On March 6, Naaman wrote, in pertinent part:

Welcome to the club no one wants to join.

It does appear, based upon the biopsy (which is not 100% reliable;
nothing is) that the case is indeed in its early stage.

Further than online research, I recommend:

1. Discussion of the case with a radiation oncologist, as the uro is not
likely to be fully up to date regarding radiation treatment (tx).

2. Referral to the website of the Prostate Cancer Research Institute at:
http://prostate-cancer.org/index.html
It includes a large amount of reliable and objective information.

3. Read, study, the premier book on prostate cancer (PCa), _A Primer on
Prostate Cancer_ subtitled "The Empowered Patient's Guide," by
oncologist and PCa specialist Stephen B. Strum, MD and Donna Pogliano,
PCa warrior. It is available via Amazon, UsToo International, and the
PCRI, as well as other relevant sources. It too is reliable and objective.

Once all the information on the disease and its tx is in hand, an
informed judgment can be made as to the best tx for this particular
tumor. They are all different, which is why anecdotes about someone's tx
and result, though interesting and of some limited utility, must not be
relied upon as a definitive guide to a tx regimen.

Best of luck. Please keep us informed.

Regards,

Steve J

"We must tailor the treatment to the nature of the disease. We must
listen to the biology."
-- Stephen B. Strum, MD

Well it goes to prove that both of your friends have done very well with
their decided treatments. I think it can be said that both treatments,
surgery and radiation, have improved over the last 10 years. Steve is
correct in pointing you in the direction of reading books written by
experts/doctors before committing to an actual treatment. The advice and
information that can be obtained here can be very valuable to you as
well, but it is good to educate yourself and then join discussions here.
You will find the personal experiences by the members and advice that
can be offered by some very smart people who share one thing in common,
very enlightening. My personal advice is to find a doctor who
specializes in the treatment of this particular disease. This seems like
an obvious thing to do but I'm constantly surprised that some people do
not interview more than one doctor. After quizzing my first uro, I came
to the conclusion although he was a good doctor, he lacked the surgical
experience and expertise in PCa for me to feel confident about him
actually operating on ME.

B.A.

I agree with the other posters that you should do some research on all
this using the books and websites mentioned.

Another alternative that your urologist didn't mention was "watchful
waiting".  It may be that you have a very indolent cancer that isn't
growing fast enough to ever be a danger to you.  So one possible
course of action is to insure that your lifestyle and nutrition are as
positive as possible - for example, lycopene, vitamin D, selenium,
ibuprofen, and maybe vitamin E have all been shown to have
_possible_ (not fully proven) benefit.  And conversely, reduce fat
in your diet, etc.

With watchful waiting you need to emphasize the "watchful" part,
with regular PSA tests, perhaps every 3 months or so, to be sure
that the cancer isn't going anywhere.

If I were you in your situation, and I decided on treatment, I think
I'd go for brachytherapy - implanted seed radiation.  As compared
to surgery or external beam radiation, it confines the damage to
a relatively small area and hence has relatively fewer side effects
(though there are no guarantees!), it can be done very quickly,
typically with a hospital procedure and an overnight stay, and
unless something goes wrong (again no guarantees), you'll be
on your feet again and back to normal life in a few days - though
you will probably experience urinary difficulties for some months
after the procedure.

Brachytherapy is not the best treatment for serious cases, but is
said to be highly effective in early, low grade cases like yours.

Also, if I decided on treatment, I'd want a good doctor - one
who has treated a lot of prostate cancer (not, for example a
urologist that specializes in female incontinence, or a radiation
oncologist that specializes in breast cancer), and one who
listens, answers questions, takes his time, and sounds concerned
and intelligent.

However, my opinion is worth what you're paying for it.  See a
radiation oncologist for professional advice on brachytherapy,
and discuss watchful waiting with him and your urologist.

Best of luck.

   Alan

Welcome, Naaman!

I can still remember that call, where I was sitting, and what I was looking
out at from my office.

I would not categorize it as "very" early, but it is certainly early enough
to opt for surgery.  There are two major criteria for choosing surgery or
radiation.

One is age.  And, frankly, at 72, you would often be outside the window.
But, if you are in good health and able to handle major abdominal surgery,
then you have the option.

Two is Gleason.  At G6, you are in great shape for surgery.  Your T1c would
also seem to support the G6, but then DREs are maybe 33% to 50% accurate in
determining stage and biopsies can be off about 20% of the time.

I'd say you have two very viable options.

Several people among us have tried Cryo.  Only one, Dan Dubosky, has been
thus far successful (how's that, Dan?)

www.phoenix5.org or cancer books by Walsh, Strumm and Scardino are great
resources.  What you will find is that there is a long history on surgery
results, a short history on radiation results, and a really short history on
cryo results.  Surgery advocates claim superiority.  Radiation advocates
claim results similar to surgery.  I'm not sure if I've seen cryo advocates
here or in my research.

