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Sorry to be here...but hello!

AZ Guy
Posts: 9
Joined: Feb 2017

Hello Everyone. I was just diagnosed this week and am busy immersing myself in all there is to know about Prostate Cancer. This appears to be a good place. I'm 49 years old so a little surprised I'm dealing with this, but my father was diagnosed in early 60's.

Here are my stats:

Diagnosed 2/13/17 as T1C

PSA 6.6 (actual number is 3.3 but we are doubling it due to 20 years of Finasteride (Propecia) use)

Gleason 6

2/12 Cores positive (5% involvement in one, 3% in the other)

DRE Negative

PSA History (These scores should be doubled due Finasteride use)

Date

PSA Score

11/16

3.3

5/14

2.7

2/13

1.9

10/11

1.8

2/08

1.0

The prostate is small- just estimated at 11 cc. Again, probably due my finasteride use. Any thoughts on plan of action given a small prostate? My urologist is having the Prostovision test done on my biopsy samples.

 

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Sorry to hear about your recent diagnosis.  Here is the "sticky" that I've prepared and posted for other men like you newly diagnosed with a prostate cancer of relatively low risk.  Lots of men here who will be hapy to assist in answering any questions that you have about your treatment options.  My opinion is clearly expressed below but you are of course free to make any choice that you think best for you.

 

The following is a duplicate of one that I have posted in various threads on this forum to give men newly diagnosed w/lower risk prostate cancer (Gleason 6 or 7) an overview of the treatment options available to them.

 

Anyone newly diagnosed with prostate cancer rated Gleason 6 (and usually Gleason 7) has all treatment options available to him and, since this cncer is considered "low risk", he has time to decide which choice is best for him.  So, the first thing a new prostate cancer patient should do is to do research on the available options before he actually has to make the decision regarding which treatment to choose.

The following is my response to other men who asked for similiar advice about the treatment choices avilable to them.  It's a summary of the available treatment options and my personal opinion on the matter.   You can, of course, ignore my opinion about which treatment choice I think is best.  The overview of the choices is still otherwise valid.

 . . .  People here know me as an outspoken advocate for CK and against surgery of any kind.  I was treated w/CK 6 years ago (Gleason 6 and PSA less than 10).  You can troll the forum for my many comments on this point.  Here are the highlights of the treatment options that you need to consider:

1)  CK (SBRT) currently is the most precise method of delivering radiation externally to treat prostate cancer.  Accuracy at the sub-mm level  in 360 degrees and can also account for organ/body movement on the fly during treatment.  Nothing is better.  Accuracy minimizes the risk of collateral tissue damage to almost nil, which means almost no risk of ED, incontinence and bleeding.  Treatment is given in 3-4 doses w/in a week time w/no need to take off time from work or other activities.

 2) IMRT is the most common form of external radiation now used.  Available everythere.  Much better accuracy than before but no where near as good as CK.  So, it comes with a slightly higher risk of collateral tissue damage resulting in ED, incontienence and bleeding.  Unless things have changed, IMRT treatment generally requires 40 treatments -- 5 days a week for 8 weeks -- to be completed.  I think some treatment protocols have been reduce to only 20 but I'm not sure.  Still much longer and more disruptive to your life than CK but, if CK is not available, you may have no other choice.

 3) BT (brachytherapy).  There are 2 types: high dose rate (HDR) and low dose rate (LDR).  HDR involves the temporary placement of rradioactive seeds in the prostate.  CK was modeled on HDR BT.  LDR involves the permanent placement of radioactive seens in the prostate.  1/2 life of the seeds in 1 year during which time you should not be in close contact w/pregnant women, infants and young children.  The seeds can set off metal/radiation detectors and you need to carry an ID card which explains why you've got all of the metal in your body and why you're radioactive.  Between HDR and LDR, HDR is the better choice because with LDR, the seeds can move or be expelled from the body.  Movement of the seeds can cause side effects due to excess radiation moving to where it shouldn't be causing collateral tissue damage -- ED, incontinence, bleeding, etc.   Both HDR and LDR require a precise plan for the placement of the seeds which is done manually.  If the seeds are placed improperly or move, it will reduce the effectiveness of the treatment and can cause collateral tissue damage and side effects.  An overnight stay in the hospital is required for both.  A catheter is inserted in your urethra so that you can pee.  You have to go back to have it removed and they won't let you go until you can pee on your own after it's removed.

