Diagnosed with prostate cancer and worried!!!

First John, let me say you are one of the lucky ones if you caught the PC while still confined to the prostate gland.

If you read some other recent posts, many guys did not catch the PC until it had escaped the capsule, or even metastasized. That greatly complicated their treatments and prognoses.

If you read many of these other posts and threads, you will find quite a controversy raging between AS Active Surveillance, Radical Prostatectomy including Open, Robotic and Nerve Sparing, Radiation in various forms, External Beam Radiation, Brachytherapy, Sterotactic Body Radiation Therapy, Radioactive seed implants, and ?

There are many treatment options available to you since you caught it early. I cannot speak for any of the other treatments except Davinci Robotic Nerve Sparing surgery in which incisions are cut into the abdomen and the robotic appendages remove the prostate. I was very successful for me, so of course I recommend it, but you may want to consult primarily with your doctor to determine which course of treatment you want to pursue... and also go back and read the many posts concerning treatment alternatives.

Welcome to forum no one wants to join.

From your post, you mentioned 6 of 12 positive cores with 3+3. Like H&O said, it would be good to know percentage in each core. If percentages are low then you really don’t  need to worry much.It is known that Gleson 6 does not metastasize so one less worry for you.

If you decide for treatment, all options are open. Take time and do your own research. Surgery is not always best option for Gleson 6.

You will hear all kind of input on surgery because this is heavily pro surgery forum. 

I did not see your age but since you cought it early, I assuse you are in your early fifties.

Take your time, no need to rush into anything.

MK

John,

I wonder why your doctor did discarded important and better image exams for prostate cancer, giving preferences to something that is at the bottom of the list of exams, regarding capabilities in identifying cancer. Surely a surgeon eager to operate would prefer to have negative image results. Either he is from the old guard or he is not aware of the newer recommendations/guidelines provided by urological associations around the world.

CT is linked to many false negatives when diagnosing prostate cancer. PET scan is the latest and more specific in image exams and surely important in staging a PCa case. In your shoes I would give up the farce of a CT scan and go straight to the operating theater if you trust your doctor. Why bother with a scan if your mind is already set in a treatment as you comment to Grinder above. By norm, PCa patients receive firstly a clinical stage before deciding on a therapy.  

You have not tell us your age, but I recommend you to research on the consequences of any treatment, their risks and side effects before engaging in anything. Young fellas with long life expectancy have lot to lose in quality living and old fellows may give preferences to palliative treatments. You should get second opinions (starting with the diagnosis data) and only decide after consulting your family. Do things coordinately and timely without rushing.

Survivors in this forum can help you to understand the facts but you need to share mode details of your case.

Best wishes and luck in your journey.

VGama

lighterwood67 said:

Lots of choices

First let me say you are still John.  You are the same John you were yesterday with the exception of that you know you have PC.  You will weigh out a lot of treatment options.  Take your time.  Write down questions that you have for your medical folks.  The final decision is yours.  A lot of folks base that on quality of life and treatment options.  All options have their side effects.  Pretty much you will read the stories on this site to see what side effects folks had.  There are success stories and horror stories.  No 2 PC's are alike.  Wish you the best of luck on your journey.  Stay positve and keep in touch with your human side.  Do not let all the options overwhelm you.  Sometimes you can analyze to paralyze.  Good luck.

Welcome to you, John-Can.

Lighterwoods put it so well. Prostate cancer (PCa) differs dramatically form most other cancers in having numerous treatment options. Many, perhaps most, other cancers have one preferred, first-line response. Lymphoma (which I have had) is like that: Treatment is chemo. Period. Chemo or nothing. Not a lot to discuss or talk about. And no arguments over side-effects. Live with the side-effects or die. Not complicated there either. Leukemia is the same way.  No arguments over radiation vs. surgery, or anything else.

"Analyze to paralyze."  In other words, worry over options until you can't do anything. That is a keeper, lighterwood !  I have seen it happen to guys here more than once.  Or, they make a choice and then second-guess what they did for life. No peace in their hearts, ever.  Don't be those guys.

Do your research, make a decision, and then go with it.  Often the best choice is simply the one that most fits you emotionally, the one that you just "feel good about."  And very often guys will state that they made a choice because of a doctor whom they liked, felt confident with.  It happens that at times the best surgeon or radiaton oncologist on earth is just a turd in personality. Only you can prioritize all of this and make it fit you and what you want.

Do not let the microscopic, technincal stuff overwhelm you. There is never a perfect choice, and no one size fits all.  And none of this comes with a warranty, no guarantees.  But your results sound like you have minimal, incipient disease, that should be readily beatable.

max

If what you write is what the radiologist told you then he is not to be relied upon. I think this guy to be in the same group of your urologist trying to convince you that a proper image study is unnecessary. A DRE does not diagnose cancer whatever grade such could be and the biopsy diagnoses cancer with a grade, that in your case was Gleason score 6 (3+3). The T2a element is the clinical stage which is just a guess imagined by your urologist. If your doctor doesn't believe that such stage should be verified with added information from an image study then, in my opinion you should not trust him.

Can you tell us your age and about any other experienced or existing illness?

Your comments are dubious and the responses reinforce the idea that you should go to navigate in other waters. I recommend you to get second opinions from another group of urologists. I am sure that an independent radiologist would not answer with the same negative wording that the one above did.  

Best,

VG 

John-Can said:

Met radiotherapy oncologist

Thanks a lot to everyone who answered.

