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New Diagnosis - also age 40

ATLSteve
Posts: 4
Joined: Mar 2009

I didn't want to highjack the other thread so I figured I'd start my own (somewhat similar story though). Had a routine physical last fall and PCP ran a PSA test. PSA was 2.8. Tried Levoquil for 2 weeks - next PSA went up to 3.5. Referred to urologist ... back on Levoquil for a month (stronger dose) and PSA went back down to 2.8 ... then on Bactim for a month and back up to 3.6

Had a biopsy a week ago and they found 10% on 1 sample (out of 12). Urologist said pathologist gave it lowest Gleason 6 he gives. Now my urologist wants me to talk with the ProstRcision clinic here in ATL.

Reading a lot of the stories here, maybe I've downplayed this situation too much. I certainly can't see having my prostate removed with these findings at age 40. I just received and read the materials from the Prost clinic. They tout good results, but of course that's expected. It's any potential side effects that I wonder about. Had no real problems with the biopsy (no pain, minimal bleeding, still some blood in semen) so I don't know if that should translate to feeling good about minimal side effects from radiation.

I guess I'm in the research and analyze phase. No kids and quality of life is far more important to me than quantity of life.

Olee's picture
Olee
Posts: 97
Joined: Nov 2008

Hi Steve. I was also diagnosed at 40 and just had Da Vinci surgery on February 19th. My gleason score was 7 with 9 out of 18 cores positive. Our age is an important factor in the treatment we choose, for many reasons. I am very aware of the clinic you mentioned and was referred there by a co-worker at one time. I chose my treatment for various reasons. My advice would be to consult with the clinic, which you obviously have, and to set up a consult with a surgeon to get a balanced view of your options. By your screen name being ATL I am assuming you are in Atlanta, which means we are in the same city. I would suggest Dr. Scott Miller who performed my robotic surgery. He was the first surgeon in Ga to perform the Da Vinci robotic surgery back in 2003 and teaches the method as well. I know that being diagnosed at 40 is something that is uncommon but not unfounded. I have received alot of questions about my age and diagnosis. I consider myself extremely fortunate to this day that my family physician is just one of the out of the ordinary that happens to screen for PC starting at 40 and not 50. Upon my last visit to him I shook his hand and thanked him repeatedly for screening me. I would be glad to answer any questions you may have.
Please feel free to email me. AlanLee2001@hotmail.com

whubbs
Posts: 77
Joined: Sep 2008

Steve,
Like Olee, I found it early, at age 41. I had a Gleason score 3+3, 3 of 12 cores positive with 25% activity.
Despite the antibiotics, fact is there is a positive core.

I'm not up on the side effects of ProstRcision, but do keep in mind that radiation treatments do not differentiate nerves from prostate cells. This usually translates to nerve damage relating to erectile dysfunction.
Chances of incontinence is improved with ProstRcision because it doesn't involve removal of the apex. If the cancer were to spread, the apex is typically where it 'leaks'. This is why prostatectomies remove that area, which causes damage to the muscle at the base of the bladder.
Also, surgery options are reduced if you radiate the area of the prostate first.
From what I've read, and what ultimately led me to have a robotic prostatectomy, is the fact that if your Gleason score is low, biopsy is low in terms of cancer cell penetration, you're young and erectile function is high on priorities, robotic seems to have more benefits than most other treatments.
Though, from what I've heard, ProstRcision is getting great reviews as well.
Be sure to educate yourself to ALL of the side effects and how that will affect your quality of life. I think both treatments will support your "quantity of life".
Feel free to contact me as well, cobrabite427@yahoo.com I'd be happy to walk you through my robotic treatment, the issues I've faced and continue to face.
Good luck and keep posting here, this community is a wealth of information and support.
-Wayne

ismetals's picture
ismetals
Posts: 70
Joined: Feb 2009

Sounds like I've had the same experince as whubbs. The only difference is I was 59 when diagnosed. Since then life is good and improving in the ed department. My E-mail is ismetals@verizen.net if you want any more detailed info.
Good luck

ATLSteve
Posts: 4
Joined: Mar 2009

Thanks for the notes. So I'm curious why everyone seemed to opt for surgery/removal. Was the extent of the cancer?

whubbs
Posts: 77
Joined: Sep 2008

ATLSteve-

I think it's premature to say that 'everyone' has opted for surgery, perhaps lately you are seeing more post up, but there are representatives of almost every therapy out there posting up on this site.
I think it is clear though, that surgery has a clear benefit over most all other treatments, specifically robotic surgery in that it yields the best results considering all of 3 issues;

1. Oncological (Comparable 5 yr or 10 yr remission to all other treatments for low to mid range grade PCa)
2. Erectile Function (Best return of erectile function than radiation treatments, which don't differentiate between prostate cells and nerve cells surrounding it)
3. Incontinence (Worse return of bladder control over other treatments in that the chance of affect to the apex area and bladder sphincter are high in cases of capsular penetration and surgical inexperience) - Note: There are some world class surgeons pioneering a 'catheter-less' surgery style with robotic precision. Dr. Tewari in NYC is one.

