Hello just diagnosed and very frightened

If you had a biopsy, your gleason should be assessed right there on the report.  The last page of mine contains the final answer while the body of the report shows the results of each core taken.

Richard

I have a Gleason 4+4.  Surgery is on for Thursday, May 10...4 days from this writing.  I reached the surgery conclusion after considering a number of factors.  Since I am 71, there is some logic in having radiation but, since the cancer is encapsulated (not found outside the prostate), I could just do nothing and have perhaps 10 years of life.  Bone scan is clear.  But here's what tipped the scale for me.  Radiation is easier and less invasive but has an effect on surrounding organs.  If you have radiation, you may not be able to have surgery later since other organs may be fused together.  Obviously check with your Dr. on this.  Also, if you have radiation, you will be coming back every six months or so for a progress report.  I personally dont like that either.  I dont need more drama. By removing the prostate it seems you get a much more certain result earlier, granted possibly more recover time, but your PSA goes to zero.  If it ever becomes other than zero, the docs know they need to do other testing. But you have a very easy indicator that there could still be a problem since it will be part of a routing physical.

My PSA started out at 3.5 rose (over about 2 years) to 4.5.  My Internist said "lets check with a urologist".  Hats off to him on that because many of my friends (who happen to be docs) say they would not have concerned themselves at this point.  Now, since the cancer is encapsulated and bone scan negative, I believe it is the right decision to get this over with.  Stay tuned.  I'll let you know in 3 or 4 months. :)  Get other opinions and select a Dr. with a lot of experience in robotics.  If your town doesnt have a great facility, consider where else you might be able to go for the treatment.  Hi tech is super important.  ie. Laproscopic/robotic.

Keep cool and do your research.  Once you find out about the options you'll be more relaxed and optomistic. A good attitude is a real help.  Best of luck to all of you.

Richard

I was recently diganosed March 5, 2018. I have done a ton of reserach, talked to many patient friends, my urologist, a radiation oncologist, and robotic surgeon. June 14 I am getting robotic surgery. If you get radiation it burns the tissue and leaves scar tissue, and if the cancer returns you can not have robotic surgery. I have chosen surgery to get the prostate gland, seminal vesicles, and lymph nodes all removed. I have chosen a robotic surgeon who has done 700 surgeries, and also a top hospital here in Atlanta, Ga. You have to wait 8 weeks after a biopsy before you can have the surgery to allow the prostate gland to heal. I hope this helps, I wish you well, I know the anxiety stinks. Try to be strong, positive and a lot of prayers. Good Luck.

You are very young and a good canditate for surgery if you decide to go that way. Depending on no medical issues. 

Seek 2nd and 3 opinions on treatments and go from there. Take your time slow down and educate yourself on this forum

and from reserch and doctors. Im trying to do the same being told oct i had 2 cores positive gleason 6 t2a tumor 25%

left apex. contained in prostate. It is a shock like being hit in stomach after leaving doctors office. Good Luck

Your doctor is correct; you should be seeing a RADIATION oncologist.

There are three types of doctors that are involved inn treating prostate cancer:

Urologist - the first specialist you see. They do the DRE and biopsies, and perform surgery

Radiation oncologist - they perform the various radiation treatments to eradicate PCa.

Medical oncologist - when the cancer is systemic, they prescribe chemotherapy and medicines.

In aggresssive cases, men often have to see all three of them, one after the other.

In your case, either of the first two will likely cure you.

Welcome to you Steve. 

Prostate cancer (abbreviated 'PCa') very seldom 'hurts.'   Your biopsy numbers do not suggest that what you are feeling in your 'tailbone' in any way relates to PCa. Usually, only highly advanced cases that have significant bone metastasis will hurt, and none of your numbers suggest that at all.   You most likely have incipient (mild) or moderately intermediate (slightly aggressive) disease based on what data has been shared thus far.  I sense that you are panicing a little (fairly common and reasonable).  This PCa research will become old-hat to you soon.  There is no rush; in fact, rushing is often very harmful.  Being systematic is much better. 

Because before I got PCa I had gone through massive chemo and treatment for Lymphoma, and had been around several friends with advanced PCa, when my urologist told me that I had PCa I yawned in her face (it was an early morning appointment), told her thanks, and said we would be in touch.  I had already laid out which doctors I was going to consult, and did not need recommendations from her.  In other words, there was no shock for me.  The guys here who have been fighting PCa for 12-15 years will tell you that the melodrama wears off pretty fast for most men.  PCa is beatable or highly controllable in most cases.  It has never "frightened" me at all, although it is extremely inconvenient. I do RESPECT it however, and know that is some cases it can be a killer.

You are seeing the right people: A radiation oncologist (RO), and later a surgeon.  Likely, either can cure you, meaning eradicate all of the PCa.  Both will want to share their skills on you.  Very generally, surgery is only advisible if all results fairly strongly suggest no escape of the disease from the gland.  It is also a good choice for men with serious urinary problems or chronic, lifelong prostatitis, such as I had. 

Radiation therapy (RT) generally is easier to undergo than surgery.  And there are 3 primary forms of radiation, based upon how the radiation is delivered: 

(1) Fractionated. This is the most common form of RT and its origins derive from the oldest of radiation techniques, although it is today as accurate in delivery (aim) as the other forms.  Fractionated is also best if escape is likely or definite, and areas adjacent to the gland must be radiated also out of caution.  Fractionated takes about 40 applications, usually just on weekdays; a session is painless and you will be in and out within an hour at most cancer centers.  Codenames your RO will use for fractionated delivery are IMRT or IGRT.  IGRT is an advancement over IMRT in precision of delivery -- a better mousetrap.

