HOW DO YOU CHOOSE!?!?

Sorry to read about your
Sorry to read about your father in law and yes its difficult to make the choice. As you have learned each specialist is going to usually recommend their area for treatment. I'm 57 had robotic procedure 29 months ago. Also gleason 7 3+4 and doing well so far.

Continue your research and weigh the options. Remember they all have the same goal and that is getting rid of the cancer. Your father in law will need to decide which possible side effects he can live with. I would state that if he goes with Robotic surgery to make sure and choose a doctor that has done large amounts of surgery with the robot. It has a very high learning curve. I chose a doctor that had done several 1000 surgeries with the robot and also a high number of the traditional surgery. I had originally decided to have proton treatments but then found out my insurance would not cover so also check into that factor.

My dad had the proton treatments and is over 13 years cancer free.

One advantage with surgery is you will know the extent of the cancer following surgery. With radiation you don't know for sure the gleason score, spread etc. They entire organ is sent to the lab and I found I had a positive margin post surgery. This means the cancer went to the very edge of the organ removed. The cancer might be beyond but so far no signs of recurrance.

An excellent book to read Is Dr. Patrick Walsh's guide to surviving prostate cancer. He is a surgeon but very nicely discusses options and all about the cancer in a patients perspective and easy to ready and understand.

The side effects can be urine control, leaking, loss of erections etc. And as you have mentioned If my cancer comes back I have a 'second option' of radiation followup.

Larry

Not really getting this...
I can certainly relate to how any cancer diagnosis can cause a significant amount of stress and emotion within a family, particularly in view of your mother’s bout with head and neck cancer. On the other hand, it’s very important that you and other family members who influence your FIL keep this in perspective. From what you wrote your father-in-law apparently has received an “intermediate” risk diagnosis of prostate cancer with the 3+4=7 diagnosis but it seems to just be barely in the intermediate range.

The overwhelming majority of men with similar diagnoses will not die from prostate cancer but from some other ailment, heart disease being the most common. And unless he is into skydiving without parachutes, bungee jumping, or running with scissors in his hands he is not going to die anytime soon. The median time to death after diagnosis for all men diagnosed with all stages of cancer is 17 years. Since the average age for diagnosis is in the 60s it’s pretty easy to see that men diagnosed with prostate cancer in their 60s have about the same life expectancy as men who aren’t diagnosed with prostate cancer. So, ease the stress level down a notch or two.
There are a couple of things that would make me wary…the palpable bumps felt by the urologist and the six prostate cores taken at his biopsy. My understanding is that most men get a needle biopsy that samples 12 cores not six but either way, the 3+4 is the sample that you want to keep an eye one and I recommend that your FIL have these slides read by a pathologist that specializes in prostate cancer such as the lab at Johns Hopkins. The urologist can explain to him how to do this or you can contact the lab at JHU and ask them.

One thing about your post is a bit surprising to me. Why is a daughter-in-law of a 60-year old man the one who seems to be obsessing on this, visiting the doctor, and being stressed out? Does your FIL have a mental deficiency that keeps him from doing his own research? What about his spouse? Is there a history of prostate cancer in his family? Why isn’t he on the forum asking these questions?

The reason I ask this, and I do not mean to be hurtful to you, is that although I have two wonderful daughter-in-laws that I love dearly, I never dreamed of involving them in my decision or engage them in a discussion about which might be worse: incontinence or ED? I realize all families are different but frankly, I think you may be doing more harm than good here and let me tell you why I think this way.

My own diagnosis at age 59 was a shock to me and upset my wife as well. When I told my children they were naturally upset. One of the treatments I was considering at the time was Active Surveillance and my close family who was only trying to help but KNEW ABSOLUTELY NOTHING ABOUT PROSTATE CANCER, kept harping on the CANCER word and didn’t understand AS. “You have to do SOMETHING, you have CANCER” was a sentiment I got often. While in retrospect I now appreciate their concern it didn’t help one bit in making a decision and in fact it made it worse.

The decisions your FIL must make are complicated and require a solid lay understanding of the nature of his cancer, what treatments are available, and what the potential impact of those treatments could mean to his quality of life. When I was considering options I made a matrix of the things that were important to me such as maintaining continence, not losing any length or girth with my penis, keeping a healthy sex life, a high likelihood of addressing the cancer, long term relationship with the doctor I would chose, convenience of treatment, recovery periods, out of pocket costs, and so forth. I then ranked each treatment that I considered within these personal priorities and they included open or robotic surgery, IMRT radiation, SBRT radiation, proton therapy, HIFU, Cyrotheapy, brachytherapy, HD brachytherapy, IGRT, and so forth. I met with six specialists that included surgeons, oncologists, and radiologists. I sought a candid assessment of potential side effects and the impact those would have on my quality of life priorities. I did all this before I made my decision. Having my family bug me about what I was going to do didn’t make this process easier although I understood where they were coming from.

