biopsy results in - would like thoughts

Sorry to be a new member of this club. But, here I am. After two PSA scores of 7.9 and 8.1 (over 2 months), I had a biopsy.

Results showed 5 of 12 spots positive (adenocarcinoma) (35%, 6%,10%,10%,70%). Gleason score of 6 on 4 of the areas, 7 on one.

Based on my age (49) and no other health issues, Dr. said he would strongly encourage surgery to take out the prostate. He feels best way to make sure it is dealt with completely and quickly and, at my age and current health (very good), he believes I an in a very good spot to deal effectively with side effects over time (dripping, ED).

I plan on getting a few other opinions. In the interim, I wanted to see if this path makes sense to folks here who have much more experience than I. I appreciate any insights.

Audio, sorry to hear about your positive diagnosis. First thing you need to know, is you will be ok. As the saying goes, most men die with prostate cancer, not of prostate cancer.
Important question - is your Gleason 7 a (4+3) or a (3+4)?

Most urologists are surgeons, and so thats what they recommend, surgery. Not saying your Dr doesnt believe its the best option, he likely does and thats why he is a surgeon. But as you said, you need to get other opinions. But get them from, not only other surgeons, get them from Radiation Oncologists that specialize in various types of radiation, SBRT (also known as Cyberknife) HDR Brachy, LDR Brachy, (seeds) etc.

First thing you should do is read the sticky at the top of this page for newly diagnosed, if you haven't already.

Second (or maybe tied for first, its that important) thing you should do is request that your slides be sent to a pathologist who only does Prostate slides) Its a very subjective process. Most guys here have used Jonathan Epstein at Johns Hopkins. Your Urologist will know who he is and how to send the slides. Or you can refer to instructions in the sticky above.

Third thing, is seek out the best Radiation Oncologists you can find and meet with them. Create a binder with copies of all of your records, PSA history, Pathology Report, reports on any scans you might have had (doubt scans are necessary with your PSA under 10, but many Drs do them anyway) . Bring the binder with you to your appointments.

Also, seek out the best surgeon. Maybe its your doc. Maybe not. IMO, you want someone who's done at least 1000 surgeries, in whichever method he uses (Robotic or open). The method matters less than the experience and expertise of the surgeon.

Active Surveillance maybe an option if your Gleason is 3+4, some people believe. But maybe not in your case with 5 cores positive. I'm not expert on that, others will most certainly chime in.

One more thing - Your doctor telling you that you should be in a good spot with side effects, sounds like sales talk to me. Its a load of crap. We've seen young guys here who had nothing but trouble, and older guys who've had no issues. Its a crap shoot, although you can stack the odds in your favor if you find a great, very experienced surgeon.

Good luck, you'll soon get a lot more responses. So stay tuned. And stick around. This is a great group of very knowledgeable, supportive guys and spouses.

Once you have all the facts, you can make YOUR OWN decision on treatment.

You've got a long life ahead of ya. You're not gonna wanna have to deal with stuff anymore, if you can help it.

If you choose surgery--like I did--know that it is all about the skill of the sugeon. Do your research and get someone with plenty of experience. Check their personal success rate and percent of negative margins. Sometimes the hardest part of this disease is choosing a treatment.

Good luck,
Tom

Sorry you have to join us, but I hope we can help. Pratoman nailed the advice to you--I agree with everything he said. And PCa is very slow growing so you have some time to figure this out.

BTW, while you're not a typical fit for AS, I wouldn't exclude it--something to keep in mind as you meet with our docs and try to figure this out.

audioguy, You need to respond to the questions about your G7 being a G3+4 or 4+3.

Either way, I would doubt that AS would be a long term solution for you.

The current wave of good reports and postings for treatment is running in favor of Cyberknife/SBRT.

Check that out. Good luck.

Welcome to our club, audioguy. None of wanted to join, but most of us are glad we came here to learn.

Know that there isn't a rush for you. With mostly G6 and 1 G7 core, you've got a while to gather information and make a solid decision. Don't let anyone--doctors, friends, family--rush you. You have months to make your calls and referrals and consults.

A few firsts--some to help us help you, and some to give you the information you need.

Have your slides sent off for verification to Epstein at Johns Hopkins.

