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Medical Forum / Diseases and Disorders / Prostate Cancer / March 2006One more needy guy!
I have been been part of this group since the end of 2005 and words in an e-mail will not be able to describe my "thank you" to all of you who write here. Here is my situation: Age - 49, in good health other than PCa (I recently lost 10+ lbs as I walk 1.5 miles each way to work since I moved to CA, 5'8", ~180 lbs). My father died from PCa at age 74, the discovered his prostate cancer AFTER it spread to his bones. PSA in Nov. 2005 - 30 Free PSA 22 Biopsy - Gle 7 (4+3) on one side (80%), Gle 6 (3+3) on the other side (5%) Started on HT (Casodex - 15 days and Harmonal Injection in December 2005 and in Feb. 2006) No side effects so far CT Scan and Bone Scan - Both Negative PSA in Feb. 2006 - 1.34 MRI planned for March 13 Follow up CT and bone scan - TBD Treatment Choices: Surgery or Radiation I have seen 3 specialist, my Euro, an Oncologist and a Radiation Oncologist Euro hasn't "pushed" surgery so far, and R. Onco didn't "push" radiation either! The Radiation Oncologist and the Onco have said that I will get equal benefits from Surgery and Radiation, the decision is mine. Euro suggested multi-modal therapy and he recommended the other specialists to discuss my options. If I do radiation, I can not have surgery later, but the reverse is possible. This is the ONLY advantage I see from surgery so far. I am leaning towards it. I have been asked to make a decision by end of April, so I have some time. Rad Onco has ordered the MRI, he thinks it will shed some more light on this for him to advise me better. I am off to Vegas next week to get my mind of this for just a week before I plunge back in. Any advise will be greatly appreciated, and once again - thank you to the group. map Looks like you've done your homework and that you have a good bunch of doctors. I, as have many others, leaned toward surgery for the very reason you mention - that adjuvant radiation is still possible later if needed. It's interesting that my uro (a surgeon) recommended radiation for me (seeds) which I declined. I also decided that the side effects of surgery were more acceptable to me than those of radiation. Good luck in Las Vegas. Dave Perry MAP has indeed done his homework. Good luck in Vegas...say hello to my money. :-) I always defer to the smarter and more senior group members...but by your age...I'm guessing that they will lean towards surgery. That would me MY thought, but the super bright guys here will explain your options well. My best wishes to you, Ron B. Chicago Your decision is tougher than the rest of ours. Your age would, absent other highly persuasive issues, put you squarely in the operating room. But, your Gleason and PSA might, and I emphasize "might", preclude a cure. However, a cure is not necessarily the only reason for surgery. Some get surgery just to get that mass out that they know is there. I think if it were me, I'd go surgery first assuming there is little likelihood of a cure but that it might stave off radiation for awhile. A goal for some, now at least, is to last until the Year 2015 when many of us think there will be a cure. I think you can do that better with the surgery - radiation when needed - hormones when needed route.  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum >I have been been part of this group since the end of 2005 and words in > an e-mail will not be able to describe my "thank you" to all of you who [quoted text clipped - 44 lines] > > map Hello Steve, I agree. I would look for a good Prostate Cancer Specialist, if not 3,take in my lab records, and let them decide. Go with your gut feeling, and the Dr. that makes you feel like you are on the right track.....go for it. John Loomis > Your decision is tougher than the rest of ours. Your age would, absent > other highly persuasive issues, put you squarely in the operating room. [quoted text clipped - 57 lines] >> >> map Hello Map, I was very similiar with you, and your records. I was dx'd when I was 49. (1999) I was told by my local Urologist to take homone shots(decrease testosterone) and go for External Beam radiation. I took the shot, and decided to go on. I went to Prostate Cancer Specialist's in Burlingame, Calif, and Stanford University. Dr. James D. Brooks Stanford Urology, said he could help me with Radical Prostatectomy. I took him up on that, and had RP, 1999 Nov 17th. I have had PSA test since.....less than 0.01. I do not pee myself at all. I can achieve erectile function about 85% and with viagra, 120% I would see a Prostate Cancer Specialist or 2 or 3. Dr. James D. Brooks can help you, and you could call Stanford. He may have reccomendations as to where you live. I had to drive 200 miles to see him/one way. I tell you, it was more than worth it. Make sure to bring your lab records with you when you see a new Dr. Those are yours.... I wish you only the best treatment. John Loomis Good Wishes >I have been been part of this group since the end of 2005 and words in > an e-mail will not be able to describe my "thank you" to all of you who [quoted text clipped - 44 lines] > > map > If I do radiation, I can not have surgery later, but the reverse is > possible. This is the ONLY advantage I see from surgery so far. [quoted text clipped - 7 lines] > > Any advise will be greatly appreciated. Since you asked: you MUST read a few PC books, if for no other reason than that it's the only way to learn what questions to ask of us and your doctors. The most popular ones are by Strum (you'll have to order it from the PCRI website, AFAIK), Walsh, Lange (Dummies), and Scardino. There are many pros and cons -- some quite significant -- of all the treatments, including pages on just the differences between RT and RP. Take a good book to