As I learned more and more about my prostate cancer and my options I begin to find that it was difficult to discuss it with my family. I realized that they simply did not know what they were talking about. My wife came along to the consults but she did not do any of the additional research that I was doing so our knowledge level grew wider as I zeroed in on my choices.

This is a decision only your FIL can make. If he doesn’t make it he is taking a pass on one of the most important decisions in his life. You cannot make it for him unless you are his legal guardian and you shouldn’t want to put yourself in that position.
This is a couple’s disease not an extended family disease and the impact of continence, libido, and sex life is something that he and his wife should be discussing. If he is not married then he needs to figure out what his priorities are on his own and that makes it harder but at 60 there is no way he should be thinking about giving up on either sex or continence and there is no good reason he has to. And BTW the notion the surgeon put in your head that if he does radiation and it comes back he’s “screwed” is nonsense. You should discuss recurrence options with each of the doctors your meet with and make sure they adequately answer your questions.

Believe me I do appreciate the concern you must feel for your FIL, particularly after your mother’s experience but these cancers are completely different, are not related, and have entirely different treatment approaches because of the fundamental nature of the cancer cells. This is why your FIL needs to educate himself about his cancer so that he doesn’t end up making bad decisions based on faulty data.

I hope you continue to support your FIL but when it comes to talking to doctors or giving him advice I think you (and other family members other than a spouse or legal guardian) should put your lips together and press firmly. Of course if he is unable to make these decisions and does not have a spouse then the roles change and I wish you only the best as you go through this.

BTW, I eventually chose SBRT (CyberKnife) radiation for my Gleason 6 PCA diagnosed in March 2010 and treated in July of that year. I had zero side effects and am happy to report that I am fully continent and enjoy a robust and undiminished sex life but the details of such I will not address with my daughter in laws OR their husbands.
Best of luck to you.

K

bpell0402 said:

thank you everyone for your
thank you everyone for your comments and support.

Although i took no-offense to your comments kongo i would like to reply:

Firstly, the reason *I* am post here as opposed to my FIL is the fact that I have been posting on the head and neck cancer board for over a year now and have found this site to be an informative and supportive place. Just because HE is the one with the diagnosis does not leave me without the need to vent or ask questions. I learned very quickly from my mothers diagnosis how helpful it is to speak to others in similar situations as opposed to just listening to doctors and thought I would reach out to the community here.

I also am a physician assistant for many years, a surgical physician assistant. Since my medical background grants me more knowledge that my FIL, we have all found it very helpful for me to continue to research all areas of this diagnosis to help him make the best decision. I am able to communicate with doctors differently than they can, and ask questions that they don’t think to ask. I also can translate for them when the doctors forget who they are speaking too.

I also love my FIL as if he were my own and want to help provide him with all the information possible to make the best decision for him, and luckily with the diagnosis we have the time to continue to educate ourselves. You specially stated that your wife did not do as much research as you, and I am trying to avoid that in my family. We are all going to doctors appointments together and whatever I read, re-search etc is shared with everyone. Just because libido and urination are considered private matters, doesn’t mean that I am not concerned about his quality of life because I have seen firsthand what this diagnosis can do to people. Had I not suggested to my father in law that we seek another surgeon he would have decide to go to a surgeon who has been doing robotic surgery for 1 year! He didn’t realize that that would matter, but I certainly did!

I have no intention of making this decision for him. I was simply looking for some guidance, support, just a re-assuring “I understand it’s a hard decision” from others here. We are all struggling with the diagnosis and the decision and we continue to discuss things together as a family and support each other in different ways. This discussion board was the key to my sanity during my mothers diagnosis and I was looking for a similar experience here.

Understand
Thanks for clarifying the situation a bit more and I am sure yor FIL is quite lucky to have you help him something through the data and the differing opinions the specialists all seem to give. I do think it is important that men take ownership and responsibility foe their disease and one excellent way to start this, in my opinion, is to join a forum such as this and interact directly with other men who are going through the same thing he is so I do hope you encourage him to participate directly.

Best,

K