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Newly diagnosed

Will_10_2010
Posts: 43
Joined: Nov 2010

Hello to everyone, I'm new to this site. Have monitored PSA for many years every three to six months depending on numbers. DRE revealed "nodule" on prostrate for as long as I can remember. Original biopsy was negative. Currently rising PSA (5.3) resulted in new biopsy that was positive. 13 samples (two in prostrate: Gleason 6&7) (one in nodule Gleason 8, perineural invasion, tumor is on plane of adipose tissue--suggestive of extra prostatic extension). Have met with radiologist and a surgeon. CT Scan and Bone scan were negative. I'm going for an MRI this week. I'm leaning toward DaVinci Surgery for the following reasons:
1. Analysis of prostrate
2. Continence appears to have better recovery chance in the long run.
3. If addition treatment is necessary, radiation is still an option.

I'm looking for opinions. Please don't hesitate to give me the pros and cons of my thinking process.
Thanks to everyone in advance.

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

Will,

Welcome to the forum but I am sorry that you find yourself here with a diagnosis of prostate cancer. As you probably realize now, your Gleason scores indicate that you may have a worrisome degree of PCa indicated by at least one sample in the Gleason 8 range and a suggestion that the cancer may have spread beyond the prostate capsule. The good news is that both the CT and bone scan were negative so even if the cancer has spread beyond the prostate it has not grown to a level which can be detected. More advanced stages of prostate cancer is often associated with relatively low PSA scores and your reading of 5.3 ng/ml is above the norm but not what would be considered extremely high.

One thing to consider about surgery for intermediate and advanced stages of prostate cancer that may have spread beyond the prostate is that removing the prostate will not stop the cancer from growing in other areas such as the prostate bed in the pelvis, the lymph nodes, or seminal vesicles. In other words, if the cancer is out of the prostate, why bother with the surgery to remove it? Cancer in the prostate doesn't kill you...it's the prostate cancer that moves to the liver, lungs, bones, brain, or other vital organ that kills you. On the other hand, there are conflicting studies on surgery for advanced and intermediate stages of prostate cancer and some rather recent studies have shown surgery to be an effective treatment with respect to long term survival but these tend to be in cases where a post surgical biopsy showed negative margins. Depending on the actual stage of the cancer in the prostate (not just a biopsy preview) it may be more difficult for a surgeon to spare the nerves necessary for erections and depending on if it is in the margins or not, there may be more difficulty in repairing and reconnecting the urethra from the bladder to the penile bulb (complicating continence post surgery), but this is really more a matter of exactly where the cancer is and the skill of the surgeon.

Although I elected not to have surgery, I have read about it extensively and don't think there is any significant statistical difference in continence rates between DaVinci or open and depending on the skill and experience of the surgeon, open surgery may have an advantage in this area. Of course you also get to see the complete pathology of the prostate afterward if you choose surgery and that may be an advantage in deciding additional treatments that might be necessary.

If, as your pathology suggests, you actually do have cancer outside of the prostate, I would expect your medical team would also want you to have hormone therapy, radiation, or both. Given that radiation is a potential follow-on treatment, you ought to consider talking to a radiologist that specializes in prostate cancer to understand your options with radiation as an initial treatment rather than as a fall back. There may be advantages with respect to continence and erectile function depending on the extent of your cancer and where its located and several new radiation techniques show a high potential to minimize potential side effects.

You should also consider having a second opinion on your biopsy before you make any treatment decisions. Also, when you consult and get second opinions, I urge you to be aggressive in making the doctor thoroughly explain the potential side effects of any treatment method with respect to continence, potency, post treatment penile size, recovery times, and so forth. Do your homework in advance so that you have a good idea what can go wrong and make sure the doctor explains his version of side effects compared to what you read.

At the end of the day, of course, the treatment decision is one only you can make. There is lots of material on the web and from books (check Amazon.com for prostate cancer) that you ought to be studying now. This forum is a great place to read about others experiences, and if you are pursuing surgery, there will be many who will provide you their perspective on the pros and cons of robotic over open surgery. If you do choose surgery, make sure you find the most experienced scalpel out there.

Best of luck as you sort through this.

hopeful and opt...
Posts: 1331
Joined: Apr 2009

....it the cancer is outside the capsule, it is not appropriate to have surgery,since you will still have to select another treatment,(radiation), and side effect complications will be increased.

