I'm a newbie here

Hi Mike, Sorry to hear about your diagnosis.  The good news is that with a Gleason of 6 and only 1 core being positive, you have a ton of options AND a lot of time to sort things out. 

I was diagnosed in January of this year with 2 cores, one gleason of 6 and one gleason of 7 (3+4).  After reviewing histories of others on this and other forums, I opted on doing Cyberkhife radiation instead of surgery or regular external beam IMRT radiation.  Cyberknife requires only 4-5 treatments of 45 minutes each and is much more focused than IMRT external radiation.  An overview of radiation types here - https://www.cancer.gov/about-cancer/treatment/types/radiation-therapy/radiation-fact-sheet

I would not recommend you get IMRT radiation (the 8 weeks option) as at your age, there is a higher likeihood that you could have problems later on over time as IMRT doesn't just radiate the tumor, but everything around it gets a dose as well.  I suspect if you talk to more radiation oncologists who to IMRT that they will tell you the same thing, the two I spoke with told me that at 52, they would recommend surgery as long as cancer was contained in the prostate.

The seeds are another option, but when I compared that to Cyberknife, I felt it was a better course, at least for me.  That depends in part of if Cyberknife is avaialble where you live, I live in Phoenix-area.

As urologists diagnose Prostate cancer and are the ones who would perform a prostatectomy, that is the most common option, especially for younger patients.  

I opted against surgery after visiting this and other forums and seeing the side-effects of surgery and deciding that at 52, I didn't want to risk having incontinence and/or erectile dysfunction for the rest of my life.  Note, that isn't the "normal" outcome, but it happens and while the doctors downplay it, they certainly cannot guarentee the outcome.

Spend some time evaluating your options and talk to mulitple doctors, in the end, this is a decision you and your wife need to be comfortable with the decision.  You can also pursue active survelliance as well and wait for a period of time and see how slow it is progressing but with a positive identificaiton of the location and size of tumor, I would be prone to just deal with it but it is certainly not something you have to do immediately. 

Good luck and keep us posted and jlet me know if you have any other questions about my experience or the process in general.  I am sure you will have several other chipping in as well.  While any cancer diagnosis creates a ton of anxiety, this is one that at this early stage, is deifnately beatable!

Welcome, Mike.

My case was quite similiar to yours: I was 58, Gleason 6, one core of 12 positive at 5% involvement. I never had a PSA of over 4.6, however.  A PSA of over 10 can sometimes countersuggest seeding according to some sources.  You will find that oncologists are a lot like lawyers: no two will have identical takes on a situation, although each take is reasonable.

After a lot of reading and consultation with three oncologists I chose DaVinci (robotic) removal.  For early stage, first-line treatment of PCa in the US today, right at 50% of all men choose surgery, the other half choose some form of radiation .  Both modalities have statistically identical cure rates.  It really comes down to which doctors you most feel comfortable with, and your priorities.  The more I studied, the less certain I was about what to do. PCa has more sound alternatives than most other cancers, a good thing, of course.

The pathologist's analysis of the gland after it was removed showed more involvement than the biopsy had suggested -- also not uncommon, I have read.  I was a Stage II at the time, not Stage I.

For what it is worth, 2.5 years later, I have normal continence, and sex about as good as prior to surgery, although once the gland is removed, ejaculate fluid is a thing of the past (orgasm and ejaculation are actually distinct phenomenon, I learned).  'So what' is my reaction; I'm a 60 year old man, not a surfer at Malibu.  Actually, my continence post surgery is much better than prior to surgery, since I had been dealing with significant BPH for a few years. Go figure.,.

Bless your decision. With your numbers, you should achieve a cure with relative ease.

max

mikedayton62 said:

Thank you VG

Thank you for the advice. My wife and I have been doing a lot of research, and I have an appointment with a radiation oncologist tomorrow.

Vasco gave good advice.

He asked excellent questions.

Do you have a history of PSA tests. Did you have any other diagnostic tests?

Except for the high PSA you may be a candidate for Active Surveillance. I would interview an expert in Active Surveillance, hopefully at a major institution of excellence.......one that can provide a mulitiparametric MRI with a three dimenisional biopsy machine such as an Artemis.

Not saying that you qualify but I have been in an Active Surveillance program for almost 8 years now.

.....................

