Bob:

I think that you've come to the right place...well, at least one of them.  I'm
57, and was diagnosed a month ago.  Since then, I've been doing a lot of
reading and web browsing.  The book my urologist gave me was way out-of-date,
so I bought Walsh's book and another by Blasko.  One seems to favor surgery,
the other seeds.  So, I was able to play one off the other, by reading their
biases, between the lines, and contrasting their approaches.

I also made additional Dr. appointments.  So far, I've seen two urologists, a
radiation oncologist, and a robotic surgeon (got him through a referral from
this group).

I also got some really good general info from the Prostate Cancer Research
Institute newsletters (available as ".pdf" files at "www.pcri.org").

I'm sure that some of the "older" members of this group will be able to steer
you onto even more good info.  I think that one of the keys to a successful
treatment is knowledge.  Although my treatment (laprascopic robotic RP) isn't
schedule until next month, I'm still looking.  When I go in, I will be sure
that I've done everything I can to insure that the treatment I've selected, is
the best one for me.  I'm the only one who can decide this.

It's kind of like jumping with one parachute...you want it packed right!

Chuck

Hi, Bob.... Welcome to the club nobody wants to join.
I was 51 when diagnosed in Sept. of 02.  I had a laparoscopic radical
prostatectomy in Nov of that same year.  It was the right choice *for me*.
The main thing right now is to do what you are doing.... read, read, read...
and ask questions.  It's not the end of the world... there *is* life after
PCa!!  I still remember the gut-wrenching feeling I had when I was told I
had cancer, though.... not words anyone is really every prepared for.
Another good site for information is www.phoenix5.org .  Lots of great stuff
about anything prostate related!

Take a deep breath..... and just keep looking around.  A second opinion is
always good.... or a third!  Honestly, at 49, the scales are going to be
heavily tipped in favor of surgery.  Nerve sparing is a possibility.  There
are pros and cons to any type of treatment.  For info about LRP look at
www.krongrad-urology.com .
For seed implant therapy combined with radiation, look at www.rcog.com .

Take care, guy... and feel free to ask all the questions you want.

MikeH

Well, Bob, you certainly came to the right place.  Not only do we have some
of the more foremost prostate cancer patients in the world here, we have a
few avid cyclists.  I'm assuming their cycling experience is important to
you as well.

To begin with, you should get a second opinion, and maybe a third.  In your
case, being 49, surgery is considered the only viable solution.  But, there
is three types of prostate surgery, which you will read in Walsh, and one of
them is now very successfully performed in many places with a robot.  But,
possibly more importantly, you should be looking for the best prostate
surgeon you can get.  There is probably little difference between most
surgeons and yanking the prostate out, but there is a remarkable difference
in surgeons who can do so, get all the cancer, and still leave your nerves
for erections.

Selecting the treatment plan and surgeon is the hardest thing with this
cancer.  Once done, you can forget it.  The operation is easy for the
patient.  The recouperation is over before you know it, though the catheter
can be an infringement on personal liberties.  Becoming potent and continent
will try your patiences, but after a couple of years, you look back and
think, "that wasn't so bad."

Welcome Bob.

Dr. Walsh's book was my guide.  It answered pretty much all my questions.

I'm not a doctor, but you should plan on being around for your grandchildren
too.  You can see how favorable the chances are that you've caught this
disease in time by consulting the Partin Tables in that book or online at

http://urology.jhu.edu/prostate/partintables.php

Sorry I can't recommend a surgeon, I'm on the east coast.

jimhoney
standard RRP age 52, cured, no aftereffects

I can only second what Chuck said, Bob.  Take some time to learn about
your options, and when you do decide on a treatment, be sure you pick
the most experienced, highly-qualified practitioner you can find.
Another thing--you should definitely get a second reading on your
biopsy slides.  The Gleason score is critical in determining which
options may or may not be best for you.

I wish you the best.  I was diagnosed back in January at age 62 with a
Gleason of 3+3, PSA of 4.6, and stage T1c.  Eventually, I decided on
seeds, although I do think surgery would have been just as effective.
For me, it was more a matter of deciding on which side effects I
wanted to risk and the fact that I found a radiation oncologist in
whom I had a great deal of confidence.

Ron Carter

Bob,

Welcome to the club. I had my surgery (radical, not laproscopic) five weeks
ago. I'm back at work, have 95% urinary control and am able to achieve
erections sufficient for penetration. In short, I'm nearly back to normal.

In the LA area I would recommend my urologist, Dr. Alan Weinberg. He was
trained by Dr. Walsh and does 100s of these procedures a month. I never had
a moment's pain following the surgery, and everything went according to plan
(except that I had positive margins -- but the Dr. still thinks he got all
the cancer).

Ed

Bob-
i posted a comment to your biking question in the other newsgroup...Bill

Hi Bob,

Glad you found this newsgroup, you'll get a lot of helpful advice
about everything you didn't really ever thought you'd be asking about.
I was 49 when I was diagnosed, Gleason 7 4+3, 5 of the 6 biopsy
samples had cancer. So I had my surgery September, 2002. I have always
been into cycling, though not competitevly, just commuting and club
rides, centuries, etc. I do get in a few miles every year,
7,000-10,000. After surgery I was back on the bike in 3 weeks. Make
sure you find a good surgeon that can do nerve sparing, I'm still
waiting for erectile function to return, may be a long wait, I had no
nerve sparing. It was decided that since my Gleason number was so high
that it best be all cut out.