In my opinion (from what I've read);

If your a man that is young, active, sexually active, have a low to mid grade PCa and concerned with oncological results, robotic is a good match.

If your an older man, maybe not as sexually active as you used to be, but still engage, or have a higher grade PCa (indication of more involved per biopsy or higher Gleason score), perhaps a precision radiation treatment is better.

If your an older man with an even higher grade PCa or capsular penetration is a larger concern, seeding radiation is a good oncological treatment.

If your much older, no longer sexually active, watch and wait may be preferred.
Personally, I can't imagine anyone under 70 to be watching and waiting.
Yes, it CAN be slow growing, but once it has metastasized it can accelerate.

I've also read, obese men would benefit most from perineal open prostatectomy.

ATLSteve
Posts: 4
Joined: Mar 2009

Yeah, I guess I should have said that it seems most guys here are surgery proponents. And while "do nothing" is always an option in any decision-making process, it doesn't apply here (to me at least).

I guess I view surgery as a last option - no matter what the situation. I've worked in the disability-related field for too many years that I'm naturally skeptical of rushing to cut. I've looked at thousands of medical files so maybe a little knowledge is a dangerous thing.

Of course, it doesn't help that my mom had lung cancer (not too advanced or severe), went through radiation and then her oncologist wanted to remove the remaining tissue. Though they had said having to remove the whole lung was a possibility, I'm not sure how much that was stressed. They did have to remove the lung and she died 2 weeks later in ICU from complications from the surgery (falll 2004). She might still be alive today had she not rushed to have the surgery. She was also one of those "get it out at all costs" mindsets. She had also just been passed through the process and neither her nor my dad asked enough questions or challenged folks.

So my judgment here is prejudiced I think.

dukeskid
Posts: 24
Joined: Jun 2006

Steve,

Now I understand your perspective about surgery. As I was reading your thread, I was scratching my head not understanding.

The surgery regarding the PC is much different than to lung surgery. There are side affects for sure - and all the guys on this site can talk to you about them more than I can - having discussions about my father's sex with my pop's doctor was so inappropriate for me. I just wanted to scream - I don't care if he has sex ever again - I just want him around! Today, the PC surgery is out-patient and not considered remotely life threatening. I don't mean to call you on it, but you said your quality of life was more important than your quantity - but it sounds like one of your main concerns is in regards to the surgery itself. Talk to your Dr. about the risk of the surgery - and the risk of a repeat of your mother's experience. I doubt there are many similarities.

You are young. I think you are having a good perspective on this, and not rushing into things. I realize as a daughter of a PC survivor (one who lasted more than 5 years but who ultimately died of PC), I have no objectivity. I would urge you to treat this as agressively as possible. PC is slow-growing, but incredibly deadly over time.

Duke's kid

Swingshiftworker
Posts: 616
Joined: Mar 2010

I totally agree with you opinion that surgery should be used only as a LAST resort.

This is particularly so with prostate cancer (not because of the risk of death, per se, which is always a possibility in any surgery) but because prostate surgery brings with it the risk of PERMANENT impotency, PERMANENT incontinence and, among other things caused by surgical "mistakes, the possibility of a perforated rectum and/or bladder, strictures in the urethra and the need for a TURP (Transurethral Electro-Resection of the Prostate) or the implantation of a new urinary sphincter.

I'm almost 60 and it AMAZES me that robotic surgery is pushed as the "gold standard" treatment of choice for "young" men (less than 60) given the substantial surgical risks. Even if things go well, based on what I've read and what several urologists have told me, following surgery you could still be impotent for up to 2 YEARS! and incontinent for up to a year. This means that if you can't get it up after surgery, you'll have to try ED drugs, penile injections and penis pumps until you do AND if none of that works you'll have to get a penile implant to at least attain penetration even if you can't ejaculate and don't have any feeling of ejaculation any more. As for incontinence, you'll have to wear diapers and pads (and smell like pee) for up to a year and if that doesn't work you may have to wear a catheter and carry a urine bag around you for life.