Let us know where you are--we can probably aim you at places and people to get great information

Do ask for, and get, referrals to radiation experts near you

If you don't know where else to start, google "NCCN centers of excellence"--in the US, these are the 15-20 nationally certified cancer centers. If you start at the one closest to you, you'll find the best information.

Get a copy of your written pathologist report and list it all down here, we'll help interpret it in layman's language.

Most important: breathe. slow down. know that it's not the end of the world, or the end of your life, or even the end of your manhood. Cure is a word for your vocabulary. Really. Surgery or any one of the various radiation therapies for encapsulated PC is likely to cure you.

Auguy...sounds like you have made up your mind about surgery being your choice of treatment. I`m a post toastie , and I do understand your concern about "getting it " out and being cured. But as far as all the stats go , Surgery and Radiation have the same results with your #`s. I strongly recommend you to have consul with a good RO about your radiation choices . The new radiation treatments are really dialed in now and I believe would do you better than removal with the nasty SE`s that come with it for many , not all, men .........do your research.........David

You are doing your research and are making your choices, and that is the task at hand.

audioguy - I'm another Post Toastie checking in here. My biopsy was quite similar to yours, and I also chose active treatment rather than trying to qualify for active surveillance. For me, though, surgery was not the best option, even though my trusted urologist did suggest that I would be a good candidate. I chose to research the radiation options - of which there are several. I chose the CyberKnife (also known as SBRT) treatment which took place on 5 days during a two-week period. My side effects have been minimal (my specifics probably don't matter - we're all different), and the long-term results and side effects studies have all been favorable.

That said, I am NOT advocating for any one radiation treatment over others. I am more trying to help you to understand that surgery may not be your only viable option, and to underscore the importance to favorable intermediate risk patients like you and me, that we explore the entire universe of treatment options and choose what is right for ourselves.

You've received a wealth of advice here. Please take it seriously and do the research. Then when you identify treatments that may interest you personally, come on back and ask about them. Chances are that one or more of us have already traveled that particular path and we will share our experiences to help you understand the impact of that choice.

We're here for you, brother.

By starting at GW and heading over to JH for second opinions, you're certainly dealing with 'the best of the best'. Hint: get a big folder for all the paper you're going to accumulate, and get copies of EVERYTHING. Also, many of us found it helpful to take someone along (wife?) to take notes at the consults. Write down your questions before you go...and the answers when you get them.

I agree with others who have said that surgery and radiation are equally curative for relatively mild cases like yours. The reference to your age is related to the adage that radiation is often offered to younger men with caution because of the "late-term" side effects such as rectal bleeding, or others, which may show up in 10- or 15- or 20-years. If you are 70, you probably worry less about the 20-year "late-term" effects.

Well, it has been a while since I started this post right after I received my biopsy result. I received great advice and encouragement here and want to give an update.

I went for a second opinion at JHU. Epstein confirmed biopsy results. Received the same advice in terms of surgery that I received from GWU (worked with Dr. Engel at GW and Dr. pavlovich at JHU). I also spent a bunch of time looking into radiation therapy (good center at G'town here in DC).

After a bunch of thought and research, I concluded surgery was the correct option for me.

I decided to get it done at GWU. Dr. Engel is clearly qualified and very experienced (his office is also walking distance from my house !) and spent a bunch of time with me talking through options. Surgery was done 2 weeks ago at GWU - robotic radical prostatectomy.Dr. Engel said surgery went very well.

Surgery went well and lymph nodes are clear. Dr. Engel confirmed after the bisection of the porstate that the cancer was "definately acting like cancer" and and was very good I had the surgery. He thought the actuall results from the prostate indicated a bit more advanced PC than from the biopsy. I go back in 2 1/2 months for the PSA test to make sure nothing still lurking about.

feeling very good and back to completely normal activity - not working out or running or anything like that yet, but all else is fine. Still dripping but very manageable and I can see i ill have it under control soon enough.

Some food for thought: I only found out about this because I went for a full body, head-to-toe "concierge" style physical (I am 49) where a PSA test was part of the physical. I understand that for folks my age that go for a normal physical under the ACA, PSA test is not a part of the testing. I am at least one example where the PSA quite literally saved my life.

Will follow up after PSA testy. i thank everyone for their thoughts and advice.