Advice for newly diagnosed

Skid Row Tom said:

Treatment decisions
One factor that influenced my decision (I had open surgery) was when my surgeon said I could have surgery and if necessary, follow up with radiation (it wasn't necessary). However, if I had radiation first followed by surgery, the radiation could turn the tissues into "mush" and it's like operating on jello. In other words, radiation makes follow-up surgery problematic. I chose the surgery as my primary weapon and held radiation in reserve. So far, four years of undetectable PSA's.

Kongo said:

Scout
Sorry to hear that your husband has this disease but you are both fortunate that this was discovered early and that your numbers (at least what you have provided) seem to indicate that you have several potential options for treating the disease.

I would be wary of comments from others about characteristics of some of the various types of treatment or those who strongly favor their method of combating the cancer over any others. For example, radiation does NOT turn your organs or surrounding tissue to "mush." Certain types of radiation may cause scarring in some areas that makes follow-on surgery more difficult but the overall success rates of modern radiation treatments means that very few men need any sort of follow on surgery anyway, so the whole issue is really moot. If the cancer spreads beyond the prostate after radiation then the removal of the prostate will not cure the disease and other courses of action are more appropriate.

About 70% of men in the United States choose surgical removal of the prostate as their main treatment course. Of these, about 30% will see a rise in PSA following their surgery and will require follow-up radiation often with a combination of hormone therapy. While most men who have surgery regain full urinary continence and a varying ability to achieve erections, returning to a "normal" quality of life may be problematical. This forum is filled with threads by men who suffer debilitating quality of life issues following surgery that includes incontinence, erectile dysfunction, penile shrinkage, and other side effects. Make sure the doctors explain in great detail what the potential side effects of their treatment specialty.

There are several types of radiation that successfully treat early stage prostate cancer with extremely high efficacy and much fewer side effects than surgery. Some of these include proton therapy, brachytherapy, HDR brachytherapy, IGRT, XBRT, CyberKnife, IMRT. All have advantages and disadvantages which must be carefully weighed against the specific pathology of your husband's cancer.

There are other treatments as well that include localized cyrosurgery, HIFU, and Active Surveillance. AS, as Ira mentioned in his blog is a very viable option for men with early stage prostate cancer because there is a good probabililty that your husband's disease will never progress beyond the slow-growing indolent stage that was described in your postings.

You have really do your homework on this disease and trust nobody to make these important decisions for you. Urologists are mostly surgeons and over 90% of them will recommend surgery. Radiologists overwhelmingly recommend radiation treatment. In my own case, I read ten books, dozens of medical studies, perused hundreds of blog postings, and consulted with six specialists before making my decision. When I finally made my choices, I was confident I knew what I was getting in to, but even then I kept having second thoughts.

I would urge you to get a complete copy of all of your medical records, calculate your PSA velocity, PSA doubling time, PSA density, and so forth so that you have these statistics readily available when you begin learning about the choices you have to treat PCa.

After you have done your studies, I suggest you make a choice that has the best option of curing your husband's disease the first time, and not worry about whatever fall back plans might be out there. This is a very treatable disease.

The other thing to keep in mind, and I am sure the supecialists you consult with will confirm this, is that in your husband's case this is a very treatable disease and most any option you choose will likely be successful and this is a disease you will die with, not from. Your decision then is to choose a treatment option that promises the least side effects and impact on your quality of life.
Best of luck to you as you start this journey.

===========================================
Age at Dx: 59. DX PSA 4.3, Tx PSA 2.8 (after elimination of dairy)
DRE normal. No history of PCa in the family.
Biopsy: 1 of 12 cores positive with ardenocarcinoma, 15% involvement.
Gleason: 3+3=6, Stage T1c
PCa diagnosed in March 2010. Treatment with Cyberknife radiation in June 2010.
Side effects: None

steckley said:

Advice
Scout,

Sorry for delay in getting back to you.

I was in the hospital one day. I had surgery in the morning; up and walking in the afternoon; and reurned home the next day. It was only a 15 mile ride home ... don't think I would have wanted to go further.

I needed a lot of help the first week (thank God for my wife's help); slept in the recliner.

The cath came out after a week and the amount of help I needed after that went to zero. But I was moving slow and carefully. I was lucky and had no leakage problems after the cath was removed. By the third week my walks had increased to over a mile and I was feeling pretty good. I think around week six I felt normal, but had the occasional pain.

I work part time (consult) so I did not have to go to work each day ... if I did I don't think I could have done it on a daily basis untill after week 4.

Hope this helps ... if you have any questions, please feel free to ask.

Good luck with your research and best wishes to you and your husband.