Less than a week after diagnosis - which treatment is best???

ProfWagstaff said:

Sorry to hear that your
Sorry to hear that your husband has been diagnosed with PCa. You've come to the right place for information. As any urologist will tell you, the real experts on PCa are the guys who've gone through it.

Your question has no easy answer. As you've already found out, there is a wealth of treatment options available. The reason for that is that most of them work - especially in early stage cancer. The hard part is finding what is the best choice for this particular case. You and your husband will be the ones to determine that. You've taken the best possible first step. You'll hear feedback from many great people here with info about many treatment choices. Listen to them all and do all the research you can. Gleason 6 gives you some time to make a decision, but it's not license to keep putting off action indefinitely.

In my case, I was stage 2 with a gleason of 4+3=7. I opted for the robotic surgery. There are 2 ways to do the surgery - open the abdomen (done by hand) and robotic (done with about 5 or 6 keyhole incisions). My urologist had performed 1800 robotic surgeries when he did mine and I have no regrets. The robotic gets you out of the hospital sooner, you heal faster and lose less blood than open surgery. Key to success with robotic surgery is to find someone who has done at least 1000 of 'em.

Others will weigh in on the pluses of the treatment options they chose. The best choice is always what works best for you.

VascodaGama said:

Do not Rush
Dafuston

I am not surprised to read your comment on the choices on treatment given to your husband by his urologist. The three proposed treatments are all surgery related, even if seeds are radioactive. However, other choices exist and I would recommend you to research deeply before any commitment. Nothing is indicative of a need to rush.

A missing but important piece of data on your husband’s diagnosis is a chronology of his PSA. The volume of cancer found in the one core positive can also help in getting a better opinion.
Gleason grade of 3 and score of 6 is of a low aggressivity type and that of low risk case. One core positive out of twelve is also indicative of cancer in its initial status. The term “contained” from the pathologist report is again for a low probability of recurrence.

At first glance, any treatment would do well in your husband’s case (surgery or radiotherapy). In fact he might be recommended for active surveillance (AS) which it would mean no treatment at all but a controlled type of management, leading to a treatment in the future in case his status would worsen. No treatment is equal to no risky side effects.
NCCN recommends AS for similar cases of your husband. You can read details on this site;
http://www.medscape.com/viewarticle/715129

Here is the NCCN Clinical Practice Guidelines in Oncology;
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp


Your husband will do well and guys in this forum can help you understanding the steps to follow. The important is to get educated and be focus on the problem.
You can research in the net by typing “treatments for prostate cancer”, and you can read past threads in this forum by typing the name of each treatment. You can also get some books to read details about the diagnosis, treatments and their side effects.

Here is an excellent book written by a famous urologist specialist on PCa;
A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (second edition is better; June 2007); which may help you understanding options between surgery and radiation.
Here is a video on Dr. Walsh interview (the author of the above book);
http://www.charlierose.com/view/interview/9016

I was 50 years old when I was diagnosed with prostate cancer back in 2000. I had a low Gleason score of 2+3=5 (now regarded as 6 since recommendations by NCCN in 2005) and decided on open radical prostatectomy (surgery). My PSA was very high at 22.4.
This is eleven years living as a “survivor”. One should consider that we may be similar but not equal; and that one same treatment does not fit all.

Wishing peace of mind to both of you.

Welcome to the board.
VGama

Kongo said:

Many Options
Sorry to hear of your husband's diagnosis. The good news in this story is that, as you point out, it seems to have been detected early and he appears (from the brief details you shared) that he has a low risk diagnosis. And to answer the question posed in your post -- there is no single best treatment. Every single diagnosis is different. Every man is different. We all have individual priorities about quality of life, the importance of different things, and how risk adverse we are. One thing you will learn as you go forward is that there are never any easy answers in dealing with this disease.

A couple of your thoughts took me back a bit...what did you mean that "they" gave you three choices that included cryosurgery, brachytherapy (seeds), or RP. Was this the diagnosing urologist or was it your insurance company that limited you to only these three choices? If it was your urologist, I strongly suggest that you seek second opinions immediately. In the United States diagnosing urologists are required to inform patients of the full range of government approved treatment protocols and there are a lot more than three of them. Also, I have never heard of cryosurgery being recommended for a man as young as your husband with such a low risk diagnosis.

