First Post

Welcome to HW, sorry you need to be here.

First the good news - it's very treatable and likely curable.

Bad news, you need treatment.

Even worse news - likely all the main line treatments, surgery, radiation, will likely work just fine. You problem is going to be selecting among treatments that sometimes have no clear advantage over another.

At this point, you need to get a second opinion on your options. Getting the slide read by Bostwick is great. You should find an RO to talk to for your radiation options. There are the beam options and the brachy seeds. We're hearing a lot of good things about SBRT so I'd look into that.

You don't need to rush into a treatment decision, PC generally grows slowly so you have time to make an informed decision.

Hang in there and ask all the questions you want, we're here most days.
Andrew

Hi Alan from Allen,

It may give you some comfort to know that many doctors now advocate careful watching (active surveillance) until the Gleason score reaches 4+3. It is likely that you didn't miss any opportunities by waiting. You also have time to decide - this cancer is typically slow growing and waiting more than 3 months to make a carefully weighed decision is not a bad idea, and may be a good idea. There's a shock that interferes with rational decision making that seems to lessen over time.

Here are some therapies that are likely to be curative based on what you know now:
• surgery (open or robotic)
• SBRT
• High Dose Rate brachytherapy (temporary implants)
• Low Dose Rate brachytherapy (seeds) probably combined with external beam therapy

Lower on the list because of inferiority to those above on the basis of cost and convenience and with no better outcomes would be proton therapy and conventional IMRT (hypofractionated IMRT is a better idea).

Now, here's the kicker - it's not like you can go to any one doctor and get the true low down on any of those therapies. Every specialist thinks his specialty is the best (or else why would he be doing it?), and may think all other therapies are inferior. You have to seek out and meet with expert practitioners of each of those therapies, and then make up your own mind about which is right for you. It's a process that takes time and patience, but at the end, I think you will feel really good about the decision you make, and proud of yourself for the effort you've made on your own behalf. (I met with 6 specialists myself)

In Michigan, the U of Michigan is very highly regarded for prostate cancer, and I'm sure there are excellent surgeons there who have done thousands, not just hundreds, of prostatectomies. Henry Ford in Detroit is excellent as well. You also have Alvaro Martinez not too far away in Detroit who is one of the world experts in HDR brachytherapy. Farther afield, in Chicago, you have Brian Moran, an expert in LDR brachytherapy; and Arica Hirsch for SBRT.

Hi Alan, welcome to HW... Sorry you have to be here but it is great you have done some research and are gathering those important questions to make that final treatment decision. All treatments have some level of side effects, at least initially. It is good to understand which ones you can live with. Good luck on your decision and this journey. I wish you well. Keep us posted. Take care-JR

Thanks to:

InTheShop
Newton451
Tall Allen
Dr.WHO
CaliJR

for the nice welcome to the Forum. I am feeling better knowing there are caring people that can assist me with my questions and concerns.

My URO targeted my left mid quadrant with 6 needles since an abnormal lump showed up there. He felt it on the DRE. The other 11 needles were spread across the rest of the quadrants which showed no signs of disease. My question is if I decide to do radiation in that area how would I be sure one of the other 11 needles didn't miss a cancer and those areas wouldn't get treated? Would another biopsy be required at the point?

Is there a certain waiting period between a biopsy and surgery?

Thank You
Alan

Hey Alan

I had radiation treatments. Both the Beam and the seeds target the entire prostate.

Before you make a final decision for surgery, be sure to discuss radiation with a well qualified Radiation Oncologist.

Hi Alan and welcome to our corner of the world. You've already got some excellent advice upthread so I have nothing to add, other I agree with all of it. I especially agree with the part about a chance of a cure for you being very, very good.

I can tell you're approaching this in a very thoughtful manner and I think that will service you well as you go through this journey. And we'll be here to help. Good luck to you!

Hi Alan. In terms of a waiting period, I believe 6 weeks minimum is what I recall. You do need time to research options and hunt for a clinician with whom you are comfortable, so don't feel you don't have time to do your due diligence.

Hello Alan,

Welcome to the forum.

