Recently Diagnosed and am a bit confused

AussiePup
AussiePup Member Posts: 19
I will be 73 yrs old in a month and am in excellent health, take no drugs of any kind, get plenty of exorcise and eat a mostly vegetarian diet. I am devastated, as I thought I would be the last person in the world to get this cancer. I had a biopsy due to a 5.2 PSA as part of a routine physical. 1 core (right side) out of 12 had cancer, but it has a Gleason of 8 (4+4). It is stage T1c. The pathologist is a specialist and only does prostate biopsies, so I have confidence in the scores being correct. I was immediately scheduled for a bone scan and a CT scan, which both turned out negative, which was a big relief.

I had my first meeting with the surgeon last Thursday to discuss my options and was told that I was not a candidate for seed implantation due to the high risk Gleason 8 and of course, "watchful waiting" is also off the table.

He recommends doing a RP with DaVinci robotic surgery over open surgery. He has done 500 of each. He wants me to see the radiation oncologist, which I am scheduled for on Friday, but he advises me that external beam radiation can mess up my chance for "salvage" surgery, as well as the hormones usually administered can have very unpleasant side effects. He did explain the possible "bads" of surgery, such as incontinence and ED. He also explained that he wouldn't know about exceeding the margin until he got in there and that would be a major determining factor on my chances for nerve sparing. Not quite sure what this "margin" is referring to, but I think it means whether or not the cancer is completely contained in the prostate proper and not in the nerves?

He showed me how to plug my numbers into the Sloan Kettering tool and my results look promising.

After reading many posts in this forum, I see that it doesn't appear to be as cut and dried as I've been led to believe.

Any experiences by others with similar numbers would be deeply appreciated and would be very helpful in helping me arrive at a decision.

Thanks,

AussiePup


P.S. I am not Australian .. My username refers to my Australian Shepherd dog, who helps keep me fit and sane.
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Comments

  • lewvino
    lewvino Member Posts: 1,010
    AussiePup,
    Sorry to hear

    AussiePup,
    Sorry to hear about your diagnosis. It sounds like you have all ready begun the education part of your journey and want to encourage you to continue with learning all you can to fight this beast. It sounds like you are in overall good health since the doctor recommended the Davinci at age 73. Some doctors cut off the surgery option at age 70 but that depends on the patients overall health.
    As you have mentioned the Gleason 8 puts you in the cateogry where something should be done sooner rather then later.

    Typically when the prostate is removed the surgeon has to make a decision as to how wide to cut to remove all the cancer. The wider the cut can cause more problems with the urinary control and also with the nerve sparing. After the prostate is removed it is inked and sent to a lab. This is to determine if the cancer is totally contained in side of the inked area. In my Case a Gleason 7 (3+4) I had one positive margin on the inking. The cancer was found on one spot to the very edge of what was removed. This means that the surgeon either cut through that spot of cancer and maybe some cancer cells were left behind. So far I'm doing great at 20 months post Davinci. Also my surgeon estimated that on one of the nerve bundles he spared 100% and on the other bundle about 60% were spared.
    I'm doing fine on the urinary control and ED Side with the help of a levitra tablet.
    I'm age 56.

    I would assume that your doctors reasoning is to 1. remove the cancer via surgery and see how you do. 2. If recurrance then you have radiation as a backup and 3. If still problems then you have the hormone therapy.

    Some surgeons will perform surgery after radiation but the radiation causes scaring and makes the surgery more difficult.

    If you haven't all ready read it get the book Surviving Prostate Cancer by Doctor Patrick Walsh. Its an excellent book and will help you get a grasp of your options. He talks about margins and actually discovered the 'erection nerve bundles' and how to spare them.

    Best wishes and keep us updated on your progress. If you want to chat via phone or email offline just send me a private message through the email portion of this forum.