Granted many men don't develop these problems and apparently "most" men recover erectile function and continence following prostate surgery BUT NO ONE can guarantee that you will be one of the blessed and will regain erectile function and urinary control WITHOUT complications. If you troll the PCa forums (as I'm sure you already have) you'll find a number of HORROR stories from men who opted for surgery and continue to have ED and incontinence (among other problems) for years and years following surgery. Given these risks, it seems obvious to me that surgery should only be considered as a last resort for any man (let alone a young man) and that it should only be recommended when the man's life depends on physical removal of the prostate.

So, I've already decided to opt for "active surveillance" pending treatment and am determined to avoid surgery (unless ABSOLUTELY NECESSARY) and there are lots of other options: Proton Beam Therapy Cyberknife or IMRT (Intensity Modulated Radiation Therapy), and HIFU (High Intensity Focused Ultrasound) and Brachytherapy are at the top of that list. Check them out before deciding to let ANYONE cut you up for expediency's sake!

BTW, there are recent reports on the Net of a study which showed that robotic surgery presents greater risks of ED and incontinence when compared to open surgery and the belief is this is due to primarily to the INEXPERIENCE of robotic surgeons and the suggestion is that anyone with less than 150 robotic surgeries under his (or her) belt is just "experimenting" on the patient. So, if you do decide on surgery, make sure your surgeon has as many surgeries as possible (preferably in the THOUSANDS) before you select him (or her) to cut you open to remove your prostate.

Good luck!

Trew
Posts: 891
Joined: Jan 2010

Makes sense to me about considering surgery last.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I AM HERE TO TELL EVERYONE...IF YOU DO YOUR HOMEWORK AND FIND A GOOD SURGEON...MINE WAS A "ROCK STAR" YOU CAN COME OUT THE OTHER SIDE....WITH...GUESS WHAT?

1. NO CANCER
2. NO INCONTINENCE
3. PLENTY OF ORGASMS...'

I AM HERE ON DAY 70 SOMETHING...WITH ALL OF THE THREE ITEMS LISTED ABOVE...

GET REAL AND QUIT TRYING TO SCARE PEOPLE SWINGSHIFT.

Randy in Indy....telling a real life story the way it is....

Swingshiftworker
Posts: 616
Joined: Mar 2010

As I mentioned above, not everyone experiences the problems associated with prostate surgery and most men regain potency and continence following surgery. Apparently you are one of the "lucky" ones. Congratulations!

However, these problems exist and INFORMED CONSENT requires your doctor to give you this information to assess the risks so that you can decide whether surgery is for you or not. In fact, I got all of the information listed -- which is completely factual -- from doctors, medical sources and patient reports.

I know that there is a surgical bias on this board, but when a question is posted by someone new who looking for or needs information, I don't think it is fair to tell them -- Oh, I had no problems with MY surgery, so go for it." -- without also telling him that he may not be so lucky. That's what I was doing. So, don't even dare suggest that I'm trying to SCARE people.

It's the truth about the potential complication of prostate surgery that's SCARY and everyone needs to know the TRUTH about those risks -- not just glowing success stories like yours. One of the truths is also that, if you decide on surgery, you need to find an experienced prostate surgeon to do it.

On that count, we agree and I've already made an effort to develop a list of such people that I hope I will never have to use.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I really felt your post was very one sided....I cannot tell you how many failures I have personally dug up from radiation, seed implants and the like that many are still saying are the answer...I totally found the opposite when reading through many studies published in medical forums. It is crucially important for anyone considering surgery to intensely study the doctors they are considering to determine their skill level and success at the surgery they are going to perform...I did that and found what I consider to be the best or second best in the geography I was willing to travel...and like you said...it just so happens it did work out for me rather nicely...but I will take credit for that in my diligent search and find of the surgeon I choose. I totally disagree that surgery should be only as a last resort. FACT a male dies every 19 minutes for 365 days of 2009...which is just shy of how many women die each year of breast cancer. Fact - removal of the prostate containing cancer has the best result of cancer free percentages 15 years from now.

randy in indy

Swingshiftworker
Posts: 616
Joined: Mar 2010

We'll just have to agree to disagree about when we consider surgery appropriate for prostate cancer. We are obviously at opposite ends on this issue.

Given all of the available alternatives (notably proton beam, cyberknife (and otherIMRTs), HIFU and brachytherapy) which are also not without risks but none as great IMHO as surgery, there's no reason why IMHO surgery needs to be the first choice.

