In order to diagnose a T3, one would have to determine that the cancer has
penetrated the wall of the prostate and/or involves the seminal vesicles.  I
am not expert on this (nor are any of us doctors), but I would imagine that
it is very difficult, using a needle biopsy, that a T3 is not a T4.

The medical community has wavered on the treatment of T3/T4 PCa.  When my
father was dx'd with T4 (with a spot on his pelvis), they took out his
prostate and radiated his pelvis with cobalt.  That was about 1974.  When I
was dx'd 26 years later, the accepted procedure was to leave the prostate in
if the cancer was already outside the prostate.  More recently, I have heard
some doctors are removing the prostate anyway, just to get out the mass that
they know about.

If you dad was 64 with a T2, I'd be a supporting surgery.  But T3 is a whole
different ballgame and I believe the majority of the medical community is
still on the side of leaving it in.

However, if you have accurately described your father's doctor's
"counseling", I would seriously consider a different doctor.  And, in any
case, your father should seek out a medical oncologist and maybe a second
for another opinion.

What he does not will likely determine how long he has to live.

Paul,

One of the problem with this disease is that there is no universal
agreement on what is the right treatments.

There are many doctors - probably many more in the UK than in
the US, but some here too - who believe that primary treatment
for prostate cancer (surgery or radiation) does no real good.

Your Dad may be seeing one of those doctors.

It is true that some men get primary treatment and then die of
prostate cancer anyway.  It's also true that some men do not
get primary treatment and live on to die of something else.

In my humble and non-expert opinion, the key issues are:

1. Is the cancer confined to the prostate - where surgery or
   radiation can reach it?

2. Is the patient young enough that he might live 10, 15, or
   more years if his cancer doesn't kill him?

With a PSA below 10 there is a very good chance that the
cancer is confined to the prostate.  And at an age of 64,
assuming your Dad is otherwise in good health (back pain
is debilitating, but not life threatening), your Dad might well
live 10 or 20 more years - during which time the cancer may
well kill him if it is not treated.

So it seems to me that primary treatment IS indicated and,
unless there is evidence of metastasis, should be attempted.

My personal view is that, if the disease is confined to the
prostate, the success of treatment is highly dependent on
the skill of the surgeon or radiation oncologist.  A specialist
who is committed to his patients and his craft, and who treats
many PCa patients, often has a much higher successs rate
than a general surgeon or radiation oncologist who only does
a few prostate cases a year.

As to your question about getting hormone therapy now, I
think that can be a valid strategy.  It will shrink the prostate
and will temporarily slow or halt the progress of the disease,
giving you more time to investigate options.  HT is often
given as a preparatory treatment before radiation.  It is
sometimes but not often given before surgery.  I think the
theory is that it does not increase the survival rates for
surgery patients, but there is debate about that and I'm not
aware of it doing any harm - other than the normal unpleasant
effects of hormone therapy.

Best of luck.

   Alan

There is no good way for a patient to select a treatment (tx) unless he
has educated and empowered himself such that his decision is well-founded.

Some good advice has been given here.

I would add that the one book that virtually saved my life (Gleason 9,
etc.) is _A Primer on Prostate Cancer_, now in its second edition. Its
subtitle is, "The Empowered Patient's Guide." Co-authors are medical
oncologist and PCa specialist Stephen B. Strum, MD, and PCa warrior
Donna Pogliano.

Secondly, refer to the authoritative website of the Prostate Cancer
Research Institute at:
http://prostate-cancer.org/index.html
Go to the pages entitled, "Newly Diagnosed."

This patient, as have we all, has been drafted into a war against a
relentless enemy. It is necessary to prepare for combat by education on
the nature of the enemy. *That* is the next step. The task is difficult
but not impossible

Good luck. Let us know how it goes.

Steve J

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

Paul, I have read the many good replies of 8/14 and have little to add of a
medical nature, but I have been going down this road for almost six years
now and vividly remember being bogged down with information and facts and
figures and statistics in the beginning. Early on, in the learning process,
it would be nice to have just one road to follow, one course of action that
was appropriate for your specific situation, but the medical community is
not anywhere near being that far along. There are more questions than
answers, and some of the questions can be answered only by your Dad.

As you and your Dad begin this battle, it might be helpful to look early on
at the standard approaches, and the side effects associated with each, and
decide just how aggressively  he wants to fight this thing, what possible
side effects are worth risking. A cure may or may not be possible, but even
if not, surgery for the purpose of debulking is not totally out of the
question. That is the type of personal decision you have to make. Some men
will opt for fighting as aggressively as possible and let the SE's fall
where they may. Others will make an educated decision to temper their
treatment plans with a closer eye to quality of life issues.

My own battle began at age 55 with a psa of 55. A  mind boggling crash
course in pca told me that it's going to get me. I did the surgery, with its
side effects, and radiation with it's side effects, and several years of
Lupron with it's side effects, and now my psa has begun to rise again. More
drugs are coming up soon. And many more prayers. Has all of this prolonged
my life? Beats me, but right now, today, life is pretty good. It would be
devastating to me to  look back on my final day on earth and see that I
maybe could have done better by fighting a little harder.  This is just one
mans fight, against his specific cancer, and no way would I suggest that
anyone go down the same path. You have to decide what's right for you.

Keep getting educated, but try not to get bogged down with all of this
information, and by all means ask all the questions you want of this
newsgroup. It has been a huge help to me, both as a support group and as a
source of information. These guys have been there, and want to help. Best of
luck to you.