    Lewvino (larry)

    Oh yes - I love dogs and almost bought an australian sheperd this spring. Ended up with my favorite instead a golden retreiver.
  • Kongo
    Kongo Member Posts: 1,166 Member
    Sorry
    AussiePup

    Sorry to hear of your diagnosis but welcome to the forum. There are many men here who have gone through similar circumstances and I'm sure you will get much support and advice based on their experiences.

    As you know, your diagnosis is troubling because it indicates a higher risk cancer which has cells that are much less differentiated that a Gleason 3+3, for example. Assuming you have been having regular physicals where PSA testing was done, you should have a good history of your PSA scores. If you put them into the Sloan Kettering nomograms then you can calculate your PSA density, your PSA velocity, and PSA doubling time. All of these help give you some perspective on the aggressiveness of your cancer.

    If I were you I would be heartened to know that only one core came back positive which may be an indication that the cancer tumor in your prostate is relatively contained. (Of course, it could also mean that they just missed any cancer in the other core samples).

    Your doctor is right to have a sense of urgency about this and he is being smart to have you consult with a radiologist as well as his specialty. As Larry pointed out and your doctor alluded to, surgery following radiation for salvage therapy is more difficult but not impossible.

    Your doctor may have discussed with you that there are differing opinions about whether surgery on a Gleason 8 cancer is prudent or not, your age notwithstanding. Gleason 8 cancers have a much higher probability that some of the cancer has moved outside your prostate even though the bone scan showed negative results. Removing the prostate after the cancer has spread will not slow the progression of cancer outside the gland. (Prostate cancer inside the prostate isn't fatal...but the relatively small percentage of men who DO die from prostate cancer succumb to the damage to their organs outside the prostate). On the other hand, if there is good evidence that the cancer is still contained, there have been some recent studies published that show excellent results in long term absence of recurrence following surgery. You should also consider that if indeed tha cancer is contained in the prostate, then several forms of radiation may also be appropriate.

    One particular form of radiation that is frequently used with your stage of prostate cancer that is apparently contained within the gland is HDR brachytherapy where temporary radioactive wires are inserted into the prostate for a short period of time. This is frequently done in conjunction with a limited course of hormone therapy. When you meet with the radiologists, I would include HDR (High Dose Rate) brachytherapy on the list of possible treatment options to discuss.

    Despite the fact that your pathologist apparently specializes in prostates, I would strongly encourage you to seek a second opinion from one of the major medical schools such as Johns Hopkins. The initial diagnosis in your case is so important and so much rides on it that i would go the extra mile on this.

    You shouldn't feel guilty about leading a healthy lifestyle and coming down with prostate cancer. I'm not sure what a "mostly vegetarian" is but I would encourage you to read The China Study in addition to the standard issue prostate cancer books. I would also consider eliminating dairy if that is part of what you eat because of its strong association with the IGF factors and cassein which accelerate cancer growth.

    Best of luck to you.
  • AussiePup
    AussiePup Member Posts: 19
    Kongo said:

    Sorry
    AussiePup

    Sorry to hear of your diagnosis but welcome to the forum. There are many men here who have gone through similar circumstances and I'm sure you will get much support and advice based on their experiences.

    As you know, your diagnosis is troubling because it indicates a higher risk cancer which has cells that are much less differentiated that a Gleason 3+3, for example. Assuming you have been having regular physicals where PSA testing was done, you should have a good history of your PSA scores. If you put them into the Sloan Kettering nomograms then you can calculate your PSA density, your PSA velocity, and PSA doubling time. All of these help give you some perspective on the aggressiveness of your cancer.

    If I were you I would be heartened to know that only one core came back positive which may be an indication that the cancer tumor in your prostate is relatively contained. (Of course, it could also mean that they just missed any cancer in the other core samples).

    Your doctor is right to have a sense of urgency about this and he is being smart to have you consult with a radiologist as well as his specialty. As Larry pointed out and your doctor alluded to, surgery following radiation for salvage therapy is more difficult but not impossible.