The rational often advanced for choosing surgery first is because, if it doesn't work, you can still get radiation and you can't do that if you choose one of the radiation treatments. That's just not true.

If radiation treatment fails, you can still be retreated with the same or different alternative therapies and, if the treatments have been done w/precision sufficient to avoid collateral tissue damage, surgery is also still an option.

Of course, whether surgery is "necessary" depends on the stage and aggressiveness of the cancer. Surgery for late stage and aggressive cancer in combo w/radiation and chemo is probably the only choice but in that case, it is still the treatment of last resort.

So, from that perspective, I opt to view surgery as a last resort and will continue to advance that view point whenever it is appropriate to do so -- as I'm sure you'll do the opposite.

Regards!

mrshisname's picture
mrshisname
Posts: 186
Joined: Feb 2010

I still feel that in a young man, radiation is not a good first choice. If my husband (God willing) has 30 more years on this earth, and he chose radiation as the first line of treatment, I would be extremely worried that he would develop a secondary cancer from the radiation itself. It is entirely possible.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

The fact that you may have witnessed secondary cancer from radiation patients...I know my better half CCRN would have an opinion on this.

:)

tonybear
Posts: 92
Joined: Mar 2009

i had what is called brachy therapy followed by tomo radiation. i had an exceptional doctor. he has a 98% success rate and a 1% to 2% side effect record. i have had no side effects. it wasn't an over night treatment, but i am happy with the results. at my 6 month check up he said every thing felt okay and my numbers are coming down. i am 54 and didn't care for being cut on. my wife didn't like the idea either. so we saw this doctor who gave me options and plenty of information. he then left the choice to me and the wife. good luck in your search.

bobshell1956
Posts: 18
Joined: Dec 2009

I'm 53 and was diagnosed last November. PSA was 2.6 and DRE performed by my PCP indicated that I should have a biopsy. 1 out of 12 cores showed 10%. I went to see a Radio for brachytherapy consultation and was told that I would need hormone therapy and beam radiation before I could get the seeds (due to the size of my enlarged prostate). Went for second opinion and opted for RRP. I done a lot of research on this. I bought Dr. Walsh's book, talked to fellow co-workers who have had prostate cancer and visited various discussion boards. The message here is to research and analyze prior to making a decision. Best of luck.

jminnj's picture
jminnj
Posts: 129
Joined: Nov 2009

Steve, I was diagnosed in November at age 47. Very similar numbers. 2.9 on PSA, one core 10%positive. I looked at all of the options and decided that for me, in my situation, Robotic Surgery was the best option. Upon full biopsy, the cancer had impacted 35% of the gland, which surprised me given the low PSA, and only one positive core. I was fortunate that everything was contained to the middle of the gland.
It is a personal choice we make, and you have to weigh all the factors and do what is best for you and your family. We are all here to help you with information. Best of luck on this journey.

Take care,
Joe

Trew
Posts: 891
Joined: Jan 2010

If you are serious about wanting quality of life, then you realy need to look at proton therapy. Find my threado proton sites and begin looking seriously at this alterntive to surgery. It is amazing how many doctors are treated with proton therapy at Loma Linda University Medical Center in CA. A little expensive perhaps, but like one guy told it, its like the price of a new car and its worth the cost to me. He did not want to risk the side effects of surgery.

And after Proton therapy you can still father a child- impossible after surgery.

randy_in_indy's picture
randy_in_indy
Posts: 493
Joined: Oct 2009

I am going to go have a fun time at neighbors party. I will tell you I have a defininte Opinion on this and some will not like what I post ...but I think I will tell it like it is ...stay tuned.

mrshisname's picture
mrshisname
Posts: 186
Joined: Feb 2010

Really? I find this quite interesting? Can you direct me where I can read about this??

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

Steve, I believe you have plenty of time to make a good decision and that you will. I had a very high psa and gleason of 9, and was given about two years if lucky, that was over 6 years ago. I had to take the radiation because the cancer had already spread. Radiation killed ALL the cancer cells in my prostate, which was confirmed by a secong biopsy over five years after the radiation. Side effects from the radiation were very small and though my psa is now well over 100 I live a nearly normal life. I account a lot of my success to getting all the stress out of my life and a very good marriage. I was only 52 when diagnosed, pretty young like you. You have a very low grade cancer which should be easily cured. Do not let anyone convince you they have the best solution. You have to decide what to do and live with whatever decision you make. I wish you all the best.

bdhilton
Posts: 752
Joined: Jan 2010

I live in Atlanta; I am 55 and had open surgery up in Chicago on March 3. I would look long and hard at your options and I know it must be unsettling being 40 and have to wrestle with this beast… We can all relate with you....

