New Guy

fawnsbuck1

Hi all. I just found out yesterday. I have three choices for treatment. I don't know anyone that has gone through this. I would really like to talk to someone before I make my choice. I had 4 out of 12 with a g score of 6.

Samsungtech1

Treatment

Fawnsbuck1,

You do not give alot of info, but because of your low Gleason I would thinkcyber knife  or seeds.  Hard telling.  How many cores were positive?  Any spread outside prostate?  Alot of this info is really necessary for the moreknowledgeable people can help.  You need to put all your results, and results oftests for anyone to. Make a fair guess.  You should remember that we are not doctors, we are just people with prostate cancer, and at various stages of the disease.

Mike

Beau2

Samsungtech1 said:

Treatment

Fawnsbuck1,

You do not give alot of info, but because of your low Gleason I would thinkcyber knife  or seeds.  Hard telling.  How many cores were positive?  Any spread outside prostate?  Alot of this info is really necessary for the moreknowledgeable people can help.  You need to put all your results, and results oftests for anyone to. Make a fair guess.  You should remember that we are not doctors, we are just people with prostate cancer, and at various stages of the disease.

Mike

I agree with Samsung

I agree with Samsung and would add that at a G6 you probably do not have to be in a hurry to make a treatment decision.  I'd recommend that you consider getting a copy of Dr. Patrick Walshes book, "Guide to Surviving Prostate Cancer" and reading about treatment options.  

At a G6 you may want to consider Active Surviellence.

You may also want to consider sending your biopsy slides to another lab for a second opinion.

Please feel free to ask any questions you may have.

Best of luck!

Ps. Here is a link that is directed towards newly diagnosed PCa patients.  You may find it do use.

http://www.healingwell.com/community/default.aspx?f=35&m=2652250

fawnsbuck1

4 samples were positive out

4 samples were positive out of 12. I'm thinking about seed treatment. I think it is just in my prostate

Old-timer

Take time to learn

With a Gleeson score of 6, you should have plenty of time to learn what prostate cancer is all about and about your options. Watchful waiting could be a wise choice. Any treatment might cause more problems than it solves. Learn about those potential problems before you make a choice.

Best wishes to you.

Jerry

elpasorudy

I am not a big believer in

I am not a big believer in watchful waiting. I was diagnosed with prostate cancer in December of 2005. Gleanson score of a 6. Three tissue samples of 12 were positive for cancer. Two were suspicious. My doctors constantly reassured me that prostate cancer is normally slow growing. My urologist wanted to do the traditional surgery. I spent time looking for doctors that could do robotic or laparoscopic prostate surgery. Got a second opinion at the Moffitt Cancer Center in Tampa and decided to go with Dr. Pow-Sang, who had done thousands of the procedures. Had surgery in March of 2006. My feeling at the time was that I wanted the cancer out of my body. I was told radiation was not a good fit for me because my cancer was on both sides of the prostate. Surgery went fine. Pathology upgraded my Gleason score to a 3 + 4 = 7. They also discovered there was a cancer cell right on the margin, which increased my chances of the cancer returning by 10 percent. The good news is that I have been free of prostate cancer, with my PSA stll reading as undectable. I have side effects. Although nerve-sparing surgery was done, I suffer from erectile dysfunction. Viagara helps me. And I am slightly incontinent. In 2010, I needed bladder neck surgery. Scar tissue from the prostate surgery had started to close the bladder opening. That surgery increased the incontinence. It could be worse, so I'm not unhappy with my decision. If someone in your family had prostate cancer, that increases your risk of getting it by 50 percent. My father had his prostate cancer treated with radiation, and he was clear of the disease until he died at 88 from Alzheimer's Disease. My brother Greg had surgery; my brother Tom went with radioactive seeds. All are doing well. Greg has an incontinence issue. There are pluses and minuses with each treatment approach. The Healing Well site is good. There is a prostate cancer listserv whch is excellent, and another site in which individuals talk at length about their treatment and recovery (I will get you the web addresses). Would be happy to talk to you at any time. The good thing about prostate cancer is that it is curable if it has not spread.

fawnsbuck1

elpasorudy said:

