Welcome Ron.

You should calm down, because like Ray who just joined us, you have a
dangerous case but it has probably been caught in time.

Next thing is to decide on treatment.  I recommend the book, Dr. Walsh's
Guide to Surviving Prostate Cancer, but others here will recommend some
web sites.

You're young enough to qualify for radical prostatectomy, but diabetes
is a complication on which you need the doctor's advice.

You could probably get the same cure with radiation.

You are young enough that permanent impotence is unlikely.  Permanent
incontinence is very very unlikely.

So be optimistic.  It helps.

jimhoney
standard RRP age 52, cured, no significant aftereffects

Hey, I was petrified when I found out too, even though my father died
of it and my younger brother (40 at the time) had an RRP. So, knew that
it wasn't likely that I would escape. After finding out the rest was
just going at it one step at a time, which involved finding out as much
as possible about options, getting second opinions, choosing an option
scheduling the surgery, and then trying to live my life as normally as
possible while I waited for the surgery date. There was nothing brave
about it as I was scared the whole time....
Then I had the surgery and things were really tough for a couple of
weeks, but gradually they started getting better, until at 6 weeks when
I would resume normal activities I really started feeling better about
life then I did before I was diagnosed. Continence returned about then
too.
Right now  I feel that this was a bump in the road so to speak. I have
ED issues, which before the surgery, was something that I had no idea
how I could live w/o full function in that area. But now, it really
doesn't matter to me. I want it all back, but it just doesn't seem to
be an important part of what makes me happy now....

The bottom line is, no special courage required, just take it one step
at a time and focus on the things that you need to do to beat it. With
that approach a few months from now you will wonder why you were ever
so freaked out about it....

I know what you feel like.  For what it is worth, your diagnosis is not
too different from mine at age 67, four and one half years ago.   I had
a radical prostatectomy, and my PSAs have been undetectable since then.
 Also, I am continent.  I was impotent for something like 18 months,
but that didn't stop my wife and me from having an active sex life.
Erections started to return at 18 months and today I can manage without
any aids but I do better with a bit of Viagra.   Of course, your case
may be different, but it should reassure you to know that many men in
your situation do just as well or better than I did.

Northwestern Memorial has some really excellent urologists.  One of the
world's leading urologists, William Catalona is there.

Feel free to write to me privately if you feel it will help.

Everyone here must have been scared at one time or another by this. Believe
me, so was I, and I still am to some manageable extent. Although I cannot
compare myself to these brave and  extremely well informed people here, but
I will offer some very simple advice. First, get several opinions from
different doctors. (I went with robotic laparoscopic surgery last December,
I am 52 and in otherwise good health). Second, read as much as you can on
the subject. There are several books out there that are extremely
informative. The people on this ng are extremely knowledgeable on the topic
too. Read their replies. The earlier you catch this disease the better.
Third, make a decision on treatment. Fourth, act on it. It will be over
faster than you think and you will get your life back. I wish you the best!

Bob Anthony

On February 7, 8 8 (a pianist,perhaps?) wrote of his concerns because of
a finding of a T1c Gleason 7 tumor, with a PSA reading of 7.2.

First, slow down. He's not a "dead man walking." I do not believe that
the findings are a death sentence.

He has time to study the biology of his tumor and select the treatment
most likely to help him.

In addition to the Walsh book, which will lead him toward radical
prostatectomy, 8 8 should read _A Primer on Prostate Cancer_ by Stephen
B. Strum, a medical oncologist who specializes in prostate cancer (PCa).

He should first and foremost visit the following two websites:

Prostate Cancer Research Institute http://prostate-cancer.org/index.html
and
the support group Us Too! International http://ustoo.com/

There is far more to learn than is possible to do before tomorrow's
appointment.

I have seen recommendations that patients bring with them a trusted
friend and/or a tape recorder. It is unlikely that the patient will be
able to remember everything, and these two measures will help, well,
immeasurably. No medic worth his Mercedes Benz or Rolls Royce would object.

I am not a medic, but I suspect that 8 8's diabetes will be a factor in
the decision re: what to do.

I recommend that 8 8 take a deep breath, maybe have a drink, and decide
that he's going to approach this life-changing event (and that's what it
is) with calm resolve. It will not help to go running off in all
directions. As I have said (probably too often): Study, learn, take charge!