From my perspective and my perspective only you are too young for radiation and you have several choices (including radiation) as your clinical grading seem low based on your statements…Radiation in my option should be used a plan B and you might come to this conclusion during your journey of selecting the best option for you and you only.

Be careful of groups that are just marketing themselves…I would be happy to provide names of some surgeons in Atlanta and/or urologist if you want to move in that direction…Bottom line is that you want somebody with extensive experience and excellent results that can actually be measured (i.e not manipulated in marketing hype)….

Having said that I will be having radiation 90-120 days out from my surgery because my Right Seminal Vesicles was positive for cancer after surgery but I am leaning towards MUSC Hollings Cancer Center (Charleston Medical School) out of Charleston, SC (actually their extension at Carolina Regional Cancer Center out of Myrtle Beach) that is a National recognized cancer treatment center in the USA there are only 64 of these in the USA. Emory also has one of these National recognized Cancer Centers too… So if I was looking at radiation I would be looking at Emory…but that is me…

Best of luck and if you want to talk let me know as it is a real mind F&$*#@ at the beginning of this process for most of us and a slippery slope... bdh@bdhilton.com

Hoosierdaddy's picture
Hoosierdaddy
Posts: 16
Joined: Mar 2010

We all know that on top of the stress of being diagnosed with cancer is the additional stress of having to make a critical and irreversible treatment choice. Read all you can and talk to as many people as you can. Every provider will tell you what he does is the best, and they all seem to recommedn that you schedule their procedure immediately. But every treatment option has its advantages and disadvantages...and every choice has some nasty worst-case scenarios. It looks like you have some time. If I were in your situation I would think seriously of watchful waiting (different docs give it different labels).

BigMax
Posts: 1
Joined: Aug 2010

My grandfather passed from PC that had spread, my father was diagnosed fairly young, so it's not really a surprise that I'm looking at surgery. I'll be 43 this year, so it's a sucky place to be, but I have a family to live for. I'm hoping I can live well, but "nerve sparing" for my dad didn't work so well. I'm lucky it was found somewhat early (my PSA had hit 3 after bouncing up and down), and 3 small spots out of 12 samples... now my real choice seems to be robotic or open, and wher to go. So far John's Hopkins is the winner

chitown
Posts: 90
Joined: Mar 2010

My father and uncles have died painful deaths before 60 because of this beast and have several cousins who have chosen various option to treat it. I was diagnosed this year and got robotics surgery 7 weeks ago. My PSA was only 2.1 but biopsy was positive with a palpable nodule. Now it is 0. Back to normal now, fully continent and sex nearly back to normal with the blue pill. Best thing is to find the doc with most number of surgery and get yourself as physically fit as possible before surgery. The technology and recovery protocol today vastly superior than even a few years ago. We are lucky to have trapped the beast early in our life, so a young age is a good and not a sucky place!Good Luck

griff 1
Posts: 114
Joined: Jun 2010

sorry to hear your family has had to contend with all that bull. i am 52 now and found out i had it when i was 51 so its a bummer anyway you look at it. i had the robotic on june 23rd and it went pretty good. i use only 1 pad a day so i am lucky for sure. anyway goodluck in what you choose. griff

GatorDad's picture
GatorDad
Posts: 6
Joined: Aug 2010

BigMax,

Welcome to drinking from the firehose... :)

I was 47 when pegged, and I also chose surgery (DaVinci, Jan/2009). Nerves spared on both sides, all margins clear. I had a sling "installed" in Dec/2009 to assist with the incontinence issues. That helped a lot, although it's not a perfect solution and not without some side-effects. ED is still an issue, but things are improving (rapidly now). Even when the nerves are fully spared, it takes time for all little guys to heal and start talking to each other again. One to two years on average, and I've noticed a marked improvement at about the 1.5 year mark. It's almost like a "switch" was flipped.

As far as preparing... I would strongly advise any type of exercise for the pelvic floor. Sure, to do your kegels religiously, but walking (a lot) will do you wonders post-surgery. Basic common sense: the better shape you're in before surgery, the better shape you'll be in after surgery. :)

Note: laparoscopic surgery uses a gas to bloat you up (I think it's co2). A small percentage of patients (me) have trouble with the gas: it gets trapped in there and hurts like nothing you've ever had before. Oxycotin don't touch it. Morhpine won't help. Dilaudid neither. The *only* thing that will ease the pain of those gas bubbles is walking. Yep. Walking. Get a nurse, grab your IV/cath tree and start walking.

