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Seeking Best Treatment Option of Prostate Cancer

akhlak
Posts: 6
Joined: Mar 2017

Dear Sir,

I am Mohammad Asaduzzaman from Bangladesh. I am 43+ years old.

I am writing about my prostate cancer and seeking the best & proper treatment option.

 

Pathological History: Bangkok Hospital Medical Center

PSA (Prostate Specific Antigen) level: 6.83 ng/ml

Date of Test: 24-02-2017

***********************************

Prostate Biopsy: Report

Prostate, core biopsy specimen, right lateral zone:

oBegin Prostatic Hyperplasia

oNo Adenocarcinoma in the specimen 

Prostate, core biopsy specimen, left lateral zone:

oProstatic Acinar Adenocarcinoma

Gleason’s Grade 3+3=6/10

Involving 3 out of 7 cores

Maximum Percentage of core involvement approx 20%

No Perineural Invasion

No Angiolymphatic Invasion

 

Date of Test: 01.03.2017

*****************************************

Bone Scan: Report

No Evidence of Bone Metastasis

Date of Test: 16.03.2017

*****************************************

Chest PA: Report

No Active Chest & Pleural Disease 

Date of Test: 16.03.2017

*****************************************

MRI Abdomen: Report

Left peripheral zone: Subtle 11x15 mm T2WFS/ ADC hypointensity lesion at posterior aspect of middle level to apex level.

Cancer is probable diagnosis.

No periprostatic fat invasion.

No pelvic lymph node enlargement.

Seeking the Best Hospital:

I am seeking the best treatment option of prostate cancer. 

You are requested to review my pathological history/report and suggest me the details pathway (step by step) of this treatment. 

 

N:B All reports are attached with this mail.

 

Kind Regards,

Mohammad Asaduzzaman

Steelchuggin26
Posts: 36
Joined: Mar 2013

Hello there, sorry to read you have been diagnosed with prostate cancer.  It appears based on your biopsy report, and the imaging studies, that your cancer is contained within the prostate, which is good. This leaves your treatment choices wide open.

At 43 years of age, you are quite young to have prostate cancer, and so long as you have no significant comorbidities (heart disease, diabetes,  etc), your dr will likely recommend surgery, especially if he or she is a surgical urogist. Most drs tend to be biased towards their specialty. But that doesn't mean you have to go thst route. Radiation therapy is a good choice as well, with similar success rates as surgery.

 

When making your decision, you need to take into account your preferences. Weigh the pros and cons of each modality, and choose one that you feel is best fir you, and that you are most comfortable with. Also, make sure whomever treats you is well experienced at what they do. The more experienced the Dr, the less likely you are to have side effects and complications, and the severity of any incurred would be less severe than if done by an inexperienced physician..

 

The goals of treatment are as follow, in this order:

1. Cancer eradication 

2. Continence 

3. Preservation of sexual function 

 

Getting the cancer out is the main thing, followed by continence, which there likely will be a degree of loss, but can be regained with time and kegel excercises. And lastly, sexual function.  Sexual function can be preserved by a good physician. If surgery is done, you may notice slight shortening of the penis. This is due to having to excise btween the prostate abd bladder, and the doctor has to sow a new connection from your urethra to the bladder, and this can draw the penis in slightly.  A good surgeon can also spare the nerves respnsible for erections.

 

With gleason 6 cancer, it is slow growing, and you have time to make a decision on treatment. You don't have to rush into it. This will allow you to look into each form of treatment thoroughly, and decide whats best for you.

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

Well, I can tell you what NOT to do, even though I did all of them listed below.  Listen to all the cancer specialists.  Today one person out of three gets cancer.  I am sure this MUST be far fewer people than got cancer forty years ago, because there have been many billions spent in research in the last forty years.  So doctors today must know lots more and have great treatments.  They have radiation.  I always thought radiation caused cancer, but I must have been wrong.  Now radiation cures cancer.  And there is also Chemotherapy that pours poison in your body to kill the cancer cells.  I guess the Chemo knows which are the cancer cells and which are the body’s immune cells.  It would be a shame if the chemo killed the immune system too.  I did not do these things because my cancer was so advanced that I knew these modern effective treatments would not have time to work, and I wanted to save the many tens of thousands of dollars for my wife and children instead. And I did not want to risk my remaining days feeling totally rotten from the side effects of treatment.

       Now, the very first thing you should definitely NOT do is investigate the Ketogenic Diet with Intermittent fasting.  There is lots of info on Youtube.  The diet basically forbids eating carbs and probably about 85% of the food served to patients in the hospital.  The idea is that your body will change from running on glucose to running on fat, because you are going to eat fat about 75%.    You see, cancer loves glucose, and starves without it.   Do not ask your doctor about Keto as he has never probably heard about it in the first place, but will tell you NOT to do it.  It would be very improper for me to suggest that if you have cancer at a young age, it might well be due to your diet, and that a diet change might be of service.  Therefor, I suggest you get take-out meals from the hospital!!!  It makes sense that hospital food would be the best for you.  

        Do not check out the following really stupid and far out idea unless you are a Hippy willing to gamble with your life.  This idea is Hydrogen Peroxide therapy for cancer.  I have posted about this on the board here, and everyone agrees it is a far out, stupid idea.  Well, I know I have not helped you much, but I have given you some ideas of what NOT to do.  Love, Swami Rakendra

 

                                                                                             

Swingshiftworker
Posts: 1013
Joined: Mar 2010

Sorry to hear about your recent diagnosis. 

Anyone newly diagnosed with prostate cancer rated Gleason 6 (and usually Gleason 7) has all treatment options available to him and, since this cancer 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 available 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 CyberKnife (CK) radiation treatment 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.

5) 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!

VascodaGama's picture
VascodaGama
Posts: 3013
Joined: Nov 2010

Mohammad,

I notice you have repeated this request in another thread. I think that you should get second opinions from different specialties. Urologist for surgery and radiologist for radiotherapy. Both are proper for you but differ in risks and side effects. You can also get the opinion from a medical oncologist to verify if you could follow active surveillance (AS), postponing the treatment but being under constant vigilance for not allowing the case to get worse.

I am not aware of the quality of medical facilities in your country or even on the skills of the doctors. Surely the ones with loads of experience and modern facilities are the best. You may find many at Singapore hospitals. You can also try places in India. You can request advice on medical care in India contacting the poster in this forum named ramaka (Avi) via csn email in here: https://csn.cancer.org/user/270414 

The above survivours have given good advices which you should investigate when discussing with your doctor.

Here is a link you may find useful to understand the problem of prostate cancer and how to treat it;

http://www.ccjm.org/index.php?id=105745&tx_ttnews%5Btt_news%5D=365457&cHash=b0ba623513502d3944c80bc1935e0958 

Best wishes and luck.

VGama

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