 4) Surgery -- robotic or open.   Surgery provides the same potential for cure as radiation (CK, IMRT or BT) but which MUCH GREATER risks of side effects than any method of radiation.  Temporary ED and incontinence are common for anywhere from 3-12 months BUT also sometimes permanently, which would require the implantation of an AUS (artificial urinary sphincter) to control urination and a penile implant to simulate an erection to permit penetration (but would not restore ejaculative function).  Removal of the prostate by surgery will also cause a retraction of the penile shaft about 1-2" into the body  due to the remove of the prostate which sits between the interior end of the penis and the bladder.  Doctors almost NEVER tell prospective PCa surgical patients about this.  A urologist actually had the to nerve to tell me it didn't even happen when I asked about it.   Don't trust any urologist/surgeon who tells you otherwise.  Between open and robotic, open is much better in terms of avoiding unintended tissue cutting/damage and detection of the spread of the cancer.  Robotic requires much more skill and training to perform well; the more procedures a doctor has done the better but unintended injuries can still occur and cancer can be missed because the doctor has to look thru a camera to perform the surgery which obstructs his/her field of vision.

 4) You may also want to consder active surveillance (AS), which is considered a form of treatment without actually treating the cancer.  You just have to get regular PSA testing (usually quarterly) and biopsies (every 1-2 years, I believe) and keep an eye out for any acceleration in the growth of the cancer.  Hopeful and Optimistic (who has already posted above) has already mentioned this and is your best source of info on this forum about it. 

I personally could not live w/the need to constantly monitor the cancer in my body.  Like most other men, I just wanted it delt with.  Some men gravitate to surgery for this reason, thinking that the only way to be rid of it is to cut it out, but I did not like the risks presents by surgery and opted for CK, which is a choice I have NEVER regretted.  I am cancer free, there is no indication of remission, there were no side effects and my quality of life was never adversely affected.  Other men on this forum have reported similiar results.

 So, for obvious reasons, I highly recommend that you consder CK as your choice of treatment.  The choice seems obvious when you consider the alternatives but you'll have to decide that for yourself.

 Good luck!

 

hopeful and opt...
Posts: 2226
Joined: Apr 2009

 

The amount and aggressiveness of the cancer that was found were each very low, which may qualify you for Active Surveillance.

I have not heard of a Prostovision test. I assume that is it a gene test...is it a new company that does this? The gene test is   appropriate test.

An appropriate image test is a T3 MRI. This may show if there extracapsular extension (which is doubtful, but the test is worth getting).

PSA/prostate size ratio............an ideal candidate for active surveillance has a ratio under 0.15 , yours is higher at 0.3. Your taking finasteride may or may not affect this ratio ( you may wish to discuss with your doctor). .

I have been  treated with Active Surveillance for 8 years now. I start my ninth year in March. Please click my name to the left to see the tests that I have done, and other information germaine to the Active Surveillance protocol.. (There is a man where I am treated who was 35 at diagnosis, which was at least 10 years ago.)

 

VascodaGama's picture
VascodaGama
Posts: 3041
Joined: Nov 2010

I start this post by saying that you need to consider the pros and cons of a treatment in regards to the risks it will have in the loss of the quality of life. Doctors want to treat and will recommend what they think it better to eliminate the cancer, but the risks and side effects weigh little in their decisions. They will request you a signed agreement, before any doing, to relief them fron any wrong choice or outcome or effects caused by the treatment. It is you that must chose and tell what you want. You need to understand what is in discussion.

The best outcomes are linked to the best diagnosis. You need to certify if the clinical stage T1c and the Gleason grade are proper. I recommend you to read past threads in this board and approach the matter coordinately and timely. Do not rush. Get several prime and second opinions from separate specialists, take notes on the details and talk with your family. They will be affected too.