As Kongo mentioned it is a excellent idea to have a second opinion of the pathology from an expert in the field.........determining gleason levels is very complicated and there are only a few who are experts....one is boswick labs.

Having an MRI will show extra capsule invasion, and will show where the cancer is , in one lobe, two. ....there are different MRI machines, some better than others...there is a tesla 3.0 which is found mainly in major hospitals that specialize in cancer treatment that will do the best job....additionally, there is a test, a spectroscopy that is done in conjunction with the MRI that will improve accuracy ....the spectroscopy is considered investigational and is not paid by medical coverages, but please consider this additional test( and finding the best facility for both tests).

Life Explorer
Posts: 5
Joined: Nov 2010

I asked my husband to give his opinion since he struggled with some of the same questions:

Your situation sounds somewhat similar to mine. My Gleason after my 3rd biopsy was 3 +4 and my PSA was similar to yours. I had an open prostatectomy in December. I spoke to several urologists before the surgery and none of them recommended robotic surgery. The key issue is that the surgeon will have a view of the entire prostatic field in order to look for lymph nodes, while robotic surgery doesn't provide that. Make sure your surgeon removes all of your lymph nodes from the prostatic bed since apparently not all of them do that.

Of course it really depends on the skill of the surgeon. I had a remarkable surgeon and ended up spending only 1 night in the hospital. That was a record for him. I had no narcotics after the surgery, so my recovery was very fast. I was walking the neighborhood 5 days after surgery and back to work part time in 3 weeks.

In terms of what you can do, get in shape if you aren't already. Luckily I work out every day and continue to do so. The better shape you are in the faster your recovery will be. I started practicing my Kegel exercises as soon as I knew I would need surgery. Do them religiously. After my surgery, I had a catheter for 10 days, which is normal, and then within 1-2 days after the catheter was removed, I pretty much had control of my bladder. I spoke to someone who had robotic surgery and still has incontinence more than 1 year later. So your point #2 may be true for some men but not for others. Right now I do leak on occasion, but it's not a big deal.

I had a positive node and unfortunately, my PSA was not zero after the surgery. So I underwent radiation treatment in July/August with absolutely no side effects. I am currently on androgen deprivation therapy and won't know the success of the radiation treatment and hormone therapy for a few years. I'm not sure why you are doing an MRI since according to my urologist, it won't show anything. Anyway, find a surgeon who has done at least 100 open surgeries and find out his outcome in terms of incontinence. My surgeon is currently in Los Angeles and I would travel there to have him do the surgery.

mrspjd
Posts: 693
Joined: Apr 2010

My husband's PCa is similar. If he had elected surgery as his primary tx, he would have had open, not robotic (RRP). We agree that, even with a skilled and experienced RRP surgeon at the controls, for the guys with intermediate risk PCa that need wide cutting margin clearance and possibly more nodes disected/removed, the arms of the DiVinci cannot attain the necessary angle width as well as can be attained by the hands of a skilled and experienced open surgeon. Mr pjd elected not to have surgery and instead chose ADT3, High Dose Rate Brachy--temporary(HDR-B), and IMRT--sort of a triple primary adjuvant therapy approach. While a regular MRI may not show much re locally advanced PCa, an endorectal MRI w/Spec using the newer Tesla 3 MRI is considered the gold standard for determining if Extra Capsular/Prostatic Extension (ECE) is present. With a 3+4=7 Gleason & PNI (perineural invasion)identified in his biopsy report and confirmed in the 2nd opinion biopsy report lab results reading from Johns Hopkins, the endorectal MRI was an important test for mr pjd and confirmed that the PCa was in the rt seminal vesicle, with no evidence in the nodes. This info was important to us because it helped pjd make his treatment decision. His PSA was 2.4 @ diagnosis in Feb this year, and nodule was found on DRE that determined biopsy was necessary (9/12 cores positive).

Was wondering what specific ADT drug or drug combination Mr Life Explorer is on and how long he intends to stay on the drugs based on your docs recommendation. At 6 months in, mr pjd has tolerated the ADT well, with only minor side effects. How is Mr Life Explorer doing on the ADT? You wrote that your surgeon is "currently" in L.A. We live in So Cal & wondering if, by chance, your uro surgeon might now be at UCLA? Thanks.
Best,
mrs pjd

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

mrspjd....Just curious on your comment of the arms of the DiVinci cannot attain the necessary angle width as well as can be attained by the hands of a skilled and experienced open surgeon.