Lastly, try to get your head in shape. This process is going to eff you up. You're going to have "dark" days. You're going to question your choices. You're even going to think you made a "mistake". All that's normal and healthy. Get your mind prepared now, and it won't blow you out of the water when it happens... and it will happen.

cheers & beers,
Chris

Mark in Atlanta 49
Posts: 3
Joined: Sep 2010

I was diagnosed with PC about a month ago and have been to 3 diff Drs. My PSA went from a high of 19 to 11 to 7 to 4.7 after 6 weeks of Cypro Rx and while it never got to the "average" 3-4, my regular Dr sent me to a Urologist who did a biopsy and showed a Gleason score of 3+3 = 6. The first Urologist said my Prostate was too enlarge to have any other kind of treatment, only the radical open and remove. I had already begun my research on line and knew there are hormone treatments that can reduce the size of prostate and possibly be a candidate for robotic surgery, as I heard that the radical takes longer to heal, more nerve damages, leakage (have a catheter for 12 weeks! and poss pads), ED most likely... not the news a 49 yr old or any age wants to hear! The Dr knew I was not going to sign up for surgery so quick, so he did refer me to another Dr in same group (was hesitant since same group)but I went. This 2nd Dr said he could do the robotic and not to worry about the size of prostate. Still not sold on anything, I continued my research and found out about ProstRcision. With just these two high lights listed below from their booklet, it was a no brainer for me. No leakage and best chance of keeping your "manhood" going... they have kept a ten year record of over 12,000 surgeries and you can talk to any of their patients. Oh and by the way, you can have prostate removed after radiation, should it be necessary. Most Urologists say you can't... truth is, they can't, but an expert highly skilled Urologist can. Out of the 12,000 surgeries since 1979, only 1 patient had to have his prostate removed after radiation, and he is doing fine.
I have been down since learning of my PC, until I met Dr. Critz and learned about PostRcision and now am upbeat about my choice! We can all agree to research your options. It is your body, your health, your decision. Hope this info helps.

http://storage.pardot.com/1174/29064/Q_A_Cancer_Free_Guide.pdf

Compare ProstRcision with radical
prostatectomy, whether open, laparoscopic
or robotic.
A: The goal of ProstRcision and radical
prostatectomy is the same: destroy all prostate
cancer cells and normal prostate cells. The PSA goal
of ProstRcision and radical prostatectomy is also the
same: achieve PSA 0.2 ng/ml or less after treatment
and remain at PSA 0.2 ng/ml forever with cure
rates measured 10 years following treatment.
However, there is considerable difference in how
ProstRcision and radical prostatectomy work to
achieve these goals. With radical prostatectomy,
the entire prostate gland is surgically removed with
critical dissection at the apex, while striving to leave
the muscles that control urination and preserve
sex nerves. In contrast, ProstRcision destroys all
prostate cancer and normal prostate cells without
removing the urethra or damaging muscles that
control urination. Additionally, the sex nerves often
remain intact. A wider area around the prostate
is treated with ProstRcision than with radical
prostatectomy. Consequently, there is a difference
in results, especially with regard to three issues:
microscopic capsule penetration (particularly at the
apex), urinary leakage and the rate of PSA fall after
treatment.

Q: Is there a difference in urinary
leakage between ProstRcision and
radical prostatectomy?
A: Yes. Since the most critical part of a
radical prostatectomy is removing the apex
of the prostate where microscopic capsule
penetration is most common, and one of
the large muscles that control urination is
located there, this muscle could be cut out at
surgery. This is the primary cause for 8–17%
of men experiencing leakage after radical
prostatectomy, including the robotic or da
Vinci® technique.34,35,36, 37 With ProstRcision,
there is no urinary leakage because the muscle
at the apex of the prostate is not removed.
The only exception to this observation is if
men, prior to ProstRcision have had a TURP
(roto-rooter operation) where the other large
muscle (the bladder neck muscle) has been
removed, or in men who have severe urinary
urgency such that they leak urine before they
get to the toilet.

bdhilton
Posts: 752
Joined: Jan 2010

Mark in Atlanta,

Yes it is very important to make a well researched decision on the type of treatment you receive or not as this is a personal choice.

