am I normal???

Hi everyone, I have been stressing about which treatment I should have. Ihave a 12 PSA and a 3+4=7 Gleason score. I met with a seed doctor and he recommended hormone, seed procedure, and follow up with external radiation. My Urologist wants to do the Devinci surgery. Any feed back regarding these would be helpful. For those who had surgery, what steps were taken? Thanks everyone...   

blues said:

Pending surgery

Hi everyone, I have been stressing about which treatment I should have. Ihave a 12 PSA and a 3+4=7 Gleason score. I met with a seed doctor and he recommended hormone, seed procedure, and follow up with external radiation. My Urologist wants to do the Devinci surgery. Any feed back regarding these would be helpful. For those who had surgery, what steps were taken? Thanks everyone...   

Blues,

It should not be a surprise that a brachytherapy specialist recommends seeds and that your urologist (a surgeon) recommends surgery.  I would hazard a wild guess that if you visited another radiation oncologist that you would get a recommendation that featured their particular specialty and there are lots of different types of radiation.  To me one of the most frustrating aspectsof dealing with this disease is that highly qualified, renowned experts in their field confidently recommend radically different approaches to treating the same disease.  It is left to the layman to figure out what is best for him and too often we end up going with the doctor we seem to like the most or worse yet, only follow the recommendations of a single physician.  

The only way out of this is to educate yourself and try to take the emotion out of your decision. I urge you to visit still more specialists, perhaps one who specializes in SBRT and one who does IMRT and proton therapy to get their takes.  In my own situation I visited with several (six) specialists before deciding on a treatment.  Some may recommend consulting with an oncologist that specializes in prostate cancer believing that oncologists are somehow unbiased and will give a better recommendation.  My own feelings on this is that by definition, oncologists treat cancer with chemicals (chemo and hormone therapy) and are not unbiased at all although I am sure it varies from doctor to doctor.  

I recommend that you begin reading extensively in between consulting visits.  You can go to Amazon and download or buy hard copy a host of excellent books about prostate cancer.  Tbis forum, if you read back through a couple of hundred posts or so, is also an excellent way to gather information from men who have actually experienced what you are going through.  Just keep in mind that these are lay opinions and not medical advice and that many men, even after treatment, have only a dim understanding of the nature and course of prostate cancer.

I am sure many posters will offer their best advice but you need to give us more information such as your age, your PSA history, DRE status, family history of prostate cancer, other health issues, and so forth.  Do you have any other symptoms such as difficulty urinating or pain in the abdomen?  Have you been diagnosed with any other ailments that could affect which treatment is best for you?

Keep in mind that every treatment carries some risk of adverse side effects.  Some side effects can be much more adverse than others and run the gamut from incontinence, erectile dysfunction, penile atrophy, hot flahes, weight gain, and even death.  Doctors tend to gloss over side effects so make sure you grill them about it.  Read some of the posts about how different men are dealing with side effects and how it affect their quality of life.  At the end of the day, only you can determine what priorities are important to you.  To me, quality of life was significantly more important than quantity of life.  We're all going to die sooner or later and while we all hope that is later, some may prefer to go out with a high quality rather than cling to a physically debilitating life style.

A Gleason 7 such as you have (a 3+4) is at the lower end of the "intermediate" threat scale.  That means you have a lot of viable options available to you that you should discuss with various specialists.  Many posters seem to have gum on their shoes with respect to putting all thier faith in studies and there have been many debates on aspects of various studies.  While I think studies are important, many physicians are using techniques and processes that aren't in a study and are working fine.  For example, most studies using SBRT want a cohort of men with Gleason 6 scores, but in fact radiologists all over the country are routinely treating Gleason 7 and higher scores successfully with SBRT techniques.  So I recommend paying attention to studies but also ask the doctors what they're doing in their actual practice and how that is working.

Insurance coverage is another aspect that most men have to deal with when deciding upon a treatment.  Not all health care plans cover all treatments.  Some health care providers, such as Kaiser and other HMOs actually have very limited choices.

I ended up making a matrix that compared effectiveness, cost, convenience, and side effects and racked and stacked the options to figure out what was really best for me.  And keep in mind that every cancer is different.  No 3+7 is the same and what may be good for one may not be the best choice for you.

Good luck and keep us posted on your progress.

Best,

K

blues said:

Pending surgery

Hi everyone, I have been stressing about which treatment I should have. Ihave a 12 PSA and a 3+4=7 Gleason score. I met with a seed doctor and he recommended hormone, seed procedure, and follow up with external radiation. My Urologist wants to do the Devinci surgery. Any feed back regarding these would be helpful. For those who had surgery, what steps were taken? Thanks everyone...   

In Sunday's newspaper magazine there is an article by Dr. Ranit Mishori "Breakthrough News In Prostate Cancer"
I was quite surprised at some comments in the article. . . "Many men are better not taking a PSA test". or
"But there's another way to look at the numbers. While a man has a 17% chance of getting the disease in his lifetime, he has onlya 3% chance of dying from it, according to the journal, American Family Physician". . .
My conclusion: I am part of the 17% and the debate continues!

P.S. I had radical prostatectomy (DaVinci Method) in 2009 at John Hopkins. Would I do it again? Absolutely not.

shubbysr (jim)

John,

While I am too young to retire, I would say I have very similar thoughts go through my mind.  When I get really busy and am LIVING, cancer is the furthest thing from my mind.  I do realize the saying, "Don't sweat the petty stuff and don't pet the sweaty stuff" is about right. 

I do find my mind drifting back to what I have been through.  The cancer "down there", endometrial, is not something someone wants to talk about but it is what I had.  I think about my cancer and the future and I have to stop myself because I don't think it is a good place for me to go.

Everytime I turn around it seems I am hearing someone has cancer and it is just crazy.  I hope I can help the way people helped me.  By listening and answering questions they have, and directing them here if need be.  However, I can't see myself staying here for long.  I have to be MORE than this cancer.  I can't let it define me. 

You probably know what I mean but I do think this has changed me.  The world is very different.  I thought I could understand it before, but I see now I didn't.

Again, I hope you don't mind a woman crashed your board.  Cancer is cancer.  It sucks and we both have the t-shirt.