New Member

Any more details on your case?
AT42

I would like to welcome you but you shouldn’t be here at such young age.
I am glad to know that you have been doing some researches and want to continue before any commitment. That is the best you can do at this time of your case.

Firstly let me inform you that in prostate cancer, a proper diagnosis will lead to better decisions and therefore to better treatments and outcomes.
Second opinions on anything are a must do thing and you should start by sending your biopsy samples to be rechecked at a reliable laboratory such as at Johns Hopkins or Bostwick Laboratories. You should include a copy of the pathologist report you will get from your doctor.

You will also need to get other tests which will ascertain the aggressivity of the cancer and its spread, if any. This includes tests from blood work (infections or inflammations, etc) as well as image studies, all done at outstanding clinics and by proper physicians. The image studies should be done with the latest MRI 3-tesla capabilities or higher. Traditional CT or MRI are not reliable to detect cancer when the PSA is low (lesser than 10).

It is common to read or listen about biased opinions particularly from physicians that will try to convince patients to choose their line of speciality (some for business purposes). Urologists will imply surgery; radiologists will imply radiation and oncologists hormonal treatments. The best answers are usually obtained from independent medical oncologists specialized in prostate cancer.
Getting several opinions may create confusion but one is better informed and will be assured of what to expect as an outcome.

NCCN guidelines recommend radical treatments to young patients. However, there are many aspects to be considered because one does not want to be cured but become handicapped at such young age. Quality of life should be of concern too.

There are many books on the subject and loads of information in the net. You should prepare a list of questions so that you can present them to the doctors you will be consulting. Here are ideas that may help you in preparing your case;
http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

Here are some books that will help you to understand about diagnosis, surgery and radiotherapy;
“A Primer on Prostate Cancer, The Empowered Patient’s Guide” by Dr. Stephen Strum and Donna Pogliano;
A “Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (second edition June 2007);
You can order newer or used copies from Amazon site.

At this link you have a complete compendium regarding Prostate Health and Cancer;
http://www.lef.org/protocols/prtcl-138.shtml

All treatments have risks and side effects that will affect your life style. You should be aware of them before committing to any type of treatment.
In any case, outcomes are usually better if one gets treated by specialized care givers at modern facilities.
You can inquire on the CVs of the team caring your case by contacting the hospital/institution where he works. You shouldn’t accept a physician or centre of care that would not give you the information on their practice and its results.

I hope you get good answers to your quest.

Be confident. You will knock down the bandit and live many many years to see your kids growing.

VGama

Only Considering Surgery?
From the way you couch your questions, it seems like you're just considering surgery. Is ths correct? If so, you need to reconsider.

You have a low grade early stage cancer which is amenable to treatment w/radiation with an equal likelihood of success and with much less risk of ED, incontinence and other side effects. Your cancer is also early enough that you really don't need to worry about cancer migration, nor should you need an MRT, CAT, bone scane or ultrasound in order to determine if the cancer has spread yet.

I'm a pretty outspoken opponent of using surgery to treat prostate cancer and, if you want the straight dope on the risks of surgery (not just what your urologist/surgeon tells you), then read this article, which was written by a doctor.

http://www.hifurx.com/prostate-cancer/prostate-cancer-after-effects/

Don't be surprised if the information provided differs dramatically from what your urologist/surgeon has told you. He's not necessarily "lying" to you but each specialist pushes his specialty and is naturally inclined (biased?) to minimize the risks and accentuate the benefits of the methods s/he uses.

With surgery, it's always crap shoot. Lots of guys here have reported no problems and only limited disability caused by ED and incontinence. On the other hand, there are lots of other guys who have told us some real horror stories of long term and incurable ED and incontinence which required the use of penile implants and artificial urinary sphincters, which sometimes caused even more problems.