I did lots of research before and my surgery and had not heard that. Do you have something further I could read? I had actually heard the complete oposite that in one area the surgeon is working basically blind because of the angle and where he needs to be is up and under so that the robot allows them to get in easier and to see better with the cameras and magnification factor.

Just curious since I love to learn.

Larry

mrspjd
Posts: 693
Joined: Apr 2010

Larry,

Yes, I've heard the same reasoning about why RRP (robotic) is a "better" choice than open RP that you've commented on. After consults with both experienced and skilled RRP and open RP docs earlier this year, we heard both cases being made about why one approach may be better than the other. This goes to the frustration for us "lay-men and women" in trying to sort out conflicting info when making important critical decisions for PCa treatments. As all here have come to know, ultimately we have to decide what is "personally right" and what makes sense to us--a highly personal choice to fit lifestyle and philosophy.

In our case, a nationally known and respected open RP uro surgeon made this case during our consult about why RP, FOR INTERMEDIATE RISK PCa, MIGHT be a better choice when attempting to remove all the cancer through surgery--re angle and width of margin clearance (as written about in the previous post). He also said that that the actual tactile feel and touch of the organs during an open RP procedure can (to an experienced surgeon) be important in determining the scope of the PCa, what to remove and where and how much to cut--i.e., margins and number of lymph nodes for dissection. This md also told us that while a post RP pathology report may provide add'l PCa info, that is NOT the reason to have a RP (or RRP)--the reason, the goal, for surgery is plain and simple--to remove ALL THE CANCER and obtain clear/negative margins. All this made sense to us. In another separate consult with an RRP surgeon, we asked about potential lymph node dissection during the operation. This info was important to us because of pjd's T3 locally advanced PCa staging (at the time we did not yet have the info indicating no node involvement/metastasis). The RRP doc shocked us with his answer--he didn't remove any nodes--period! When we pressed him for more info, his unprofessional response was "well, if you want nodes removed, I can take out one or two!" Couldn't get out of his office quick enough! If we had seriously considered RRP, I'm sure we would have consulted with another RRP doc. This is OUR experience and I realize many of you (Larry included) have had wonderful consults with RRP docs who you have used for successful outcomes.

Since pjd did not elect to have surgery of any kind, the subject/discussion was dropped. If there are studies out there comparing both surgical procedures, as with a lot of study data, I'm guessing one will find a study to support which ever choice/case that they are partial to.

Larry, you have had, and continue to have, my respect from your thoughtful, insightful, and caring posts and from sharing your personal experience. Thanks.

mrs pjd

lewvino's picture
lewvino
Posts: 1007
Joined: May 2009

Oh isn't this journey grand for the male and female? I'm glad that all my decision making is in the past and that at 15 months post surgery (robotic) doing well.

Yes, In my journey I talked and explored EVERY option that was available from doing nothing, seed implants, radiation, hifu, cyperknire..etc. etc. I did not want to be where I am today and say boy I wish I would have looked at such and such. I do like to gather information though so that I can help others on their journey (most recent is the neighbor man across the street with PC)

My own urologist does open and of course gave some of the same thoughts that you have mentioned on robot versus open. Though he did tell me if I did choose the Robotic that the only person in our area that he would recommend was at Vanderbilt (Nashville, TN) and he would still provide me follow up care rather then having to make the 5 hour round trip to Nashville.

I believe in prayer and on my journey I Had somewhere between 10 - 15 experiences that could not be accounted for as just chance or some random pattern. These all confirmed to me that I was making the correct decision as to treatment type and the person that I picked for my surgeon.

I wish more would truly look into the options but so many just want the 'quick fix' and go with what ever the immediate doctor recommends.

Oh yes, I enjoy seeing a woman on the forum!

Larry

mrspjd
Posts: 693
Joined: Apr 2010

Larry, Thanks for your support. It is appreciated. While I don't consider myself a "religious" person, I've had more conversations with the man (woman?) upstairs this year than in any other year of my life. A special family friend, an extraordinary, self actualized, woman in great physical and mental condition, recently was involved in an horrific auto accident in which the jaws of life were required to pry her out of the wreck, then she was airlifted to the nearest hospital. After 5 surgeries in less than 4 wks to repair severe internal injuries and two broken legs, during the hospital bedside vigil, her family, through the CaringBridge website, asked for prayers as their belief in the power of prayer is strong. Over 13,000 invited friends, family, & community members, visited that personal CaringBridge site. Sadly, she passed away from injuries and complications sustained from the accident. Her family's heart touching thought was that their prayers were answered, but not in the way they had hoped and that there were bigger plans for her elsewhere.

