PSA5.2 , gleason 7 , 3 + 4 . T1C ,

Your friend's survival rates are high over the 20 year mark
STC

The info you posted about your friend is not sufficient to decide on a treatment. Gleason 7 (3+4) is of an intermediate risk in aggressivity but the volume of cancer is small judging from the biopsy results.
The chronology of PSAs, particularly the doubling time and the volume of the prostate gland, etc, are usually used to decide on the treatment. If the cancer is considered contained, both surgery and radiation have similar rates for success in cure. In case of metastasis, surgery is not recommended and radiation with adjuvant hormonal therapy is usually indicated. In cases similar to the status of your friend survival rates are high over the 20 year mark.

You should advice your friend about the side effects from treatment. Some are nasty and permanent, and some are of the type that one cannot live with it or without it. The choice also can influence the type of treatment. Just google “Treatment Side effects for Prostate Cancer”, to read details.

Wishing you both the best.
VGama

VascodaGama said:

STC
The info from the
STC
The info from the pathologist’s report is very positive for an indolent type of cancer. In my opinion all types of treatment would be successful in your friend’s case, and four months waiting is just fine. However, the agreement on the scheduled treatment should be flexible enough to allow for cancelation or changes of dates in case your friend decides for another treatment.
Do not rush.

Your friend may as well choose Watchful Waiting (AS) with the control of PSA (tests every two months for a period of six months) and check for PSA velocity and doubling time. If found that the cancer is aggressive he could then start the treatment which would add only two months on the schedule.

Meanwhile your friend could investigate about treatment choices, side effects, and places (facilities) where to get the treatment (surgeons for Davinci should have performed over 300 operations). He could also get second opinions from independent specialists in each type of treatment and consult about the "cramping pain", before committing.
I would advice you to read books on Pca to understand better its facts. I recommend A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh; which may help you understanding options and the treatments of surgery and radiation.

Hope my insight is of help.

VGama

3+4=7
is a moderately aggressive cancer, eventhough the amount of cancer found is very small....if your friend is relatively young, and has no other major physical problems, I think that Active Surveillance is not appropriate..what is the age of your friend?

Also historically I wonder what your friends PSA's have been .........what is the trend.

VascodaGama said:

The drop in PSA should have a meaning
STC


Surprising news but positive. I wonder what have your friend’s doctor commented in regards to the drop.
The difference of 40% down from 5.3 to 3.1 is big and it should be analyzed carefully. One possibility could be due to any supplement your friend start taking since your last post as you indicated (AHCC, etc). Some of those pills are known to include estrogen like compounds which act similarly to hormonal drugs, lowering the PSA fast.
There is also the possibility that the past PSA of May (5.3) have been “artificially” increased due to facts other than cancer. Sex the night before drawing blood or a hard stool or any manipulation in the prostate may cause an increase of the value of PSA.
You could ask your friend if he recalls the events he done at that time. Different values between different assays (different laboratories) exist but for small tolerances of 0.05. Rarely but sometimes guys report about laboratory "mistakes" with blood samples from different people.

His prostate size is normal (35ml) and the density (0.089) falls in the group of the less than 0.1 threshold to identify indolent type of cancer in normal sizes. Smaller volume prostates have less epithelial cells (cells that line the prostate gland) therefore producing less PSA. If the latest PSA was “masked” by the effect of a supplement, the density would be higher inducing a different diagnosis.

I see only one “baddy” in the diagnosis which is the Gleason grade 4. However, this grade is in very small quantity found as the secondary value in the score of 7, and in just one core out of 10 needles.

My opinion as a layman is that your friend DOES NOT NEED TO RUSH. The latest information (negative doubling=negative activity) is not of an aggressive cancer in need of the “soonest” intervention.
As commented in my above post. I would recommend you to get acquainted with the various types of treatments, their risks and side effects (nasty for 55 years olds), and that you get second opinions from different specialists. He could check again in three months where the PSA stands, and then decide for a treatment or AS.

Wishing you peace of mind.

VGama

my laymans opinion
Since your friend is 55, he is too young to do Active Surveillance long term. He needs to decide on a treatment. I believe that it is appropriate for him to take some time to seek the
"best" treatment for him, but not Active Surveillance.

I am not against Active Surveillance. I have been doing such for the the last 2 1/2 years. Even at my age of 68 I would seek treatment if my numbers were 3+4.

STC said:

He took AHCC only 500mg 1CAP
He took AHCC only 500mg 1CAP daily.
I think the negative doubling may caused by getting cure of his prostitis,(he took medicine for 2 months)

I don't know if the prostitis will affect his Gleason grade or not?