I met my radiotherapy oncologist today and we discussed the risks, advantages and disadvantages of radiotherapy. I wanted to make sure that the cancer has not spread outside my prostate. He performed DRE on me and said it is impossible for a G6, PSA 5.7 cancer to have extra capsular extension. I asked for an MRI to confirm his opinion, but he said there is no need for that. He said my cancer is T2a. As for my N and M grades, he said the biopsy report doesn’t show that, but we don’t need it at this time. I also asked him about the effect of radiotherapy on cells and tissues (prostate, bladder, urethra, semen vesicle) and he said radiation stops cell division and I wonder when a cancer cell stops dividing and eventually dies, it is ok, but what about normal cells and what may happen if they all die?

 

I’m also not sure if an oncologist can decide that my prostate cancer is T2a by just performing DRE?

Is an MRI really NOT unnecessary for me at this time?

Best wishes for all.

John-Can I agree with V and Cleve that your most recent doctor (the R.O.) used part facts, part a bit of bluster or overstatement.

It is not a clinical dogma that Gleason 6 "cannot have escaped the gland."  But it is profoundly uncommon for such to occur. What the doctor undoubtedly meant was that it was virtually impossible, not literally impossible.  A DRE only yields results for the condition of about half of the gland, and says nothing about the other half. But be aware, we read about virtually impossible stuff here all the time.

The doctor establishing Staging on no more than a biopsy and DRE is also a bit presumptous, due to the many false negatives that 12 core biopsies yield.  It is an educated guess, and probably reasonable, but not certain.

After IMRT or SBRT, the gland is in effect charcoal...my R.O. told me that himself.  This is harmless to the body, assuming all of the disease is killed, but there remains slight (uncommon) prospect of urinary stricture (constricted flow ability) later on.  But even if stricture occured, it is treatable after radiation.  Healthy tissue that is irradiated is simply killed like the cancer cells. But current radiation technology is extremely precise, and usually effective in avoiding any significant amount of healthy tissue.  Decades ago, this was not so, and colon and bladder damage was more common then than now.

So, what the two doctors have told you thus far is fairly mainstream, although some doctors would demand the further scanning the others have recommended.  My potential Radiation Oncologist (the head of the RO department), my surgeon (who did my RP), and an independent medical oncologist (the man who treated me for lymphoma) all told me that MRI, bone scan, and CT were not probably necessary in my case, but they knew I was going to choose a first-line therapy within weeks.  The RO and surgeon in fact told my wife and I that "they would not do further scanning prior to treatment."  One issue involved here is that PSA 6 suggest so little cancer that the tumors, IF outside the gland, would NOT be detectable by most scanning technologies currently in use.  So, the situation as to what to do is a bit murky.

My Gleason, like yours, was 6 also, and my PSI never got above around 4.4. I showled 5% volume, and only in one core.   But the pathology report following surgical removal showed that what was believed by all of them to be Stage I disease was actually a significant case of Stage II.  I know, "more murk."

max

My Name is Bill. I was Dx with advanced agressive prostate cancer three years ago. 3 months of radiation treatment and Eligard. suicide attempt twice. Eligard has destroyed my entire life. Not only 100 % impotent. Constant suicidal along with other things. If you are with the VA. Run!! They dont want to hear about things like that. Viagra will not help and neither do the injections. You will be left as a empty shell of what you were before. Your Brain is never the same! they will tell you it will come back. From extensive reading most research tells you that is not true. For most men you will never be the same. I am alive for now but not living.

If just being alive is more important then living get the Eligard. 5 years ago I was at the top of Mt. Everest now Im lucky to be able to run around the block.

Good luck and get informed. Dont let the medical Team decide what is best for you. For me im no longer living I am just alive.

Bill B

Bill B said:

get informed before Eligard

My Name is Bill. I was Dx with advanced agressive prostate cancer three years ago. 3 months of radiation treatment and Eligard. suicide attempt twice. Eligard has destroyed my entire life. Not only 100 % impotent. Constant suicidal along with other things. If you are with the VA. Run!! They dont want to hear about things like that. Viagra will not help and neither do the injections. You will be left as a empty shell of what you were before. Your Brain is never the same! they will tell you it will come back. From extensive reading most research tells you that is not true. For most men you will never be the same. I am alive for now but not living.

If just being alive is more important then living get the Eligard. 5 years ago I was at the top of Mt. Everest now Im lucky to be able to run around the block.

Good luck and get informed. Dont let the medical Team decide what is best for you. For me im no longer living I am just alive.

Bill B

Bill... The more you can elaborate the better. Eligard I am guessing is an Androgen Deprivation Therapy that suppresses the production of testosterone thereby depriving prostate cells of androgen to stimulate activity.

What went wrong? Side effects? Dosages? Improper diagnosis or administration? 

I feel terrible for you if you are suffering for it, and it would help to pinpoint the cause so the more expert members can give you advice, and perhaps warn others to avoid similar circumstances.

OP: Here's my long standing "sticky" on the available choice that I post for men newly diagnosed w/PCa. 

Started posting this message over a year ago and my opinion has not changed.  It mainly addresses the choice between surgery and radiation but does not deal w/cyro.  So, I'll just add that, if ED is a concern of yours, cyro is even worse than surgery in terms of the potential risks.  Every doctor I spoke w/about it told me that you are almost 100% certain to become impotent after treatment w/cyro and the probably of success would be no greater than that achieved w/surgery or radiation. 

In any event, here's my recommendation as far as the primary choices for treatment available to you.