This brings home the feeling, more than ever, that Life is precious and short. So make sure the special people in your life know they are special and loved. Tell them. Often. This PCa journey will be with us all for a long time, in one way or another. Live your life. Today. Every Day. I do not mean for this post to be morbid or burdensome, but rather uplifting. I hope it is interpreted this way.

BRONX52
Posts: 156
Joined: Apr 2010

I was also curious about the lymph node statement that they couldn't remove lymph nodes or at best remove two. I had seven lymph nodes removed during davinci for disection. I guess it truly is the skill and experience of the surgeon that matters most when making your surgical decisions---whether it be open or robotic.

mrspjd
Posts: 693
Joined: Apr 2010

In OUR experience, and as usual with obtaining info about PCa treatment, we received many different medical opinions about treating nodes and number & scope of nodes to treat, whether by dissection or radiation. Seven nodes (pelvic only?), whether by RP or RRP, are a lot to remove, unless, of course, they were all cancerous (just my lay opinion)--hopefully they were not. Indeed, Bronx, you had a very skilled RRP surgeon.

We were told of add'l potential complications and side effects from dissection of too many or all nodes (like chronic edema), especially if those nodes were not cancerous. Sometimes, prior to primary treatment, nodes are biopsied via laproscopic procedure, if node involvement/metastasis is suspected, since negative bone scan & pelvic CT do not detect microscopic cancer cells. Also, endorectal MRI using Tesla 3 technology, appears to be the gold standard for diagnosing ECE (Extra Capsular Extension) such as in the nodes and/or seminal vesicles.

I am not an expert, just spitting out what I think I learned in our PCa journey. This discussion is another reason to, first, do as much research as possible, then ask as many questions as possible during medical consults prior to making a treatment decision that you determine gives the best chance for successful treatment of your particular stage of PCa.

BRONX52
Posts: 156
Joined: Apr 2010

Fortunately all the nodes were free of cancer as well as the seminal vesicles. I was fortunate to have a very skilled surgeon. But the decisions we have to make can be overwhelming at times. So many treatment options to decide upon, then you have to choose a physician. So much research and consultations goes into this process it's enough to make your head spin!! It's amazing that a gland so small in size can cause so much trouble for us. Oh well, I guess it's the hand we're dealt and we have to play it to the best of our ability.

Life Explorer
Posts: 5
Joined: Nov 2010

Sorry for the delay in getting back to you. We were out of town and away from computer access.

My husband has been on every 3 month Lupron shots since March 22nd, and he is tolerating it really well now. He had horrible hot flashes at the beginning (every 20 minutes), but they've decreased in both intensity and frequency. (Although the doctors offered, he never went on any drug therapy for the hot flashes.) He is also bothered by dry mouth and fatigue during exercise. So far that's it. He did have a baseline bone density test before starting the lupron so they could watch for any early signs of osteoporosis, and since his cholesterol level was borderline, he was started on a statin (for the increased cardiovascular risk associated with lupron). Although the beneficial effects of aspirin in PCa is preliminary, we asked if he could start a baby aspirin a day and his urologist and internist agreed.

As far as how long he will remain on ADT if his PSA remains undetectable: that seems to be the million dollar question. When he started Lupron, they told him that he'd be on it for 2 years, but now there seems to be some new data that indicates that patients who stay on it for 3 years do better than those who stop after 2 years. We've asked 3 urologists and they've all had different opinions. We decided that we'd just keep watching the literature, and then as his 2 year anniversary gets closer, we'd have the discussion with his physicians again. What are the doctors telling your husband?

Thank you for the information on the MRI. It makes sense. When we asked about the MRI, it was after my husband's surgery. My husband's PSA pre-surgery was 5.3 with the biopsy showing only 2 out of 12 cores positive (Gleason 3+4). All the docs were shocked that he had a positive lymph node and that his PSA did not go down to undetectable after surgery and lymph node dissection. This has been a very tough year.

