Greg, some doctors might say that your numbers suggest what is
sometimes called insignificant cancer, perhaps an oxymoron, that.
However, w/ a PSA of somewhere between 4 - 6 that has shown a slow but
steady rise over several years, I would be afraid that the biopsy just
missed some of it. Did the uro say anything about an enlarged
prostate? That could explain at least some of the disconnect between
the biopsy and your PSA. Otherwise, I agree that you should seek Tx in
the near future. No need to panic, but do your homework, evaluate the
options, and move forward. No one can tell you the right modality for
you; we and your doctors can only cite anecdotal evidence and
statistics. Although there are handful of oncologists who think that
hormone deprivation Tx can be curative, the "gold standard" is still
RP. Of course, now you have the laparoscopic and even robotic options
for RP. A buddy just had the latter and he was out of the hospital the
next day and shed the catheter after a week. Not nearly as daunting as
it used to be. Good luck.

Bill Denton
RP 2/12/02
PSA 1.6
Memphis

Same age as you. I saw an oncologist prior to deciding on Robotic.  He
said based on my age and PSA of 5.4, and similar biopsy results as
yours, surgery would be best.

On Apr 16, 10:29 am, greg_newsgro...@yahoo.com wrote:

Greg-

There are 3 books, one each by Strum, Scardino and Walsh, all doctors,
any one of which (or all) you should read.  As for support groups,
check out US TOO.  There are chapters all over the country.

Good luck.

-Gordy

On Apr 16, 10:29 am, greg_newsgro...@yahoo.com wrote:

My situation was not the same as yours but I did speak to 2 medical
oncologists and they both were against watchful waiting for me
(although in
your case I suspect they might say you could consider it) and both
said there
was no scientific basis to choose between radiation and surgery and it
was
basically personal preference.

If you want to consider WW then be sure you get advice from a med onc
who
specializes in that and not just any med onc.

There are literally hundreds of case studies at Yananow for patients
who
have undergone all types of treatment.  Check out:

http://palpable-prostate.blogspot.com/2007/02/case-histories.html

which gives various Yananow links as well as links and references to a
number
of longer case studies on additional sites that you also might want to
check out.
Make sure you read cases that have had treatment sufficiently long ago
since
side effects for radiation accumulate over time so its not that useful
to read
reports of men who had recent treatment.

You can find contact info on the web site of US Too.  The American
Cancer Society Man to Man will also put you in touch.  Links to both
are on this community resources page:

http://palpable-prostate.blogspot.com/2007/03/community-resources.html

---
The Palpable Prostate
http://palpable-prostate.blogspot.com

Absolutely! Surgical oncologist, radiation oncologist, and medical
oncologist. My treatment is *my* decision, not theirs, because I know
more about *my* priorities in life than do any of them.

Most decidedly!
The rad onc said "get surgery" because I said I'd *MUCH* rather risk
urinary incontinence than fecal incontinence.
The med onc said "get surgery" because I still had a reasonable chance
of being cured rather than just postponed.
The surg (uro) onc said "get surgery" because he was paying for a real
big boat.
And the patient said "get surgery" because he'd studied a pile of PC
books, consulted with half a dozen physicians, and dug into his own
psyche, lifestyle, circumstances, and priorities until he reached a
clear decision.

Why so thorough? So I wouldn't look back from my death bed wiahing I had
researched it further.

I.P.

Wishing you good luck......the best support group in northest
Massachusetts is at the Beth Israel Hospital in Boston... They are
extremely
active and very personal and helpful...I would call the hospital and
they will connect you to the right department.  
They have wonderful doctors and oncologists there also.  

Keep up a good attitude..that helps a lot!!!!!!

Marty from Boston

These are pretty good numbers, Greg, if one has to have prostate cancer.
They would have been better a year earlier if a biopsy had been performed
then, but then that 1 needle might have missed it then.

Urologists are surgeons, so they natually feel good about surgery.  Getting
opinions from a medical oncologist and/or radiation oncologist is a very
good idea.  Researching books by Walsh, Scardino, and Strum are really good
ideas, too.

In the end, I think your best bet is surgery, but you have to come to that
decision based on an honest effort of finding which is best for you.

BTW, fear is not an issue with surgery or radiation.  One thing I have
universally heard over the years is how easy it was.

That's all good news amidst that bad news that you have cancer.