You have a few facts wrong about surgery and radiation treatments in general and I would suggest that you do some further research in general for yourself as this is a onetime decision with not retakes…

Being from Atlanta I see Dr. Critz Billboards around the city and I am very familiar with his PostRcision radiation system. I did complete review all of his literature and talk with his group about this process.

I wish you the best in your journey and your selection for treatment…This is for sure a not a one fits all size sort of decision

Mark in Atlanta 49
Posts: 3
Joined: Sep 2010

you said "You have a few facts wrong about surgery and radiation treatments in general"... please state what you think it is... what I have stated above IS ACCURATE on my research findings. Of course one shouldn't believe everything he/she reads and hears whether on here or elsewhere.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Mark,

Welcome to the forum but you have to sit in the young adult section! Seriously, it is a cruel twist to have been diagnosed so young although with the more widespread use of PSA testing more and more younger men are being diagnosed much earlier than before.

The good news about that statistic is that you have a number of attractive options, including the one you mentioned involving the ProstRcision process. You have the additional advantage in being co-located with the treatment facility while most who use it must travel to receive treatment.

I know they have posted impressive statistics and I also researched it during my own investigative phase. In the end, my only negative view of their process (and its only slightly negative) is that brachytherapy seeds seem to have more incidence of toxicity (both urine and bowel) than more modern means of delivering radiation externally through an SBRT process. I also thought their marketing hype was a bit too much on the hard sell side and disagree with their claim that it has the lowest rate of side effects. And I'm instantly on guard when any group that claims to be the best or that I need go no farther to find my ansers. As you know by now, seeds have been around a long time but they really became mainstream in the 90s. I feel that there are better ways today to achieve the same dosage levels with fewer potential side effects with other forms of radiation, although I am sure the doctors at the center will rely heavily on their long term statistics to counter that suggestion.

From the conditions you described, it is likely that your elevated PSA levels were caused by BPH or even prostatitus and they happened to find cancer during the biopsy. Had your prostate not been bothering you, it may have been years before PCa was discovered, if ever. Now that you know you have it, I am sure you feel you have to do something about it. I know I did. There is a great book I read over the weekend called "Invasion of the Prostate Snatchers" by Ralph Blum and Mark Sholtz, MD that makes a strong case for active surveillance for men with low risk prostate cancer. I would commend it to you as you consider all options in sorting out your treatment. I too chose a treatment course, but I think I could have done AS with acceptable long term results. But, as one doctor told me, "this isn't going to kill you, but at your age (I was 59) you're going to have to deal with it sooner or later." AS also means a rigorous ongoing protocol of lifestyle and diet changes, frequent PSA testing, multiple biopsies, and an undercurrent of anxiety that is always with you. On the other hand, studies have shown that if you follow the protocol faithfully, it has the lowest side effects of any treatment and that if conditions change, you have time to take a course of action that can effectively deal with it. For many men, they never have to take a course of treatment at all.

In any event, you're smart to investigate many options. This is one of those diseases that the more you learn, the less you realize you know. Early after my diagnosis I thought I had it all figured out but I now realize there were volumes and volumes of informatino I didn't take into consideration when I made my decision and I continue to learn more about it every day.

Keep us posted as to how things turn out.

===============================
Diagnosis in March 2010. Age at Dx: 59 PSA at Dx: 4.3 which dropped to 2.8 before treatment after elimination of dairy. Gleason 3+3=6. 1 of 12 biopsy cores positive with 15% involvement. DRE normal. No history of PCa in family and no physical symptoms. Stage: T1c

Treatment: SBRT delivered by CyberKnife system in June 2010. 5 sessions of 40 minutes each every other day. Side effects to date: Zero

hopeful and opt...
Posts: 1278
Joined: Apr 2009

"But, as one doctor told me, "this isn't going to kill you, but at your age (I was 59) you're going to have to deal with it sooner or later." "

Yes it is possible that one may have to deal with it, however many do not...there was a study done in a major city where it was determined that many men died with prostate cancer, not because of the disease.....this pretty much is the reasoning for the active surveillance treatment option......please forive me but I do not recall the specific study where they did these autopsies. (it coulda been in Phidelphia)

" AS also means a rigorous ongoing protocol of lifestyle and diet changes,"

Actually one who lives a heart healthy life style is doing what is required for active surveillance or any other PC treatment option. This life style is critical since heart disease is by far the major killer of men. Incidently, men with PC as a group live longer than the rest of the male population because many have made this change.

"PSA testing, multiple biopsies, and an undercurrent of anxiety that is always with you."