I hope your husband has continued success with the ADT therapy. I know that this is a very stressful time for both of you.
Best,
Life Explorer

mrspjd
Posts: 693
Joined: Apr 2010

Life Explorer,

From one wife to another, I appreciate your reply. We appear to have much in common. My husband, PJD, started ADT3 in May, just a few months after your husband. He is on the 3 month (22.5mg) Lupron injection, and takes Casodex (generic) and Avodart in addition. Like Mr Life Explorer, PJD’s ADT side effects have so far been minor, with occasional mild hot flashes. PJD also had a baseline bone density test, (the QCT) for the same reasons you stated. He has no history of heart disease or heart issues, but also saw a cardiologist to get a baseline stress EKG and related info prior to start of ADT. While maintaining a heart & prostate-healthy diet and exercise plan, his cholesterol #’s were still borderline high. He recently agreed with his cardiologist & oncologist to start a statin for potential PCa and heart-health benefits. He continues to take a few supplements and also takes one 81mg aspirin most days. He exercises & works out several days a week with a personal trainer for obvious reasons, but also to proactively combat any potential ADT side effects, such as bone loss. While I notice (he doesn’t notice) that he seems more tired or fatigued, he hasn't slowed down & has maintained his work routine, and usually gets in one or two rounds of golf a week. More than likely the recent fatigue is from the IMRT which was completed end of October (or a combination of both the RT & ADT) and hopefully will resolve soon.

Ah, yes, the million $ question: How long to stay on ADT, especially for the men presenting with locally advanced intermediate risk T3 PCa & no test evidence of distant metastasis, such as to the bones or organs. And so many different research studies, both here and in Europe, to sort through with different or conflicting study results (6 mos, 1 year, 2 years, 3 years, intermittent??). Like you, we have read & received several different medical opinions on this subject and are assessing it month by month. The one year “Lupron” anniversary will mark a critical decision point. Fortunately, PSA, testosterone and DHT levels continue to significantly decrease and respond well to the ADT, both pre and post RT tx. Like your husband, it will be a year or so (after ADT cessation) before his “true/real/nadir” numbers stabilize & are known. PJD does not have a problem with this concept because, after careful evaluation, he decided the benefits out-weigh the risks and believes his chances of successful treatment are significantly increased by the ADT and RT combination for his stage of PCa.

Thank you for your good wishes. I wish the same for you and your husband. Hope you stay in touch.

mrs pjd

Life Explorer
Posts: 5
Joined: Nov 2010

Mrspjd,
I agree that our husbands' cases have many similarities. It sounds like he is adjusting well; and if he's like my husband, he has not let this stop him from doing anything he wants.

How are you doing? Like you, I have had many conversations with the guy upstairs, complete with full-flood tears. We have been married for over 29 years, and he is the best part of my world. I can't imagine life without him. But, no matter how challenging this year has been, it has also been a real growth experience. I have met people (and read about some on this site) with much worse prognoses who live their life with amazing grace, dignity and good humor. They are my inspiration, and I am trying hard to emulate their positive attitude as much as possible. My husband and I are closer than ever, and we have a renewed appreciation of just how lucky we are and have been.

I, too, hope you will stay in touch. And I hope that other wives out there will join in our discussion. Although we are not the ones who are going through this challenging journey, we are the ones who love them and would do anything to make this go away.

Have a wonderful thanksgiving.
Life Explorer

mrspjd
Posts: 693
Joined: Apr 2010

LE,
I couldn't have said it any better and I whole heartedly echo your comments and sentiments. In spite of this insidious disease and all "we" (as PCa is a couples disease requiring a team effort) have been through, I believe there is much to be thankful for.

Best wishes for a Happy Thanksgiving and may everyone find much to be thankful for, now, and in the future.

mrs pjd
PS You're just a newlywed...this December, in a few weeks, we celebrate our 38th Wedding Anniversary!

mrspjd
Posts: 693
Joined: Apr 2010

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meita33
Posts: 3
Joined: Nov 2010

I found this room last night and an grateful for the love and support. My Dad is 80 and his urologist says that going by his Psa #'s (5?) and combined 13 that he has PC.they decided to wait 6 months because of his age and just see what happened, but they went up.He also said he felt a little hardness.But everyone seems to contradict each other.3 different doctors ( my48 year old brother also has PC, but he isn't speaking to me )have said DOn't GET SURGERY NO MATTER WHAT!!.His two doctors seem OK with just doing nothing.I know he's 80, but he is in excellent health and his Mom lived to 99! He decided to get a biopsy so he can at least know What he is on the Geason scale.Another doctor told him ,aggressiveness doesn't matter to someone his age. I am trying to find out as much as I can, but am hearing alot of contradictions.I do know I'm not ready to just give up on him.Any suggestions on where to go for more info? I tried mayo Clijnic and john Hopkins, but again there wasn't much about 80 year old patients.Positive thoughts and prayers go out to all of you. Thanks.

