May 02, 2013 - 3:51 pm
I'm a new member of the PC club and I'm finding this forum very helpful and interesting. I'm hoping to obtain some feedback on treatment options relevant to my specific circumstances, which are as follows:
I'm 61 (I almost wrote "I'm a 61-year old male", then came to my senses) and otherwise healthy. There's a family history of PC (two first-degree relatives). A weak urine stream led to bloodwork in early March and a PSA reading of 34, which was confirmed by another blood draw and reading two days later; a digital rectal exam by a urologist the next day was positive. All fourteen cores of an April 8 biopsy were positive (!), most cores were 60 - 90% malignant; three cores were Gleason grade 3 + 3, five cores were 4 + 5 and the rest were 4 + 4 for an overall Gleason score of 4 + 5. Two CT scans in March were negative, as was a post-biopsy bone scan (surprisingly, according to a surgeon consulted a few days ago), although a full bladder from which I could void just a few cc's at a time partially obscured the pelvic region from the view of the gamma camera. After learning the diagnosis a week ago I received two injections of digarelix for rapid relief of the urine retention problem, which had rapidly progressed from mild to severe during the past two months.
So I'm in the research and discovery phase before I settle on a therapeutic course of action. My burning question is, should I go with surgery or radiation therapy + androgen deprivation therapy? My urologist and the radiation oncologist he immediately hooked me up with - both are non-academic physicians - are recommending radiation and two years of anti-hormone therapy (digarelix). I've reviewed the findings of a Phase III study of digarelix efficacy - it seems like a good approach for knocking down testosterone, and it sure seems to be working for me with regard to urine retention ( I'm no longer considering moving my office desk into the men's room at work). An academic urology surgeon has indicated that the radiation and hormone regimen laid out by my current docs is a good one; his argument is: 1. although it may not have mestastisized, given its aggressive nature the tumor likely extends beyond the prostate (actually, he put the odds at 100%) and it would be difficult to eliminate completely with surgery, and 2. because of the large size of the tumor, surgery would likely leave me incontinent. These seem like convincing arguments, and I'm impressed by the fact that as a surgeon this doc is turning away business with this recommendation. A second academic surgeon, however, recommends a radical prostatectomy based on the argument that it would be more effective at eliminating tumor cells and would also eliminate nearby lymph nodes. However, the first surgeon thinks the lymph nodes can be adequately dealt with using radiation. All of these guys are extremely bright and competent with stellar records of success - hence my dilemma. I'm also getting mixed signals from these docs about how urgently (timewise) I should pursue my options and decide how to proceed.
My wife and I are reading up on the subject voraciously and I've scheduled consults with two more surgeons and a radiation oncologist during the next few weeks. I'll certainly ask them lots of questions. The radiation oncologist (who is at a major cancer center) has also arranged for a second look at the biopsy slides, although I'm reasonably confident the cores were called correctly the first time. I think it's possible however, that none of these docs can provide the unique perspective of a well-informed patient (or patient's significant other) who has made their way through the process of being treated. This clearly describes many of you posting to this forum on a regular basis. I realize my dilemma is one that most of us have faced and I'm aware of previous posts that addressed similar questions - but it appears the tumor I've been diagnosed with is especially large and aggressive. Any thoughts on the best route to take - as well as references to hard data - would be greatly appreciated.
Thanks, and best wishes to you all . . .