I have been told that studies show that, all other things being
equal, doctors with the greatest experience have the highest
success rates.  The doctor doing 200 per year, 4 per week, has
probably seen every shape, size and condition of prostate and
tumor.

The fact that he gave the most thorough DRE is also an excellent
sign.  My first urologist was in and out in 3 seconds, told me there
was nothing there (though others later had no trouble finding it),
and left me with some damage from his clumsy finger.

Unfortunately, there is a chance of recurrence with either surgery
or radiation.  However, my very non-expert reading of the tea leaves
is that both are very successful with early stage Gleason 6
cancers.

From what you said above, Doc number 2 sounds like the
right one.

I don't know if this will reassure you or not, but I believe the
chance for a complete cure is above 90% with either radiation
or surgery for PSA < 10 and Gleason < 7.  There is an
interesting nomogram at: http://www.mskcc.org/mskcc/html/10088.cfm
It relates pre-treatment condition to different therapies and
then correlates it all with outcome statistics to tell you your
odds with each therapy.  Who knows if it's right or wrong, but
it's published by Sloan-Kettering - as good a source as any
I think.

Yes.  Most surgeons will not perform a prostatectomy on a
man who has had radiation.  The rates of complication are
very high and the success rates are fairly low.  Some
surgeons will try it, but I'm not sure it's worth trying.

There are new therapies that can be attempted after failed
radiation.  HIFU is now being used for that in some countries,
but is new in the U.S.

I did not see a medical oncologist.  I did see a couple of
different very good radiation oncologists and learned a lot
from them.  However I think the surgeon I saw was not very
good and I learned less from him than I would have from
a very good one.

I had a combination of "high dose rate" brachytherapy plus
"3DCRT" external beam radiation, with 4 months of Lupron
mixed in.

So far, I'm very pleased with the results.  My PSA bounced
around after treatment, but reached a low of 0.2 at two years
and was still 0.2 at three years, at the most recent reading.

I chose radiation (at age 57) in the belief that the outcomes
were similar to surgery and the side effects were less.  However
every person's mileage varies.  Some have had bad side
effects with either treatment.  Some have had recurrences
with either treatment.  I found, to my great surprise, that
there is no consensus, either among doctors or among
patients, on what the best treatment is.

I imagine "Us Too" is there.  And of course this online
support group is available all over cyberspace.

And best wishes to you.  You are facing some difficult
decisions and some changes in your life.  But there is
an excellent chance that you will live out your life without
dying of prostate cancer.

Good luck.

   Alan

Greg:

Firstly, our condolences for having to join our club.

Secondly, I believe it is a mistake to ask for individual member's
experiences. The only thing that is relevant is you and how you react to a
given treatment. Only large, statistically significant studies can give you
any clue as to how you will react.

Thirdly, surgeons believe in surgery. Is that any surprise? Please, consult
with radiation oncologists to get their view of RT.

And do your research and become as expert in the statistics as the experts.
Then make your own choice.

IMHO, surgery does have a lot to offer for a 55 year old. It may not have
the best side effects profile, but it does have at least as good a cure rate
as other therapies and maybe the best.

David

On April 16, Greg wrote:

(snip)

An oncologist is a *cancer specialist* not only a surgeon. One who is
familiar with prostate cancer (PCa) will, I guarantee, have useful insight.

"Beam" radiation I will take to mean EBRT (External Beam Radiation
Therapy) or, more exactly, IMRT (Intensity Modulated Radiation Therapy)
or one of its cousins.

It has a good record.

I underwent successful IMRT, but my experience is absolutely no basis
upon which to choose that tx.

No one's experience with any tx is reliable for that purpose. Anecdotes
can be interesting, but that's all.

There are 13 UsToo chapters in Massachusetts. The list can be found at:
http://www.ustoo.com/chapter_nearyou.asp

I also recommend reference to the authoritative and objective website of
the Prostate Cancer Research Institute (PCRI) at:
http://prostate-cancer.org/index.html
The section "Newly Diagnosed" is a gold mine of essential information.
See http://prostate-cancer.org/education/education.html#newly_diagnosed

Lastly, I recommend study of the premier prostate cancer text, _A Primer
on Prostate Cancer_ 2nd ed., subtitled "The Empowered Patient's Guide"
by medical oncologist and PCa specialist Stephen B. Strum, MD and PCa
warrior Donna Pogliano. It is available via the PCRI site and other such
websites, Amazon (30+ five-star reviews) Barnes & Noble, bookstores. A
life-saver. I know.