    Your doctor may have discussed with you that there are differing opinions about whether surgery on a Gleason 8 cancer is prudent or not, your age notwithstanding. Gleason 8 cancers have a much higher probability that some of the cancer has moved outside your prostate even though the bone scan showed negative results. Removing the prostate after the cancer has spread will not slow the progression of cancer outside the gland. (Prostate cancer inside the prostate isn't fatal...but the relatively small percentage of men who DO die from prostate cancer succumb to the damage to their organs outside the prostate). On the other hand, if there is good evidence that the cancer is still contained, there have been some recent studies published that show excellent results in long term absence of recurrence following surgery. You should also consider that if indeed tha cancer is contained in the prostate, then several forms of radiation may also be appropriate.

    One particular form of radiation that is frequently used with your stage of prostate cancer that is apparently contained within the gland is HDR brachytherapy where temporary radioactive wires are inserted into the prostate for a short period of time. This is frequently done in conjunction with a limited course of hormone therapy. When you meet with the radiologists, I would include HDR (High Dose Rate) brachytherapy on the list of possible treatment options to discuss.

    Despite the fact that your pathologist apparently specializes in prostates, I would strongly encourage you to seek a second opinion from one of the major medical schools such as Johns Hopkins. The initial diagnosis in your case is so important and so much rides on it that i would go the extra mile on this.

    You shouldn't feel guilty about leading a healthy lifestyle and coming down with prostate cancer. I'm not sure what a "mostly vegetarian" is but I would encourage you to read The China Study in addition to the standard issue prostate cancer books. I would also consider eliminating dairy if that is part of what you eat because of its strong association with the IGF factors and cassein which accelerate cancer growth.

    Best of luck to you.

    Thanks for comments
    First, I have just ordered the book by Dr. Walsh ... Thanks Larry ... your results are encouraging and comforting ... definitely gives me hope

    Kongo, you mention brachytherapy as an option. My doctor told me it's only for low risk patients ... that my Gleason 8 precluded that option. He said that external beam radiation is the option that would be open to me. He is the director of the urology oncology department at University of North Carolina hospital in Chapel Hill, NC. Of course, his specialty is surgery. Have you heard anything regarding this teaching hospital's expertise or success in this field?

    I will let you know what the radiation oncologist tells me at my appointment on Friday.

    This site is a wonderful resource ... I am so glad I found it!

    Thanks to both of you,

    Martin
  • Kongo
    Kongo Member Posts: 1,166 Member
    AussiePup said:

    Thanks for comments
    First, I have just ordered the book by Dr. Walsh ... Thanks Larry ... your results are encouraging and comforting ... definitely gives me hope

    Kongo, you mention brachytherapy as an option. My doctor told me it's only for low risk patients ... that my Gleason 8 precluded that option. He said that external beam radiation is the option that would be open to me. He is the director of the urology oncology department at University of North Carolina hospital in Chapel Hill, NC. Of course, his specialty is surgery. Have you heard anything regarding this teaching hospital's expertise or success in this field?

    I will let you know what the radiation oncologist tells me at my appointment on Friday.

    This site is a wonderful resource ... I am so glad I found it!

    Thanks to both of you,

    Martin

    HDR Brachytherapy
    Martin,

    While brachytherapy (permanent seeds) is generally considered a solution for low to medium risk patient, HDR brachytherapy is another story altogether with a much higher dose rate very precisely administered. Brachytherapy and HDR brachy should not be confused with each other.

    Check it out at: http://www.prostate-cancer.org/education/localdis/demanes_HDR.html

    Good luck.

    K
  • Julietinthewoods
    Julietinthewoods Member Posts: 15
    AussiePup said:

    Thanks for comments
    First, I have just ordered the book by Dr. Walsh ... Thanks Larry ... your results are encouraging and comforting ... definitely gives me hope

    Kongo, you mention brachytherapy as an option. My doctor told me it's only for low risk patients ... that my Gleason 8 precluded that option. He said that external beam radiation is the option that would be open to me. He is the director of the urology oncology department at University of North Carolina hospital in Chapel Hill, NC. Of course, his specialty is surgery. Have you heard anything regarding this teaching hospital's expertise or success in this field?