Generally surgery has the greatest side effects from active treatment, to include but not limited to erectile dysfunction and incontinence. If you choose an active treatment a type of radiation such as SBRT would have less side effects

As others have mentioned, take your time to make the best decision for you.

It sounds to me like you can expect a long, cancer free life after treatment. 

I had four cells involved, two 6's and two 7's with a PSA of 4.8. I chose RT. But I am 71 years old. If I was 54 I would have found the best surgeon I could and gone for prostate removal.

My urologist and RT Oncologist both said if I was younger, and had a longer life expectancy, surguery would be their recomendation. Mainly because after RT, if the cancer returns, surgery on the protsate is not done because of scare tissue. That limits your options down the road.

If you do chose RT, I would find a location that has Image guided external radiation systems or other newer methods of delivering the external radiation. Also, I would look for a facility that did a space-oar type of implant prior to radiation to protect the rectem from damage. 

Hey man welcome to the party.  Sorry you got an invite.  I was 49 had a PSA 4.1  biopsy 1 of 15 posative Gleason 3+4 PNI present.  When I had surgery I was up graded to a 4 +3 and it was in both sides much more than biopsy showed and was luckily contained.  No Seminal or lymph nodes with any signs.  My first thought is with a PSA 12 you have more going on.  Was there a lot of BPH present, any idea of the prostate size?  A PSA of 12 is high for your dignosis .  At a young age as we are both 54 2 things I believe firmly.  First remove it, get it out and see what you are actually dealing with.  Second, nobody can ever predict re-occurences. I have 3 friends all good outcomes now after 5, 5  and 4 years all are getting radiation for slavage treatment.  You need to go to a good oncologist and if you do surgery go to a place that specializesin it.  MAke sure the doctor has done hinreds of them at least.  Good luck man and stay posative. 

Mike: People here know me as an outspoken advocate for CK and against surgery of any kind.  I was treated w/CK 6 years ago (Gleason 6 and PSA less than 10).  You can troll the forum for my many comments on this point.  Here are the highlights of what you need to consider:

1)  CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer.  Accuracy at the sub-mm level  in 360 degrees and can also account for organ/body movement on the fly during treatment.  Nothing is better.  Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding.  Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

2) IMRT is the most common form of external radiation now used.  Available everythere.  Much better accuracy than before but no where near as good as CK.  So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding.  Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed.  I think some treatment protocols have been reduce to only 20 but I'm not sure.  Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

3) BT (brachytherapy).  There are 2 types: high dose rate (HDR) and low dose rate (LDR).  HDR involves the temporary placement of rradioactive seeds in the prostate.  CK was modeled on HDR BT.  LDR involves the permanent placement of radioactive seens in the prostate.  1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children.  The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive.  Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body.  Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc.   Both HDR and LDR require a precise plan for the placement of the seeds which is done manually.  If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects.  An overnight stay in the hospital is required for both.  A catheter is inserted in your urethra so that you can pee.  You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

4) Surgery -- robotic or open.   Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation.  Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function).  Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body  due to the remove of the prostate which sits between the interior end of the penis and the bladder.  Doctors almost NEVER tell prospective PCa surgical patients about this.  A urologist had to nerve to tell me it didn't even happen when I asked about it.   Don't trust any urologist/surgeon who tells you otherwise.  Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer.  Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

4) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer.  You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer.  Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it. 

I personally could not live w/the need to constantly monitor the cancer in my body.  Like most other men, I just wanted it delt with.  Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted.  I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected.  Other men on this forum have reported similiar results.

So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment.  The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

Good luck!

Mike,

Welcome to the board. Please...as VG says, your numbers would indicate several options, the first being Actice Surveillance (AS). AS candidates usually have no more than 2 of 12 positive samples, and with your Gleason 6, AS seems a real possibility. That's what I hoped for when I got the news, but I had 3 of 18 positive with a 3+4=7 Gleason. At 61, I decided the time was right for treatment.

After about a year of research, I decided on CyberKnife (SBRT). Some advance work, including placement of gold markers (fiducials) in my prostate prior to receiving 5 treatments over 1 1/2 weeks. Looking back, it was no big deal. I'm celebrating two years since completing my treatments as I write this, and while I have had some side-effects for the most part I feel I'm much better off for having chosen SBRT than any surgical option. Of course, we all have to decide what's best for us.

Here is a thread I began after my treatment for those considering CyberKnife: http://csn.cancer.org/node/292915.  

All the best as you proceed.