In my case I get a PSA test twice a year. The average male needs to get at least one a year....it's a simple blood test.

Well yes , lots of biopsies, although there are many men on AS who do not and elect other methods, however I choose biopsies and MRI's as well.....I have agree with you and say lots of tests.

As far as anxiety, one of my docs who is a surgeon told me that if I am going to stress , he can do an operation with a 99 percent chance of success.....so anyway one has to have a no stress attitude, and go on enjoying life, or seek active treatment.

"it has the lowest side effects of any treatment and that if conditions change, you have time to take a course of action that can effectively deal with it. For many men, they never have to take a course of treatment at all."

Agree..additionally AS results for localized prostate cancer that has a low gleason and small volume compare favorably with other treatment options over time.......I remember reading a comparison for 15 years forward.

cheers,
Ira

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Agree completely with your post. I think that AS is a very viable alternative to treatment for men with low risk prostate cancer and I didn't mean to overstate the monitoring process which is really no more onerous that the follow-up we follow after treatment. I just meant to imply that for AS to work there is a big emphasis on the "active" part of this course of action.

bdhilton
Posts: 752
Joined: Jan 2010

I can recommend many books but I would suggest the following few to get a sense of what you are getting into:

Guide to Surviving Prostate Cancer by Walsh

Invasion of the Prostate Snatchers as Kongo suggest

Saving your sex life by Mulhal

About your facts..

I do not have time to go through your entire post but two are:

I do not know of anyone that had a catheter in for 12 weeks perhaps 12 days (surgery or robotics) but I guess it is possible. I have not leaked a drop since the day they took the cath out but I do hear of many guys that suffer with this issue…

You say you made a decision based on “With just these two high lights listed below from their booklet, it was a no brainer for me. No leakage and best chance of keeping your "manhood" going...” Well, most side effects from radiation come after a year or so after treatment. I am sure many here would be happy to share stories with you plus this information is readily available…

This might be the best choice for you and if this is what you have decided then the best of luck. I am suggesting that you dig a little deeper and compare the facts…You just might decide to watch and wait…

Again, I wish you the best and we can all related to receiving the “bad news” about our PCa…

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

I agree with BD on this one (shock, awe, gasp of disbelief from regular readers --- we actually agree on more than we disagree on). 12 weeks for a catheter seems to be highly exaggerated. Also, side effects do certainly occur with radiation. A seed placed too close to the urethrea or colon can cause a lot of issues.

The nerve sparing is often glossed over both in RP and radiation treatments. The nerves in question are about the size of a human hair. Certainly they can be damaged through surgery but also radiation and, as BD points out, radiological impact on ED may take years to manifest itself and there is about 15% chance of an inability to achieve an erection with even the most modern types of radiation delivery (such as SBRT). Fortunately, for those of us who chose to be microwaved, most can regain potency through Vitamin V or other erectile enhancing medication where those who have surgery and lost their nerves need more physical methods to achieve suitable erections.

In any event, for a man your age with a low risk cancer there is a high liklihood that if you are potent before any form of treatment you have much higher liklihood of being potent afterward. Same analogy for continence.

But be careful about ED statistics. Most men who are diagnosed with PCa are in their early to mid-sixties (although as mentioned earlier more and more men in their 50s or late 40s are being diagnosed). As men get older, their libido is usually going to decrease, although there are always going to be a few old bulls who never seem to come down. It's hard to measure, particularly over the long term as men grow older while having prostate cancer whether a decrease in the ability to achieve an erection is a function of the treatment or a natural course of growing old.

hopeful and opt...
Posts: 1278
Joined: Apr 2009

I'm sorry to hear about your diagnois....we all have gone thru depression and all the feeling associated with it. this generally last a few months.

Can you please provide more information about your condition. How many cores were taken in your biopsy; how many were positive, what was the geason of each, and what was the involvement of each, that is what percent of the core was cancerous? Do you have PSA results from previous years?....all this information can helf you decide the best treatment for you.

By the way is is a very good idea to get a second opinion about your pathology from a pathologist that is an expert in the field. Determining the gleason is very complicated, so it is important to contact an expert in this.........there are about 10 in the united states.

As was mentioned, I recommend that you do more research about this beast, since most of yor statements are not accurate. Not trying to disrespect you, but this is too important for me not to mention this.

I have been doing active surveillance for about 1 and half years now.....if you wish you can click on my name and read what I have done, suggested tests, and a study that documents why AS is appropriate for some.

Mark,,,,,,,we are hear for you so keep o posting

Ira

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