hi lyn - hummmm........57.5 years in the horns of the dilemma.......  i
was 57.3 years when i was told, and 57.5 years when i did something
about it.  i had a psa of 6.35, which is close to yours.  most cancers
are around a gleason of 5 or 6 when found, so if you were lucky and your
gleason was 3 or 4, your outcome would still be close to what my doctor
told me.  

i flat out ask him if i did watchful waiting, how long would i live?
after reviewing my records for a couple of minutes, he said that you
will not see 70 and your last three years will be pain.  so, that is
what i will pass on to you.  the average life when pca is found is 13
years if you do watchful waiting.  8 for the pca to mest. and 5 before
death would occur.  

after my doctor told me those facts, he suggested that because that i
was a young person 57.3,  i should do something.  he didn't push one
treatment over the other, but did say that either surgery or radiation
would extend my life and i need to do something within the next 60 days.

i can tell you that my dad did watchful waiting and the pain is not
something i would want to go through.  i would like to tell you that
they watch his psa climb from 6 to a level of 288 before they did
anything.  so if you wish to do the watchful waiting route, email me and
i will be more descriptive of what you can expect.  

my recommendation to you is to get either radiation or surgery.  both
have been proven to have good track records in regards to beating the
prostate cancer.

given the problems you are having already with the prostate - poor
stream and discomfort, you might look a little closer to the RP type of
treatment.  either RRP or LRP will produce similar results.  my logic -
you will do away with you poor stream problems for good.  otherwise, i
would say both treatments are pretty well equal.

hope this helps.

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."

I'm not a fan of WW, unless you happen to have  some other more serious
health issues.  If it were me I'd get it treated by operation or
radiation, both good and have plus and minus issues which should be
thought over carefully.  

The idea of having PSA tests every two months and twice yearly biopsies
is not appealing to me.  Waiting for something to happen would drive me
nutty.  

Good luck
Dale

<snip>

*someone at 57.5 years smack on the horns of a dilemma.
*
*I'd be most appreciative of any thoughts aired.

Well, I'm 43 and PCa free since Feb of last yr. I'm now remembering my
Gleason as 3+3, think PSA was 6 or 7. My uro didn't push for one
treatment over another and was mildly surprised when I gave a quick
decision "I want it out!". As stated by the others, WW sounds too
risky when there's treatment available that may be much more
effective. I went for RP w/nerve sparing due to young age and overall
good health. Haven't regretted it one bit.

Al

Please be quiet if replying via email,
flames will be deleted promptly.
I won't even read the whole message...

You'll find some good information on watchful waiting at the following
websites:
http://prostate-help.org/caterryh.htm and http://www.yananow.net

Personally, I'm with Dale on this.  At your age, I think the only
thing you would be waiting for is the cancer to grow.  (Some argue
that you can reverse it or stop it with diet and supplements.  I just
haven't seen any good evidence of that.)  You'd have to undergo
regular biopsies and other tests, all of which I found were, for me,
much more distressing than the actual treatment . . . which, in my
case, was brachytherapy and which was absolutely painless with no
serious side effects at all.  (No guarantee of that, of course, but if
you choose the right doctor, the odds are greatly in your favor.)  You
also have to have the right temperament for watchful waiting.  I would
have become obsessed with my PSA, I think, and panicky over anything
that might remotely have looked like an indication that the cancer was
growing.

From the sounds of it, Lyn, you might be Gleason 6 (maybe even 5) and Stage
T1a.

Of course you need to know exactly what you stage and Gleason are before
making a decision, but rather than a dilema, we'd like to think you have an
opportunity.  At 46, I had no such decision.  Like you said, after a certain
age, you lose the decision again.  However, at 57?, you can make a choice.

If all is very low and non-aggressive, I think you should lean towards
prostatectomy.  If you get up to a Gleason of 7, especially 4+3=7, and if
you are T2c or so, then radiation might be very attractive.  But, if it is
thought to be small and non-agressive, if for no other than your mental
outlook, I'd have it taken from me.

A lot depends on the Gleason score, so you really need to find out about
that.   "Low-grade, non-aggressive" could mean anything from Gleason 4
(or lower) to Gleason 6.  Gleason 6 seems to be the most common.  If
that is the case, I think you are a bit young for watchful waiting.  But
keep in mind that it is really life expectancy which is relevant, not
age.  My cancer was diagnosed as a Gleason 7 at age 67, but I was in
pretty good health and had a life expectancy of 15 years or more.  So
there was no question in my mind that watchful waiting was not a
reasonable choice.

