I'm a newbie here

You have done the homework and gotten an excellent grade (from all of us) for thinking the issue through.

Best wishes for an uneventful recovery from the procedure.

As you know, you will get a detailed pathology report of your 'missing organ'.

I, too, wish you good luck and the best of outcomes, as you start a new milestone on your PCa journey.  You asked questions, listened to the answers, your performed your own research, you asked more questions, and finally you made your own informed decistion.  Nobody can ask you for more.

Keep us up to date on your ongoing experiences, and if you ask, we will continuue to provide you with our 'lay' opinions, based upon our own PCa journeys and accumulated research.

mikedayton62 said:

MRI vs Gleason score

I believe that the MRI and the Gleason score indicate two different things. The MRI can see the size of a tumor, but the Gleason score is actually an estimate of how aggressive the cancer is, how quickly it will spread, and how aggressive the treatment plan should be. So in my case it appears that I have an 8mm tumor (from the MRI) comprised of cancer cells that were rated Gleason 6 under the microscope (from the biopsy), meaning that it is slow growing, giving my wife and me time to make a treatment decision. With a tumor that appears to be wholly contained in the prostate, and a Gleason 6, it is highly likely that no cancer cells have made their way out of the prostate yet. In addition to this, there are a number of other things factoring into our decision between Brachytherapy and Robot Assisted Laproscopic Prostatectomy:

1. We have ruled out AS due to my age and relatively good health.

1a. My PSA has doubled since last year (6 to 12). This is another factor that leads us to rule out AS.

2. The argument is still out as to which treatment has better long term non-recurrence results. Based on what I have found, this ranges from a draw to a slight advantage for the Brachytherapy.

3. Immediate side effects are probably worse for the RALP, but long term are worse for the Brachytherapy.

3a. I recently spoke to a friend who is still recovering from open prostatectomy. He is very pleased with the result.

4. Should we opt for RALP, the urologist who will perform the procedure has done it many hundreds, if not thousands of times, thus improving the chances of a positive outcome with regard to side effects.

5. Emotional concerns - definitely a large factor in our decision, because I will be living as a cancer survivor, and I want a few unknowns as possible into the future, and I would like to live those years with my wife at my side, not suffering from her own fears. With the RALP, the side effects will be immediately apparent, but also very likely treatable, and the only real unknown going forward is the chance of my PSA going up again later on. Given my numbers, this probability is quite low, but should this happen, there will be treatment options. With the brachtherapy, however, there could be side effects that might not show up for a number of years. Because of this, both of us are leaning toward RALP.

We are awaiting one final piece of advice before making our decision. Through the health plan provided by my employer, we have a service called Expert Medical Opinion. With this program, three separate doctors look at my records and give a report. Once we have their opinions, we will proceed with our chosen treatment.

Sorry for getting long winded, but I hope I was able to at least partially answer your question.

Good luck with your next steps!

Just a little point on rad choices.  Brachytherapy involves inserting radiative seeds into the prostate.  Prior to Cyber-knife, it was probably the most preferrable non-surgical option (even Andy Grove chose that path - his story was in Fortune Magazine here http://www.phoenix5.org/articles/Fortune96Grove.html .  It works, but as I younger guy, I wouldn't want to go that route as it will likely cause some downstream complications over time.  Cyberknife is short-term radiation performed in 4-5 45 minute treatments and you are done.

I do not understand all the comments about bowel problems that I read in this thread as it relates to "radiation".  There are numerous radiation options so for those who continue to lump all radiation in the same basket of "issues", please get your facts straight or at least expand your knolwedge beyond what your Uroligist will share to get your business.  Cyberknife is sub-mm precision, is does not impact the bowels or the bladder.  It doesn't lead to immediate incontinence or ED.  It has a 10+ year track record and results that are on par with the best options including surgery for those with early-stage cancer and a normal sized prostate.  I admit complete ignorance for more advance cancer or enlarged prostates. I did not have either issue thankfully. 

I chose CK because I didn't like the long-term impact of surgery.  Surgery is what most men are steered to unless they do their own research, that doesn't mean it is the best choice, just the one urologists want you to take.  I concluded that I did not want to have some form of leakage the rest of my life and years of ED challenges at 52 years of age if there was a better alternative that provided similar results without those side effects.  CK gave me an option to avoid those side effects.  That was my decision, I certainly respect others in their choices.

Mike,

Thanks for the update. I am glad for your positive atitude in spite of the worsen pathologist report. I hope they managed to remove the whole cancer and that you are now cured. Upgrading results is common in surgeries. The biopsy can miss those cancer spots and different pathologists may judge differently when classifying grades. The critical finding is the tertiary Gleason grade 5. I wonder about other findings such as the seminal vesicles and the lymph nodes.

As a note to your wife's concern on the difference in the reports; one should think that the biopsy examines just a fraction of the whole gland. For instance, a 12 needle biopsy draws about 0.2 cc of tissue (2cm x 1mmD x 12) which is less than 1/30th of a normal sized gland (25 to 30cc). Your gland weighing 57 grams (=57 cc) means that it was larger than normal (or that they have included the weigh of the seminal vesicles).

Best wishes for full recovery.

VG

mikedayton62 said:

UPDATE

Sorry I haven't been here in a while. I had my prostate removed by RALP on October 26, 2016. A week later we got the pathology report back.

As a reminder, my pre-op indicators were:

DRE normal, PSA 12.04, PSA one year prior was 6, Gleason 6, one core of 12 positive at 35%, Prolaris score was +3.3(!)

Based on the pathology report, my prostate weighed 57 grams, 30% of it was cancerous, the cancer was bilateral, Gleason was 3+4=7 with tertiary Gleason 5 present. The margins were negative (this is an indication that I am likely cancer free now). I will receive the results of my first post-op PSA on December 5.

As expected, I am experiencing 100% ED and significant incontinence. I know it is way too soon for the ED to begin to subside, and with the incontinence I have good days and bad days, but the general trend seems to be positive.

My surgeon (who is the partner of my urologist, mentioned below) is keeping me out of work probably until December 5, but based on my longeivity with my employer and their very supportive short term disability policies, I will continue to receive full pay while I convalesce.

My wife was seriously concerned about the difference between the biopsy and pathology reports, specifically, how 6 of 6 cores on one side, and 5 of 6 on the other side can completely miss the cancer in a prostate that was 30% involved bilaterally. Our other concern was why my urologist never mentioned the 3.3 Prolaris score, which indicated a highly aggressive cancer, supported by the tertiary Gleason 5 from the pathology report. We feel like he had us make our treatment decision without all of the facts, especially the one pre-op indicator we had of a highly aggressive cancer. Luckily, we got this information from the free second opinion service provided with the insurance package from my employer. As of right now, my wife and I both like and trust the surgeon much more than his partner who was my original urologist. We are going to switch to him from now on.

I have seen a lot of discussion here and on other sites about the value of the PSA test, but as far as I am concerned, it saved my life.

I just now noticed your November 20 update. Thank you for submitting it. As you might guess, I am sort of keeping tabs on your PC journey. It appears that things are working OK for you. From my experience, the ED and incontinence will continue to improve. I applaud your wife for her support. I am so thankful for my wife's loving companionship during 67 years of marriage and 25 years of PC survival.

May all of our years be brightened by glowing sunshine and glistening rainbows.

Old-timer (Jerry)

At my surgery the surgeon used PSA=0.06 as the threshold to judge success. Remission is taken as PSA<0.05 by most doctors. Yours is way bellow that. Congratulations.

ED is of concern. You need to be active to avoid atrophy.

Best,

VG