I am not a big believer in

I am not a big believer in watchful waiting. I was diagnosed with prostate cancer in December of 2005. Gleanson score of a 6. Three tissue samples of 12 were positive for cancer. Two were suspicious. My doctors constantly reassured me that prostate cancer is normally slow growing. My urologist wanted to do the traditional surgery. I spent time looking for doctors that could do robotic or laparoscopic prostate surgery. Got a second opinion at the Moffitt Cancer Center in Tampa and decided to go with Dr. Pow-Sang, who had done thousands of the procedures. Had surgery in March of 2006. My feeling at the time was that I wanted the cancer out of my body. I was told radiation was not a good fit for me because my cancer was on both sides of the prostate. Surgery went fine. Pathology upgraded my Gleason score to a 3 + 4 = 7. They also discovered there was a cancer cell right on the margin, which increased my chances of the cancer returning by 10 percent. The good news is that I have been free of prostate cancer, with my PSA stll reading as undectable. I have side effects. Although nerve-sparing surgery was done, I suffer from erectile dysfunction. Viagara helps me. And I am slightly incontinent. In 2010, I needed bladder neck surgery. Scar tissue from the prostate surgery had started to close the bladder opening. That surgery increased the incontinence. It could be worse, so I'm not unhappy with my decision. If someone in your family had prostate cancer, that increases your risk of getting it by 50 percent. My father had his prostate cancer treated with radiation, and he was clear of the disease until he died at 88 from Alzheimer's Disease. My brother Greg had surgery; my brother Tom went with radioactive seeds. All are doing well. Greg has an incontinence issue. There are pluses and minuses with each treatment approach. The Healing Well site is good. There is a prostate cancer listserv whch is excellent, and another site in which individuals talk at length about their treatment and recovery (I will get you the web addresses). Would be happy to talk to you at any time. The good thing about prostate cancer is that it is curable if it has not spread.

elpasorudy

Thanks a lot. I too think I want to get treated after considering every option. I am leaning toward the seed treatment. My wife is concerned that if I get a seed treatment and later it doesn't work would I be able to do surgery? I am getting the three books by Dr Walsh. I'd like to talk. I don't know anyone that has gone through this. It's good to get support from family members but they can't answer my questions and I can't answer some of their's.

Beau2

fawnsbuck1 said:

elpasorudy

Thanks a lot. I too think I want to get treated after considering every option. I am leaning toward the seed treatment. My wife is concerned that if I get a seed treatment and later it doesn't work would I be able to do surgery? I am getting the three books by Dr Walsh. I'd like to talk. I don't know anyone that has gone through this. It's good to get support from family members but they can't answer my questions and I can't answer some of their's.

Seeds

It is my understanding that surgical removal of the prostate after brachy is a difficult surgery due to the radiation scaring; however, there are some surgeons who will attempt it.  It is also my understanding that there are other methods to address a recurrence if brachy fails, such as external beam radiation methods. You should ask your brachy doctor what he would recommend if you had a recurrence.

Speaking of external beam radiation, have you considered it for your primary treatment?  Many of the guys on this site have used it (i.e. Cyberknife) and swear by it.  Would your insurance cover it?

I am not too sure how many brachy (seeds) guys are on this site (I had surgery) so if you do not get one of them to speak up you may want to try the "www.healingwell.com" site and go to their prostate cancer discussion area.  It is a very active site with many brachy guys who could answer your questions.

hopeful and optimistic

Beau2 said:

Seeds

It is my understanding that surgical removal of the prostate after brachy is a difficult surgery due to the radiation scaring; however, there are some surgeons who will attempt it.  It is also my understanding that there are other methods to address a recurrence if brachy fails, such as external beam radiation methods. You should ask your brachy doctor what he would recommend if you had a recurrence.

Speaking of external beam radiation, have you considered it for your primary treatment?  Many of the guys on this site have used it (i.e. Cyberknife) and swear by it.  Would your insurance cover it?

I am not too sure how many brachy (seeds) guys are on this site (I had surgery) so if you do not get one of them to speak up you may want to try the "www.healingwell.com" site and go to their prostate cancer discussion area.  It is a very active site with many brachy guys who could answer your questions.

Active Surveillance and diagnostic tests

The genral guidelines for AS with low, low  level, that vary slightly by institution are less than two core with a 3+3+6 with less than 50 percent involvement of each core positive. A PSA less than 10, and a PSA to prostate size ratio less than 0.15. Various institutions such as Johns Hopkins are now extending the criteria for AS that include Gleason 3+4=7, etc for men 70 and over.

If you meet the above criteria for AS, I strongly recommend that you seek this treatment in order to avoid the potential side effects of active treatment which can be very major.

So that you are not under or over treated, I recommend that you have a second opinion on your biopsy by a world class pathologist that specializes in prostate cancer; and a 3.3 Tesla MRI to help identify extracapsular extension.

mrspjd

hopeful and optimistic said:

Active Surveillance and diagnostic tests

The genral guidelines for AS with low, low  level, that vary slightly by institution are less than two core with a 3+3+6 with less than 50 percent involvement of each core positive. A PSA less than 10, and a PSA to prostate size ratio less than 0.15. Various institutions such as Johns Hopkins are now extending the criteria for AS that include Gleason 3+4=7, etc for men 70 and over.

If you meet the above criteria for AS, I strongly recommend that you seek this treatment in order to avoid the potential side effects of active treatment which can be very major.