(2) SBRT.  SBRT does what fractionated does, but faster. A patient will only go for about 5 treatment sessions, since each session has much more radiation delivered at once than fractionated does.  It is reportedly painless also.  There are a variety of SBRT manufacturers, but the most popular machines are known by their tradenames of Cyberknife or Varian Truebeam.  If the RT discusses either of those, he is discussing SBRT. Initially uncommon, SBRT today is almost as commonly available as fractionated and is a popular choice, although a few rural areas around the country still do not have SBRT in-house.  Most better centers today have both fractionated and SBRT to choose from in the same office.  I read this week that SBRT is now being used at some centers for area radiation outside the gland if the location of metastasis is well established, similiar to how ROs use IGRT.  This is still somewhat experimental however as a use for SBRT, and not something most ROs currently do with SBRT.

(3) Brachytherapy ("Seeding").   Seeding involves a surgeon placing tiny radioactive seeds, or pellets, inside the gland itself, as close to the known tumors as possible.  Seeding is usually not advised for more advanced or serious cases.

Although a few writers here are highly critical of surgery, it can be a good or even the best choice is some cases. One such case is when there is serious urinary blockage; surgery is then the best option, if metastasis is not suspected. A psychological advantage to surgery for some is that when the gland is cut out and studied by a pathologist in the lab, a man knows EXACTLY what he was dealing with: level of aggression, and escape from the gland is almost definitely confirmed or ruled out in most cases. My own case was diagnosed at Stage I using available data, but as soon as the pathologist dissected it, he knew with certitude that it was a significant Stage II.  This would most likely not have been discovered with RT.  While T3 MRIs and bone scans are much better than older PCa scans, imaging to establish where metastatic PCa is located (or to determine if there is any metastasis) are very imperfect; false negatives (missing tumors because they are too small for detection) are not uncommon at all.  Imaging in general for PCa is among the worst of all cancers due to how tiny metastatic PCa tumors can be.  Ordinarily, a CT for instance cannot spot a mass smaller than 3mm or a bit larger, but PCa can be significantly smaller than that. I am describing a generality in PCa detection, and am not interested in arguing with anyone over minutiae regarding what this or that machinc can do. 

Following surgery, the PCS will almost instantly (within 2 months or thereabout) go to zero and stay there forever, if the surgery was successful.  This can be an asset for men prone to stress.  

Conversely, following radiation treatments, PSA will oscillate for some time, ocassionally even a year or so, until a lowest PSA value, called a nadir, is established. Thereafter, the nadir is compared to subsequent PSA results over the years, and a formula is used to determine if relapse has ever occured. Differing cancer centers or labs use differing thresholds, or tripping points, to conclude relapse. But PSA following just RT will never go to zero. This is not a problem, just potentially unsettling for some men.

Surgery will leave almost all patients impotent for six months or more (a year is not uncommon).   But in the majority of prostectomies, most men regain potency at some point, unless age or significant preconditions preclude this.  Today, a technique called erectile nerve sparing is almost always used by surgeons, unless what they discover when the patient is open precludes this. Decades ago, nerve sparing was highly uncommon, leaving nearly all men impotent for life.  Luckily, no longer the case.  Rare horror stories occur in surgery and post radiation, as they do following any medical proceedure.  But RT side-effects are delayed, not instantaneous, and in general are usually milder for most men.  As one would expect, a person with problems is more given to report their situation than a person with no problems, so issues post-surgery appear frequent to some evaluators. 

I hope this helps a little. It is very general in nature; what you experience will not be exactly like what any other man experiences.  The ancedotal accounts men share with you will not be identical to your own, unique reality and results.

Good luck !

max

It is doubtful that your pelvic pain is associated with your prostate or prostate cancer.   Prostate cancer is typically asymtomatic unless extremely advanced.   As far as the size of your prostate, 55cc is not very big at all.   Mine was 225cc at time of surgery, which admittedly is huge, but it caused me no discomfort (it did cause lots of urinary problems).   One thing I will tell you, between the time I got my diagnosis after the biopsy, and the time the doctor told me that the bone scans and MRI did not show any spread, I was having aches and pains all over, sure that I was riddled with cancer.

The best thing is to find the best and most experienced doctors you can, research and ask questions so you can make the best decisions about treatment, and then have confidence that that your innate good health and the excellent care you are receiving will carry you through.

You and I are tracking pretty much the same as what I've read from you.  I even skipped a year in my PSA screening.   I was born in 1961 as well.   PSA originaly high when I was 51, five years ago.   I most likely had my 3+4 for a couple years prior to that,   So 7 years I'm thinking at least.   I did have surgery, and my PCa was contained.  I tell you this because there is a good chance it is contained for you as well.  Also a 3T MRI eluded to that prior.    My MRI was prior to my biopsy, used to help locate it.   I'm not sure if the insurance companies care if the MRI is prior or post PCa detection.   Maybe others know, you should ask.

Heed the advice of those here.   Take some time now to research your options and pick the one that's right for you after you have learned of them. Don't get too focused on surgery immediately.  Really look at options equally now.  It may seem like it's taking forever to make a decision, but when you look back in a year, a couple months to research will seem like a blink of an eye in retrospect.   Everything you are doing now is in a heightened state, you can slow it down.  Tell yourself over and over, "I will be fine".   Because you will be.

Take care - Dan