Unfortunately, there are a lot of uncertainties in all of this, and what
you choose depends on how risk adversive you are.  If I had even a 20
percent chance of developing metastatic prostate cancer within 10 years,
I would do what I could to avoid that.   But no will can tell you with
any certainty what the risks are.

You can find out more about these matters by reading Patrick Walsh's
Guide to Surviving Prostate Cancer.

Hi Lyn...Unfortunately, today there are no reliable tests to tell the
newly diagnosed man whether he has indolent or aggressive PCa.  What
is known is that about 25% of the men with low-risk PCa (T1c, PSA<10,
GS<7) and who practiced WW, have not progressed after 8 years of
observation (J. Moul et. al., Journal of Clinical Oncology, Vol 21, No
21 (November 1), 2003: pp 4001-4008; Temporarily Deferred Therapy
(watchful waiting) for Men Younger Than 70 Years and With Low-Risk
Localized Prostate Cancer in the Prostate-Specific Antigen Era).
Hopkins has defined a subset of low-risk men that have what they term
"insignificant" or "low-volume" disease
(http://urology.jhu.edu/diseases/prostate/management.html).
Presumably, the number of men with non-progressive PCa in this group
would be even larger than the 25% found in Moul's study.  Find out
what all of your stats are (it's your right to know) and determine
which risk group you fit into.

Traditionally WW has been a consideration for men with a remaining
lifespan of 10-15 years, but it is becoming somewhat more common among
younger men today.  WW is a bit of a misnomer as most who practice it
seem to make significant lifestyle changes (stress reduction, diet,
exercise) and actively monitor the status of their cancer.  Color
Doppler by an artist is one of the monitoring tools used.  It would be
highly recommended to have a Color Doppler run at the outset to make
sure the cancer is not near the edge of the capsule.  While WW does
not have the morbidities associated with the more traditional
treatments, it does have its own set of drawbacks.  For example, some
men would have psychological difficulty living day-to-day with cancer
inside of them.  Further, it has yet to be demonstrated that men who
start with WW and later move on to traditional treatment have not
"lost" anything.  Moul is currently studying this question.

You are wise to consider WW among your various treatment options.  WW
isn't right for most men, it wasn't right for me, but only by
considering all options can you make an informed decision and a
decision that is best for you...Best wishes and good health, Ron

lyn,
My PSA was 7.7 before I went in for the biopsy at age 55.   I then did
a bunch of studying of my options and made my decision for RRP.  It
was based on several things: one was that of the ten cores the uro
took 4 had cancerous tissue,  I wanted it out NOW, and that should
radiation in either form (seeds or EMRT) fail then surgery wasn't a
follow-up option.  As it has turned out the Gleeson 3+3+6 T1c or T2
(dependly on which report I am reading)was at the apex of the
prostate.  Now I am on Lupron (HT) and doing the EMRT.  I can't say
whether or not going the other route would have made any difference
but I am not looking back. Hindsight, or coulda, shoulda and woulda's,
just don't even factor in.
I learned a lot from listening and reading what other PCa patients had
to say about their experiences and the decision made was, I feel, the
right one for me.
Hope this helped in a small way.

Chuck McClellan

...

..

This is such a tough decision!

If you get treatment, and don't die of cancer, you'll never know
whether the treatment saved you or was unnecessary.

If the treatment results in nasty side effects - incontinence,
impotence, complications - you might wind up wishing you
had never done it.  Some guys come through surgery or
radiation with no lasting after effects.  Some guys don't.

On the other hand, if you wind up with metastatic cancer,
you'll kick yourself every day for not having treated it earlier.

It might be that more extensive (and unfortunately, expensive)
testing will tell your doctor more about your condition.  One
poster suggested a color doppler ultrasound test.  I was treated
in a clinical trial, and they did a whole battery of tests (partly
because they needed accurate baseline information to get the
most scientific information they could from the trial.)  One of
those tests was a series of MRIs done with an antenna in the
rectum.  They came out with remarkably clear pictures that
showed the tumor in considerable detail - and showed that it
was fairly big and was pressed right up against, if not through,
the prostate capsule wall.

The National Health probably won't authorize anything like that.

I don't know what to recommend about treatment vs. WW.
However, if you do opt for WW, I would strongly emphasize
the "watchful" part over the "waiting" part.  Check often.  If you
see the PSA creeping up, don't delay.  Get it treated.  It sounds
like your doctor is very strong on that with 2 month PSA tests
and twice yearly biopsies.

Best of luck.