Regards,

Steve J

"Empowerment: taking responsibility for and authority over one's own
outcomes based on education and knowledge of the consequences  and
contingencies involved in one's own decisions. This focus provides the
uplifting energy that can sustain in the face of crisis."
--Donna Pogliano, co-author of _A Primer on Prostate Cancer_, subtitled
"The Empowered Patient's Guide."

Hello, Greg:

Sorry to hear about the cancer, but as you know from watching your
father's experience, you know that there are options.

(And by the way, you said he's satisfied with his decision.  How's he
doing?)

Given the diagnosis, those are pretty good numbers.  Your docs will
probably tell you that you're a good candidate for either surgery or
radiation.

That's quite a word, 'thorough.' ;-).

But it's really not a close call, here, right?  The doc with more
experience is of course the one you'd want to go with if you choose
surgery.  My local urologist as much as told me that even though he
does the surgeries here (in Western NY), I'd be better off going to
one of the big cancer centers if I chose surgery (which I eventually
did).  And with your numbers, you should ask about laparoscopic
procedures.

True, but my local uro did insist that I speak with a radiation
oncologist before I made any decision.

Both the uro and the onc I saw here in Elmira presented the stats in a
way most favorable to the treatments they each provide.  That's not
surprising.  I learned from both, and I needed to hear what both had
to say, but I did not feel that I got anything objective until I
started reading some of the literature.

Others have suggested books by Scardino, Strum, and Walsh.  I'd add
Prostate Cancer for Dummies, by Lange.  Sounds like a weird book to go
to for info, but I've found it a handy and up-to-date reference.

Others have written about UsToo!.  You could also check out Man-to-
Man, the PCa groups sponsored by the American Cancer Society.

Good luck with this, and please keep us posted about your progress.

All the best,

charlie

On Apr 16, 10:29 am, greg_newsgro...@yahoo.com wrote:

HI GREG, MY HUSBAND HAD AN RP WHEN HE WAS 48. THAT WAS 10 YEARS AGO.
HIS GLEASON WAS 7. HIS PSA WAS 12 AFTER 2 NEGATIVE BIOPSYA FINALLY THE
3RD SET OF BIOPSIES WERE POSITIVE ON THE RIGHT SIDE.
HE IS 58 NOW HIS PSA HAS FLUCTUATED BETWEEN .10 TO .20 FOR 8 YEARS. IN
THE LAST 2 YEARS IT HAS HOVERED AT .30. OUR URO RECOMMENDS EXT BEAM
RADIATION SO DID THE ONCOLOGIS. BOTH ALSO SAY IT MAY BE BENIGN TISSUE.
WE ARE GOING TO MAKE AN APPT. WITH CHARLES MYERS ,M.D. IIN VIRGINIA.
HE USES A SUCCESSFUL HOLISTIC APPROACH . WE ARE NOT COMFORTABLE WITH
THE RADIATION ESP. IF ITS BENIGN TISSUE.
YOU MAY ALSO WANT TO CHECK OUT DON COOLEYS WEBSITE IT HAS A WEALTH OF
INFO ON AND ALL UP TO DATE TX.
GOOD LUCK TO YOU.
LIZ

Yes.

Yes.

The oncologist I saw was particularly qualified:  he was a PCa patient
as well!  You, myself, and he were all in our early to mid 50's when
diagnosed with confined Gleason 6 tumors.  He opted for IMRT for
himself; I decided if it was good enough for him, it was good enough
for me.  I have zero regrets:   no cancer, zero incontinence, ED 100%
treatable with Vitamin V.

Currently, another therapy, IGRT, has succeeded IMRT as  the cutting
edge in External Beam therapy.

See:  http://www.igrt.com/external_beam.asp#4

I truly believe (personal opinion) that surgery for patients with
"curable" stats, surgery is overkill on the order of killing squirrels
with an elephant gun.

Consider this:

"Many patients with good-risk, early-stage prostate cancer conclude
that their best option is to try and eradicate disease by ablating the
prostate gland. Three popular options exist: surgery, brachytherapy
(radioactive seeds), and intensity modulated radiation (IMRT). This
booklet compares and contrasts the pros and cons for these three
treatment alternatives.