Long periods of Finasteride use is not just linked in halving the PSA but also to the idea that it eliminates lower aggressive types of PCa (Gleason rate lower than 3) leaving the ones more aggressive and, therefore, turning the case into high risk. The Prostate Cancer Prevention Trial has shown the influence of this 5-Alfa reductase inhibitor in Pca cases. You can read the many links in the net on the matter. Here is what the National Cancer Institute tells us about;

https://www.cancer.gov/types/prostate/research/finasteride-reduces-low-grade

A compendium on Prostate cancer diagnosis and care;

http://www.lef.org/Protocols/Cancer/Prostate-Cancer-Prevention/Page-01

Welcome to the board,

Best wishes and luck in your journey.

VGama

Clevelandguy
Posts: 470
Joined: Jun 2015

Hi,

There are several options in two main categories, surgery or radiation.  Each one has it benefits & side effects.    I don't feel watchful waiting is an option with cancer but that's up to you. With a 3+3 and if the cancer is totally inside of the prostate you could go either way, surgery or radiation. I would talk to the oncologist to get his view.  Surgery usually has its side effects up front and gets bettter over time.  Radiation has usually very little side effects up front but can develope over time.  Either way there will be challenges to overcome after your treatment option. Neither the ED or leakage hampered my life style over my 2 yrs. + journey.   I chose surgery, had ED & leakage after surgery but after almost three years no ED and minor dribble after urination.  Get a surgeon with as much experience as you can find, it will pay off in the end.  I do not regret choosing surgery, I sleep well at night knowing that my prostate and hopefully all the cancer was removed in one shot.  I did not have to do any followup radiation or drugs.  Other people will chime in about which treatment option they prefer but in the end it's still up to you to decide, not anyone on this message board.  Good luck on your journey to get rid of the bandit and get on with living.

Dave 3+4

MEtoAZ
Posts: 37
Joined: Feb 2016

You have a lot of options and you don't have to do anything in a hurry at your stage.  I was diagnosed at 52 in similar state, 2 cores positive out of 12 but one was 3+4 the other 3+3.  I ended up going Cyberknife using Phoenix Cyberknife.  I spoke to probably 5 different specialists, surgeons, conventional radation, SBRT (Cyberknife) and I recommend you likewise speak with at least a couple of surgeons and radiologists.  I would not recommend conventional radiation at your age.  Likelihood of long-term effects is increased the younger you are.  SBRT (Cyberknife) isn't the same as conventional radiation.  I would recommend you also talk to Dr Kresle at Phoenix Cyberknife if you are in the Phoenix area.

The most popular option is surgery and that is likely the direction you have been pointed by your urologist as mine did as well.  Just educate yourself on the positives and negatives of the various approachs and I am sure you will have a successful outcome.  Early stage prostate cancer is something you can beat or even wait on.  Good luck with your decision and stay positive!

AZ Guy
Posts: 9
Joined: Feb 2017

Thanks for the warm welcome. Yes, I am in Phoenix. Met with my urologist for the results but have scheduled meeting with Dr Grado of Southwest Oncology to get the view on radiation and possible seeds. I'll look into Phoenix Cyberknife as well. I've moved past the initial shock (and wanting a surgery the next day) to getting informed best I can of my cancer diagnosis and the best treatment for me. I recognize that the cancer is low risk, but trying to understand how the small prostate factors into my risk and treatment options. As Hopeful stated above, the PSA/prostate size ratio does not appear to be in my favor. Just how much "weight" to assign to that metric relative the other considerations will factor into my decision. I haven't seen too much discussion around finasteride use and smaller prostates with cancer. My urologist doesn't seem to be too concerned about the size.

I recognize Active Surveillance may be an option but wonder if my brain will allow me to carry on without too much stress about it. My wife had a nasty battle with Breast Cancer 9 years ago and is doing great. She was brave through bad news and difficult proceedures so I will need to follow suit with what is certainly a less serious diagnosis.

Laxdad
Posts: 2
Joined: Jan 2017

Good luck with your decision.  I had robotic surgery at 55.  Best advice i recieved, outside of which path to chose to recitfy the cancer, was to get in the best shape I could.  Treat the surgery like a road race or a triatholon.    You will 1) make your surgeons life easier if he does not have to deal with excess tissue, 2) you will get your mind right by excercising and 3) it will help you reboud more quickly from the surgery.  The better shape you are going in, the better you will be coming out.. 

good luck. 

Guber4
Posts: 6
Joined: Feb 2017

What is your Free PSA? 

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