Just got my biopsy results .. now what?

If your surgeon is that good, go for it. A six month waiting list is a good indication that he is in high demand. Also, it will give you time to read some of the past successes and failures in this forum to decide if this is right for you.

One side effect he cannot minimize is the shortening. A section of the urethra is actually part of your prostate that will be removed. The urethra is then pulled up and reattached, and your sex tool will retract along with it by one to two inches. Can you deal emotionally with that? Unless you start out hung like a horse, you won't be winning any contests after surgery.

You likely will be incontinent 3 to 6 months, then recover full continence eventually after successful robotic surgery.

After a successful surgery, you should regain erectile functioning up to a year or more later. Some guys regain it in a very short time. You may want to find out the average recovery time for most of this surgeon's patients as a guideline.

Other guys can fill you in on the particulars... those are the general guidelines.

Hi Grahambda,

Looks like you are doing your homework and studying the various treaments and their side effects.  Don't be afraid to talk to both the oncologist & urologist if you have not already done so.  I had surgery back in 2014 and don't regret it, still have a little stress incontinance and probably will have it for the rest of my life but no ED. It took me about a year to fully reover from my ED with progress being made over that time.  Hopefully your doctors will guide you to a treatment based on where your cancer lies inside of your prostate and what collateral damage could happen from both surgery or radiation.  Take the time to study and learn.  Sounds like the doctor you have picked has a good track record, very important for your sucess.

Dave 3+4

I've heard of Dr. Patel; he is one of the most experienced surgeons.

This is the 10th year that I have been following an active surveillance protocol where I have avoided the side effects of active treatments. It may be that you might qualify. Can you share more about your situation; any other diagnostic tests to include but not limited to image. PSA history , dre results, size of prostate, etc etc

I haven't read anything about radiation stimulating cancer and changing DNA. I wonder if you can share more about , "Was considering  radiation till I read “the truth about cancer “ and the suggestion radiation can stimulate other cancer cells and impact DNA" to include the author, and the qualifications.Here is a list of potential treatments that another member has posted on many occassions which you may find helpful.

"

The following is a duplicate of one that I have posted in various threads on this forum to give men newly diagnosed w/lower risk prostate cancer (Gleason 6 or 7) an overview of the treatment options available to them.

Anyone newly diagnosed with prostate cancer rated Gleason 6 (and usually Gleason 7) has all treatment options available to him and, since this cncer is considered "low risk", he has time to decide which choice is best for him.  So, the first thing a new prostate cancer patient should do is to do research on the available options before he actually has to make the decision regarding which treatment to choose.

The following is my response to other men who asked for similiar advice about the treatment choices avilable to them.  It's a summary of the available treatment options and my personal opinion on the matter.   You can, of course, ignore my opinion about which treatment choice I think is best.  The overview of the choices is still otherwise valid.

Choices You Need To Consider:

 . . .  People here know me as an outspoken advocate for CK and against surgery of any kind.  I was treated w/CK 6 years ago (Gleason 6 and PSA less than 10).  You can troll the forum for my many comments on this point.  Here are the highlights of the treatment options that you need to consider:

1)  CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer.  Accuracy at the sub-mm level  in 360 degrees and can also account for organ/body movement on the fly during treatment.  Nothing is better.  Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding.  Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

 2) IMRT is the most common form of external radiation now used.  Available everythere.  Much better accuracy than before but no where near as good as CK.  So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding.  Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed.  I think some treatment protocols have been reduce to only 20 but I'm not sure.  Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

 3) BT (brachytherapy).  There are 2 types: high dose rate (HDR) and low dose rate (LDR).  HDR involves the temporary placement of rradioactive seeds in the prostate.  CK was modeled on HDR BT.  LDR involves the permanent placement of radioactive seens in the prostate.  1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children.  The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive.  Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body.  Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc.   Both HDR and LDR require a precise plan for the placement of the seeds which is done manually.  If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects.  An overnight stay in the hospital is required for both.  A catheter is inserted in your urethra so that you can pee.  You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

 4) Surgery -- robotic or open.   Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation.  Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function).  Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body  due to the remove of the prostate which sits between the interior end of the penis and the bladder.  Doctors almost NEVER tell prospective PCa surgical patients about this.  A urologist actually had the to nerve to tell me it didn't even happen when I asked about it.   Don't trust any urologist/surgeon who tells you otherwise.  Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer.  Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

 4) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer.  You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer.  Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it. 

