MY HUSBAND

Hi,

Gleason 3+3 all cores that were positive, the cancer cells are scored with 3 being the least agressive, 4 a little more, ect..ect.  The first number is the most abudant type of cells and the second number is the smaller amount of cells from the biopsy.  A 3+3 is not a bad score(for cancer) which adds up to Gleason 6.  If it's all inside the prostate that's even better.  The American Cancer Society has a good online section describing all the various type of treatments for PCa.  Good luck................

Monika,

Here are some ideas for your list of questions. Take notes or tape the conversations for later analysis at home. Surely you can always call the clinic for explanations on things discussed but still in doubt. Do not accept this consultation as a final decision on the next step. Take time and digest every thing is told and recommended;

http://csn.cancer.org/node/224280

http://www.cancer.net/patient/All+About+Cancer/Newly+Diagnosed/Questions+to+Ask+the+Doctor

A good book to guide you on radical treatments but biased through wards surgery is this:

“Guide to Surviving Prostate Cancer” by Dr. Patrick Walsh (third edition).

Gleason rate 3 and score 6 is the lowest in aggressivity. The next step will be to get a clinical stage (locating the cancer) so that treatments options can be accessed. This is done adding the biopsy findings to image studies. DRE should also be investigated  so that you can request the doctor to do a digital examination  in your next consultation. You need to inform his doctor about his testosterone injections. Hypogonadism patients can benefit from estrogens patches substituting the testosterone shots. Probably the urologist is not the proper doctor to discuss on the matter but try. You can always get a separate consultation with a endocrine specialist and bind the recommendations from both doctors.

You should start thinking in a therapy beginning with investigation on the risks and the side effects. Quality of life is in jeopardy so that your husband needs to consider a treatment that can provide cure with the lesser "unwanted" consequences.

I would recomend you to obtain copies of the biopsy report, including the size of the prostate and other tests so that you can get second opinions from various specialists.

Let us know what has been discussed.

Best wishes and luck in his journey.

VGama

Hello:

This is a duplicate of a message that have now re-posted several times on other threads for newly diagnosed PCa patients like your husband.  He has a very low grade cancer and has time to make a decision, which he should take to make the right one for him.

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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 recurrence, 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!

When I was diagnosed with Stage 4 with multiple bone matastasis, I was a bdoy builder doing Test twice a week.  I had to stop cold turkey and started taking Biclutamide to stop all testosterone production.  I suffered greatly from the side effects of this withdrawal.  Your husband should be aware that his TRT therapy may cause him greater side effects than one who was not on TRT.  And, in any case, many suffer unpleasant side effects from T withdrawal.  I hope you husband does not have severe side effects.  And, his prognosis should be good with the test results you printed.  And always remain positive.  I had bone cancer abuot as bad as anyone can get it.  Now, 43 months later, my Uro says that at 85, the cancer is no longer a threat to me.  He also said that I was the only patient that the had that lived more than 2 1/2  years with severe matatases.  All the other patients did treatment, and I was the only one who refused all treatment except for orchiectomy and bicalutimide, and if I had the chance to do it again, I would NOT have taken the bicalutimide.  Take you time, and do not jump to hasty conclusions.  Your husband,s prognosis looks good to me.  Love, Swami Rakendra

It's my understanding that 'nerve sparing' sometimes (!) is not possible due to the location of the tumor(s).

It's true that the Gleason score frequently has to be changed once the whole prostate is examined.

Having a surgeon with a lot of practice is highly desirable, whether one chooses to have 'open' or 'robotic' surgery.

Just repeating what others have mentioned: there is ample time to consider your husband's options (see the 10/21 post of Swingshiftworker). And yes, the 'velocity' (rate of PSA increase) is a relevant parameter as well, as Max pointed out. 

Please feel free to ask further questions.