Well, that sucks.

I won't give you any advice because in the ensuing weeks you will probably
learn more than you care to know and because, having recently been through
the same thing myself, I find I have a lot of knowledge but little wisdom.

Somehow we all muddle through.

Sorry to see you here, but glad you found us!

You should definitely find the best pathologist in your area and get
another opinion. That sample reading seems to be part art, part science,
part magic, and highly subjective.

You're off to a good start (except for the cancer part) --- do lots of
research and ask many questions. Come back here often for consultation
and consolation.

I had the DaVinci surgery 10/13/2003 and I'm pleased with the outcome.

Peace be with you,

Larry

Sorry to hear about the diagnosis, but glad that it sounds like it was
caught early.  I was 55 when diagnosed three years ago, a T1c, Gleason
of 6, 6% in two biopsy specimens, and PSA of 5.0.  I went with nerve
sparing surgery just because at the time the other men that I knew that
had gone through this had the surgery and were doing fine.  The other
argument was that you can do the surgery and then, if necessary, follow
up with radiation so you get a second swing at the beast if you need
it.  Things are different today.  The science behind the radiation is a
lot better than it used to be, and I think most here will tell you that
the outcomes for surgery and radiation are about the same.  However,
there is more than one treatment modality under the heading
"radiation", so you need to investigate that thoroughly.  I can't help
you there, but for sure there are people here who can.

I had open surgery, RRP.  The robot was not available locally yet back
then, and I guess my doc just did not prefer the laparoscopic
procedure.  He liked to get in there up close and be able to have the
hands on to feel around.  Anyway, I did not have any serious discomfort
from the regular surgery, so if you have surgery, especially the robot
or laparascopic, I would not be afraid of the post operative pain.
Going in I was really worried about that, and it turned out to be
soreness that I experienced, not "pain".  The worse part was the foley
catheter, which I had to wear for three full weeks.  I was glad to see
that damn thing go.  Most men these days do not have to keep the
catheter anywhere near that long from what I hear.

Good luck to you.  Feel free to ask anything here.  The discussion is
frank and includes the problems associated with sexual matters, urinary
incontinence, and practical advice on catheter care, what kind of pants
to wear, etc.  For example, be sure to bring an absorbant pad or two
when the catheter is removed, just in case it is needed.

David S.

On July 13, RML wrote, in pertinent part:

Bill Denton referred to the opinion of Dr. Stephen B. Strum that the CT
and scan are often useless and waste of resources. I believe that this
is correct, and that the automatic and thoughtless use of such tests on
men with relatively low-risk PCa is defensive medicine with little
relationship to good clinical practice.

I recommend referral to the comprehensive and objective website of the
Prostate Cancer Research Institute's information for the newly
diagnosed. Start at:
http://prostate-cancer.org/education/patient_guide.html

The site also includes information on specialist pathology labs that do
second-opinion studies on, among other things, prostate biopsy
specimens. The cost is ~$300, and is probably covered by insurance and
Medicare. It takes about two weeks. It is definitive and much more
reliable than the local lab is likely to be. I had Bostwick Labs do
mine, and they reported much interesting information that was simply
omitted from the local lab's report.

_A Primer on Prostate Cancer_ subtitled "The Empowered Patient's Guide"
by medical oncologist and PCa specialist Dr. Strum and PCa warrior Donna
Pogliano is essential reading for anyone who wishes to learn about this
disease and its treatment (tx).

Lastly, I recommend resistance to any effort to stampede the patient
into the medic's favorite tx. There is time to study and reflect on what
is best among a range of choices.

RML has been drafted into a war, and the better he prepares himself, the
more likely there will be an optimum outcome.

Please keep us informed.

Regards,

Steve J

"If you know the enemy and know yourself, you need not fear the result
of a hundred battles. If you know yourself but not the enemy, for every
victory gained you will also suffer a defeat. If you know neither the
enemy nor yourself, you will succumb in every battle."
-- Sun Tzu, "The Art of War"

As you may or may not be aware of, the clinical GS biopsy is not written
in stone to what actually may reside deep in the prostate. You do have
Pca. I went from a 3+3 at clinical biopsy to a 4+3 at pathology after
robotic surgery on 12/04. You of course, may not. My numbers
(clinically) and my age are similar to yours. Read and do lots of
research, get a few other opinions from other doctors that specialize in
Pca, both for radiation and surgery. This is very important. Learn what
is best for your case. It appears that you have lots of choices at this
juncture. I chose surgery because I wanted the cancer out, and I wanted
to know the true pathology, and I could use radiation as a backup if
need be. I chose robotic because it's relatively non invasive as
surgeries go. I also felt comfortable with the technology used and with
the surgeon as well. Feel free to ask any more questions regarding the
robotic procedure if you'd like. I will be happy to answer in the best
way that I can.