BTW, there was a recent thread which reported and commented on the experience of a doctor who chose surgery for his prostate cancer but "if he had to do it over again" would have gone w/active surveillance instead -- which is obviously a choice available to you too. See: http://csn.cancer.org/node/236334. Here's what the doctor/patient had to say in conclusion:

"Where am I now on the PSA dilemma in light of the recent US Preventive Services Task Force recommendations? It is clear that prostatectomy results in a very high chance of 20-year prostate cancer–specific survival, but even when the procedure is performed by an expert urologist, it can also result in significant rates of sexual, bladder, and bowel dysfunction and other less common adverse effects, such as my weakness. Active surveillance with longitudinal PSA tests and physical examination is associated with very low rates of bowel, bladder, and sexual dysfunction and has a high probability of correctly identifying when to move from surveillance to treatment.

If I could do it all over again, I would not undergo the surgery; instead, I would opt for active surveillance. Even the most informed patient (me in this case) has difficulty making a truly informed decision."

If you aren't comfortable w/the idea of "doing nothing", the obvious other choice is radiation and, if you choose radiation, there should be no need to be out of work for 8-10 weeks as you would for surgery.

The best of the currently available methods of radiation treatment for early stage cancer patients is CyberKnife. It offers the most advanced and precise method of radiation delivery which accounts for both organ and body movement during treatment with minimal side effects. Treatment only takes 4-5 days outpatient treatment and no need to lose time from work. I and a number of members here have received this treatment with good results. Low Dose Rate Brachytherapy is often recommended for men w/early stage PCa, but I'm not a big fan of it because of the imprecision involved in the use of seeds. If you go w/BT, the better method is High Dose Rate BT which involved the temporary placement of strings of seeds that are removed after treatment. I believe that down time for HDR BT is just a couple of days in the hospital and maybe a total week of recovery time. Proton Beam Therapy is also a good method of treatment but it requires 28-40 daily treatments and you have to live or move near to a treatment center. So, that might not work for you.

In any event, I suggest you check out all of these alternate methods of treatment and compare them with the risks/benefits of surgery and, if you do, I think you'll conclude (as other here already have) that surgery is NOT necessarily the best way to proceed.

Good luck!

Thoughts on Considering Surgery
I am 6 weeks post robotic prostatectomy, after being diagnosed in July with early stage low-grade PCa (mid-50s, PSA 5.3, 1 core positive <5%, Gleason 3+3). Wrestled with active survelliance, but research and consults led me to the decision to proceed with surgical treatment.

Not an easy decision, but am glad to be moving proceeding thru the stages of recovery (1st post-op PSA test is this coming week).

Advice to those considering the decision of surgery
-Do research (Walsh, Scardino, McHugh books)
-Gain insight of individuals through a Protate Cancer Support Group
-Interview surgeons, finding someone you are confident in, who specializes in this procedure, and has a reputation as being "one of the best"

Although each procedure is unique, if one has a skilled surgeon, it is possible to be fortunate to have a quick recovery with minimal side effects. In my case, I was able to return to the office part time after 3 weeks, and full time after 4 weeks.

Some perspective from long ago
Twenty years ago, at the then age of 65, I faced what you are up against today. I chose surgery over radiation and watchful waiting. With limited knowledge about treatment options and after very little research, I chose surgery because I wanted to get the cancer out of my body. The cancer came back after 13 years. Subsequently, I under went radiation, and then went on hormone therapy. My cancer, though still with me, has been in remission for nearly four years. I am satisfied with the decisions my urologists and I have made. Of course I have coped with side effects but I have experienced very little discomfort or pain. I have lived, and continue to enjoy, a good life.

Entering this journey at the age of 42 will be very different than what I have experienced. I had already retired, so I did not need to be concerned with earning a living. My children had grown up and their children were on the road to growing up. Also, Medicare was there for me.

My advice to you: study your options thoroughly, get good medical advice, and then go in the direction in which you feel most comfortable.

I wish you and your family the best of luck.

Jerry

PCa_at_42 said:

Update
Thank you all for the information and support. Sorry for any confusion with the 2.x and 3.x regarding the follow up PSA scores. The scores were 2.something and 3.something, i just couldn't remember what the decimal places were. Also, I am in the Boston area and being treated at Beth Israel Deaconess.