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

Meita,

Welcome to this forum although I wish you didn’t have a need to be here. I know that sorting out ground truth regarding medical conditions for aging parents is a challenge.

Your post is a bit confusing and I am not sure what you’re saying…did he have a PSA of 5 or 13 or was it something else? Assuming your father has been having regular physicals for several years, there is most likely a very thorough history of what his PSA readings are. This trend can help you and his medical team to determine the severity and potential aggressiveness of his cancer (if that is what is causing it). I don’t understand the urologist’s statement that “going by his PSA he has PC.”

The only way a doctor can positively confirm prostate cancer is through a biopsy. Many things can cause an elevated PSA reading such as a hard stool shortly before drawing blood, a urinary infection (common with older patients), an enlarged prostate caused by benign factors that are not related to cancer, or even doing the rectal exam before drawing the blood. Waiting six months also doesn’t make much sense…typically a one month or three month interval between elevated PSA readings is recommended. I would encourage you to ask the doctors if they have ruled out another cause for the elevated PSA and how they did that.

As you have already discovered, you are likely to receive lots of conflicting advice from different specialists, particularly because of your father’s age. Most surgeons will not consider surgery for a patient in his 80s for a variety of reasons. Radiation is an option but there are side effects that should be considered within the context of your father’s overall quality of life. Also, if your father does have prostate cancer, having it detected at this stage in his life is a fairly good indicator that he will die with the disease not of it. In other words, even if he has PCa, the odds are that it will not adversely affect him or shorten his life.

Several studies have shown that most men in their 80s have some form of prostate cancer (as much as 80%). It seems to be one of those diseases that will inevitably show up if you live long enough. Many, if not most of the men who have prostate cancer discovered at this age have an indolent form of prostate cancer that will never pose a life threatening risk.

Having a biopsy can confirm the presence of prostate cancer and enable a pathologist to determine the Gleason score. On the other hand, if your father has only a small amount of cancer, the biopsy may not detect it. It doesn’t mean he doesn’t have cancer, it just means that they didn’t find it. There are some slight risks associated with a biopsy and you should have the doctor's explain these in detail.

Something else to consider when children become involved in the medical care and decisions of parents is who is going to be the lead sibling in dealing with these issues? It should be someone that all the siblings can agree upon, you should have legal documents drawn up that give you access to all the necessary medical records, and you should have the authority to make the necessary decisions should your parent be unable to make them. Once you’ve gone through that process, then the others need to back off and not get involved with quizzing the doctors and so forth as it can get very, very confusing for everyone concerned. There are several who contribute to this forum that are going through similar situations as yourself and can offer sound advice on how to deal with these issues.

At this point you have much to be thankful for. Your father is not suffering from any symptoms and is otherwise in good health. If he does have cancer then there is a very good chance that it is a low risk, indolent form of prostate cancer that will never pose a threat to your father. And finally, there are several treatment choices that can address the issues should it come to that which do not involve surgery.

Please keep us informed of your progress and best of luck to you and your father.

meita33
Posts: 3
Joined: Nov 2010

Thank You so much for your time and information.I lost my mother last Sept. to breast cancer, adn she made me executor, so my two siblings are not speaking to me.The one who lives by my dad was also recently diagnosed with prostate cancer.He chose not to share his experience with my dad, because he didn't want him to tellme about it.Anyway, from what we could get out of his daughter, (he's 48) he chose the seed, because radiation would interfere with work.She said if the cancer returns,ther willbe nothing they can do, because of the seed.Is this true?And my stepmother is actually the one who has legal say so over my Dad, but he relys on me because I research everything (like I did for Mom)until I can't find any more info.What you wrote is just what the doctors have said, but he is in such good shape according to his labwork, and his MOm lived to be 99,so he wants the biopsy tofind out the Gleason #.I mean if you're 80 and get diagnosed with prostate cancer, and there is nothing really wrong with you, what happens? So he decided to at least have the biopsy, and if it is not the aggressive kind he very wellmay leave it alone, althoughhis friend who is two years younger also had it and went through radiation and hormone therapy and is doing great.Anyway you really reassured me and this is a great site.He isn't getting his biopsy until January, but willupdate if anything chages.Thank you for the grace and strength you have shown me.May all go well for you.

