Surgery bound?

Hi! I was diagnosed with prostate cancer two weeks ago but I have been reading this forum for a month. I had a gleason score of 3+3 in eleven cores and 3+4 in the other. My PSA was 5.6 before the biopsy two weeks ago and now it is 7.9 (probably because of the biospy). Two cores are 50% involved and one is 85%. There is no spread outside the prostate that is apparent. I am scheduled next week for an MRI and a CT bone scan. I believe all the 'slow growing' part and 'active surveilence' part happened before my PSA started to rise.

What I gather from reading these posts is that those who chose not to have their prostates removed have been fighting a many years battle with ever changing modalities of treatments with various undesirable side effects. As many members have expressed, the fear of recurrence hangs over them each day with no guarantee of cure. This to me is like keeping a demon in a box in one's house and never discarding the box. Many have lost their fight and even some who underwent radical prostatectomy so it concerns me why some folks who are good candidates for surgery would not take that option.

I know that even at 'low risk', that surgery may not be an option for me if prostate cancer is found elsewhere on the scans next week. For now though, I am inclined to opt for surgery early to raise the odds that the nerves can be spared and to better insure a good outcome with the continence issue. Also, I am relatively healthy, at 63 to be a good candidate. I may not be as healthy a few years down the road and surgery would be off the table.

I know this is a lot for my first post but I am glad to be here to support and learn for the rest of the members!

?Fighting a many years battle?
Perhaps you have missed all of the posts from men who DID have their prostates removed and have been "Fighting a many years battle". It goes both ways as far as I can tell. One size (treatment) does not fit all.

It is most certainly too bad you are here but just like the rest of us you have found a really great source of information and inspiration. I hope you use it wisely.

May you be well, may your choices be the best for you and may you live long and healthy.

Roger

CC,
You owe it to yourself to research your options fully. If you take anything away from this forum, it’s that. You need to be your best advocate to work your way thru this. Don't jump at the first option presented. You’ll do yourself an injustice. Take your time. Speak to doctors in both fields. Surgery and Radiaton. Find the best facility you can to treat you. Make an informed decision about your treatment plan. Ask questions on this forum. Everyone here has been or is in the same place you are right now. Both treatments have their side effects and both can and have failed. But I think you may have misread some of the posts in the forum as others have already stated. There are no doctors on here. Just a bunch of people who are fighting the same battle. But their experience is a great resource. Surgery or radiation will be up to you. Just make sure you understand everything you possibly can about both. And don’t hesitate to ask questions.

You don't state your age, but if the above are your goals, you definitely have to reconsider surgery.

My numbers are somewhat like yours. I had RT, and have had years of great living with minimal side effects. A bit of ED, a few bowel issues, all manageable and mild.

You have all the options on the table, and every reason to hope - even except - a positive outcome that years from now will make this look like just a bump in the road. Surgery isn't your only option, RT will work. It really comes what makes sense to you and what you're comfortable doing.

I predict that years from now, you'll be asking "what was I worried about."

Andrew

"I believe all the 'slow growing' part and 'active surveilence' part happened before my PSA started to rise."

I think you hit the nail on the head. Time for treatment. Either surgery or radiation should do fine for you. It really depends on your temperament. Surgery is everything at the beginning, radiation everything comes with time, both good and bad. Either one will probably cure you.

Dear Subdenis,

I am curious as to why you are having a 3rd. MRI when it is unlikely that the cancer will spontaneously disappear. Untreated, it seems to me that the cancer will continue to multiply. I ask because I am hoping that my scans next week will settle any treatment decisions that my urologist and I make. I am hoping that I can be well into my recovery by February since I always feel better during cold weather.

I still am leaning towards open surgery since that option is taken off the table if I try something else first. To me, I would rather remove the breeding ground first and round up the little demon children latter if any are found.

It is good that your cancer has been found early which should increase your chances of success!

