Nov 27, 2011 - 6:00 pm
I am a 63 year old male and was diagnosed with PC on July 27, 2011. I am now trying to figure out my therapy options.
With a PSA over 5, I had my first biopsy (2 out of 14 cores positive; left base 25% and left base lateral 30% with Gleason score 3+3 = 6, clinical T2) The first biopsy also showed one PIN on the right mid lateral.
With a Gleason score of 6, I opted for Aggressive Surveillance (AS) and found a new urologist who was not opposed to AS. I wanted time to find out if my PC was low risk or highly aggressive. I then had a PCA3 test (good results of 14.0, result Negative). Since I decided for AS, my new urologist wanted a second biopsy to obtain a more informed AS starting position. Second biopsy at the end of Sept, 2011 (2 out of 14 cores positive; left base 20% and right base lateral 5% with Gleason score 3+3 = 6).
I now had PC found on both the left and right side on my prostate. My urologist told me I was still a candidate for AS.
I then interviewed a urologist (my fourth) with a great deal of DaVinci Robotic surgery experience at the Mayo Clinic. The clinic reviewed all the slides from both biopsies and scored the second biopsy as Gleason 3 + 4 = 7 instead of the original Gleason 3 + 3 =6. The Mayo doctor suggested I should not wait too long to make a decision.
At this point if I decide to have surgery, I will opt for DaVinci RP at Mayo. I am not committing to surgery so I am continuing to investigate other options. So far I still really don’t know if my PC is low risk or very aggressive. My next PSA results are due on Monday which will give me information about my AS choice.
Next Tuesday, I am interviewing a well respected radiation oncologist to discuss Brachytherapy (BT). I am reading about Brachytherapy and would welcome any comments or experiences you could share about this therapy. Looking at a chart reproduced from a 2009 Journal of Clinical Oncology at www.pcf.org (click Understanding Prostate Cancer, choose Side Effects and scroll down to the bottom of the screen) clearly shows BT handles both incontinence and ED better than radical prostatectomy. Of course I believe you won’t find a similar chart in the Journal of Urology.
In my opinion today’s curative therapies for PC come at a high cost in terms of quality of life (i.e. incontinence and ED) for about 30% to 60% of PC patients. Yes, the wide 30% to 60% range was deliberately included to show how many statistics found in PC discussions bring little clarification to the discussion. These wide percentage ranges address the necessity of finding the very best doctor regardless of therapy choice.
I keep reading PC patients should search for the best therapy choice (and the best practitioner) for their own situation. As an amateur in the field of PC, you are at a disadvantage when interviewing experts with years of experience. Several therapies may appear to qualify as the best choice. Every doctor (only 7 so far) I have interviewed made sure to mention NO CLINICAL TRIAL DATA is currently available to compare the different PC therapies. All of these doctors were also very careful to pause, get your attention and slowly say “xxx is shown to be JUST AS GOOD AS yyy” where xxx is their area of training. Very helpful indeed so go ahead and make your own best choice.
Thanks for viewing my story and Good Luck on your journey.