How to Decide?

I see an RO on Friday, the 3rd, for a consult. Given my situation and recognizing that I am still trying to decide a course of action, what specific questions I should ask to help me get the best information upon which to make a decision?

Bob in Elkridge said...
I see an RO on Friday, the 3rd, for a consult. Given my situation and recognizing that I am still trying to decide a course of action, what specific questions I should ask to help me get the best information upon which to make a decision?

Go to the top of this forum page-"Newly Diagnosed? Read this First" You will find a list of questions to ask.

I hate to say it, MK, but that simply isn't true. Many, many men have had RP and come out with minimal side effects. The stats are hard to come by--because they are based on questionaires and cover all kinds of issues.

Yes, some percentage of men have the kinds of SE's that you're having--but it's a relatively small number--(which sucks if you're one of them).

That being said, RP for what is basically a significant BPH problem seems like overkill. Green light laser, TURP, something like that seems a lot less invasive and problematic.

There certainly is a lot to process, being newly diagnosed with PCa on top of the BPH problems and almost non-existent T, I am trying to get a handle on all of the possibilities. The low T seems to complicate the landscape--although it shouldn't. The the practitioners I have been working with so far are unwilling to address the T issue along side the PCa and BPH. I see an RO tomorrow and next week I have a consult with the Director of Urological Oncology at Hopkins where I am hopeful that the cutting edge of medicine has arrived.

Wow, one core of G6 and he didn't think you were a good candidate for AS? Does that mean he thinks *no one* is a good candidate for AS or is there something about your BPH or T level that is behind his thinking?

LDR brachy was not a good option because I have a hole in my prostate as a result of a TUNA procedure four years ago. The RO said that makes emplacement of the seeds problematic. My prostate is not that large, just 29.6 cc.

As for the AS, I think it was a combination of life expectancy, the T, and BPH that played into the advice against AS. My smallish prostate puts me in the low-risk category since my PSA density is almost double the definition of very low-risk.

I've been reading through the documents in the introductory posts to the board and I can understand his recommendation for something other than AS--it seems supported.

Bob, do ask about AS in your case. JH has one of the most respected AS programs in the country--even though their requirements are also possibly the strictest. With 1 G6 core, you should certainly qualify.

Bob in Elkridge said...
As for the AS, I think it was a combination of life expectancy, the T, and BPH that played into the advice against AS. My smallish prostate puts me in the low-risk category since my PSA density is almost double the definition of very low-risk.

Please explain why you think you are not a perfect candidate for AS. Your PSA density = 4.5/29.6=0.15, which qualifies as very low risk - even Johns Hopkins would take you. Longer life expectancy is a reason to go on AS:

/pcnrv.blogspot.com/2016/08/can-man-be-too-young-for-active.html

I don't understand why you think your T level or BPH is against AS.

While you can't have LDR brachy because of your prior TURP, you can have surgery, SBRT or HDR brachy. You have to speak to specialists in each of those to find out about them.

I appreciate all of the thoughts. They are excellent.

My consult with the MD from Hopkins was interesting. I was leaning towards RALP just to get it out and be done with all of the problems my prostate is causing me. While AS was an option, he did not think it the best option given my life expectancy and the requirements for continual biopsies and MRIs. The likelihood that I would have to deal with the PCa in the future was a good probability. I really did not enjoy my biopsy and the idea of a biopsy next year and every other year does not appeal to me. I want to kill the cancer--just saying.

He advised that RT was probably my best option. Get it treated and get on with my life. He also said there was no reason I could not be on T replacement and he is helping me find a urologist to get be back on T maintenance.

That's where my head is right now. But I am still open for ideas. Surgery is out and LDR brachytherapy is also off the table.

Thanks. I will look into it. They are talking 8 and 1/2 weeks of daily treatment. 5 sessions would be a lot easier.

Bob said...
he did not think it the best option given my life expectancy and the requirements for continual biopsies and MRIs.

Could you please explain this "life expectancy" thing that you mentioned before.

Even JH has backed off of annual biopsies.

Please don't take this as I'm trying to talk you into AS if you don't want to do it--I mentioned earlier that it's a very personal decision. But I do want to refute the doc's logic. Sure, you may not get 20 years on AS (although you could), but you'll certainly get *some* period that's free of SEs. There is a benefit in that--you don't just have to be on AS until you die for it to pay off as a strategy.

And it's not like it's risky. The 20-year AS study (from Johns Hopkins) showed the same (extremely low) death rate from people on AS as those that chose treatment.

There is something called "watchful waiting," which is typically for older guys that are likely to die of something other than PCa. But in my opinion, AS is *best* for guys that are younger and want to stretch out their SE-free years...