Prostate cancer diagnosis

Based on the data provided, radiotherapy does appear to be an option. But it would be good to have more info regarding the biopsy and other relevant health issues. I am sure that others will chime in once we have those data.

Pawpaw (MI?) - Do not dismiss surgery. It does have advantages over radiation, which by the way does have side effects also.  Generally - and I repeat generally, surgery is the quickest and most thorough way to address the cancer for younger men, those under 70. Generally. I do have to repeat that because any statement regarding "historically conventional thinking" on the matter is always subject to refute. This is the internet after all.

Your grade 4 component and elevated PSA would indicate that you should preceed with treatment in the near future.  Often a biopsy will miss higher grade tumors, so there may be more in there than is apparent.  In surgery your prostate will be removed and the gland and surrounding tissues will be carefully examined by your surgeon and pathologist(s). The true nature of your cancer will be identified and further treatment may be required. Pathologic upstaging is not uncommon.  Most side effects are immediate and recovery proceeds over the following months and typically are fully resolved within the first year.  ED is the most lasting SE and may last years.  There is also a 5% possibility of urinary incontinence.  The objectives are 1) cure the cancer 2) regain urinary continence and 3) redevelop sexual function - in that order.

Numerous forms of radiation therapy exist, and more are being developed constantly.  The most common is IMRT and generally requires two months of daily treatment. Side effects are cumulative and become worse with time. Some late radiation toxicity may not become apparent until more than a decade later.  Radiation is administered based upon external scans.  The treated tissue remains in your body.  It does affect sexual and urinary function to some extent, so for example if you tend to have frequent prostatitis the radiation will not make that any better. Your PSA will gradually decline until it reaches a nadir over the years following radiation.

Adjuvant or salvage radiation may be required even after surgery if your pathology reveals higher grade or more extensive cancer.  Options for salvage following radiation are generally very limited.  Radiation is often chosen by older men who may have other health conditions that might preclude surgery. The cutoff is generally age 70, though there are exceptions.  You are a very young man, and understandably loss of sexual prowess may be a major concern. However you should also give thought to the strong likelihood that you will live an another thirty years or so with your pelvic organs having been radiated.

All forms of treatment have side effects.

Old Salt said:

Please

Provide evidence that the procedure worked well. Feeling good right after the procedure is great, but doesn't prove that the cancer was totally eradicated. 

I hate to put a damper on your enthusiasm, but success needs to be ascertained at one-year intervals for at least five years.   

Well, the ablation destroyed the tissue. I saw both the pre and post MRI. I guess you and I have nothing to talk about for another five years. I'm sorry, what insurance company do you represent again?

RobLee just accurately described my experience with DaVinvi robotic prostatectomy. I was struggling with frequent prostatitis caused by an apparent recurring Staph infection. Even after antibiotic treatments, at my biopsy the prostate was still enlarged to 250cc compared to normal 25cc. I could have done active surveillance at Gleason 6 3+3, but opted for surgerry because of the triple threat of BPH, Prostatitis, and cancer.

Radical nerve sparing prostatectomy in June 2016. Incontinence recovery after 6 months or so, 98% recovery now. Erectile dysfunction recovery after one year, still recovering, about 90% with only minor issues, hopefully full recovery by two year mark.

My experience was exactly in the order RobLee described. One more SE should be mentioned... when the prostate is removed surgically, the urethra section goes with it, and the urethra is pulled up and reattached... leading to about 1-2 inches of penile shortening.

Whatever treatment you choose Pawpawbg, make sure you have skilled, experienced professionals administering the treatments. I invite you to read far into the archives of this forum and discover the commonality among all successful forms of treatment... skill and experience of the professional administering the treatment.

RobLee said:

All treatments have side effects

Pawpaw (MI?) - Do not dismiss surgery. It does have advantages over radiation, which by the way does have side effects also.  Generally - and I repeat generally, surgery is the quickest and most thorough way to address the cancer for younger men, those under 70. Generally. I do have to repeat that because any statement regarding "historically conventional thinking" on the matter is always subject to refute. This is the internet after all.

Your grade 4 component and elevated PSA would indicate that you should preceed with treatment in the near future.  Often a biopsy will miss higher grade tumors, so there may be more in there than is apparent.  In surgery your prostate will be removed and the gland and surrounding tissues will be carefully examined by your surgeon and pathologist(s). The true nature of your cancer will be identified and further treatment may be required. Pathologic upstaging is not uncommon.  Most side effects are immediate and recovery proceeds over the following months and typically are fully resolved within the first year.  ED is the most lasting SE and may last years.  There is also a 5% possibility of urinary incontinence.  The objectives are 1) cure the cancer 2) regain urinary continence and 3) redevelop sexual function - in that order.

Numerous forms of radiation therapy exist, and more are being developed constantly.  The most common is IMRT and generally requires two months of daily treatment. Side effects are cumulative and become worse with time. Some late radiation toxicity may not become apparent until more than a decade later.  Radiation is administered based upon external scans.  The treated tissue remains in your body.  It does affect sexual and urinary function to some extent, so for example if you tend to have frequent prostatitis the radiation will not make that any better. Your PSA will gradually decline until it reaches a nadir over the years following radiation.

Adjuvant or salvage radiation may be required even after surgery if your pathology reveals higher grade or more extensive cancer.  Options for salvage following radiation are generally very limited.  Radiation is often chosen by older men who may have other health conditions that might preclude surgery. The cutoff is generally age 70, though there are exceptions.  You are a very young man, and understandably loss of sexual prowess may be a major concern. However you should also give thought to the strong likelihood that you will live an another thirty years or so with your pelvic organs having been radiated.

All forms of treatment have side effects.

 

how do u know that that often they miss higher grade tumors in biopsies ..reallly says who you...quit scaring people like you scared me a while back ...u don’t know what the hell you are talking about 

Steve1961 said:

Wow here u go again scaring people

how do u know that that often they miss higher grade tumors in biopsies ..reallly says who you...quit scaring people like you scared me a while back ...u don’t know what the hell you are talking about 

You are wrong.

A biopsy is like a needle in a haystack (usually only twelve samples). It's not uncommon to miss a cancerous spot which may be a higher grade one.

And it's against forum policy, and plain impolite, to state that a member doesn't know what he is talking about. 

Steve1961 said:

Wow here u go again scaring people

how do u know that that often they miss higher grade tumors in biopsies ..reallly says who you...quit scaring people like you scared me a while back ...u don’t know what the hell you are talking about 

Honestly, I don't remember what I might have said that scared you.  I tried to read your blog here that you mentioned below, but it is empty.

I believe that patients should be well informed. My doctor told me very little. He never mentioned cancer. I only know what I am talking about because I have lived it... four years so far. More actually. It is hard to not feel resentful when I think back on it. And I don't want others to end up that way, so I try to tell them what I have learned, the hard way.

Again, I am sorry and I hope your experience is much better than mine has been.

Radiation appears to win out.

https://pcnrv.blogspot.ca/2016/09/patient-reported-outcomes-from-protect.html