CC:
I had surgery scheduled with great prospects for outcome but have decided to do SBRT instead. Mostly from a QoL viewpoint. That said, that is a personal decision and need not be yours. I will be able to say down the road though that I am comfortable and at ease with the fact that I did my "due diligence".
So far in this thread I have not heard you mention seeing ANY RO even though virtually everyone responding to you has suggested you do so. Here is a question for you. If you do have surgery without ever having consulted with even one RO and then let's say you do have BCR will you be able to sit back and say "I did EVERYTHING I could have in the beginning or did I miss something"?
My point here is not to speak against surgery but only that IMHO someone with PCa should talk to someone in every mainline field before deciding.
If you were a judge at a cooking contest wouldn't you taste every dish before making a decision on a winner? If you were a judge at an art contest wouldn't you view every exhibit before awarding the prize? Why then won't you talk with someone from every discipline in this PCa contest. You are the sole judge in this contest, and contest it is my friend with life as 1st prize, and thus should give every contestant a fair chance. "IF" and hopefully "WHEN" you have looked at all of the possibilities and made your decision based upon the evidence and your personal feelings you will hear nothing from me but "GOOD LUCK and may you be well"
Is there a reason you seem to be so resistant to even talking with one or more RO's?

May you be well and make a great decision.

Roger

Hello CC,I was initially choosing Surgery with my Wife in full agreement.Until I found this wonderful site.After visiting top Surgeons,Dr. Shalav,Univ,Chicago,top Low dose bracky docs,DR.Moran,top high dose bracky Dr. Martinez and eventually looking into Cyberknife SBRT which resembles HDB but without the invasiveness. I read the 9 yr study on SBRT compaered to the 11 yr study on IMRT that requires about 40 radiation treatments compared to 5 of SBRT. My decision was made. Im 18 months out with no side effects. I had some urgency to pee but thats about it. No incontinence,no bowel issues,ED is baseline which is workable.

Again take your time to make the decision yours. Visit ROs in all fields. PSA testing continues for surgery and radiation for years. You owe it to yourself to read all you can and ask questions as I did when I entered this great forum. Good Luck,God Bless. SemperFi,John

CCII:

Here's a list of salvage options if primary radiation therapy should fail:

/pcnrv.blogspot.com/2017/09/focal-salvage-ablation-for-radio.html

I think many newbies have an impression salvage therapy is no worse than the primary therapy. That is not the case. The rate of complications are higher after salvage, whether salvage after radiation or salvage after prostatectomy. It's important to choose the primary therapy that gives the best odds of a cure from the start. Fortunately for you, all therapies, surgery or radiation, have excellent and about equal odds of providing you with a cure. So your decision has to be made based on other factors.

Here are some questions to ask yourself:

Questions for yourself

• Do I need to see a pathology report to tell me how contained it was?
• If I choose radiation, can I live with the fact that PSA goes down over a number of years, with bounces along the way, and never becomes undetectable?
• If the pathology is adverse and PSA does not become undetectable, am I prepared to undergo adjuvant radiation with all the potential side effects that entails? (Your doctor has hopefully run a nomogram showing the probability of this happening)
• If the radiation doesn't work, am I prepared to have a biopsy and possible focal brachy re-treatment?
• Which bothers me more - the potential for incontinence and ED after surgery or the potential for retention and irritative effects after radiation? (given the probabilities of those side effects)
• Do I understand the other possible side effects of surgery? (e.g., infection, hernia, climacturia, penile shrinkage, stress incontinence, etc.) Am I prepared to take on penile rehab?
• Do I understand the other possible side effects of radiation? (e.g., fatigue, proctitis, hemorrhoids, frequency, urgency, burning while peeing, ED).
• Am I prepared to undergo radiation therapy and its side effects?
• Am I prepared to undergo surgery and its recovery?

Hi CC, let me add my welcome to everyone else's. Very sorry about your diagnosis, but hope you get some direction here that's helpful for you. This site was a life saver for me when I was diagnosed five years ago.

You've already got excellent advice above, so let me just make a few points:

1) Get a second opinion on your biopsy slides from Johns Hopkins. It's quick and easy to do.

2) Take your time getting used to your situation and learn everything you can. It might change your thinking about treatment or it might not--but whatever you decide will be a considered decision.

3) If you do decide to investigate non-surgical alternatives (and I hope you do), it can get more complicated since there are different types of radiation and different ROs practice different types. We can provide you some guidance here if we know where you're located.

4) I'll bet you an adult beverage that your bone scan won't show a thing. (Well, it will likely show you the results of every possible bump you've had over the past 50 years, but it won't show any cancer.)

5) Unless you get a reclassified Gleason score by Epstein (it can happen, but not likely) or the MRI shows something very weird (even more unlikely), your odds of primary treatment curing you are very good. So focus on SEs since every treatment has them, although as you can see here it's definitely a YMMV situation.

Good luck to you!