Please do let us know how it goes. The men and women here care.

Regards,

Steve J
__
"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 L. S. Churchill

I haven't time for a well-thought-out essay, but here's its outline off my
cuff.

We're all gonna die from some darn thing or another.
Some ends are more tolerable than others. PC is one of the others, but . . .
it's also one of the slower ways to go. It often takes 15 years even if we
do nothing. Your T1c is "easy" to nail, but your 7 borderlines on being
aggressive, thus more likely to return some day.
You've got so FREAKING much to learn that you don't have TIME to get scared.
You need to study half a dozen books and quite a few websites, and do a lot
of thinking. Then you need to choose a treatment, schedule it, catch up on
the stuff you let slide during all that research.
None of the treatments except HT is a big deal, and that's not a common
first treatment. You should recover potency, given your T1c and a good
radiologist or surgeon, so pick whatever your criteria come up with and feel
good about it. By the time you've done all that research, the "right"
treatment for you will be obvious. No need to worry at that point.
Then get your initial treatment and kill the bastard. Once you're done that
it's time to feel GOOD, because you've gotten smart, made the right
treatment decision for YOU, GOTTEN your treatment, killed the cancer, and
are home free for now. No NEED to worry now.
Then you get tested much more frequently, so you KNOW what's going on. No
need to worry about THAT, because no news is great news.
Then, maybe, one day many years out, one of those tests may be bad news. Or
you might get hit by a truck. Or get a heart attack. SOMETHING's gonna get
you, but there's no reason to WORRY about it. You just eat right, stay fit,
watch who the hell you sleep with, keep getting those PC tests and annual
physicals, and buckle your seat belts. If you're LUCKY, your next threat
will warn you, with a climbing PSA, some angina, a foot infection, etc., so
you can hope for the best, fight like hell, and get your affairs in order
for the worst.
You STILL got too much to do to waste time worrying. If not, you need more
hobbies.
Then some day your PC, or your diabetes (there are LOTS of ways to manage or
cure THAT), whether Type I or Type II. But fight it you must, for it can tie
PC as a crappy way to go), or some other gremlin will rear up and bite you
with no solution. If that alligator gives you warning,  you'll be too busy
getting all your relatives taken care of to worry. If it gives you no
warning, it denies you the privilege of worrying.
Now let's assume you do get terminally ill 10 or 20 years from now, and
those last few weeks or months look absolutely awful for one reason or
another. You STILL have research to do and decisions to make, because there
are solutions to ANY medical problem at EVERY stage.
You see, there's no productive point or time for worry. If you have a
problem, your time is best spent solving the problem. If all your problems
are solved, what's there to worry about?

I.P.

"8 8" <Gimel@webtv.net> wrote >

Ron,

You've already received a lot of good advice from some of our members, here.
We've just about all "been there...done that...got the T-shirt." That first
24 hours or so after having your worst fear confirmed is pretty scarey. My
own Urologist, after my DRE and even before the biopsy, suggested I get and
read Dr. Walsh's book, "Guide to surviving Prostate Cancer." (I could pretty
well guess what his guess was!) I think Jim Honeychuck already suggested
this to you. I want to reinforce his suggestion, and those of others like
Rob, Leonard, Bob, Mike, I.P., etc. You need now to do a crash course in
PCa-101 to determine which of the many treatment options may be right for
you.

And you can be sure, we're all here pulling for you. We can offer support;
we can relate our own experiences; some of us are qualified to provide
substantive information. But, after all is said and done, you will be making
this decision in consult with your physician(s). It's a decision you'll want
to be comfortable with, and once made, not second-guessed..

Please keep coming back here, and keep us up to date on your situation. Good
luck and good health.

Good evening Ron,

After my diagnosis, I was too busy to be scared.   I was a little
numb but I wasn't "scared".

I was in serious information gathering mode.    

Here's the good news, with a PSA 7.2, T1c (they don't really know)
and a Gleason 7 (3+4) at 56, you've got an advantage over me.

I clocked a PSA 10+, the uro-doc called it a T1 but the rad-doc said
I might be a T3. Gleason 7 (4+3, but only part of one needle).  I
was 57 at the diagnosis.  

Your choices are surgery or rad.  Those are the only options that
make sense.  Your docs will explain but you might as well start
mulling it over now.

