Newly dianosed, lots of questions and concerns

I am sorry for your diagnosis and the stress that you are feeling. This extreme stress generally lasts for a few months.

In order to provide best suggestions for you, more informaton is needed about your case.

You mention that your Gleason was a 7, is that a 3+4=7 or a 4+3=7....the first number of the Gleason is most prevelent. Also what is the percent involvement of each of the cores that were cancerous, that is how much of each core was cancerous.

What is the size of your prostate, large prostates lay on the uretha and secret more PSA

What is the progression of your PSAs

What did the digital rectal (finger wave in the anus) indicate.

Did you have any other diagnostic tests, ie. MRI?(may show extracapsular extenstion, if the cancer is outside the prostate), etc

Did you have a second opinion by a world class pathologist of your biopsy slides.....there is a difference in skill and facilities of pathologists.

You mention that the surgeon will remove the nerves; with this erectile dysfunction is certain.

I also wondered if you interviewed various surgeons......................there is a difference among surgeons, and there is a steep learning curve for robotic surgeons....at least several hundred to be proficient...many have done thousands.

You need to do your due dilengence....and interview a radiation oncologist....radiation will provide the same cure rate with less chance of severe side effects.....and in your case, since the surgeon said he would go wide and not spare the nerves, radiation would most likely be more appropriate since the perimeter of the radiation can be adjusted to go outside the prostate and have a wider range of treatment, to include some area outside the prostate.

I strongly suggest that you cancel the scheduled surgery so you can gain knowledge and do your due diligence. Prostate cancer is slow growing and you have some time. You do not want to be treated with a method that you are not sure of and will have regrets. .....treatment choice is crutial and will affect the rest of your life

Come back to us with questions and information requested about your situation

Best

As stated above, PCa is not as virulent as many forms of cancer.  It's essential that you take your time to feel comfortable with the treatment you choose.  I strongly suggest reading "Invasion of the Prostate Snatchers:.  The somewhat whimical title of this book is unfortunate, in that it contains a wealth of information on the various forms of treatment.  I found the section on cryotherapy especially enlightening.  The NCCN also has an online guide that can be downloaded and contains lots of good information. 

As the name implies, Focal Laser Ablation (FLA) attempts to eradicate tumors that have been identified (foci). The problem is that (very) small tumors in the prostate may not have been identified and thus, will not be treated. Once these 'grow', they will need to be treated again (and again).

The American Urological Association has the following to say:

Clinicians should inform intermediate-risk prostate cancer patients who are considering focal therapy or HIFU that these interventions are not standard care options because comparative outcome evidence is lacking. (Expert Opinion).

Here is the link:

https://www.auanet.org/guidelines/clinically-localized-prostate-cancer-new-(aua/astro/suo-guideline-2017)

sr,

It seems you have mostly decided upon surgery.  It is good that you met with a radiation oncologist first, and do consider his imputs.   I wholly agree with what Old Salt wrote regarding FLA. We are not doctors and cannot give medical advice, but do read further before going that route.

But I absolutely would not let a surgeon say before even beginning that not attempting nerve sparing was ok.  Depending on what he finds, nerve sparing may be quite possible, and even relatively simple.  It just depends on what he finds.  Scanning before surgery to establish staging is much better than it was years ago, but still relatively primative.  It cannot provide certitude of negative involvement outside the gland, although it can prove movement outside the gland.  That is, it cannot prove no metastasis, but can prove that there IS metastasis (or at least a mass that is reasonable for metastasis, which would require biopsy for confirmation).   I would not trust a surgeon who was of the attitude to "just cut everything out."  Surgeons vary greatly in skill and even in attitude. Speaking to another surgeon might be well advised. But do not go to another guy in the same practice, since they will be under some pressure to agree with their coworkers.

Surgery has benefits and limitations. But one thing about it that I like is that when the gland is removed and under a microscope in a pathologist's lab, you know EXACTLY what you were dealing with, in a way a scan or lab testing could never establish.  But preserving erectile function should be a priority for any surgeon.  Make it be so for yours.  There is no reason at this point to forfit future potency for no good clinical reason.  It is not really even ethical for a doctor to do so.

Some men agonize over what to do regarding PCa for months or longer before doing anything, others do the first thing their doctor suggests, without ever asking any questons of anyone.  You appear well in the middle, a healthy position to be in.  But do consider what the radiation doctor shared.  There is no rush, but if you are certain of your decision, then neither is there any reason to dally forever.  And you are correct: The more a man studies this, the LESS obvious a decision is.  There are more "statistics" thrown about here than in a TV football commentary; it never ends.

Proceed with confidence and trust, hoping for the best.  After making a sound, outcomes-based choice, hope is all any of us has,

max

It's been a year since my stage 4 gleason scor 4+5=9 was diagnosed.  I have followed exactly as directed by Oncologist.  Prostate removed, radiation and ADT.  Just ordered a 68 page patient guide from the Prostate Cancer Foundation.  Best move so far.  The oncologist plan is to now hold tight, do nothing but the Lupron shot every 3 months for 2 years.  At this point we will see.  It's [Content removed by CSN Support Team.], (sorry only way to put it). Chance of survival very, very low so wait then when they are sure go for Chemo.  New evidence shows go for it all now.  I am working to get get Chemo bofore the 2 years is over.  As improtant what you can do now is diet and exercise.  Fasting 1x week for 24 hours, cut out red meat, sugar and all junk food.  When Dr. says just follow their program but do everything else the same it won't work.  

Good Luck and be strong

Jim

jimlu said:

next step

It's been a year since my stage 4 gleason scor 4+5=9 was diagnosed.  I have followed exactly as directed by Oncologist.  Prostate removed, radiation and ADT.  Just ordered a 68 page patient guide from the Prostate Cancer Foundation.  Best move so far.  The oncologist plan is to now hold tight, do nothing but the Lupron shot every 3 months for 2 years.  At this point we will see.  It's [Content removed by CSN Support Team.], (sorry only way to put it). Chance of survival very, very low so wait then when they are sure go for Chemo.  New evidence shows go for it all now.  I am working to get get Chemo bofore the 2 years is over.  As improtant what you can do now is diet and exercise.  Fasting 1x week for 24 hours, cut out red meat, sugar and all junk food.  When Dr. says just follow their program but do everything else the same it won't work.  

Good Luck and be strong

Jim

Please start a new thread if you want responses tailored to your situation, which, unfortunately, is very different from the one of the original poster (sr642).