    I will let you know what the radiation oncologist tells me at my appointment on Friday.

    This site is a wonderful resource ... I am so glad I found it!

    Thanks to both of you,

    Martin

    Brachy/IMRT combination
    Martin, I believe the combination treatment of ldr brachy followed (or preceded, depending on the doctor) by IMRT (modern external beam) could also be an option for you. I think brachytherapy as a monotherapy is the issue for higher grades of cancer. The combination of the two types of radiation gives a higher dose of greys and covers the margins. You might want to at least ask your radiation consultant about it.

    From what I have read, your PSA (less than 10) and stage are both factors in your favor. I really wish you luck!

    Juliet
  • Swingshiftworker
    Swingshiftworker Member Posts: 1,013 Member
    Gleason 8 and Stage T1c?
    I know it's possible, but I don't think I've ever heard of anyone w/a Gleason 8 (high grade cancer) also being diagnosed as Stage T1c (early stage cancer undetectable by DRE or imaging).

    This apparent inconsistency suggests the need for a 2nd opinion on the biopsy. Dr. Jonathan Epstein at Johns Hopkins, who is one of the experts in the field, did a 2nd opinion for me and I highly recommend him. His contact information is available here: http://pathology.jhu.edu/department/services/consults/urologic.cfm.

    If you really have a Gleason 8, surgery is usually suggested (but not absolutely mandated) as long as the cancer has not migrated beyond the prostate capsule. There are other radiological alternatives, as other have already suggested.

    While your slides are out for reanalysis, take the time to investigate your options before submitting your body to the knife. The negative consequences of surgery are quite draconian and various forms of radiation treatment may still be the better choice.

    BTW, don't let the suggestion that surgery after radiation is contraindicated deter you from choosing radiation over surgery as the primary treatment. If surgery fails you'll have no choice but to opt for radiation and/or chemo later, which are the same follow-up choices if the initial radiation treatment fails.

    Good luck!
  • AussiePup
    AussiePup Member Posts: 19
    Kongo said:

    HDR Brachytherapy
    Martin,

    While brachytherapy (permanent seeds) is generally considered a solution for low to medium risk patient, HDR brachytherapy is another story altogether with a much higher dose rate very precisely administered. Brachytherapy and HDR brachy should not be confused with each other.

    Check it out at: http://www.prostate-cancer.org/education/localdis/demanes_HDR.html

    Good luck.

    K

    Pretty Interesting
    Kongo,

    The link you furnished is an outstanding bit of info, that I thank you for and will be asking about HDR brachytherapy with the radiation oncologist on Friday. It sounds almost too good to be true! Of course, none of the tables cover my numbers, but that may just be due to covering only the most common number combinations.

    Will keep you posted

    Thanks again,

    Martin
  • AussiePup
    AussiePup Member Posts: 19

    Brachy/IMRT combination
    Martin, I believe the combination treatment of ldr brachy followed (or preceded, depending on the doctor) by IMRT (modern external beam) could also be an option for you. I think brachytherapy as a monotherapy is the issue for higher grades of cancer. The combination of the two types of radiation gives a higher dose of greys and covers the margins. You might want to at least ask your radiation consultant about it.

    From what I have read, your PSA (less than 10) and stage are both factors in your favor. I really wish you luck!

    Juliet

    Thank you for your comments
    Juliet,

    I will also be taking your comment with me on Friday and will let you know the outcome.

    Thank you very much for your interest,

    Martin
  • AussiePup
    AussiePup Member Posts: 19

    Gleason 8 and Stage T1c?
    I know it's possible, but I don't think I've ever heard of anyone w/a Gleason 8 (high grade cancer) also being diagnosed as Stage T1c (early stage cancer undetectable by DRE or imaging).

    This apparent inconsistency suggests the need for a 2nd opinion on the biopsy. Dr. Jonathan Epstein at Johns Hopkins, who is one of the experts in the field, did a 2nd opinion for me and I highly recommend him. His contact information is available here: http://pathology.jhu.edu/department/services/consults/urologic.cfm.