The gleason grade
measures the aggressive of the cancer that is found in the biopsy. The prostitis does not affect the gleason grade.

It is very important for your friend to get a second opinion of results found in the slides from an independent pathologist who specializes in this so that he is not under or over treated. There are only a dozen or specialist in the country. Boswick being one of them.

robert1 said:

Lot's of Options
Your friend has quite a few options. AS is difficult choice for those touched by the disease. A biopsy with more total cores (12-14) could yield the same results or turn up something not yet seen. Although this is typically a slow progressing disease, without treatment it will progress.

When looking at surgery, one of the top brass at a major cancer fighting organization told me not to consider a surgeon for open or robotic procedures that has less than 1000 under their belt. While the progress from procedure 250 to 2000 is less profound than that from 1-250, he felt it was very important for the trifecta (cure, continence and potency). The more expereinced surgeons will gladly tell you how many they have done and they should all be able to produce some staistical results. Look at these results very closely and question them.

As for Radio Therapy, he has over a half dozen options. External radiation (IGRT), Brachytherapy (seed implanation), Proton Beam Therapy (PBT), High Dose Rate Brachytherapy (seeds temporarily), CyberKnife (CK) and the combination of external raditaion and seeds. All have produced excellent results.

There is also freezing (Cryosurgery) and High Intensity Focused Untrasound (HIFU). These treatment options also have been effective and certainly have their place.

Your friend has time to study or have someone help him study. The information is there, so urge him to take total charge of this decision use his time wisely.

Please send our sincere best wishes,

robert1

STC; Get Second Opinions
STC

The medication for proctitis would not affect the Gleason grade. His treatment for proctitis is highly indicative as the cause of the decrease in PSA. Inflammation or infections are known to cause high variations in PSA serum.
This is a relief and I would take this value of PSA=3.1 as “real”. That also validates a density of 0.089 indicating a higher probability for an indolent type of cancer. For peace of mind you can check again on PSA in three months.

I still insist that your friend do not need to RUSH. Monograms indicate survival rates over the 20 year mark in identical cases. He should get acquainted with the various types of treatment, their RISKS AND SIDE EFFECTS, and procure for a doctor and facilities that he would be satisfied with.

Your friend’s Gleason score of 7 is at the “border” for yes/no AS option but the volume of cancer is relatively small. NCCN guidelines recommend AS to similar cases. Nevertheless, biopsies can miss cancerous "pockets" in the gland.
Surgery as suggested by his doctor can be successful at the proper “hands” too. A good book to check about the difference between surgery and radiotherapy is; a “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (second edition June 2007), himself a surgeon therefore biased through surgery. You can listen to an interview done with him here;
http://www.charlierose.com/view/interview/9016

Getting second opinions is proper and a “must do” thing. Surgeons will always recommend surgery and so do radiologists recommend radiotherapy. The final decision must be done by your friend (he will sign the agreement for such treatment), so that he should be confident on his choice.
You can investigate on the treatment team’s experience, by contacting the hospital/clinic and getting their CVs, and checking on the number of successes and failures. You can also talk with some of their patients.
If they reject to give you the information that means that they are not confident of their own job on prostate cancer cases.

A word on AHCC; this is a good anti-oxidant supplement for cancer patients as it protects/helps the immunologic system. However, some brands include other compounds in the mixture which are not recommended in the care of prostate cancer. Here is a comprehensive study done to the stuff;
http://www.ncbi.nlm.nih.gov/pubmed/20522448?dopt=Citation

Hope for the best.

VGama

Prostate cancer so young is very serious...
Hello, Please read: "My Journey for the newly diagnosed & Success!" This gives a good look at doctors giving my husband the advice of "Watchful Waiting" or "Active Surveillance". At first he had only ONE positive core out of 12. However, after they removed his prostate... his cancer was throughout his prostate. I am not confident in the core biopsies as a measure as to whether it is contained or throughout. His was also upgraded from a 6 to a 7 after the full biopsy of the organ. Good luck with your decision.

God's Blessings.

STC said:

Thanks to you all.
My friend
Thanks to you all.

My friend did PSA test again on yesterday,
again the result was 3.1.
However he decide to have a RP on the next week.

Thanks for the information
STC

I am glad to know that you have reached to a conclusion. RP will provide peace of mind and most probable a total cure to your friend.
I hope the surgery is eventless and that he recovers the soonest. I will appreciate your sharing with us details on the procedure.

Good luck to him and soothingness to you.
VG