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New to this and a little confused

Gitanesteel
Posts: 2
Joined: Mar 2021

I've been reading a lot of posts here and find myself getting more confused.  I'm 55 and was diagnosed with cancer on July 6.  My dad had his prostate removed in 2013 at age 72 and that was followed up with radiation about 6-7 months later.  My 54 yo brother was diagnosed with 3+3 cancer last year and is on active surveillance.  My PSA jumped this year from 3.5 to 7.5 and a biopsy was ordered after a DRE with the urologist.

Biopsy stated:

Left base:  Benign prostatic glands and stroma with some atrophy and increased chronic inflammation

Left mid: benign prostatic glands and stroma with some atrophy

Left apex:  Prostatic adenocarncinoma, Gleason 3+3, Grade group 1, tumor in 1 of 2 cores, longest length of of confluent tumor: 3mm, involves 9.3% of prostatic tissue

Right base: Prostatic adenocarncinoma, Gleason 3+4, Grade group 2, % of pattern 4 - 15%,  tumor in 1 of 2 cores, longest length of of confluent tumor: 2mm, involves 6.9% of prostatic tissue

Right mid:  Benign prostatic glands and stroma

Right apex:  Prostatic adenocarncinoma, Gleason 3+3, Grade group 1, tumor in 2 of 2 cores, longest length of of confluent tumor: 2mm, involves 16.7% of prostatic tissue

When diagnosed the second sentence by the local urologist was "I think we need to remove the prostate.".  This felt pretty rushed.  So, I scheduled a second opinion with my dad's doctor from the Seattle Cancer Care Alliance and Univ of Washington Medicine.  Had that consult today.  He stated survellance is a possibility but felt I would probably need surgery within 2 years.  He talked about a study of AS that he is involved with and roughly 50-60% of participants have needed surgery within 10 yrs.

He went through the options of radiation and surgery and side effects.  I'm quite active between cycling, weight lifting, my daughter's softball and taking care of my place so the radiation is frankly not very appealing.  Of course, the side effects of surgery, especially incontinence are a little bothersome.  The doctor didn't seem as concerned about long term incontinence because of my age and activity but I know there are no guarantees.

At this point I'm leaning toward surgery by the end of the year (from a timing perspective).  Wanted to throw it out here for discussion though as I'm hoping there are some here that were in the same age group and how you approached it.  What other questions should I ask of the doctor in Seattle?

VascodaGama's picture
VascodaGama
Posts: 3406
Joined: Nov 2010

Hi G, welcome to the board. 

From the info you share above (PSA, DRE, biopsy report) I would think that the Seattle CC's doctor is giving you a good advice with AS. However you still need to confirm that the cancer is contained. I recommend you to request a mpMRI before deciding on what to choose. 

In my opinion, the PSA level is consistent with the number, volume and Gleason rates of positive cores but it doesn’t mean that the case is contained. You should inquire about his judgment on a clinical stage. 

Surgery (RP) is recommended to contained cases but radiation (RT) can be the best option when one is not sure if cancer has spread. Radiotherapy covers the whole gland in addition to surrounding areas. Both therapies have attached side-effects being RP connected to erection dysfunction and incontinence. I think you should investigate deeper into the consequences of each treatment as it will prejudice the quality of life forever. AS is for me the best choice if one's status permits it. AS is not a postponement of therapy  as it involves a regimen of strict and periodical testing and exams, but it allows the patient to decide when to involve a radical. You should involve your wife in the decision process. 

PCa in the family could signify that your children (male and female) need to be more attentive to issues related to prostate and breast cancer, at early stages.

Best wishes and luck in this journey. 

VGama

Old Salt
Posts: 822
Joined: Aug 2014

For a cases like your, there are several radiation options other than 20+ sessions of IMRT. and I strongly advise that you consult specialists in the following areas:

Low-dose brachytherapy

High-dose brachytherapy

Stereotactic Body Radiation Therapy

These are just three of possible modalities and each has its own set of specialists (AND SIDE EFFECTS!).

It is not going to be easy or straightforward to decide, but you have time, so don't cut yourself short.

Max Former Hodg...
Posts: 3699
Joined: May 2012

Git,

Your doctor stating that you need surgery soon is seemingly odd, unless it is because he is factoring in the family history.  Certainly you should visit with a Radiation Oncologist and review options, including, as Old Salt mentioned, Brachytherapy ("seeding").  SBRT (Cyberknife) is another conveneint radiation modality to consider.  Of course, when PCa is contained wholly within the gland, surgery does work as well as anything, but your manner of proceeding shoud only occur after careful review of all options.  Nothing in your biopsy screamed "Emergency!"

Gitanesteel
Posts: 2
Joined: Mar 2021

I felt the doctor did a decent job of talking about the different types of radiation treatment as well as the surgery and what to expect.  I'm not sure why the first doctor was so quick to say I needed surgery.  He is doing a Prolaris test on the cores.

Thanks for the comments.  I'll send the Seattle doctor a few questions in the morning.  My wife really wanted to be on the call yesterday but was, unfortunately, in surgery at the time.  We have talked a fair amount about where things are at.

On a side note, my 52 yo brother had an appointment today with another urologist and some lumps were felt with the DRE.  Looks like he's heading toward a biopsy too.  Definitely a family thing.

Clevelandguy
Posts: 704
Joined: Jun 2015

Hi,

Sounds like your doing the right thing by evaluating all your options.  All the treatment modes have side effects and those side effects vary widely from person to person.  I feel the big thing is that you are comfortable with your choice because once you choose there is no turning back so take your time.  Good comments from the folks above. Good luck to you and your brother.

Dave 3+4

lighterwood67's picture
lighterwood67
Posts: 300
Joined: Feb 2018

On the lighter side, you are certainly fortunate to have folks around you that have had to deal with PC and you have time.  You are doing your homework.  I had a RP in March of 2018.  I am fully continent; I am intimate with my wife;  most importantly my cancer is in remission (no detectable PSA in over 3 years now).  The decision you make is your decision based on the facts you are presented.  So, good luck to you.  Please keep quality of life in front of you.  Please read my surgical report, if you like (this will give you a reference as to what happened to me).  If you elect surgery, make sure you get a copy of the post surgery biopsy report (I also posted that report on this site).  In my opinion AS was not for me (gleason 4+3=7).  Surgery is a tough road, but can lead to cure.  Just reading, radiation can also be a tough road, but also can lead to cure.  In a lot of cases, the side effects issues will drive curative decisions.  Good luck on your journey.  Hopefully, the folks on this site will clear up some of the confusion.

ASAdvocate
Posts: 162
Joined: Apr 2017

I question that doctor's statement about 50-60m percent of AS men needing treatment with ten years.

Johns Hopkins and MSKCC have two of the longest running most successful AS programs. In my group at Johns Hopkins, we have 1,800 men enrolled, starting in 1995.

After fifteen years, over fifty percent of our men have not needed treatment. Of those who dropped out, many did not have an upgrade of their cancer, but rather decided to have treatment for emotional reasons.

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