    If you really have a Gleason 8, surgery is usually suggested (but not absolutely mandated) as long as the cancer has not migrated beyond the prostate capsule. There are other radiological alternatives, as other have already suggested.

    While your slides are out for reanalysis, take the time to investigate your options before submitting your body to the knife. The negative consequences of surgery are quite draconian and various forms of radiation treatment may still be the better choice.

    BTW, don't let the suggestion that surgery after radiation is contraindicated deter you from choosing radiation over surgery as the primary treatment. If surgery fails you'll have no choice but to opt for radiation and/or chemo later, which are the same follow-up choices if the initial radiation treatment fails.

    Good luck!

    Definitely have a textbook definition of stage T1c
    SwingShiftWorker,

    Your comments are duly noted and will be considered in my decision making. The only think there is no doubt about is the stage T1c, as it is defined. I had the biopsy due to the elevated PSA and the tumor is not palpable or detectable during a DRE. Also, 3 different doctors have assigned T1c to me. I am considering asking for another pathologist's opinion on my slides.

    Thank you for your interest,

    Martin
  • mrspjd
    mrspjd Member Posts: 694 Member
    AussiePup said:

    Definitely have a textbook definition of stage T1c
    SwingShiftWorker,

    Your comments are duly noted and will be considered in my decision making. The only think there is no doubt about is the stage T1c, as it is defined. I had the biopsy due to the elevated PSA and the tumor is not palpable or detectable during a DRE. Also, 3 different doctors have assigned T1c to me. I am considering asking for another pathologist's opinion on my slides.

    Thank you for your interest,

    Martin

    HDR-B
    Hi Martin,

    Welcome to the PCa forum. A bit about our PCa journey: After multiple consults with skilled and experienced docs in all tx modalities, my husband, PJD, chose HDR-B as his primary treatment in combination with ADT (Androgen Deprivation Therapy aka hormones) and IMRT. He is doing very well with good results todate, enjoying golfing, skiing, working, exercising, etc. In all the confusion & fear of a cancer diagnosis, there is, afterall, for many, a good life after PCa!

    Briefly, PJD was dx’d with PCa in Feb 2010 @ age 67. He was otherwise healthy, fit, and active, with no major pre-existing health issues. He had a history of low PSA’s. PSA @ dx was 2.8. Nodule found on DRE lead to a twelve core biopsy resulting in 9 cores positive with many of the nine cores @ 70-100% positive. Local pathology lab reported Gleason 3+3=6, stage T2 with PNI. PJD sent his biopsy lab slides out to a well known and respected PCa pathology lab, Johns-Hopkins, for a 2nd opinion reading. The J-H’s report downgraded (worse) the Gleason to 3+4=7, confirmed PNI (PeriNeural Invasion), and lead us to seek further diagnostic testing in order to determine the correct staging. We felt that establishing the correct pre-tx staging was critical in order to evaluate which tx would offer the best chance of successful outcome with the least side effects since no two cases of PCa are the same. Staging was ultimately determined to be intermediate/high risk T3 locally advanced PCa with ECE (extra-capsular extension).

    If you wish to read a few of my recent summary postings relating to our PCa experience and HDR-B, they can be found in the following threads:
    http://csn.cancer.org/node/193113 (May 2010 & March 2011 posts)
    http://csn.cancer.org/node/215851 (April 9 & 14 posts)

    To read more about a topic of interest or previous posts made by a particular user/board member, you may wish to take advantage of the search box feature located on the upper right side of the PCa forum home page. Just enter a topic, key word(s) or user’s name.