So that you are not under or over treated, I recommend that you have a second opinion on your biopsy by a world class pathologist that specializes in prostate cancer; and a 3.3 Tesla MRI to help identify extracapsular extension.

Cart before the horse

Fb,

If you're considering a tx decision only 4 days after receiving a PCa dx, then, with all due respect, you need to slow down...WAY DOWN! You're putting the cart before the horse. 

I wonder: What is your PCa clinical risk level & Tumor stage? Do you have copies of your biopsy (Bx) report & recent medical records? What is the % of cancer in each of the 4 positive cores?Are any imaging tests indicated to confirm risk/tumor stage? Have you sent your Bx core specimens to a nationally recognized pathology (path) lab to have them analyzed by an expert PCa pathologist?  Have you obtained 2nd & 3rd opinions from a range of specialists, including a PCa oncologist? Without the answers to these & other questions or add'l info about your PCa, anyone (doctors included) who recommends this or that type of PCa tx is, IMO, unintentionally doing you a disservice. 

 

Whether you choose to share your add'l PCa info or not on this forum is entirely up to you. The important thing is for YOU to understand the info/answers and how they may factor into YOUR PCa risk level, tumor stage and tx decision process. Evaluating PCa txs & making tx decisions without this critical info puts you at a dangerous disadvantage. It's like walking across a busy highway, eyes closed, ears covered & "hoping" to make it to the other side safely.  Both scenarios can have serious consequences and be life changing. 

 

There are more than 3 tx options for PCa. Often the diagnosing urologist or PCP describes the tx choices that he or his medical colleague referrals are familiar with or that are available in an HMO. This happened to us. We had to look outside our then HMO to discover other viable tx options than the few being offered by the HMO. There are various forms & combinations of RP, RT, ADT (hormones), and an Active Surveillance/Monitoring option for very low risk PCa patients whose risk profile fits an AS/M protocol. 

 

You are your own best medical advocate when it comes to your PCa tx & care. It is to your medical advantage to learn & understand as much info as possible about this disease before you make any decisions. This PCa education process takes more time than 4 days and requires action (active research/reading); hence the advice to "slow down."  It took us almost 3 months of researching 24/7 before we felt we had enough info to make an informed tx decision. 

 

I suggest you check out the info @ following link to find an established face2face PCa networking group in your area and attend the next meeting with your wife:

http://www.ustoo.org/Chapter_NearYou.asp?country1=United%20States

 

Hope you find the info & answers you need. Best of luck. 

 

ob66

Listen to mrs pjd

Fawnsbuck1:

It is so important for you to have a ptiy party, along with the gathering of data. Study, study, study. Question everything. This is your life. You are it's best advocate.

Do no rush, but at the same time do not procrastinate too long. Those of us who have been there know the impact of "that news". I know it put me in a "dead man walking" funk for days. Then it was time to move on and do something about my problem. I was lucky enough to also have a great co-partner (as in wife) like mrs pjd. She attacked the problem with more energy than me, and I am no pussycat.

Read, read, read. Ask questions here, and of all your health practioners. Get answers that are pertinent to you. As time goes on you can compartmentalize your PCa, but right now it must be the focus of all your thoughts. There are tons of good people who are also good resources here. Do not be shy. I personally have been through daVinci Sx, Rad Rx, HT, and have an AUS to boot. In addition, I challenge you to study diet and excercise with regards to PCa, so you can make decisions there if you so desire. Asian and Med diets are particularly good. UCSF has good recommendations on same.

Ask away, and good luck,

Bob

elpasorudy

Advocate for yourself

Here are a couple of excellent sites: "You Are Not Alone" (yananow.org, excellent first hand stories divided by treatment options), Phoenix 5 (phoenix5.org), a wealth of information and long list of web sites related to prostate cancer ... I spent two months researching the pros and cons of the different types of treatment. Talked to seven doctors and got second opinions at the Cleveland Clinic and Moffitt Cancer Center. Advocate strongly for yourself, research thoroughly. When I went to the Cleveland Clinic, the doctor there said he would not do robotic or laparoscopic surgery becuase of my weight (250, 5'11'' tall). But I found plenty of doctors who said I was a good candidate for the procedures. Moffitt did the laparoscopic surgery.

fawnsbuck1

mrspjd said:

Cart before the horse

Fb,

If you're considering a tx decision only 4 days after receiving a PCa dx, then, with all due respect, you need to slow down...WAY DOWN! You're putting the cart before the horse. 

I wonder: What is your PCa clinical risk level & Tumor stage? Do you have copies of your biopsy (Bx) report & recent medical records? What is the % of cancer in each of the 4 positive cores?Are any imaging tests indicated to confirm risk/tumor stage? Have you sent your Bx core specimens to a nationally recognized pathology (path) lab to have them analyzed by an expert PCa pathologist?  Have you obtained 2nd & 3rd opinions from a range of specialists, including a PCa oncologist? Without the answers to these & other questions or add'l info about your PCa, anyone (doctors included) who recommends this or that type of PCa tx is, IMO, unintentionally doing you a disservice. 

