Sorry about the confirmation of cancer.  The rising PSA was a strong
indicator though.  Now you have a big decision to make regarding
treatment.  All the routine treatments - the various forms of surgery
and radiation - offer pretty much the same statistical outcomes if
performed by experienced and competent physicians.  My decision was
based on the side effects I felt I could tolerate if I were unlucky
enough to experience them vs. those that I could not tolerate.
Erectile disfuntion and incontinence I could tolerate, any kind of
bowel disruption I could not.  So, for me (and I emphasize "for me")
surgery was my choice.  Sure enough, I have both ED and incontinence,
even nearing three years out, but I don't regret having the surgery.
While many guys have no lasting side effects, they're usually a bit
younger than you or me so at age 66 you should expect some SE's
although I assure you they won't be "tremendous" to use your word.
Perhaps annoying, maybe frustrating occasionally, but not tremendous,
and you learn to live with them just as if you had a missing finger or
false teeth.  Finally, you'll get plenty of advice about "this is the
best" or "that is the best" but in the end, it's your decision.  Just
read and read and read, get opinions from a few other doctors, read
some more, and go with whatever seems best for you.  The chances are
excellent you'll be rid of this disease no matter what decision you
make and with only moderate side effects if any at all.
Good luck.
Dave Perry

I'm very sorry to hear about the diagnosis.

While the bad news is that you have cancer, the good news
is that you caught it early, while it is still highly treatable.

If the cancer is small and localized, it may be years before
it becomes dangerous.  That doesn't mean you should
ignore it, but does mean that you have time to educate
yourself and think through what you want to do.

There are a number of good books and good websites
where you can begin.  Searching this newsgroup will find
them for you.

I think some of the tasks ahead are:

1. Consider getting a second opinion on the biopsy slides.

Pathology slides for PCa are notoriously hard to read and
are often inaccurately done.  But it can make a significant
difference in your treatment planning if you have a Gleason
6, 7, or 8 cancer.  Ask your doctor about getting the slides
sent to one of the specialized labs for a second reading.

2. Inquire around about the best doctors in your area.

The doctor who diagnosed your disease may or may not be
the best one to treat it.  There are many competent urologists
who don't specialize in prostate cancer or don't specialize in
surgery.  They don't have the regular, weekly experience that
keeps their surgical skills finely honed.

Someone once told me that he'd rather have a lucky
surgeon than a skilled one.  What he meant was that bad
things sometimes happen even with very skilled doctors.
But bad things happen less often with highly skilled, highly
experienced doctors.

The same is true for radiation oncologists.  Some of them
specialize in, say, breast cancer, don't have a lot of PCa
experience, and aren't up on the latest PCa radiation
techniques.

3. Ask for appointments with both a surgeon and a radiation
oncologist.

It will be useful to hear what each has to say.  It can happen
that both recommend surgery, or both recommend radiation, or
that both recommend watchful waiting.  If they do, great.
More likely, you'll have decisions to make.

It is a big shock to hear that you have a potentially fatal
illness.  Every one of us on this newgroup knows just what
you are going through.  But most of us are still here, slogging
along.  Don't lose heart.  Hopefully, 10 years from now you'll
still be checking in here from time to time and telling the new
guys what your treatment was like and how you came through
it.

Best of luck.

   Alan

Now is the time to become educated, *before* selecting a course of
treatment (tx).

It does not appear that the medic was particularly informative.

How many specimens were taken?

How many of the specimens showed evidence of adenocarcinoma (PCa)?

Of those specimens, how much of each showed evidence of PCa?

What Gleason score was assigned? This is *vital* because everything that
is done from here on depends upon the aggressiveness of the PCa, and the
Gleason score is the measure of that. The Gleason score is expressed as
primary grade, secondary grade, and sometimes tertiary grade. For
example in my case: 4 (primary) +5 (secondary) = 9 (a very high-risk
case, by the way).

The specimens should be sent to a pathology laboratory that specializes
in the prostate cancer. The Prostate Cancer Research Institute (PCRI)
and Dr. Stephen B. Strum both recommend:

David Bostwick, MD
Bostwick Laboratories
4355 Innslake Drive
Glen Allen, VA 23060
T: 1-866-816-4793 (Jennifer)
F: 804-545-9725
www.bostwicklaboratories.com
Gleason 2nd opinion $400; ploidy $360
Need patient demographics, insurance info, call to site that has
slides/blocks
Corrine @ ext 1103 re: second opinion

The expense should be covered by insurance and Medicare, but even if it
were not, I believe that the assurance gained by a specialist's opinion
is well worth it.