    Once you have all the facts and educate yourself about your options, you will be able to make a tx choice that will be right for you. Wishing you all the very best.

    mrs pjd

    PS: Next to Springer Spaniels, Aussie Shepherds are great! Rescue dogs of course.
  • VascodaGama
    VascodaGama Member Posts: 3,495 Member
    mrspjd said:

    HDR-B
    Hi Martin,

    Welcome to the PCa forum. A bit about our PCa journey: After multiple consults with skilled and experienced docs in all tx modalities, my husband, PJD, chose HDR-B as his primary treatment in combination with ADT (Androgen Deprivation Therapy aka hormones) and IMRT. He is doing very well with good results todate, enjoying golfing, skiing, working, exercising, etc. In all the confusion & fear of a cancer diagnosis, there is, afterall, for many, a good life after PCa!

    Briefly, PJD was dx’d with PCa in Feb 2010 @ age 67. He was otherwise healthy, fit, and active, with no major pre-existing health issues. He had a history of low PSA’s. PSA @ dx was 2.8. Nodule found on DRE lead to a twelve core biopsy resulting in 9 cores positive with many of the nine cores @ 70-100% positive. Local pathology lab reported Gleason 3+3=6, stage T2 with PNI. PJD sent his biopsy lab slides out to a well known and respected PCa pathology lab, Johns-Hopkins, for a 2nd opinion reading. The J-H’s report downgraded (worse) the Gleason to 3+4=7, confirmed PNI (PeriNeural Invasion), and lead us to seek further diagnostic testing in order to determine the correct staging. We felt that establishing the correct pre-tx staging was critical in order to evaluate which tx would offer the best chance of successful outcome with the least side effects since no two cases of PCa are the same. Staging was ultimately determined to be intermediate/high risk T3 locally advanced PCa with ECE (extra-capsular extension).

    If you wish to read a few of my recent summary postings relating to our PCa experience and HDR-B, they can be found in the following threads:
    http://csn.cancer.org/node/193113 (May 2010 & March 2011 posts)
    http://csn.cancer.org/node/215851 (April 9 & 14 posts)

    To read more about a topic of interest or previous posts made by a particular user/board member, you may wish to take advantage of the search box feature located on the upper right side of the PCa forum home page. Just enter a topic, key word(s) or user’s name.

    Once you have all the facts and educate yourself about your options, you will be able to make a tx choice that will be right for you. Wishing you all the very best.

    mrs pjd

    PS: Next to Springer Spaniels, Aussie Shepherds are great! Rescue dogs of course.

    Quality of life should be considered at your age
    Martin

    You got here several comments to consider in your decisions to a treatment. However, none of the above suggestions can assure you cure. Treatments for prostate cancer are still not perfect (very “primitive”) and are based on “guess work”. You cut a “piece” of your body or burn it inside you, expecting that cancer is within it.
    If, in fact the cancer is not totally in there, you end up with a recurrence, confronting side effects and “less money in the pockets”.

    Quality of life should be considered at your age. Major radical treatments can harm you permanently which would not be part of your plans while advancing into the 80th.
    There has been a tendency of avoiding radical approaches to guys over 70. The NCCN guidelines expresses that and recommend palliative treatments which are lesser aggressive.

    I believe that you feel healthy and that you could withhold a treatment that would close this chapter of your life, but your “excellent health” status seems to have betrayed you. Many of us had the same experience and many (in the 70th) have reported to find other health complications while preparing for cancer treatment.

    Prostate cancer is known to have a slow progress and guys in worse cases with metastases survive 8-10 years without any treatment. Others live long 10-15 years with hormonal treatments. I do not agree with your doctor’s opinion regarding hormonal treatment. The “very unpleasant side effects” he comments are symptoms similar to menopause (hot flashes, mood swings, etc) that disappear once the treatment is stopped. Many guys mistakenly relate hormonal therapy with that of chemotherapy which has nasty side effects.

    One has to weigh the fact of living with the possibility of side effect or continue with quality of life and probably die younger of other illnesses.