I went the rad route.  It's easy, no pain, very mild discomfort,
less than a tooth filling.  

There are side effects, these include having to pee every 2 or 3
hours for about two months.  Many people do that anyway, so big
whoop.

The cost is a knee-buckler.  My insurance covered most of the
procedures, tests, and some of the meds.  I slammed over $3,000 on
my credit card for co-pays, un-covereds, non-perscription stuff.

Two Lupron shots left me impotent but I've managed a couple partials
without vitamin-V, so that's coming back.   The worse of the hot
flashes were in the late fall and winter, not a problem in cold
weather.

What was a problem was feeling exhausted.  Rad and Lupron have that
as a side-effect.  I've been sleeping 9+ hours a night and taking
naps on weekends.  

I've had one PSA post seeding,  At about 2.5 months I clocked a
<  0.1 which is real good.   The docs are pleased.  I am cautiously
optimistic.

My uro-doc pitched surgery, "at your age and staging, surgery will
very likely result in a full cure."   I believe that this is true.  

The rad-doc said the same thing but promised minimal life
interruptions, no hospital stay, swing by on my way to work 25 times
for 15 minutes of IMRT, external beam radiation.   Do the seeding
one morning and I'll back at work in a couple days.

I took 4 days off, just because.  

For external beam radiation followed by seeding, there is
approximately the same 10 year survival rate as surgery, over 93%.  
They say 10 years because that's how long they have the data.

The other 7% are mostly guys who were treated too late.  Their
cancer was more advanced and already spread to the lymph nodes,
bones, etc.

No guarentees though.   We have no guarentees from anyone.

Incontenance is unlikely with rad. BUT.  No guarentees here either.
My primary care doc told me that a guy who went the rad route about
the same time that I did (and I'm guessing at the same facilty) is
catheterized months after the seeding.  He can't pee.

I'm at the point where I can almost write my name in wet concrete.  
No guarentees.

Here's the good news summary,

Most of the stuff you'll read in books is already out of date.  

If you look at surgery, you have the nerve-sparing, the laproscopic,
robotic, all kinds of techniques that make it better, easier, safer.

Rad?  The standard is the IMRT, where robot driven lead shutters
shape the beam to deliver the maximum radiation to the tumor and
protect your colon and bladder.  

With Palladium seeding, they can precisely position the seeds in
three dimensions, minimal collateral damage, maximum energy
delivered to the cancer.  

There are risks of radiation injury but the rad-team gave me
medication and instructions to minimize those odds.

ED?  Consider this, a large percentage of guys our age are already
having trouble getting going.  

I'm in recovery and have started exercising again.  It's getting
better.  

Bud, we've all been there.
I think we'll all agree, however, that you should relax, take a deep breath
(maybe a shot o' Jack Daniels if you're inclined), and really THINK about
your next steps.
You are going to be hit with a lot of information, but you have
time....time, your best friend.
Read, study, ask questions, become informed.....then you will  make your
best informed descision...the one that is best for YOU.
...........and because the decision is YOURS, we will be here to suppport
you.
Hey, bud.....we all know you've been kicked in the nuts.  Now, you just
gotta rise to the occasion and jump into the frey.
We're here for ya, buddy.......we really are.

jh

Knowlege is power.  You have gained much knowledge, and now need to move
ahead. Treatment.
Diagnosis,  7.2 Psa high....
Get a digital recal exam, and biopsy.
Find out the truth of your numbers.....
Decide to go with RP, or Radiation.
RP seems a good answer to you problems.
You may have incontinence, and such, and also ed disfunction/
Time will give you back al of the above.
My best wishes, sorry you have joined this club/
John Loomis

I'm the new guy Ray. If you want technical stuff listen to these guys,
because like you I'm learning and thus would not dream of giving advice in
that area. However on the emotions - don't fear PC because as in all wars
frightening the enemy gives it fertile ground to conquer.. don't give PC
more ground than it as now.

Ah, how many times have we seen this subject?  Welcome, 88, to the club not
one of us wanted to join.

The bad news, you already know.  You have cancer and it is often fatal.  The
treatment has side effects that will change your life and not for the
better.

However, there is some good news.  Neither your PSA, Stage or Gleason score
is outlandish.  Much better than mine, in fact.  Your age allows you all
options for treatment.