By the way, I believe that in most, probably all, jurisdictions the
specimens are *the property of the patient.* Friends have reported that
a certain Mayo facility "had a fit" when they requested that the
specimens be sent to them. They did get the specimens by standing firmly
for the rights of the patient.

Further education will be gained by reference to the authoritative and
objective website of the PCRI at: http://prostate-cancer.org/index.html

And especially the "Newly-Diagnosed" link at:
http://www.prostate-cancer.org/education/education.html#newly_diagnosed

Lastly, til should get a copy of his entire medical record and maintain
a file of everything -- everything -- that develops in the future. Such
a file will be absolutely priceless. Rights again: he has a legal right
to a copy of his medical record.

This is war, and empowerment through study will help to reach a good result.

Regards,

Steve J

"What are the facts? Again and again and again -- what are the facts?
Shun wishful thinking, ignore divine revelation, forget 'what the stars
foretell,' avoid opinion, care not what the neighbors think, never mind
the unguessable 'verdict of history' -- what are the facts, and to how
many decimal places? You pilot always into an unknown future; facts are
your single clue. Get the facts!"
--Lazarus Long

Dammit, til.  I'm damned sorry to read this.  Looks like you can exchange
your visitors' pass for a membership card.

As I recall, your last PSA was 4.5.  On top of that, they had a hard time
finding your cancer.  That would support an argument for a very low Stage,
but your DREs bump it up a bit.  I'm guessing T2a.  So, the final puzzle
piece is your Gleason score.  Based on your history, you may be one of those
fortunate few with a Gleason 5.

Your doctor should have told you what these numbers are and you need to know
before discussing options.  But, at 66, if you're in good shape, you have a
plethora of options from which to choose.

Sorry to hear it, til, but glad it is small and localized.  I know this
has been said, but you're going in tomorrow morning and need to know:
Your Gleason Grade.

A Gleason 5 or under (total-that would be, say, 3+2) is a minimal
cancer.  Not likely to be aggresive or fast growing.  Not likely to
metastatize.  Your two friends probably had very different Gleasons.  A
Gleason 6 takes more decision making.  Here is where the individual
numbers come in.  Once you get up to a 4 in the sub-numbers, those
cells are more out of control.  Tend to be more aggressive.  If you
have a G6 (3+3), you would have a real choice between immediate
treatment and Active Surviellance (watchful waiting).  If you have a G7
or higher, you're more likely to need to have surgery or radiation.  If
you had a G8 or 9 or 10, then you get into a whole 'nother assessment
of just how far the cancer has extended, and if it is even still local.
I seriously doubt that is what you are looking at.  In fact, I'd be
shocked.  I am imagining you have a G5-7, somewhere in there.

The reason I'm saying this even though everyone else said it, is that
the first urologist we saw made us feel that his purpose was to order a
biopsy to get us on the operating table.  Like a cattle chute.  We did
have surgery, eventually (much higher #s and younger age than you), but
at least we knew what we were doing and made some choices, instead of
being railroaded.

If you have a PSA of 4.5, and small, localized cancer, then there is no
reason to think that you need to do *anything* right this minute.  Find
out your Gleason, get a 2nd opinion on the biopsy slides, and watch
that doctor.  If he is pressuring you to get treatment right now then
just walk out.  Forgive me if I am being too harsh, but it is such a
shock to deal with a new diagnosis, you can be vulnerable to a pushy
doctor out there.

With your age, the choices between surgery and radiation are a real
wash.  They really depend on your feelings about the different SEs.
You don't have to have an opinion about that tomorrow morning.  You can
take your time.  IF you even need to do either one.

Let us know what the doctor says, and get a copy of your pathology
report (and all your other records, as Steve said) and let us know what
the pathologist said.

We have some good information about different treatment choices but
there is time to talk about that.  When you get into that, there are so
many options for RT and even for surgery, that taking your time to
decide is the only thing to do.

Best wishes, good luck, and God bless.

laurel

I think everybody else has said it. Educate  yourself on PC and its
treatments. A low PSA and a Gleason of less than 7 makes you a prime
candidate for brachytherapy. Find a good radiation oncologist. If you are
anywhere near Virginia then consider MCV's  Michael Hagan. His failure rate
is still zero with brachytherapy.
Bev