    I would recommend you to read about the side effects of each treatment and check about palliative treatments. O good book for cases similar to yours is “Beating Prostate Cancer” written by the famous oncologist Dr. Charles Myers himself a survivor of prostate cancer.
    Another interesting story I recommend you to read, which was posted here before, is the fascinating experience of a surgeon when he confronted the position of being a PCa patient. You can read it here;
    http://www.renalandurologynews.com/lessons-lived-ailments-get-personal-for-some-docs/article/200925/b

    Here is the site for NCCN;
    http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

    I hope you find that decision and peace of mind.

    VGama
  • bdhilton
    bdhilton Member Posts: 803 Member
    I always hate to hear about
    I always hate to hear about guy another falling victim to PCa…but from my perspective you are a very blessed man as I was diagnosed when I was 54….I had surgery but at your age with some of the complexities you mention I would be looking into some form of radiation (Kongo can you believe I am making this recommendation) that in my opinion would give you the best quality of life at your place in life…Whatever you decided I wish you the best….and Chapel Hill is a great teaching hospital!
  • finbar
    finbar Member Posts: 26
    Prostate Confused
    I had a very similar report on my p cancer. That was 3 years ago at age 82.
    With the help of both patients and doctors, I looked into all the treatments
    available and and soon came to the very solid decision to get rid of the cancer
    once and for all. Once I settled on the Davinci robotics, the next step was
    to find a surgeon with a great deal of experience having at least a 1,000 operations
    a year. Not only saving as much of the nerve bundles as is possible but making
    re-connections to the bladder is vital to a good outcome. I was most fortunate to
    now have a near zero PSA that has been checked every six months. Should you wish
    further info, I can emailed at [email protected]
  • guards
    guards Member Posts: 72
    GET ANOTHER OPINION
    Get an opinion from an unassociated doctor. Hopefully they don't even know each other. I can't imagine how you can have an 8 off a 1 out of 12 but maybe another doctor can explain it better to you. At 73 seriously find out if it is slow growing and perhaps watchful waiting or hormone therapy will work for you. I promise you the side effects from surgery or radiation can cause significant changes in you life style and if you can have another 10-20 years without committing to more radical proceedures I for 1 (been there) reccommend consideration. I think that the doctors truly beleive that what ever they use is the best route but I think it is often not so. perhaps there is a suvivors group at your local hosp. you could talk to . You certainly are not critical right now take a few weeks or months to decide.
  • AussiePup
    AussiePup Member Posts: 19
    mrspjd said:

    HDR-B
    Hi Martin,

    Welcome to the PCa forum. A bit about our PCa journey: After multiple consults with skilled and experienced docs in all tx modalities, my husband, PJD, chose HDR-B as his primary treatment in combination with ADT (Androgen Deprivation Therapy aka hormones) and IMRT. He is doing very well with good results todate, enjoying golfing, skiing, working, exercising, etc. In all the confusion & fear of a cancer diagnosis, there is, afterall, for many, a good life after PCa!

    Briefly, PJD was dx’d with PCa in Feb 2010 @ age 67. He was otherwise healthy, fit, and active, with no major pre-existing health issues. He had a history of low PSA’s. PSA @ dx was 2.8. Nodule found on DRE lead to a twelve core biopsy resulting in 9 cores positive with many of the nine cores @ 70-100% positive. Local pathology lab reported Gleason 3+3=6, stage T2 with PNI. PJD sent his biopsy lab slides out to a well known and respected PCa pathology lab, Johns-Hopkins, for a 2nd opinion reading. The J-H’s report downgraded (worse) the Gleason to 3+4=7, confirmed PNI (PeriNeural Invasion), and lead us to seek further diagnostic testing in order to determine the correct staging. We felt that establishing the correct pre-tx staging was critical in order to evaluate which tx would offer the best chance of successful outcome with the least side effects since no two cases of PCa are the same. Staging was ultimately determined to be intermediate/high risk T3 locally advanced PCa with ECE (extra-capsular extension).

