Newby seeking advice

Been-by
Fonso:
First, to address the issue that is with you daily, a good mental health check-up is worthwhile. Sleeping well? Mind focused? There are lots of ways to deal with such things. I recommend a regular check in with your local prostate cancer survivors group. If you are in Florida there is likely one around the corner. Good men and women and good advice which is offered with earnestness but is worthless. The key thing is to tease out their experience and dispose of their prejudices. Just hearing their experiences and mistakes and troubles will put all into perspective. Anecdotes, properly vetted, can be educational. And the Mental support is priceless.
Now to the questions: Second opinion? ALWAYS a good idea as the biopsy specimen contains the most key information leading your doctor.
2. There is permanent seeds which dislodge rarely, and then usually pass even then. Also temporary brachy, which involves a template and needles that circulate a radioactive solution into the tissue and then are withdrawn. This may require multiple treatments over a short perod. This leaves no materials in the body. Andy Grove, CEO of INTEL famously had this in the late 1990's.
As to the Proton issue, the key thing is the skill and expertise of the practitioner/doctor/radiologist and not the cost or wow-factor of the machinery. If the person working the machinery is not the most experienced and talented that you can find, forget it.
I must say that immediate treatment is not the only choice. For the stats you present you can do only surveillance, and perhaps for a long, long time. No side effects, no (additional) cost, no treatment issues or insurance arguments and no regret since treatment may commence at your schedule.
Find your group members and run it by them.

Sorry...
I do know little about prostate cancer. My father was diagnosed in 2000, at that time he vas 71 years of age and his Urologist recommended Brachytherapy. He had it in 2001 and in 2007 the cancer came back with bone met. I strongly recommend to seek other options to avoid recurrence. Best wishes.

Noniu

Welcome
NYFonso,

Welcome to the forum although I'm sorry that you have to be here.

I know you're anxious about your rising PSA but from what I've read I would not be surprised if most of that was not attributable to the BPH (or getting lucky the night before the blood draw). Interestingly, PCa often starts growing near the time that prostates begin to enlarge and one of the big failings of the PSA reading as a stand alone indicator is that it isn't specific with regards to root cause. Exercise can also elevate PSA slightly as well as ejaculation before a blood draw, a hard stool, and even OTC medication such as Advil. After ejaculation, the half life of PSA in your bloodstream is about 48 hours so the bump up you describe following sex is well within what might be expected. Your doctor should have advised you that many drugs taken to shrink the prostate also mask PSA readings and your actual PSA should be factored upwards by almost 2:1 while taking drugs like Avodart. If you google Avodart and PSA you will find many discussions and papers about the affect on PSA.

I think tarhoosier gave you some excellent advice. By all means, please get a second opinion on your biopsy. Although changes to a pathology reading are uncommon, it happens frequently enough to be worrisome and it's something I would want to have firmly established before embarking on a treatment based on single pathologist's interpretation.

Like you, I had a biopsy after a referral to a urologist after a PSA rise of about 1.5 ng/ml over an 18 month period. Not knowing anything about PSA or biopsies or PCa at the time, I went along with everything. My biopsy results were 1 of 12 cores positive with 15% involvement. I researched and scheduled consultations in bathytherapy, proton therapy, open and robotic surgery, and various other forms of radiation before making my final decision. An important factor to me was quality of life and like you I quickly became wary of my urologists recommendations for surgery after reading up on potential side effects. I also consulted with Loma Linda Medical Center, the original site for proton therapy, and it eventually became my second choice. Since then I've read many studies that indicate proton therapy is no more effective than IMRT radiation (and way more expensive) which is why some insurance companies balk at shelling out the nearly $100K for treatment. Unless you live close to a site, you will also need to move there for a few months for the treatment sessions and incur those costs out of pocket. Having said that, there are many, many men who swear by proton therapy and have been successfully treated by it. It is a complicated procedure involving Bragg peaks and immobilizing the prostate instead of compensating for its natural movement but all in all I believe it to be one of several effective tretment options for lower risk PCa.

There are other treatments such as IMRT or SBRT (CyberKnife) that you may wish to look at as well, depending on your personal priorities and insurance coverage. HDR brachtherapy, (tarhoosier referred to that as temporary brach) is another method with outstanding results. I would also suggest that you consult with a urologist the specializes in open surgery and one who does robotic so that you can weigh the pros and cons of that approach against the others. You won't get any do-overs on this and the decision you make will affect your daily quality of life for as long as you live. You're betting your life on picking the right treatment for your individual cancer so please make it carefully.

Most specialists tend to downplay the side effects of their preferred treatments unless you really grill them on it. Questions to ask as you do your interviews and research are liklihood and severity of continence, potency, ED, penile shrinking, fatigue, surgical recovery, biological recurrence, and so forth. Surgical impacts occur, obviously, immediately upon treatment. Radiation effects may take longer to occur. Make sure you understand the nuances of any treatment method.

Regarding fighting the insurance companies...good luck with that. They of course are in the business to make money and I believe men should pay closer attention to what they sign up for but at this point, you've pretty much got what you've got. I expect that the proton therapy center will have experience in appealing insurance claims and may be able to guide you in this process.

If, by chance, you are a veteran who served in Vietnam, the government presumes that Agent Orange caused the PCa and will cover the treatment expenses (Proton therapy is one of the treatments Tricare will cover...at least they did in the Southwest region) as well as give you disability. Just another avenue to check out if you qualify.

Best of luck to you as you start your PCa journey. I know that the added stress of going through a divorce while fighting this disease is an onerous load to bear. This forum is a great place to get a lot of advice and support.

Best,

nyfonso said:

Thanks Noniu.
Sorry to hear
Thanks Noniu.

Sorry to hear about your Dad. How far along was he when diagnosed? When reaching his age, the chances are higher of positive met because the PCa has likely been hanging out for a while.

The biggest issue to manage here is recurrence.

Good luck with your father.

NYFonso

Sorry I did not respond
Sorry I did not respond sooner. He diagnosis is as follows:


Diagnosed as intense acute, subacute and chronic inflammation with urothelial ulceration, interstitial hemorrhage and mildly atypical urothelian hyperplasia; posterior wall

Infiltratin moderately differentiated prostatic adenocarcinoma, Gleason's Score was 3 + 3 , with perineural invasion, involving most pieces, roughly 20% of the tissue; righ. Also present chronic prostatitis.

Fibromuscular hyperplasia of the prostate with moderate chronic inflammation; left

I guess it was an early stage possibly curable?

Thank you for your support and suggestions, and good luck to you. God Bless...