Posted on 12/03/2018 7:07:37 AM PST by fwdude
I have mentioned previously that my rising PSA levels necessitated several biopsies in the past several years. The latest result has been that my "grade" has gone from Gleason Score of 6 (3+3) to a 7 (4+3). I'm soliciting advice and experience wisdom from other FReepers who've been through this, as I am navigating unknown waters.
Surgeon is recommending surgery (radical prostatectomy) but radiation is also an option.
Lot's of questions and concerns. I'm soliciting advice from all quarters on this. Thanks.
I’ve read that almost every man, if they live long enough, will have prostate cancer.
It will be harmless to them.
If it is an aggressive cancer, I’d treat it as you describe.
If it is one of the very slow growing cancers, and you are older, I’d seek alternatives.
Just my 2 cents and could be wrong.
It is what I’d do.
You need to research Radiation Seeds. A seed is inserted directly into the prostate tumor. The seed self dissolves over time. My uncle had this done for colon cancer for successful treatement.
3 friends of mine all opted for removal.
1 went VA other 2 went private and all are pleased with the results.
Dont get into intamacy discussions with them but others here I am sure will chime in.
Good luck and good for you being pro active.
Look into HIFU...High Intensity Focused Ultrasound...my hub had procedure (in Mexico by Florida doc)...tremendously successful..no drugs, no side effects, etc
PS...HIFU is now “legal” in US
Was diagnosed prostate CA 14 years ago at age 49. The most distressing aspect of the whole experience was the variety of treatment options, and that I could not get a straight answer from any of my doctors. The surgeon recommended surgery, the radiologist recommended radiology, etc.
I decided on prostatectomy, done via minimally invasive surgery. Yes, there were consequences that I am still dealing with; but I preferred to have a procedure that provided a definitive outcome — that is, a post-op biopsy that declared that everything was taken out.
Please know that there are many options, and in the end you will be fine.
Don’t do surgery without second opinion. Mine went to. 7.5 back to a 5 then back to 7 then back down. I had 3 biopsies, with one showing very small grey area which could possibly be cancer but doc said so small that the biopsy might have taken it. He says I’m just one of those guys whose PSA fluctuates.
Make sure no sex 48 hours before PSA TEST!
I’m back to checkups every 6 months. Upside he prescribed Cialis in case of ED probs, but it helped more with urine evacuation! Cheap now too cause it lost its patent.
Had it. Did the Image-guided radiation therapy (IGRT)/ Intensity-modulated radiation therapy (IMRT). Very successful in defeating the cancer. The problem is that most of the older treatment options have their potential drawbacks. There are several newer treatments that may reduce the after effects so you may want to do a lot of research on the internet before committing to a treatment option. Also the newer treatment may be really expensive so that may limit your options depending on your financial standing and your health insurance coverage.
In discussing this and the potential outcomes with my urologist he said, “In some men the nerve causing an erection runs through the prostate. In others, it runs outside the prostate.” I asked how he knows which it was. He said, “If the patient is unable to get an erection after the organ is removed, it was running through the prostate.”
I’d opt for radiation. Also, I had my prostate ultrasonically heated. The theory is that cancer has fewer blood vessels due to the way cancer grows. The blood supply cools the tissue. The idea is to heat the organ as much as possible without killing the good tissue. The cancerous tissue dies and is absorbed. My prostate shrunk considerably and I was very happy with the result. (I had benign prostate hyperplasia, not cancer. My PSA dropped but it wasn’t particularly high.)
Apparently, this equipment is very expensive and most urologists don’t have it. But, ask about it. I drove 250 miles to a doctor who had the equipment and stayed for a week locally after the procedure. It is done in the office under oral pain medication. You will have to have a catheter for the full week.
My Dad has it and choose alternative medicine because at least 5 doctors told him he had less than 90 days. Anyhow, that was almost 2 decades ago, and he is still around today doing well. He travels most of the time.
I am not a doctor, but I would look at all options including alternative medicine.