    If you wish to read a few of my recent summary postings relating to our PCa experience and HDR-B, they can be found in the following threads:
    http://csn.cancer.org/node/193113 (May 2010 & March 2011 posts)
    http://csn.cancer.org/node/215851 (April 9 & 14 posts)

    To read more about a topic of interest or previous posts made by a particular user/board member, you may wish to take advantage of the search box feature located on the upper right side of the PCa forum home page. Just enter a topic, key word(s) or user’s name.

    Once you have all the facts and educate yourself about your options, you will be able to make a tx choice that will be right for you. Wishing you all the very best.

    mrs pjd

    PS: Next to Springer Spaniels, Aussie Shepherds are great! Rescue dogs of course.

    Thanks for your links
    Mrs PJD,

    The posts in the links you furnished in this comment are very helpful. They have helped me put together some good questions to ask the radiation oncologist in tomorrow's meeting.

    I love Springer Spaniels, too!

    Regards and thanks again,

    Martin
  • AussiePup
    AussiePup Member Posts: 19
    bdhilton said:

    I always hate to hear about
    I always hate to hear about guy another falling victim to PCa…but from my perspective you are a very blessed man as I was diagnosed when I was 54….I had surgery but at your age with some of the complexities you mention I would be looking into some form of radiation (Kongo can you believe I am making this recommendation) that in my opinion would give you the best quality of life at your place in life…Whatever you decided I wish you the best….and Chapel Hill is a great teaching hospital!

    Looking at radiation options tomorrow
    Thanks for you comments, bdhilton

    I will post my impressions of tomorrow's meeting.
  • AussiePup
    AussiePup Member Posts: 19
    finbar said:

    Prostate Confused
    I had a very similar report on my p cancer. That was 3 years ago at age 82.
    With the help of both patients and doctors, I looked into all the treatments
    available and and soon came to the very solid decision to get rid of the cancer
    once and for all. Once I settled on the Davinci robotics, the next step was
    to find a surgeon with a great deal of experience having at least a 1,000 operations
    a year. Not only saving as much of the nerve bundles as is possible but making
    re-connections to the bladder is vital to a good outcome. I was most fortunate to
    now have a near zero PSA that has been checked every six months. Should you wish
    further info, I can emailed at [email protected]

    Good advice
    finbar,

    congratulations on your excellent results and progress.

    I agree that it's very important to find a doctor with a great deal of experience in whatever specialty you are considering.

    Does anyone have any idea what numbers are considered "a great deal of experience" for the different surgeries and radiation treatments?

    Thanks,

    Martin
  • cooksey23
    cooksey23 Member Posts: 2
    PCa
    Found out when I was 48 years old that I had prostate cancer. Gleason 8 (4&4). Did the Davinci. Clean since June 2007. Other problems with CLL. Radiation and 4 rounds of chemo. Your life has changed but, always make the best of it. No matter what the side effects. Like for me, once in your life you have to think about you.

    God Bless

    Willie Teague
    [email protected]
  • AussiePup
    AussiePup Member Posts: 19
    cooksey23 said:

    PCa
    Found out when I was 48 years old that I had prostate cancer. Gleason 8 (4&4). Did the Davinci. Clean since June 2007. Other problems with CLL. Radiation and 4 rounds of chemo. Your life has changed but, always make the best of it. No matter what the side effects. Like for me, once in your life you have to think about you.

    God Bless

    Willie Teague
    [email protected]

    My appointment is not until Friday @ 3pm
    Sorry for any confusion that I may have caused by saying my appointment with the radiation oncologist was today ... it's not until tomorrow ... just got confused ... will post my impressions, etc. on the meeting over the weekend.

    Thanks again to all,

    Martin
  • 2ndBase
    2ndBase Member Posts: 220
    Treatment Choice
    I was diagnosed with psa of 24 and Gleason 9 in 2003 at age 52. The only treatment I took was the maximum radiation allowed. A second biopsy 3 years ago showed no cancer left in the prostate. My cancer had already spread so surgery was not a choice. You will have much less side effects with the radiation than with surgery and you will be able to get the cancer cells killed and at age 73 I woould think that would be the best option. But it is your decision and you will make the right one for you and I wish you all the best.