professional sources that indicate education, experience, memberships, board certifications, publications, participation in studies and trials, etc. Look at the center as the equipment, technicians etc. are all very important. Ask for referrals to patients they have treated.

Certainly not a science, but I think there are many ways to gain information that would steer you to certain practitioners and away from other practitioners.

Hi Art. Sorry you have to join this club. At this point you are doing the right thing, research and more research. In the end, your treatment decision is a personal decision. Some people just don't like having the cancer inside so they get it cut out. Yet others don't want to be cut and go with radiation. Tall Allan's advice is great to start the process on here with the Newly Diagnosed sticky thread. I had consultations with 5 doctors: 2 urologists (surgeons), 2 Radiation Oncologist and a Medical Oncologist. In the end, I started the process that I could live with as everything has some sort of side effects. Good luck on your journey. Take care. -JR

A basic question we ask everyone is 'where are you located'? I note you're under care at Mayo, obviously a great place to start. My take on your diagnostic info is that G6 is a good thing (Low risk), but 10/25 cores bumps you up a bit.

Please, in the name of complete research, look into Active Surveillance...which is a process of regular checks and monitor if something starts to move. It seems to make no difference over the long haul as far as longevity is concerned. Also, even if you're not particularly interested in the surgical option, it's still a good idea to get solid info about it.