Treatment or No Treatment?

barryw

I have a PSA of 6.4 and had a biopsy with a Gleason Score of 7 (3+4) with 4 of 6 samples positive and on the other side a score of 6 (3+3) with 2 of 6 samples positive. My DRE was negative and I have been scored as T!C stage.(moderately aggresive) It has been suggested that I have surgery, however, I am not impressed by the side-effects, thus I am not sure if I should just do nothing or have the surgery. I do not feel sick, and have never had surgery before thus I it is a very hard decision. Any suggestions????? Barry W

yankeefan

you didn't say how old you are....

I was recently diagnosed with pc, a gleason score of 7 in only one of 13 cores. My urologist advised against doing nothing, i.e. active waiting. He went over the options with me: surgery, radiation, hormone treatments, though he pretty much focused on either surgery or radiation for my situation. He was pretty sure that my cancer had been detected early enough that it would be confined to the prostate. Thankfully he was right about that. I would guess that your urologist, given your biopsy report, would also advise against doing nothing. I am 68. Assuming you are no older than that, doing nothing is unwise. Your urologist should give you the names of some other urologists/radiologists to talk to to get second opinions. Assuming you're no older than I, you have too long to live, assuming you are in good shape with no other underlying health problems, to do nothing.

No one chooses to get this disease; but the other doctors/urologists I spoke to confirmed my urologist's recommendations. While it is important to be aware of the potential side effects of both radiation and/or surgery, it is not a given that they will all effect you. I elected to have surgery so I know more about that than radiation. I will tell you that everyone I spoke to emphasized that the out come of the surgery will depend in a very large part on the skill, or lack thereof, of the surgeon. So, if you should ultimately elect surgery, you should do your homework and choose one with an excellent track record/reputation. You want a surgeon who has done literally thousands of these operations...you certainly don't want anyone who has done less than a few hundred. 

I know people who have had surgery and have little or no bad side effects, i.e. no incontinence, no ED. I also know folks who have suffered from both, especially those who had this surgery quite awhile ago, i.e. before modern nerve sparing techniques became the norm. So there are no givens. My sense is if you are in good shape other wise and you get a good surgeon you will probably not have to worry about incontinence (again, there's that 3 % that have it and if you are one of them it's a big problem). If you are relatively young and have good sexual abilities now, there is a good chance you will ulitimately recover that ability; especially if you have caught the cancer early on and you are a candidate for nerve sparing surgery. It's a good sign that your dre is negative.

The bottom line: if you do nothing (neither radiation, surgery, other treatment) you are going to regret it in 5-10 years, (If you think you will only live another 5-10 years anyway, then maybe doing nothing is ok for you.)

The biopsy showed you have cancer, you want to get rid of it before it matastisizses and spreads outside the prostate. The longer you ignore it, the more likely it is that will happen.

These are my comments, you may find there are others who say, "don't risk the side effects and just do nothing; you may live another 15 years anyway." If that's ok with you, than you can choose that path. I will tell you that all the urologists I spoke to told me I would have significant problems in 5-10 years if I did nothing. 

I remember getting the results on my biopsy...news no one wants to hear. Do your homework, talk to others, get all the info you can, and make your choice. My urinary condition is actually better now than before surgery....(I suffered from bph). I'm still waiting to see if I can recover from the ED...I'm only 7 weeks post surgery so it's too early to be sure of the ultimate outcome in that area....

.......best of luck, whatever your choice.....

barryw

age 54

My age is54

hopeful and optimistic

More information

Hi Barry,

I am sorry for your diagnosis, and the aggitation that you are feeling.

First, determining the Gleason scores are subjective. There is a difference between Pathologist in skill level. I strongly suggest that you have a second opinion by a world class pathologist that specializes in prostate cancer, so that you will not be under or over treated.

The highest Gleason score, which so far in your case the 3+4=7 is the score that is used for treatment decision. This score is low aggressive. At your age of 54 unless you have physical ailments that will limit your life expectence to 10 years or less, you will require active treatment, not active surveillance(unless another pathologist will reclassify the Gleason score), that is watch and wait.

You did not mention the involvement, that is the percent of each of the cores that were positive. This will  give an indication of the extent of the cancer.

Additionally what else is mentioned in the pathology report that may be relevant.

 

 

WORLD CLASS PATHOLOGISTS and Labs,  according to “the Primer on Prostate Cancer” which I keep in my desk and often refer to.

David Bostwick (Virginia) 800 214-6628

Francisco Civantos (FL) 305 325-5587

Jon Epstein (Maryland) 410 955-5043

David Grignon (Michigan) 313 745-2520

John McNeal(California) 650 725-5534

Jon Oppenheimer (Tennessee) 888 868-7522

Dianon Laboratories 800 328-2666

UroCor 800 411 1839

(UroCor and Dianon have recently merged into one company)

 

Barry, there is an other diagnostic test that is appropriate for you to see if the cancer has escaped the prostate (extracapsular extension), that will give an indication if the cancer is in one lobe or two, and will stage the cancer. This is an MRI with a powerful 3.0 Tesla. Mostly major institutions, centers of excellence have such equipment and skilled personnel to operate same.

By the way it is important for you to find the best, most experienced doctor that you can afford to handle your case and provide the active treatment of your choice, ie surgery or various forms of radiaiton, etc.

It is very important for you to do research, read, the net, books, attend local support groups; two international groups that have local chapter that you can attend are US TOO and Manto Man.

Let us know where you live, hopefully one of the members may be able to direct you to a doctor , hospital, local support group etc.