New diagnosis - I am 52

Spudboi,

Welcome to the board. At 52 years old you are confronting a process that may prejudice your quality of life forever. Be cautious and do not accept any proposal without knowing details (pros and cons) of what has been proposed. Try to educate about the disease and get second opinions from different specialist.
Urologists are set to recommend you surgery as much as radiologists would recommend radiotherapy. It would be interesting if you have said that your surgeon has suggested for you to do radiation the soonest. LoL

From the information you shared above, your Gleason score is (4+3) 7 signifying that there is an high risk for existing metastases, and therefore lesser probabilities for a contained case. In such respect, one should look for a treatment that better can address his status. Surgery is best when the cancer is whole inside the gland (contained). Dissecting the gland it would dissect the cancer. In extra prostatic extension cases (not contained) radiation therapy has higher points for success. Accordingly, Gleason 7 cases (intermediate risk) in voluminous cancer case (13 cores positive out of 14 with 60% or higher involvement) need more careful examinations on the options. The pathologist findings should be reviewed and the clinical stage (T2a) needs more specific tests. T2a stands for cancer found in only half of one of the lobes of the prostate gland. I think it to be an error. The biopsy of 14 samples were not directed to just a portion of the gland (one lobe). Probably you meant T2c.

In your shoes I would not sign or reserve surgery to be done that fast (July 26) even if the surgeon is fully booked for August. Prostate cancer does not spread overnight. The therapy of your choice and the outcomes would not differ if that was done in three months time.

I would recommend you to research about image studies that can provide better diagnosis of your case. Having surgery to diagnose the lymph nodes is not proper. You can dissect some without major incisions. PET scans can also reveal metastases to a certain extent. Would Kaiser cover these type of exam? 

Regarding treatments, these are linked to risks and side effects that you should know in advance. Surgery is very much linked to incontinence and ED (erection dysfunction), even if one opts for the nerve spare technique. Radiation is linked to colitis and prostatitis. Both treatments may jeopardy your possibility in fathering a child again.

Here is a site that may help you understanding details;

http://www.lef.org/Protocols/Cancer/Prostate-Cancer-Prevention/Page-01

Best wishes and luck in your journey.

VGama

Spudboi,

Very sorry to hear of your diagnosis.

As VG said, Take your time.  Study and learn all you can.  Check with as many doctors as you can.  Look at the possabilites of radiation, surgey etc.  Check all forms of treatment.  Our cases are all different. 

I was diagnosed in Aug of 2013, at the age ot 67.  I had no symptoms, but it was found that I had a PSA of 69, when first diagonsed. My Gleason was 3+4-7.   I paniced and wanted the cancer gone.  I was ready to have the surgery right away.  My urologist would not do it that soon.  He wanted me to see the Radiation Oncologists first.  Which I did.  Then I was convinced that I was going to do the radioactive seeds and other radiation.  However, something told me to have the surgery, a little later in my study.  So, I had a DaVinci, Robotic Assisted surgey in December 2013. The surgery took 5 1/2 hours because of previous hernia repairs (mesh) and my muscle development from being a road cyclist.   Turned out the radioactive seeds wouldn't have worked because of a birth defect, in that my prostate was adhered to my bladder.  So, they couldn't have gotten the seeds where they were needed.  From August  until December seemed like forever.  In my case, the surgery was the only answer.  My PSA dropped to <0.010 in two months post surgery.  It remains at that level to this day.  I had one lymph node involved. I was listed as a high, aggresive Stage 3 ( I forget the the exact numbers, I think a T3b1?).  40% of the prostate was involved. So, I had 8 weeks of radiation, post surgery, and was on Lupron for two years. They treated me very aggresively as if I were an advanced Stage 4.  I've been off the Lupron for 5 months at this point, and my PSA is still holding at "0".  My testosterone has started to come back up. They had my "T" clear down to 17.  Normal is between 250 & 1,000.  When last checked my "T" levels had come up to 140 ish.   So, we are watching very carefully to see if the PSA stays at "0"or starts to rise.  My next appointment for blood work and check up is in August (2016).  My doctors are hopeful that I remain a "Big 0".  If not, then we have to look at going back on some sort of hormone therapy (ADT)

So, don't make any snap decisions.  Make sure and explore all treatments and ask tons of questions.  Make sure you are ready and understand all the side effects of  the surgery, the radiation and hormone therapy, so you know what to expect.  Make sure and think about your quality of life.  This is a tough battle. You are at the right place on the web site to ask questions, So ask as much as you want. Those here will help as much as we can.