You've gotten a lot of good advice here. Mostly I'm just saying hello but I will touch on a few bits that seemed significant.

You have an intermediate-risk cancer that will need treatment but can most-likely be cured by any of the available treatment options available. It needs to be treated soon but it doesn't need to be treated today. You have time to talk to a number of specialists in different treatment options. Be sure to include at least one more surgeon if you are considering surgery. Your surgeon's 300 DaVinci surgeries actually puts him in the middle of the learning curve. There are high-volume surgeons who do that many surgeries every day before lunch... OK, maybe I exagerate... a bit... but there are surgeons who have done ten times that many procedures and studies have found that more-experienced surgeons do have significantly better results.

Hi, Alan, and I'll add my own "welcome" to the club. I'm about the same age as you, and was just diagnosed in early July. My pathology is a bit less serious than yours (my GS7 is the 3+4 variety), but we share the same dilemma. If you look back at my prior posts, you will find a lengthy recap of my visit with my urologist when we discussed my biopsy results and treatment options. He basically told me, as Tall Allen has mentioned "Essentially any of the standard treatment modalities can give you the same results. We can cure this. You just need to choose your treatment based upon the side effects of each, and how you can adjust or tolerate them."

My urologist asked me if I was interested in Active Surveillance. I told him that with my GS7 biopsy, I wasn't really comfortable with that. After that, we discussed surgery, but due to my history (other major surgeries and co-morbidities), I have thus far chosen not to consider surgery. I just think that for me the risks are too great, and surgery has no higher "cure" rate than properly administered radiation treatment.

With those decisions made (conditionally), I have scheduled appointments with two regional Radiological Oncologists to discuss my options in radiation treatment, with a specific interest in CyberKnife (SBRT). The first of the appointments is this afternoon. Of course, I will start a new thread with my impressions from this appointment, so watch for that.

I have received some of the best advice here, from most of the same folks who have responded to this thread. The first and greatest advice was "Don't Panic!" As TA mentioned, this cancer is relatively slow growing. We have the luxury of time to decide, so we must use that gift wisely. Once we start on a path, most are irreversible.

P.S. At "our" age, I'm personally not worried about the extreme difficulty of salvage surgery after radiation because modern radiation techniques like CyberKnife report mid-term (9 years for CyberKnife) rates of non-recurrence way up in the 90+ percent range. Why would I reject a non-invasive treatment mode to have another option for salvage therapy but only 3 to 5% of patients need that salvage? And, even if the worst came to be, and I experience biochemical recurrence some years after radiation therapy, there are other therapies that can be used to control the disease, usually for extended periods of time.

Hang in there. We will all get through this together.

Alan - I forgot to mention one of my personal observations in my last post. At the risk of starting a flame war, I volunteer to be the first to be critical of Dr. Walsh's book. In my (very humble) opinion, Dr. Walsh does a fantastic job of educating the reader about the disease of prostate cancer and about the history and current state of surgical options, but he sounds like a surgeon when he writes about radiation therapies. He seems to pass most of them off as "experimental" therapies which should be subjected to more rigorous study and testing prior to their general acceptance. He is, to me, especially over-cautious and condescending about Stereotactic Body Radiation Therapy (SBRT, like CyberKnife). While they have published "only" 9 years of results, their outcomes are as good as those of surgery or high-dose brachytherapy. With FDA approval and such good results, I'd hardly consider them as needing more testing to be proven.

Alan said...


@Newton-451 and InTheShop It appears that the wait time between biopsy and surgery is close to 2 months. I wonder if it is the same if you decide to go with radiation.

Alan

It's the same. Sometimes radiation can be a bit longer wait because you not only have to heal, but sometimes they need to implant marks for the machine to line up on (another biopsy like procedure) and you have to heal from that. At my clinic the wait time also had to do with scheduling time on the machine. I had to wait an extra couple of weeks because I wanted a specific time slot.

The good thing about PC is that it's not that time critical. Other than the anxiety of waiting, there's not a problem for an extra few weeks here or there.

Andrew

Alan, you may have already figured this out..but two of our stalwart members are near you: Compiler and Redwing are both in that part of Michigan.

Best of luck to you.