Anyways, I'm sure you'll do great, being in good physical shape helps.
I was continent within 2 weeks of the catheter removal, I suspect
you'll make a complete and fast recovery.

Take care and ask a lot of questions,

Tom
Portland, Oregon

I am 46 and was diagnosed in April.  It came as a bit of a shock,
despite having had prostate trouble of other kinds for years, and I
had a steep learning curve.  For a second opinion, I went to a
radiation oncologist.  I think it was important to look at both types
of treatment (or all three, considering seed implantation and external
radiation as separate options).

My diagnosing Urologist set up the appointment for me.  He said that
at this time, for someone with my numbers, radiation would be equally
effective as surgery in treating my cancer.  I never found anything to
prove him false.

I found an interesting paper, "Monotherapy for stage T1-T2 prostate
cancer: radical prostatectomy, external beam radiotherapy, or
permanent seed implantation."  It was in Radiotherapy and Oncology 71
(2004) 29-33.  It's easy to find on the web.

The article begins with: "Treatment of localized prostate cancer
remains controversial as a result of the lack of conclusive
well-controlled or randomized studies comparing outcomes..." and ends
with: "Treatment selection does not affect biochemical outcome.
Expected biochemical outcomes are generally excellent, regardless of
treatment choice from this patient population."

Eventually I decided on surgery, for a variety of reasons (you can
find my post on this, if you're curious).  However, it was important
to me that I looked at all sides of the question before making up my
mind.

The New York Times had an article on breast cancer yesterday.  This
quote, from Dr. Steven Katz of the University of Michigan med school,
really applied to my situation: "There are no right or wrong
decisions," Dr. Katz said. "There are just informed decisions."

Age 46
PSA: 1.4 (12/2000), 2.0 (7/2002), 10.3 (3/2/04), 6.0 (retest 3/18/04)
Biopsy 4/5/04 cancer in 10% of one core
Gleason 6 (3+3); clinical stage T1c
Bone Scan negative
RRP scheduled 7-27-04

Bob -

Welcome to the club nobody wants to be a member of.  If it makes you feel
any better, I'm 47 - was diangosed in March and am having RRP tomorrow at
Sloane Kettering in NYC.  This group has been very supportive.  My brother
(51) was also diagnosed and had his prostate removed 3 weeks ago.  His
comment to me was that he hopes I have as esay a time of it as he has.
Sure, there's going to be the anxiety and wondering.  Find a doctor that you
are comfortable with and go from there.  Everyne has told me that I'll be
fine - I'll be posting my progress to the group.  Good luck to you.

Sandy K.
Age 47 2/04 PSA 4.9
Biopsy 3/5/04 - 9 of 10 cores malignant
Gleason 3+3 = 6, T2b
RRP = 6/17/04

*Hello
*I'm 49 and went to the Dr for a physical.  He found my PSA was 9 up
from 2.0
*two years earlier.  I had the biopsy 2 weeks ago and the Urologist
told me
*that I have prostate cancer.  Gleason 3+3.  found in both sides of
the
*prostate.  His recommendation was radical prostectomy.  Man it was a
shock.

<snip>

Greetings, you've come to the right place. I had RRP last yr., at age
42, was diagnosed at 41. I'm sure it's been said already...read up on
your procedure that you chose. I had nerve sparing and have been
thoroughly pleased. It's frightening as hell to learn of PCa, but once
the operation is completed, and they dissect a few lymph nodes, and
you hear them say they were negative, enjoy the knowledge that it's
out of your body. Have you had a bone scan yet?

Al

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

Hello Robert...

As always, you have received excellent inputs from all that have
answered..this group is just great.....I live in Corona...just 45 miles east
of LA and I work in Burbank.....I was 49 when Dx'd and had RP here in
Corona....my Doctor advised me that he was going to be very aggressive in
the RRP and that he was going to try to do partial Nerve sparring.......

Results have been great even with only one nerve bundle spared...My PSA was
5.2 and initial Gleason of 8 but later changed (after RRP) to 6.....I just
got my 5 year pot op PA and it is still <.1  I am active here in the Corona
area in helping newly diagnosed men...I would be more than happy to chat
with you and give you more info on my story....you can e-mail direct to
kp4dx@amsat.org

The best to you and yours,

Fernando

Hi, Bob..........
Me?  52, diagnosed 12/03. Pre-op Gleason was 3+3=6.
Post-op Gleason was 3+4=7
Had Robotic LRP on 3/26/04, and was back to work 3 weeks after surgery.
Today, 100% continence, but only about 5% erectile function (HBP meds
resulting in ED prior to surgery).  There *IS* life after PCa.
You're young and in an area that can offer a plethora of resource in this
struggle.  Take advantage of the time available to you.  The diagnosis is
not a death knoll....only a warning flag that you must heed.

jh