I realize you are very early on in the post diagnosis process and still going through a wide range of emotions that include fear, denial, anger, confusion, and on and on. The best way, in my opinion, to get past this stage is to educate yourself and become an empowered patient. You have many, many choices of treatment at this stage but until you learn this information on your own you are at risk of being led toward a treatment that may not be best for you and your husband, despite how nice the doctor may be.

A great place to start your education is right here in this forum. Please take the time to read back through several pages of postings to see what men faced with the same decisions as your husband have done to combat this disease. You should also seek second opinions (and third or fourth or more opinions) so that you get a full appreciation of all the options open to your husband and the advantages and disadvantages of each. You may be surprised to learn that there is very broad and strong disagreement among the professional community about how to treat the different stages of prostate cancer. They all can't be right and they all can't be wrong but somewhere in the mix is what is right for you.

Besides the three treatments your doctor gave you, you also have the option to do Active Surveillance which at this stage of your husband's cancer may be a prudent move. Besides brachytherapy, there are a variety of modern external radiation techniques that include IMRT, SBRT, IGRT, proton treatment, and HDR Brachy. You have the choice of "open" radical prostatectomy or robotic (DaVinci). There are various types of hormone treatments, orchiectomy, and all of these are just what is approved within the USA. If you're willing to pay out of pocket and go offshore there are other options and some men swear by them. At least one poster in this forum favors the strawberry milkshake diet and asparagus. i'm sure I have overlooked some options but I think you get the idea. You have a lot of choices.

As you start your journey, I suggest that you get complete records of your husband's last several physicals so you can track the PSA trend, a copy of the biopsy report, referring notes between your primary care physician and the urologist, and anything else that might come into play...like a detailed list of all medications and so forth that you will need when you consult with other doctors. You should start a notebook where you keep all this information as well as notes from doctor visits and lists of questions you will want to ask different specialists. You should also get a second opinion on your husband's biopsy slides and your doctor's office can explain to you how to do this. When your husband visits different specialists it is good if you go along as well since he will forget some things that you may remember. Ask the doctor if you can record the conversation so you can refer to it later.

You also need to consult with your insurance company to learn what they will and will not cover. Large HMOs like Kaiser tend to offer fewer options than some others.

If your husband is veteran there may be a host of additional coverage options.

You should do a little internet research and learn how to calculate your husband's PSA doubling time, his PSA velocity, and the PSA density. You have all the information you need to do this in his medical records.

Shortly after my diagnosis I went to Amazon and downloaded just about every book they had on prostate cancer and did a crash course. 18 months ago I couldn't spell PSA and barely knew where my prostate was. I am a lot more educated now.

It would be helpful if you could post whether or not there is a history of PCa or breast cancer in you husband's family, what his PSA history is, and the results of the DRE.

It is great that you are involved. This is truly a couple's disease and it will profoundly affect both of you and he will need your emotional support. Prostate cancer affects the center of his sexuality and he may have many fears he is unwilling to articulate at this early stage. Prostate cancer and its treatments can have profound and permanent effects on continence, virility, erectile function, and emotion.

You should encourage your husband to also join this forum. You can always relay information to him but he needs to take ownership of this disease.

Best of luck to both of you.

K

p.s. I was diagnosed in March of last year with a similar pathology: PSA = 4.3, Gleason 3+3, 1 of 12 cells showed PCa, contained in the prostate, no family history, and a normal DRE. After much research I chose to have a SBRT radiation treatment (fully covered by my insurance) known as Cyberknife. Upshot is that 14 months after treatment my PSA is below 1, there is no evidence of cancer, and I have had no side effects whatsoever.

Kongo said:

Cryosurgery
I am not an expert on cryosurgery but essentially it is a process where super cooled probes are inserted into the prostate and they freeze and thaw the cells which kills the prostate cancer. It also kills the other cells as well. Cryosurgery is not a common procedure and runs a much higher risk of incontinence and complete erectile dysfunction than other treatments. There are some new advances that have occurred and you should check it out with someone who specializes in this treatment. Just make sure you fully understand the potential side effects.