B.A.

Well, I'm one of those other ones that David mentioned. While you are
checking various doctors you should consider talking to a radiation
oncologist about brachytherapy. Of course you should find someone who does
it routinely and has a good track record. (That should be for all the
doctors you see for your prostate cancer!) In Richmond, Virginia we have a
doctor who has been doing brachytherapy since 1989 and has yet to have one
failure! He is not alone in his field.

I will give you a little info on brachytherapy. Tiny radioactive seeds are
implanted into the prostate through a big needle while the patient is
asleep. The seeds destroy the cancer and the prostate. It is an outpatient
procedure but you must remain quiet (couch potato) for a few days
afterwards. There are several companies make the seeds and there are a few
differences between them. Brachy is not an option for many men as you must
have a low Gleason score (7 or under) and a fairly low (under 10) PSA.

Sometimes the brachytherapy is preceded by a few weeks of external beam
radiation. That just means you jump on the table for a few minutes each day
while a dose of radiation is beamed into the prostate area.

There is still plenty of misinformation about radiation floating around.
Folks will tell you all sorts of horror stories and how it will fry
everything from your colon to your skin. A good doctor with good equipment
and none of that will happen today. Also you will not be radioactive in a
way that will harm your wife/SO/children/grandchildren.

It's a viable alternative to a radical prostatectomy. You probably will not
miss but a few days of work post brachytherapy. The vast majority of men
have no problems (sexual, urinary, or rectal) and just go back to living
their life so they don't bother to hang out on the newsgroup. As with any
prostate treatment you can kiss your ejaculate goodbye but with
brachytherapy most men can continue to have a active sex life with no
problems as the nerves are not destroyed.

Also with brachytherapy the entire prostate is destroyed this is something
that is almost impossible with surgical removal because the prostate is
tucked up against the bladder and they do not want to harm the bladder
trying to remove the prostate. Brachytherapy is not for everyone and it
needs to be done by a highly qualified doctor. Please consider it and make
an appointment with a radiation oncologist.

If you have more question please feel free to email me. Also if by chance
you are a Vietnam veteran there is a whole bunch of info that needs to come
your way.

Bev (hubby had brachytherapy May 2002 his present PSA is 0.01)

RML:

The advice you have received on this group is right on.

Let me give you my recent experience with laproscopic surgery. I had the
procedure about 4 weeks ago. I had to keep the catheter in for two weeks. My
urologist told me that to take it out early as some do, risks more
incontinence. So, even though it was a pain in the you know what, I endured
it and it came out a few weeks ago.

I am now about 90% dry and use only one pad a day. I expect within a week or
two I will be beyond that. I expect it will be much, much longer for sexual
function to return, but I expect it will.

My age, PSA, Gleason scores, stage, etc were very similar to yours. Don't
take much comfort in that only one core showed malignancy. Biopsy is a crap
shoot and the pathology was worse for me (both lobes involved) than the
biopsy indicated. I wouldn't worry too much about second opinions on the
biopsy samples; they are all suspect.

You very, very probably have localized, and contained Pca and if you cut it
out or irradiate it into submission now, your survival chances are the best.
Active monitoring and waiting is an option. But as others have pointed out,
the chance of metasis goes up with time. You have to weigh your quality of
life by waiting versus solving the problem now and once and for all (one
hopes).

With regard to surgery, I had the simple laproscopic kind and it was great.
Pain and recovery was easy. I doubt if there is any real difference in
robotic or more conventional laproscopy. My urologist has performed hundreds
if not a thousand or more laproscopic procedures and I have great confidence
in his skill. He tells me that there is no difference in outcomes between
the two procedures. He definitely believes that the laproscopic procedure
yields better outcomes than the open type and I agree.

So, consider your options carefully. And good luck to you.

David

Good idea on the 2 uros.  Your doc comes up a little short in the staging
area.  Also, you may consider a second opinion on your Gleason, but surgery
is a good choice regardless of 6 or 7.

I had biopsy on a PSA score of 9.5 and it proved cancerous at age 58.
I opted for surgery and have had an undetectable PSA for almost 2
years.
I was very fortunate as there were no complications. Bladder function
is back to normal and so is the errection although this took about 18
months to get it back fully. (needs a bit of work !) If you opt for
surgery and need any help or support get back to me.
Best,
David.