Quoting Edward:

Danny replied:

Danny is absolutely correct about the Gleason grade of the
sample, and the fact that it's a tiny sample at best.

Other important -- no, *vital* --  factors are:

1. The TNM score.
2. The PSA score.
3. If "free PSA" and/or PAP (prostatic acid phosphatase) were
checked, what result?
4. Edward's age and general health.

Edward is entering into a phase of his life in which PCa very
well may be a factor as long as he lives. The earlier he begins
the struggle, the better are the prospects for good results. And
good results often mean simple survival, not necessarily "cure,"
however it's defined (and there are differences on that point).

As for cryotherapy: Based upon a Gleason 9 score (4+5, 6 of 7
cores, right side), T2bN0M0 (palpable tumor, no lymph node
involvement nor metastases), PSA 4.75 diagnosis, at age 67 (good
health, otherwise) I underwent cryosurgery on November 20, 2003.

I am not pleased with the result.

Due to rising PSA observed post-procedure, a second biopsy was
performed on July 20, 2004. It disclosed that the Gleason 9 tumor
was evidently destroyed by the cryo, BUT one of six cores
disclosed a Gleason 8 (4+4) tumor at the left base. The
urologist's explanation: "we missed it." Swell.

Side effects: IIRC, cryo results in impotence for some 80% of
patients. There is a period of time when a catheter must be used
to drain the bladder. In my case, it was a suprapubic catheter
through the lower abdomen, though a Foley (through the urethra)
might be used, instead. I'm a slow healer, and it took a month
before it could be removed. Then, the catheter wound leaked for a
couple of weeks while it healed. Fortunately, it was not a
constant leakage; only when I urinated. Had to wear a gauze pad,
though. Yech.

And, yes, I'm impotent.

I have now just completed a course of high-dose radiotherapy
known as Intensity Modulated Radiotherapy (IMRT), and presently
am on androgen deprivation therapy (ADT). This from an oncologist
recommended by the uro, who it seems gave up on me.

Whether any of this will have a good result remains to be seen.
As my onc says, we're going to be together "forever." At the
beginning, he told me frankly that he had no idea how this would
go, as the cryo "threw a monkey wrench" into his evaluation. So
far, though, he's pleased. I hardly need say that I am, too. But
it remains to be seen whether it worked as desired. He has one
other patient who is in much the same situation, though his new
tumor did not manifest itself for over a year post-cryo. For
privacy reasons, the onc cannot discuss that patient with me, and
the patient did not respond to a phone message I left about a
month ago. Reason: unknown.

Regarding invasiveness, I'd place cryo between radical
prostatectomy and IMRT (most-invasive --> least invasive).

Each modality has its benefits and its risks. Edward has a choice
to make and I recommend that, unlike me, he not be stampeded.
Study the various treatments (which include "watchful waiting")
and select that in which he places the most confidence. Also: do
not be afraid to ask exhaustive questions of his physician. Check
the various news groups. Go to ustoo.com and explore. He's
probably got time to do research.

If he does so, he'll probably be comfortable with whatever
decision he makes.

Meanwhile, if he'll supply the info requested above, I'll try to
be helpful. So will others. This is a fine group.

Regards,

Steve J
__
And, most importantly,

"Never give in--never, never, never, never, in nothing great or
small, large or petty, never give in except to convictions of
honour and good sense. Never yield to force; never yield to the
apparently overwhelming might of the enemy.''
--Sir Winston Leonard Spencer Churchill

Actually, intermittent triple androgen hormonal blockade is also an
option.  There are no 15 year statistics available yet, but for patients
with stage T1-3, with an average PSA of 12.7 and an average Gleason
score of 6.6, the results after 8+ years is no prostate cancer (or
treatment related) deaths yet reported for the 109 patients involved in
that study. 0% for 8 years is a far better death rate than that reported
for any surgery or radiation studies, even though those are usually
performed on patients with much lower PSA's.

Ed Friedman

that was supposed to be "some here would consider you a damned fool".  Fat
fingers.

...

I agree it would be a mistake not to consider radical prostatectomy.
It is a proven life saver.

But I don't think it would be foolish to conclude, as some do,
that it's a mistake for a younger man to choose any other treatment.

I admit that my own experience is still too recent to draw
any conclusion from.  But so far at least, I'm not sorry I chose
radiation at age 57.

Just like prostatectomy, radiation is a proven cancer killer.
Like RP, it doesn't always work.  Like RP, it can be applied
skillfully or clumsily.  But when it's done well, I believe it does
work.

Unfortunately, in some of us cancer has already established
itself outside the area where either RP or RT can reach it.  For
those men, treatment fails no matter which modality they
choose.

Even more unfortunately perhaps, some of us are treated
by surgeons or radiologists who don't do a good job and
leave some cancer behind.

So picking a good doctor is just as important as picking
a good treatment modality.

   Alan