Know that you are in my Thoughts and Prayers

Fight like the devil.

Peace and God Bless

Will

That was in January of this year (January 7th to be exact).  My urologist likewise wanted to schedule surgery and we initially scheduled for Feb 2nd and I spent the next week doing the "pre-op" testing like chest Xrays, clearance for surgery, etc.  In the process, my PCP made a few recommendations for second opitions and I pursued several.  I went to a radiation oncologist, MD Anderson Cancer Center where I saw another Radiation Oncologist and another urologist and also spoke at length with people from cancer treatment centers of America.  All leaned towards the surgery approach so I rescheduled surgery for April as all those consults took some time.  I did check out HIFU which, while probably viable, I did not want to do outside of US with latest tech.  I had one more referral, Phoenix Cyberknife.  I almost cancelled that referral until I saw some posts on here about its success.

I went there and ultimately had the Cyberknife radiation over 5 45 minute treatments.  The biggest inconvenience during that time was the low gas diet that essentially meant you ate next to nothing.  I lost 11 pounds in 9 days!  Next week I have my first PSA test post radiation and then followup with doctors the following weeks. 

My cancer was also 2a, but I had Gleason scores of 3+4 and 3+3 only two cores out of 12, with two more being "abnormal" those two were located along the side and doctors thought they might not be able to do nerve sparing on that side.  One of the points my Cyberknife doctor made was that with the preceision of Cyberknife (sub-mm), they can also target along the outside edges of the Prostate where necessary.

Many, many people opt for surgery and have good outcomes, cancer-wise.  However, as you read many of the posts here on this forum and others, doctors seem to downplay the potential for side effects.  Cyberknife now has an equivilent "cure" rate of 93% over 10 years WITHOUT hormone therapy before treatment for Stage 2a or lower.  Hormone therapy will give you another percent or two.  In my case, I didn't think the extra 1 to 2 % warranted the additional side effects that come with hormone treatment even though my Cyberknife doctor pushed for it.  I have no side-effcets from the treatment at this time and that is pretty consistent with most other experiences.  There are exceptions, but they are MUCH rarer than with surgery.  As a 52 year old, my concern about the negative side effects was one of the primary influencers for my decision.

As others have said, this is ultimately your decision.  Each doctor will likely perform well with the treatment option they recommend.  However, each doctor will lean towards what they do as that is going to be their natural bias although normal radiaiton is not recommended for people our age, although in your case, they may still want to do radiation post surgery which is something else you need to consider.  Prostate Cancer is generally slow growing although your Gleason score of 4+3 indicates a more aggressive cancer.  You don't have to make a decision in a week.  Once you do make your decision, be at peace with it and press on!

If you would like to speak with me further about my own experience since we are starting in a similar status, I would be happy to share what I went through in more detail, just reply to this thread and I will provide you with some contact details.  Best wishes for a cancer-free outcome!

If so, ask for a referral to the Kaiser NorCal CyberKnife center in SSF to see if you may be an appropriate candidate for CyberKnife radiation treatment of your prostate cancer.  You'll have a much better probability of a full remission w/o any of the major potential side effects from surgery, if you do.

BTW, IMO there is nothing worst than surgery for the treatment of prostate cancer and I would avoid undergoing surgery for prostate at all costs.  That's what I did.  I was a Kaiser patient when I was diagnosed w/PCA in Jan 2010 (Gleason 6).  The only options presented to me by Kaiser were surgery (in Oakland) or brachytherapy (in Roseville).  The CK center in SSF existed but was not doing PCa treatment at that time.  I didn't like the choices and quit Kaiser to join Blue Shield so that I could get CK at UCSF in Sep 2010.  I am currently in remission w/a PSA level below 1 and still dropping.