Timing for surgery after diagnosis

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I met a number of men who had that attitude of just getting the thing out of there. I can't said I held that option. Looking back I wish I had considered just the hormone and radiation route myself. And I wish I had worked with an onoclogist team instead of an individual doctor. I like the team approach used at some cancer centers.

As far as getting the Thing out of there, that doesn't mean you are home free. Even after surgery the cancer can come back. What I should have considered more carefully is the quality of life after treatment. Looking back is always easier than looking forward, but 1 year out from surgery I wish I had considered other options more carefully.
Something else to consider while you are waiting. I learned from poster Erisian who quite involved in PCa that frequent PSA tests have some value. I wish I had the doctors take three PSA tests from the 1st one I have in NOv 08 that got everything started. I should have had a PSA taken in Jan,Feb, early March to see if the PSA was moving upward or holding. That would have given my an idea if the cancer was aggressive or not. That may impact the type of treatment chosen, too. If I were in your shoes, my first choice whould be proton therapy, but I didn't have that option. Too bad. I did not like surgery, and I still leak. I was very active, now the leaking is an anchor on tht part of my life, too.

Just another prospective on this nasty thing you now have to deal with in your life.

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Charlie, like you my urologist recommends surgery at an early opportunity arguing that an early stage, indolent cancer has a good chance for a "cure" (defined as post-operative PSAs being < 0.1 ng/ml). Like most surgeons, he recommends surgery. Am only a week out from diagnosis myself and have not yet talked to an oncologiest or radiologist and am in the process of scheduling those now. Interestingly, my urologist did not reccommend the robotic surgery that many in this forum favor as he felt that in our area (San Diego) there simply weren't enough surgeons who has significant experience in the procedure although he felt that in the future most protatectomies would be robotic. One point he made which I thought was valid is that surgeons are surgeons primarily based on their abilty to use their hands and he felt the advantage of tactile involvement with the organs was a significant factor for an experienced surgeon over one who was performing the operation from a keyboard without tactile sensation. He also indicated that open surgery essentially had a single, 6-inch incision vice about six, 1-inch incisions. He also expressed that the rapid rise in in robotic surgery was the result of a very aggressive marketing campaign. Prostate cancer is big business in the United States.

When I queried my urologist about side effects he candidly indicated that there is a small, but significant percentage of post-treatment incontinence in varying degrees. Many posts in this forum allude to these complications (see the interest in artificial sphincters) Regarding potency and erectile function, he pointed out that after surgery sex was not going to be like it was before but that if nerves could be spared, more than 50% of men reported the ability to achieve erections "sufficient for penetration," often with the help of viagra-like drugs, penile vacuum pumps and associated paraphenalia. In addition to being sterile, orgasms change significantly without a prostate as there is no ejaculation (the seminal fluid being produced when the prostate spasms during climax), the erection is not as hard as before and the frequency of being able to achieve an erection is much less. Although different, he indicated some patients reported that when they occurred, their post-surgery orgams were more intense than before.

Besides the standard Gleason score, biopsy results, and PSA readings, you may also find it useful to assess your condition with a couple of other parameters that are easily calculated. PSA density is a measure of PSA to prostate volume and is easily calcualted by dividing your PSA at diagnosis by prostate volume which should have been calculated when they did the transrectal ultrasound during the biopsy. Another factor useful for determining long term risk factors is the PSA doubling time, which is a logarythmic function. The more PSA data points you have over time the more accurate the prediction. I found several readings from previous annual physicals going back to 2002. There are several PSA nomograms available on the web that can calculate this number for you. I used the one from the Sloan-Kettering site although Johns Hopkins has similar online tools.

Generally the literature I've read indicates that a low PSA denisty and a long PSA doubling time is indicative of having plenty of time to make an informed decision. One thing about PSA to keep in mind, however, is that the more aggressive forms of PCa tend to produce much less PSA than less aggressive strains so in the case of a large volume of cancer in a biopsy, evidence of capsular extension to seminal vessels or lymph nodes may mean that PSA denisty and doubling times aren't appropriate for your form of cancer.

The literature that I have read indicates that if you are T1c, PSA <10, Gleason <7, and low biopsy volume, low PSA density, and long PSA doubling time, the long term survival statistics for surgery, radiation, and active surveillance are the same.

I am also investigating some radiation techniques other than the rather standart brachy and XBRT that include a procedure known as Cyberknife (see cyberknife.com), proton therapy at Loma Linda Medical Center, and a very new procedure called Altaris Tx where there are ongoing clinical trials in San Diego. These procedures aim to achieve the same levels of radiation treatment to the affected areas in much less time and much more accurately administered (sub millimeter accuracy) that is supposed to minimize side effects and potential damage to surrounding tissue.

Good luck with your decison process.