   Alan

Lyn
I have read the voluminous threads on your post, and it seems to me that the
the concensus of opinion is that you really don't have enough information to
make an *informed decision*.  I am not familiar with the health care system
in the UK; however, please be aware that we in the "colonies" are an
independent bunch.
Get a second opinion....ask that the biopsy slides be sent to a second
pathologist for a reading (after researching for experts in prostate cancer
pathology)...have them sent to a SECOND Urologist of your choosing for
determination...*KNOW* your gleason scores and what they mean (there's
plethora information on the web concerning PCa)....know what the options are
relative to your gleasons (re: age, overall health, life expectancy, hopes
for quality of life....what you'd be willing to give up in favor of ?....
You must know, KNOW, *KNOW*!!!
Do NOT feel embarassed or reluctant to ask for the second opinion.....it's
YOUR cancer that you're dealing with, not the physician's.  It's YOUR life
expectancy that you're dealing with, not the physician's.  It's YOUR quality
of life that is being determined, not the physician's.
(Not to mention YOUR money that's paying for all this!!!)
Be informed, then make the decision based upon ALL of the data YOU can
aquire.
Lyn, it's all up to YOU, but don't be complacent.  Be procative in your
health, and your future.  Do the research.  It sounds like you might have
the time (and that's the key).
Sorry.....the others on this newsgroup will attest that I'm very
long-winded........the above proved only so.
Am interested, and will follow your progress......
Respectfully,
Jeff

WW is just ducky fine if you already have one foot in the grave so to speak.
If you were 57 years old and in congestive heart failure the a bunch of
other medical then WW would be just fine. But WW is a bit like standing in
the middle of a busy highway waiting to be hit by a big lorry. Because WW is
just waiting to die, slowly and very painfully.

Now, there is nothing wrong with taking some time to educate yourself about
PC and the various treatments. Considering the biopsy findings you have
probably caught this in the very early stages. Therefore just about every
known treatment would probably be available to you. So you need to spend
some time reading up on the various treatments and finding out who does
which and at what hospitals in your area.

Give yourself 3 to 4 months to make a decision on the type of treatment and
which doctor where. Talk to a radiation oncologist, your urologist, check
with the large university hospitals and see what is going on there and what
it would take to get into their program.

Every treatment has some side effects but a few side effects sure beats the
alternative -death. And don't figure because you have treated your PC that
you will never be the same. Things change. But that doesn't mean it a bad
thing. Most guys think if the treat their PC that they will become impotent
or incontinent. Either can happen usually for a brief time if you surgically
remove the prostate (RP) but not always. And the younger you are the better
your chances or not having a problem with that. It is extremely rare with
brachytherapy - that doesn't mean it won't happen but it usually doesn't
happen. But these are the things that you need to look at and then decide
just what you want to do.

Quite honestly I think men with loving, supportive partners have less
problems then those without. If you have a partner then you need to talk to
the partner, together you can work on the research and discuss the
side-effects of each treatment. Ultimately it is your body therefore your
decision on treatment.

One of the best websites has had some problems lately and might not be up
and running  but keep checking on it. http://www.phoenix5.org

http://www.cooleyville.com/
Is an excellent site for information on brachytherapy and the other
radiation treatments.

If you have questions along the way I'm sure you will find the folks here
willing to give their experiences on their treatment. I think just about
every possible medical treatment for PC is represented here amoungst the
posters. And just about every age group is also represented. We've also been
known to answer some very "delicate" questions with honesty.
Bev (the wife of a PC survivor who had brachytherapy)

I'm grateful for everyone's reply and thanks again to those who followed up too.
I'm on the move for a couple of weeks so will be out of touch but would
appreciate a chance to pursue this further later on - this notwithstanding the
fact that for many on this NG I can see the advice is to act NOW.  I read the NY
times article referenced by a poster here, and I note also that this coincides
with a similar report (probably the same source) in the UK which undermines the
proactive cause.  What struck me most about my last meeting with the urologist
(I've yet to be introduced to the surgeon and radiologist) was his absolute
neutrality. At the end of the meeting he even asked to be reassured (by me) that
he hadn't shown any bias in favour of a particular treatment.  He hadn't, and
for me this has the ring of uncertainty about it, a sense that figures, in spite
of their abundance, hasn't yet provided solid bases or clear conclusions for
action.  

I'm still uncommitted but will be reading up what I can (thanks to all for
various refs) and may well suddenly decide to jump the WW ship after the next
PSA which I would expect soon. If the anxiety of waiting and wondering weighs on
me as much as I can see it has on some of the posters here then I will have
first-hand experience of that particular problem.

Thanks again.