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

About your brother: Seeds are also radiation. They implant 80 or more radioactive "seeds," each about the size of a grain of rice, into the prostate. This is known as internal radiation because the curative effect comes from inside the prostate instead of from outside the prostate. Seeds are generally very effective in treating prostate cancer but if it recurs, there are indeed other methods to treat it so the statment "there will nothing they can do" is not correct at all.

Like many families (including mine) it sounds as if you have a complicated set of relationships between siblings, step mothers, and so forth. This obviously complicates a lot of things, including the information available to you, so you have to find out what you can can control and let go of those things you can't control.

As far as treating an 80-year old with prostate cancer...the answer is "it depends." A lot of it depends on the stage and aggressiveness of the cancer. The odds are that if PCa is only discovered at the age of 80 it is probably an indolent, low risk cancer that may be safely handled by an active surveillance protocol where PSA readings are DRE exams are closely monitored on a regular basis to see if there is any change. If a biopsy shows a more worrisome form of cancer there are some new radiation techniques using delivery methods such as IMRT or SBRT (you can research these on the web) that pose minimum risk of adverse side effects that could affect your father's quality of life. Depending on the extent and stage of any cancer, hormone therapy may also be used either as a stand alone treatment or in conjunction with radiation. Surgery is generally not recommended for someone your father's age.

The first thing I would do, even before a biopsy, is to be sure that the PSA readings are not being caused by some other condition such as a urinary infection or BPH. If your father has difficulty in passing urine or he experiences pain with urination it may be a urinary tract infection that can be treated with standard antibiotics. If his prostate is enlarged (the doctor can tell this from a digital rectal exam) there are drugs or physical procedures that can be used to reduce the size of the prostate. If your father allows you access to his medical records, you should carefully review them for a history of PSA readings or any other condition which might cause an elevated PSA.

You are likely going to get different opinions from different experts. Often men tend to trust their GP but keep in mind that they are not specialists in prostate cancer. Other specialists will give you recommendations based upon their specialty or impression of what your father may want at his age. I would be on guard for any doctor who dismisses the seriousness of a potential situation based soley on your father's age. Regardless of how old he is, you deserve clear, compassionate, and understandable recommendations.

Hang in there.

shubbysr's picture
shubbysr
Posts: 87
Joined: Jun 2009

Hi Meita,

My research and talking with many doctors in Michigan (my hometown), South Carolina and at John Hopkins seem to have the same conclusion. Which isthat prostate cancer is slow growing and most men will die of "something else" before it is from prostate cancer.
Kongo is right with his comments and it is a tough decision. Your dad is healthy so he may have no problems with radical prostate surgery but, why or why not?

I will send some good thoughts and prayers your way. try to put this aside for now and enjot the holiday break.

Jim

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

My cancer had already spread and surgery was not an viable option and would have done nothing to slow the cancer. I had 40 or so radiation treatments and those killed all the cancer in the prostate. This was confirmed by a follow-up biopsy four years or so later. I have had no bad side effects from the radiation and have survived 7 years now with an original diagnosis of a 50% chance to survive 2 years. I now am in hospice care but work and play golf every day. I keep any stress life presents in check and accept things for what they are. All the best to you as you try to determine your best plan. As long as you choose it and can accept it, things will work out fine.

Will_10_2010
Posts: 43
Joined: Nov 2010

The response to my original post has been terrific! Everyone has given their heartfelt thoughts and opinions. I am grateful to everyone. Your responses have given us (my wife and I) a lot to think about. We now have a new list of questions that will either reinforce our original feelings or help us to make changes in our quest. Thanks again to everyone for your support. Tomorrow I am going to Columbia University Medical Center for an Endo Recatal MRI. When the results are in I'll speak with the surgeon about the results and our new list of questions. I'll keep you posted.

tarhoosier
Posts: 182
Joined: Aug 2006

Will:
If you have a G8 (confirmation needed) and evidence of extraprostatic spread, then surgery is a substantial risk, with certain side effects, for a very limited chance of cure. If radiation is the best way to sterilize the area, including areas outside the prostate which surgery cannot touch, why wait? Why not hit it with your best (only) loco-regional treatment? And do it now, rather than later, when side effects and healing will aggravate and deepen the surgical side effects.

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