Do not be hard on yourself.  Read my first sentence again.  Almost everyone
in the club introduced himself in exactly the same manner.  Look back at the
archives if you need confirmation.  We were all scared.  To some degree we
all still are.  If indeed we are brave, remember that fear is a requirement
for bravery.  If you were not scared, you would be neither brave nor sane.

Questions?  There are so many it would be impossible for you to remember
them all.  And, then, if you are like me, you won't remember very many
answers.  My only recommendation would be to not make a decision today in
his office.  You have plenty of time to research this dreaded disease and
make an intelligent decision as to treatment.  You should begin today by
hearing his opinion of the various treatments and asking for a second
opinion on the Gleason score -- very important decision-making criterion.

   My RRP was 8-1-2003 and I am still incontinent to a degree and totally
impotent.  My suggestion to you is to trash the fear.  First, if you have
been caring for elderly relatives, which I have first hand experience in
that department, you are surely tough enough to handle this little bump in
your life.
   Two, you need to make some important decisions in the near future, so
educate yourself as best you can so you can make the most informed decision
that you can.  No room for emotion.  You need facts and to be in control as
you make your decision.
   Three, the T1c, same as me, sounds good.  The Gleason at 7 is not so
good.  Mine was 6, but after surgery the path report dropped it to a 5.  The
T1c would indicate a good chance for a cure.  Again, get the facts and talk
to your doctor.  Do not get paralyzed by fear or the number of options
available.  Do not wait months to make a decision on treatment.
   Four, I live just fine with incontinence, 2 pads a day average now, 5-6
when the catheter first came out.  BTW I was 55 at the time of surgery, and
now 57.  I had ED problems going in, so the impotence was not entirely due
to the RRP.  I use Trimix injections to assist in achieving the erection.
It does not hurt, so do not be afraid of the needle.
   Bottom line is that life goes on.  There is nothing to be afraid of.
Your situation is better than others here for sure.  Be positive.  Once you
make the treatment decision put it behind you and move forward.  No looking
back.
   Good luck to you.  You have found a great place for support.  A lot of
very good people here, and tons of direct experience.
   Thank you.
David S.

Fear not apprehension. Certainly initial fear helps us to have courage to
face the challenge. But in the time scale we have living in fear only
advances PC to the brain, do we really want to help it spread. So what do we
fear?

Fear of death, what is to fear in dying? PC or not one day we will all do
it - that's another club like or not we're all in. And PC or not we could
die the very next second, thus PC does not add to that. So perhaps them we
fear for our your loved ones' coping, being concerned is only natural.
However living the time remaining in fear for them, which they will see,
will not help them, thus have no fear.

I know easy words from someone with faith, but please don't add fear to PC,
isn't PC enough for you to cope with.

Ray

"Hi" back to ya! ;-}  Boy, have you stirred up a hornet's nest- more than 30
responses already!  
Diabetes can kill you fast if not treated.  But it is easily treated.  A
bother- measuring blood sugar regularly, diet, and insulin injections- but no
big thing.  PCa caught early is similar.  Don't worry, just get with the
program.  Brave?  nah, it's something like sitting in the waiting room on the
ground just before your first parachute jump.  I don't think many of us have
gotten into the scary part yet.
Best wishes.

Ron, it may be easy for me to say, but "settle down."  You have a ton of
really good replies to your plea, so I'll be brief. I began my trip on this
road at age 55 with a psa discovered to be 55, gleason 3+4, large volume,
two tumors in seminals, on the bladder surface, and so on.  That was 4+
years ago. I had the surgery (even though the cancer was known to have
escaped the prostate), had external beam radiation to the pelvic cavity, and
went a year on Lupron. Then two years off Lupron were a nice breather but a
rising psa has me back on it again, this time for two years and I am almost
mid-point now.  At this point in time, I am happy to still have a weapon to
ply against the cancer, and I'm not too unhappy about the side effects.  I
have made my choices and will be as aggesssive as I can be in this fight.

Do your research, decide how aggessive you want to be, and let the fight
begin.  You will see how your prioroties in life change, and how you look at
most things in a different light than you once did.  There is no sense in
letting what may happen sometime way off in the future, ruin what you have
today.  I have had four good years since diagnosis and hope for at least
than many more. Advancements are being made all the time.  My short reply to
you is getting long, so I'll leave you for now.  Lots of luck to you, and
may you come to grips with this quickly.