My father chose brachytherapy at your age.... and six years later he's doing
fine!  Each treatment has it's pros and cons.... Just research them
carefully and read all you can.... and decide what you think is best *for
you*... and then never look back!

I wish you well!
MikeH

Try the Sloan Kettering website

www.mskcc.org/mskcc/html/10088.cfm

They only give 5 year biochemical failure rates based on pretreatment
criteria.  But if you keep in mind that it takes quite a while after
biochemical failure for the development of clinical symptoms, that may
be enough to get started.

In fact, with your statistics, you stand an extremely good chance of
being cured for all practical purposes by either surgery or radiation.
At your age, it is easier to avoid impotence with radiation that with
surgery.  Keep in mind, in any case, that impotence can be treated and
need not mean the end of your sex life.  I've never been convinced that
brachytherapy has any advantages over external radiation, but if only
the former is available to you, I don't see any reason not to choose it.

Cryotherapy has not had a good repuation generally, and that seems
confirmed by the anecdotal evidence reported here.  The people who've
used it don't seem to have had good experiences.

Your situation is very similar to mine.  I was diagnosed in December
with a PSA of 6.2 and a Gleason of 6.  I researched on line and read
many books and conluded the any treatment option was worse than the
disease.  That said, I have opted for Brachytherapy (i.e. radioactive
seeds) and am scheduled for March 16th.  THere is a good book I am
presently reading on surviving prostrate cancer without surgery.  If
you want the title email me and I will bring it to work so I can give
you that information.

I wish you the best in what is truly a difficult decision.

Jamie

I want to thank all of you who have taken time to weigh in here with
suggestions, advice, recommendations and your experiences. I see I still
have a lot of research and consultation to do.

Just visited my family doctor for another problem today and asked for
past PSA scores, which were: 3/1/03, 2.6; 9/16/04, 3.4; 3/17/05, 3.8;
10/11/06, 4.5, which was when he sent to to the urologist. I think there
are a couple of scores missing in the series, but the trend  is obvious.
Oh, the free psa on my final test was 15.1.

Again, thanks to all of you.

Naaman

hi. I had a radical surgery when I was fifty. psa 3.7, gleason 6.  It
was the best decision I've ever made.  long period of recovery because
of major surgery - but once the cancer is out you'll never have to
worry again.  your psa isn't all too high considering your age.  if you
are a strong man, physically, then go ahead and have the
surgery--otherwise consider the seeds, radiation lastly.

Hi Naaman

You might consider just waiting. My case is similar to yours. I
was diagnosed in 1997. Age 71. PSA 7.6. Gleason 6.

I was told that I needed an operation or radiation. After a lot of
study I opted for a natural health program instead. Diet,
exercise, supplements, life style and a few other odds and ends.

It's not an onerous program. For example the diet includes lots of
meat, fat, fruit, vegetables.  Red wine - not a lot - just a
couple of glasses a day. Just about anything as long as it's a
natural food. The other activities are on a similar theme.

I'm still waiting after nine years. My health is better than It's
ever been. Bexause of the health progrom. No symptoms of PCa. I've
now turned 80. My PSA in January was 4.5.

I can send you complete details of what I do and the complete
history of PSA readings etc if you think you might consider this
alternative.

Whatever you decide I wish you the very best.

Tom

You're not missing them, they don't exist.  One of the most difficult
parts of the decision making process is to understand that really long
term data regarding the efficacy of one treatment over another just
isn't out there.  The studies are underway, but with a slow growing
cancer such as PCa usually is, any treatment option or no treatment
usually results in similar 5 and 10 year survival rates, the benchmark
that other cancer treatments are judged by.
I agree with the others, get educated and pick what works best for you,
chances are, you will not make a bad decision whatever you pick.
FWIW, I chose surgery.  I was diagnosed at 46.
Good luck.
CPW

Just got results of latest PSA 3/27: 4.0.

I'm scheduled to meet with my urologist in about 10 days to discuss this
latest result and see what, if anything, he suggests we do next. I will
probably set up an appointment with a radiation oncologist that has been
recommended just to further educate myself. Also probably will quiz my
urologist more about RP.

Meanwhile, I'll continue to monitor this newsgroup (which is a wonderful
support group), do my homework and think positively.

Naaman

Just returned from a visit my urologist He says the fact that my PSA now
is down to 4.0 is good, and that he wants to wait four months and check
it again. He also did a DRE and found that the area of the prostate in
which the biopsy showed cancer is smooth on the surface. Of course, the
cancer is still there inside.

Meanwhile, I plan to schedule an appointment with another urologist for
a second opinion and an appointment with a radiation oncologist to talk
about brachytherapy.

I also made contact with a support group in Tucson and will attend their
next meeting, where I hope to learn more about the local experiences of
others with respect to doctors, hospitals and treatments.

Naaman