 

Whether you choose to share your add'l PCa info or not on this forum is entirely up to you. The important thing is for YOU to understand the info/answers and how they may factor into YOUR PCa risk level, tumor stage and tx decision process. Evaluating PCa txs & making tx decisions without this critical info puts you at a dangerous disadvantage. It's like walking across a busy highway, eyes closed, ears covered & "hoping" to make it to the other side safely.  Both scenarios can have serious consequences and be life changing. 

 

There are more than 3 tx options for PCa. Often the diagnosing urologist or PCP describes the tx choices that he or his medical colleague referrals are familiar with or that are available in an HMO. This happened to us. We had to look outside our then HMO to discover other viable tx options than the few being offered by the HMO. There are various forms & combinations of RP, RT, ADT (hormones), and an Active Surveillance/Monitoring option for very low risk PCa patients whose risk profile fits an AS/M protocol. 

 

You are your own best medical advocate when it comes to your PCa tx & care. It is to your medical advantage to learn & understand as much info as possible about this disease before you make any decisions. This PCa education process takes more time than 4 days and requires action (active research/reading); hence the advice to "slow down."  It took us almost 3 months of researching 24/7 before we felt we had enough info to make an informed tx decision. 

 

I suggest you check out the info @ following link to find an established face2face PCa networking group in your area and attend the next meeting with your wife:

http://www.ustoo.org/Chapter_NearYou.asp?country1=United%20States

 

Hope you find the info & answers you need. Best of luck. 

 

Learning

My wife and I have started gethering books and info. I had my labs one at bostwick. I am going to get a second opinion for treatment. My % of the four core samples are 5.15,10,5. I don't plan on waiting and watching but I do plan on learning about everything, talking to everyone I can. I've looked into joining a support group and have talked to a few guys from them. My library is going to have to make a shelf just for me to put all the books I have reserved. I know I'm not buying a car. I'm sure it will be months before I decide which treatment is best for me. My urologist didn't mention cyberknife. I have another urologist in mind to talk to. Thanks, Tim

Kongo

mrspjd said:

Cart before the horse

Fb,

If you're considering a tx decision only 4 days after receiving a PCa dx, then, with all due respect, you need to slow down...WAY DOWN! You're putting the cart before the horse. 

I wonder: What is your PCa clinical risk level & Tumor stage? Do you have copies of your biopsy (Bx) report & recent medical records? What is the % of cancer in each of the 4 positive cores?Are any imaging tests indicated to confirm risk/tumor stage? Have you sent your Bx core specimens to a nationally recognized pathology (path) lab to have them analyzed by an expert PCa pathologist?  Have you obtained 2nd & 3rd opinions from a range of specialists, including a PCa oncologist? Without the answers to these & other questions or add'l info about your PCa, anyone (doctors included) who recommends this or that type of PCa tx is, IMO, unintentionally doing you a disservice. 

 

Whether you choose to share your add'l PCa info or not on this forum is entirely up to you. The important thing is for YOU to understand the info/answers and how they may factor into YOUR PCa risk level, tumor stage and tx decision process. Evaluating PCa txs & making tx decisions without this critical info puts you at a dangerous disadvantage. It's like walking across a busy highway, eyes closed, ears covered & "hoping" to make it to the other side safely.  Both scenarios can have serious consequences and be life changing. 

 

There are more than 3 tx options for PCa. Often the diagnosing urologist or PCP describes the tx choices that he or his medical colleague referrals are familiar with or that are available in an HMO. This happened to us. We had to look outside our then HMO to discover other viable tx options than the few being offered by the HMO. There are various forms & combinations of RP, RT, ADT (hormones), and an Active Surveillance/Monitoring option for very low risk PCa patients whose risk profile fits an AS/M protocol. 

 

You are your own best medical advocate when it comes to your PCa tx & care. It is to your medical advantage to learn & understand as much info as possible about this disease before you make any decisions. This PCa education process takes more time than 4 days and requires action (active research/reading); hence the advice to "slow down."  It took us almost 3 months of researching 24/7 before we felt we had enough info to make an informed tx decision. 

 

I suggest you check out the info @ following link to find an established face2face PCa networking group in your area and attend the next meeting with your wife:

http://www.ustoo.org/Chapter_NearYou.asp?country1=United%20States

 

Hope you find the info & answers you need. Best of luck. 

 

Good advice

Mrs PJD has given you great advice.  Slow down.  Learn.  Think about the impact of the different treatments on your quality of life.  I know that you want to start taking charge of this disease but you really need to learn a bit more about it first.  Best of luck to you.

 

K