My thoughts was that given your husband's relatively low risk diagnosis, I could not grasp why your doctor would recommend a procedure that carries such a risk of adverse side effects on a man as young as your husband.

Your doctor's recommendations seemed to come right out of a 1990 play book. Is he an older physician by chance? When and where did he get his degree?

You may be interested to know that prostate cancer is BIG business. For men over 50, nearly 25% who have biopsies will show some evidence of prostate cancer. The PSA history you described doesn't seem unusually high and I wonder why a biopsy was done. Doctors make a lot of money on biopsies and then of course, they can count on 25% of them needing follow on treatment which is another business development opportunity. More and more younger men are being diagnosed with prostate cancer but I suspect that is because we're testing more of them not that there is an epidemic of prostate cancer sweeping America. Although the studies I have read indicate a strong correlation between the typical American diet and prostate cancer. Men who have high dairy intake and eat a lot of red meat are more prone to prostate cancer. (Breast cancer too, incidentally). In Western nations about 1 in 6 men will be diagnosed with prostate cancer. In Asian nations with a much lower intake of meat and virtually no dairy, the incidence of prostate cancer is about 1 in 100,000. Asians who immigrate and adopt Western diets have the same rates of PCa as the rest of us. You can see the obvious link here and if you're interested, I would recommend you get a copy of The China Study for more detailed information.

Good luck in your research.

lewvino said:

I work in Chattanooga, Tn
I work in Chattanooga, Tn (live in Cleveland Tn) Not in the medical field though my wife is an RN in Labor and Delivery.

After MUCH search and talking to numerous Doctors I selected Dr. Smith at Vanderbilt in Nashville, Tn. He is head of the Urology department. He will do Open or Davince procedure. It was performed Aug. 2009, PSA 5.3 Gleason 7 (4+3). I used a total of 1 pad the day the Catheter came out and that was that. Very lucky with total urinary control. On the ED front again very lucky. Dr. Smith starts patients on Levitra a few weeks after surgery as a low doze and builds the doseage. At about 3 months post surgery things worked! At two years now working great using Levitra about 1 time per week.

Not sure how much detail you are wanting but the patient and the skill of surgeon will deterime outcome of surgery. There are two nerve bundles that go around the outside of the prostate. These nerve bundles control erections. The Surgeon has to remove this and save the bundles. In my case 100% were spared on one side and in Dr. Smiths opinion 60-70% of the nerve bundle spared on the other side. This was due to cancer being present in that area. So again I have been very happy with Dr. Smith's skill. If you happen to choose surgery you DO NOT WANT A DOCTOR that has done in the low hundreds,,,,Dr. Smith had done over 1,500 robotic two years ago.

Swingshiftworker said:

Not Just 3 Options!
Your husband's cancer is early and you have time to make choices.

Don't let the 3 options that your urologist gave you limit the choice you make. As others have already noted, there are many other options available including various forms of radiation (other than low dose rate brachytherapy -- ie, seeds or LDR BT), including cyberknife (CK), proton beam therapy and IMRT, HDR (high does rate) BT, surgery (open or robotic) or cryosurgery and HIFU (high intensity focused ultrasound). You can also choose to do nothing -- which is called "active surveillance" and is considered a "treatment" option too.

Take the time to read up on these options -- it's complicated and you need time to process all of them -- how they're different and most importantly the different side effects. Then choose the option that is best suited to your husband's needs/wishes and see if it's covered by your medical insurer or not. If not you may have to choose another option or pay for it out of pocket.

But, please don't go in thinking that you only have 3 options to choose from. That's simply not the case.

I was a member of the Kaiser Permanente group in Northern California when I was diagnosed and I was offered a choice only between surgery (open or robotic) and LDR BT. I didn't like those choices, did my research and chose CyberKnife (CK) radiosurgery -- a form of radiation treatment which would be suitable for your husband. CK was covered by Blue Shield of California. I was able to switch from Kaiser to Blue Shield to get CK treatment and did not have to accept the limited options offered to me by Kaiser.

You have other options too!