I have since had the detailed follow up with my Urologist and read Dr. Walsh's Guide to Surviving Prostate Cancer (in addition to a number of other publications). I found Dr. Walsh's book to be the best source of information.

In the detailed follow up meeting with my Urologist, I learned the important details. My Gleason score is 6, the one positive biopsy showed 20% cancer (higher than I had hoped, but not high enough to send me into shock) and my stage is T2a. The chance that the cancer has spread rounds to zero so there is really no need for a bone scan, ultrasound, MRI or CT prior to treatment (and the risk of a false positive make the tests a bad idea). I will likely opt for surgery given my age and the stage of the cancer, most likely open rather than robotic. I feel better knowing that the surgeon will have me open and will have the ability to look at and feel everything before closing me back up. He also noted, based on his experience and how the gland felt on the DRE, that it would not surprise him if the Gleason score went up to a 7 when the prostate is evaluated post surgery.

I will be getting second opinions in the coming weeks, of both the pathology report as well as the course of treatment. I do plan to meet with a radiologist, another surgeon and a medical oncologist to get all of their views, however, unless I hear something radically different than what I have learned so far, I will likely be scheduling surgery sometime in the next 6 weeks. My surgeon did suggest that ED rates are higher than generally reported--regardless of the surgeon or method I chose--but that with injections and/or drugs, a very high percentage of men are able to have an active sex life.

I'm looking forward to being able to give you all a positive report after treatment. Of course, I'm sure I'll be looking for all of your guidance and encouragement many times between now and then.

Need to have a copy of all your medical records
it is the law, simply ask them to send to you....this is important to have as you see various docs, and ask questions of others, such as this site....be prepared.

This surgeon,

How did you come to him?

How many surgeries has he done?

Does he keep records of his outcomes

What are his outcomes

Remember you get only one chance at surgery and you want the best, there are no do overs.

I strongly suggest that you have an MRI with a spectroscopy to see if there is extracapular extension, or at the least a tesla 3.0 MRI.

PCa_at_42 said:

Update
Thank you all for the information and support. Sorry for any confusion with the 2.x and 3.x regarding the follow up PSA scores. The scores were 2.something and 3.something, i just couldn't remember what the decimal places were. Also, I am in the Boston area and being treated at Beth Israel Deaconess.

I have since had the detailed follow up with my Urologist and read Dr. Walsh's Guide to Surviving Prostate Cancer (in addition to a number of other publications). I found Dr. Walsh's book to be the best source of information.

In the detailed follow up meeting with my Urologist, I learned the important details. My Gleason score is 6, the one positive biopsy showed 20% cancer (higher than I had hoped, but not high enough to send me into shock) and my stage is T2a. The chance that the cancer has spread rounds to zero so there is really no need for a bone scan, ultrasound, MRI or CT prior to treatment (and the risk of a false positive make the tests a bad idea). I will likely opt for surgery given my age and the stage of the cancer, most likely open rather than robotic. I feel better knowing that the surgeon will have me open and will have the ability to look at and feel everything before closing me back up. He also noted, based on his experience and how the gland felt on the DRE, that it would not surprise him if the Gleason score went up to a 7 when the prostate is evaluated post surgery.

I will be getting second opinions in the coming weeks, of both the pathology report as well as the course of treatment. I do plan to meet with a radiologist, another surgeon and a medical oncologist to get all of their views, however, unless I hear something radically different than what I have learned so far, I will likely be scheduling surgery sometime in the next 6 weeks. My surgeon did suggest that ED rates are higher than generally reported--regardless of the surgeon or method I chose--but that with injections and/or drugs, a very high percentage of men are able to have an active sex life.

I'm looking forward to being able to give you all a positive report after treatment. Of course, I'm sure I'll be looking for all of your guidance and encouragement many times between now and then.

Thanks for providing back
Thanks for providing back your recent stats and discussion about your visit with the Doctor.

Wishing you the best as you continue on this journey.

Lewvino