 I personally could not live w/the need to constantly monitor the cancer in my body.  Like most other men, I just wanted it delt with.  Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted.  I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected.  Other men on this forum have reported similiar results.

 So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment.  The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

 Good luck!"

Best wishes

Thanks...........interesting information...good use of sources

As far as the possibility of Active Surveillance, monitoring, read about what I did. 

https://csn.cancer.org/node/315620

Additioanlly if you are over 70 the guidelines for active surveillance are more relaxed.

As far as the high PSA, there are various factors other than prostate cancer that can elevate; infection, sex or bike riding before the PSA  even a hard stool. In addition larger prostate lay on the uretha thus secreting more. In active surveillance one looks for the ratio of the prostate size to PSA to be less than 0.15

................

I agree with ASAdvocate, radiation is a perfectly aceptable choice for cure, with less side effects than surgery. Like ASAdvocate I have been in an active surveillance program for many years, and have had a chance to study the various treatment modalities during this time........my thoughts about active treatment are virtually the same as ASAdvocate; SBRT is my first choice and HDR is my second....(kinda interesting since I was not aware of ASAdvocate until he started posting at this forum in Apr 2017)

Here is a nine year study about SBRT which lists outcomes by risk ranking, low, intermediate and high, and side effects that were found.

https://prostatecancerinfolink.net/2016/01/06/nine-year-outcomes-after-treatment-with-sbrt/

more

https://csn.cancer.org/node/315653

Your PSA is high and of concern; which hopefully is due to factors other than cancer, infction, bike riding , sex before, etc. If that is so and a new targeted biopsy reveals that the cores that you had and are positive are cancerous, are small, that is, have not extended outside the cores  that were found. You will have to do additional testing to see if you are eligible for AS. To be honest you are currently on the cusp.

There is a targeted biopsy that is done, which I think that you had; that consists of  a T3 MRI--the results of which are locked into a three dimensional ultrasound biopsy machine that major institutions of excellence have. The facility that did mine used a machine manufactured by Artemis. there were four cores of small amounts of cancer that was found in your biopsy. If i this was a three dimensional, not a two dimensional biopsy that is done in most doctors offices,  the urologist had the ability to go back to the exact same spot where a 3+4's were located to see if the tumors were more extensive.........also the doctor can take other cores in the prostate to determine any onther activity if any....because, if there is a lot of cancer even of gleason 6's, it is likely that a gleason 7's and above can be hidden. If there is a lot of cancer in the prostate active treated is necessary

Now to answer your direct question, the PSA is an indicator only....the critical information is found in the results of  the biopsy, the gleason; so for example in my case, the doctor does a biopsy every two years unless there is something going on, then an extra biopsy is done....I've had 7 in the last 10 years.

It is important for you to see a urologist who specializes in the ACtive Surveilance protocol, preferably at a major institution of excellence, who has the t3 mri and a three dimensional biopsy machine ,  to obtain an opinion before enrolling in an active surveillance protocol. Currently there are four cores ound, although small in volume that was found in your porstate, which is high for AS,  , so you want to speak with an expert medical professional to see if you qualify to investigate active surveillance as a treatment.

Apparently the urologist who did the biopsy recommends active treatment. You may ask for his opinion on going back to the cores that were cancerous to see how extensive, but 5 out of 14 is a large number, and active surveillance may be in the cards

As far as surgery I am not an advocate of surgery because the great side effects of which ED is a potential issue..

If I were to do surgery there is a doctor tewari in NYC who is the best of the best.  He developed a technique to minimize incontinence.

http://www.prostatecancercenternyc.com/robotic.html

http://www.mountsinai.org/profiles/ashutosh-tewari

I strongly suggest that you look into SBRT aka cyberknife, novalis and other machines that deiliver SBRT. The side effects during thee administration which is done in 4 or 5 sessions depending on the preference of the radiation onchologist are mimimal, and you can go on with your daily life.

As far as sexuality, there will be a dry ejactulation, I believe.

Nine year study of procedure listing cure rates and side effects

http://www.prostatecancercenternyc.com/robotic.html

I dont want my prostate back, period. It was ruining my life, not to mention the threat of cancer. I wish I could give that guy my prostate. He would run screaming to the surgeon "Get this accursed thing out of me and good riddance!" .