Vegas. Speaking of your doctors ... if they told you to choose between RP and RT with no more distinction than you relate, they're just mechanics. If they're great mechanics, feel free to let them fix you. But do NOT trust them to make any decisions for you. I.P. > If I do radiation, I can not have surgery later, but the reverse is > possible. This is the ONLY advantage I see from surgery so far. I am > leaning towards it. Did you do your nomograms on the www.mskcc.org site? Ours shows a 56% chance of cure (5 yr) with RP, 46% w/brachy, 79% (82% adding HT) w/the highest dose of EBRT. But we are still doing RP, because if it does cure, it will be done. Also, a history of cancer in the family. Radiation increases the chance of cancer, a little bit I think, but when you're so young, why give any other cancer a boost? Also, as awful as potential impotence is, I think the thought of rectal incontinence in your 40s was a clincher. Also, someone posted on another list about getting 80gy of RT and STILL had detectable cancer in the prostate. Drag. When he asked his doctor about that, the doctor just said, "Sometimes that happens." Just a comment... The MSK nomographs are wonderful but they're based on historical data and that data represents a period of time where the detection and treatment of PCa had changed radically and is still changing, particularly for this person's age group. 10 years ago almost no-one in your age group was included - they simply didn't get tested. Anyway the standard deviation of this data is lousy. I would suspect that the survival rate for your age group may be much BETTER than is predicted by these nomographs. Thank you all for your comments and advise. I am looking forward to the journey. > Thank you all for your comments and advise. I am looking forward to > the journey. Crap! Sounds like we painted too rosy a picture of it. OTOH, may it last 40 years. I.P. I just wanted to add my experience with brachytherapy. I'm 65, and had similar numbers to yours. After 9 mos. everything is back to normal and my PSA readings have dropped as expected. I belong to a HMO that offered either surgery or brachytherpy. Several surgeons said that their results for people with my numbers was statically the same. The data goes out to 15 years. Since I wanted the fewest side effects, I chose the seeds. This is not to suggest that your first decision was wrong. You are younger than me and you may not have access to doctors that perform 3 implants per week. If you are like me you will have frequent urination and slight burning for a couple of weeks. I seldom have morning erections but still can perform, especially with Viagra. I did not have hormone therapy. Best of luck. Woody e > Thank you all for your comments and advise. I am looking forward to > the journey. > I just wanted to add my experience with brachytherapy. I'm 65, and had > similar numbers to yours. After 9 mos. everything is back to normal and my [quoted text clipped - 17 lines] >>Thank you all for your comments and advise. I am looking forward to >>the journey. Woody, Thanks for the info about your personal experience. I came REAL close to going with BT right off the bat. Wish I had. The guy that will be doing the BT was the radiologist who I had discussed it with before. He laid everything out and also said the procedure has about the same cure rate as RP. He did point out that since I was fairly young and healthy, with good numbers, that RP was probably a wiser choice and then still have radiology as backup later on just in case. I think we (docs, wife and myself) made the correct choice, it just didn't turn out as planned. Thankfully there ARE other ways to skin this cat. -jj SignatureRemove BOB to email me >> If I do radiation, I can not have surgery later, but the reverse is >> possible. This is the ONLY advantage I see from surgery so far. I am [quoted text clipped - 10 lines] >in the prostate. Drag. When he asked his doctor about that, the >doctor just said, "Sometimes that happens." When I was researching, one of the things I noticed in regard to the radiation was that historically it is a series of escalating dose levels. At one time they did 55 grays, now they are doing around 70 and I read nothing that indicated they thought they should stop at that level other then the fact that they need to figure out how to give higher doses where they want it and not where they don't want it. One might conclude from that that the practitioners do not believe the current levels are high enough yet to really be sure of "getting it all". I think not enough is said about the psychological advantages of successful surgery (see a recent posting elsewhere in this group for the effects of unsuccessful surgery). I had my RRP last July. As a result I know exactly how much cancer was in my prostate, exactly how aggressive it was, that nearby lymph nodes and seminal vesicles were not involved, etc. I also have two foolow-up PSA tests to say "it looks like it's all gone". So I sit here believing myself to be cured (though accepting that there's a chance I might not be). Contrast that with radiation - goes on for months, your PSA bounces up and down, you never know what was really in there, whether it has really all been nuked, etc. On top of that, if my PSA ever does start rising again, I know I have another primary treatment option in my arsenal (radiation). Now my PSA was a lot lower than yours and my biopsy was a lot better. It is questionable whether surgery alone will give you a "cure". However, even "unsuccessful" surgery would still give you a much clearer idea of what is going on in there; and I believe that early removal of as much of the cancer as possible can only help reduce the risk or rate of metastases. SignaturePeter Headland |
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