My brother-in-law had that treatment. The problem is the seeds can move for about 2 weeks after implanting. In his case one moved close enough to his colon it burned it and he has had bowel control problems since.
I think your age matters regarding the path forward. Most men will get it. My dad was just diagnosed.....he is 87. They are going to monitor PSA scores....the C is clearly not growing fast.
I’m 56, if it were me, I would have the surgery so I never had to think about it again.
Good luck
Ignore it.
Die when you die.
Many people live years after cancer diagnosis and still die of natural causes.
Why give your estate to Doctors instead of your children, especially when Big Med only adds 6 months longer?
Die when you die. It is okay. You were born into this life. Where is the proof that life is only a one shot event?
I’d exhaust any and all alternatives before submitting to radical prostatectomy. Wait and watch. If radiation,drugs and all else fails, find a urological surgeon skilled with the Da Vinci robot or laser surgery.
In my experience, surgeons usually recommend surgery. I am not suggesting that they are wrong, but surgery is what surgeons know best.
I would strongly recommend going to one of the large cancer treatment centers for a second opinion, even if your insurance does not cover it (my obamanationcare insurance covers virtually nothing). They see a much larger volume of patients with very similar conditions. For example, I have friends who swear by Cancer Treatment Centers.
https://www.cancercenter.com/prostate-cancer/
I am 86 and have a large prostrate (120 grams) . The size of prostrate also has bearing on psa. I pay no attention to psa because of so many false. Reports.
I too was concerned for cancer but have had a microwave procedure about 10 years ago. I take 3 drugs that are supposed to shrink the problem. I have had 2 Urologists who said I need surgery it my 3rd says no and I do not have cancer. My prostrate is shrinking!!’
Always avoid surgery if you can and it sounds like you can. Take radiation and then seeds before you think about having surgery. I’m a 15 year survivor so things were very different then. I had 25 radiation treatments - today it can be as few as 5.
Either way remember don’t panic. If treated early and aggressively most tomes you will be okay. When they ask you what appointment time you want say you want the first one in the morning. That way it won’t disrupt your day and if the machine breaks down (happened twice) they can reschedule you for the same day in a slot someone else had to give up.
Afterward they will check to see if the cancer has moved into other parts of your body. Bones first. Don’t worry about these after treatment tests, they are not problems most times. Just be thankful you live in America where prostate cancer is a minor threat. In the socialist Europe 1/3 of men end up dying if they get this disease.
Thanks. Yes, I’m seeking a second opinion on the latest labs. They searched long and hard for the cancer based only on PSA levels rising (which is not always a good indicator.) First two came out negative a year apart. Doctor advised an MRI-guided biopsy. They found a very small single core of Gleason 6 in less than 3% of the core. Decided on active surveillance.
Changed urologists and the new one was much more aggressive with diagnosis. Another (4th) biopsy found the same small amount of Gleason 6. He still wasn’t happy and ordered an Oncotype genetic test on the material which showed intermediate risk. The last biopsy found 2 cores of Gleason 6 with one core near the apex of Gleason 4+3=7 (30%).
I’ve developed what I consider a healthy skepticism of the health industry, knowing that there are many economic incentives for everything they do. So hence, the second opinion. I’m looking forward to a conversation with the urologist to gauge his reaction. That will say a lot.
Two of the smartest people I know had to face this decision. One is a Princeton PhD in Physics and the other is a Harvard Med MD/PhD in anesthesia. Both were very well connected in the medical world and did extensive research.
Both chose the old fashion, nerve-sparing open surgery route.
The reason was that the prostate was removed whole, not cut up in pieces as with minimally invasive or robotic surgery. This allowed the pathologist to fully examine the ex-planted prostate and determine how far along the cancer was (staging) and how/if/where it had spread.
Both have full sexual function and urinary control.
My father-in-law was a Princeton/Harvard Med/Hopkins surgeon and he chose the radioactive seed route. The seeds turned his prostate into a clump of scar tissue, but it stopped the cancer. He died at 87. However, he lost sexual function and urinary control at 80, so his last seven years were spent miserably in diapers. He really regretted the radioactive seed decision.
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