Good-risk, early-stage patients, who have a Gleason of 3+3=6 or less,
a PSA less than 10, and a third or less of their cores positive, have
a better than 80% chance for cure with expertly applied ablative
therapy. So far there are no convincing studies indicating that one of
these three forms of treatment leads to a better chance for cure. Let
me repeat, THE CURE RATES ARE THE SAME. Therefore your decision should
not be based on some fantasy that you can kill it more dead with
surgery over radiation or visa versa. Arguments touting surgery as the
"Gold Standard" stipulating the advantages of "cutting it out" are
based on old data generated before the advent of modern forms of
radiation."

http://www.prostateoncology.com/resources/?pg=patient_education&id=8

Best of luck to you.

On Apr 16, 10:29 am, greg_newsgro...@yahoo.com wrote:

......

Greg - the numbers look good and your diagnosis was done early.

I had IMRT (external targeted radiation) largest area & highest dose
and it failed - later I found out radiation has a high failure rate,

Remember to find the doc that has the best reputation at cure AND
minimal side effects - ALL treatments leave us with with some adverse
effects - choose carefully as you will have to live with them a long
time.

Good luck
Lud

Let me add my voice to the list of responses.

First of all, don't take seriously anything you think you have learned
here, including what I say.  In the end, you have to bounce any ideas
you get off a physician or physicians you trust.

But now let me say a few things.

First, from what I've read, n your particular case, most medical
authorities on prostate cancer would recommend surgery.  But some would
argue that radiation is also a viable alternative.  The argument for
surgery is that it has a long track record, so there is more uncertainty
about how effective radiation is after 15 or 20 years.  Also, in a man
your age, PROVIDED you have a skilled surgeon, the likelihood of side
effects are similar for surgery and radiation.  (For older men,
radiation might have the edge in that respect.)  Another argument is
that radiation will leave behind some prostate tissue in which a new
cancer could develop in time.

If you do choose surgery, find the most skilled surgeon available to
you.  Ask questions about the likelihood in case like yours of long term
incontinence---should be very low---or impotence.  The best surgeons
have a success rate of avoiding impotence of 70-80 percent or higher in
men your age.

Second, keep in mind that radiation can be done in various ways.  There
is lots of conflicting evidence on the subject, but I've not been
convinced that there is a good argument for seeds as opposed to the best
  external radiation treatment in which high doses are focused
carefully in such a way to avoid damage to surrounding tissue.  (IMRT)

Third, the term "oncologist" can mean more than one thing.  A "radiation
oncologist" will treat you with radiation, possibly supplemented on a
short term basis with androgen suppressing drugs like Lupron  (ADT).  If
you want to investigate radiation as a possible treatment, seeing a
skilled practitioner might be advisable.   Medical oncologists, on the
other hand, generally treat men with metastatic prostate cancer on a
long term basis with ADT.  A few medical oncologists claim success in
treating early prostate cancer with ADT as a primary treatment.  I would
avoid people like that like the plague.  ADT has profound side effects
and you are not a candidate for such treatment now, and we hope you
never will be.  Seeing a medical oncologist at this point would be a
waste of time.  A competent one will tell you to choose surgery or
radiation, and you want to avoid the others.

Finally, about books to read.  I like Scardino and Walsh.  Both are
internationally recognized leaders in research on prostate cancer.
Some people tend to discount what they say because both are surgeons.
But, in fact each is part of a team which includes experts in many
aspects of prostate cancer, including radiation and medical oncology.  I
doubt that you are going to find other sources with better balanced
treatments of the subject.

Finally, it is canard that urologists are likely to recommend surgery.
   It really depends on the individual physician.   In my case, at age
67, my urologist told me I could either go with surgery or radiation.
Had I chosen the latter, he would have been happy to refer me to a
qualified radiation therapist.

My numbers were very close to yours.  My father also had it.  I chose
the surgery, now over four years ago.  Today, I am still able to jog,
walk, talk, the whole nine yards.  It is a scarry experence,, but I came
out ok and I am 100 percent in all the activities I like to do.  I had a
surgeon that knew how to do this operation correctly, that is most
important.  Finding the right surgeon is the trick.  If you were in the
Mpls/Stp Mn area I could give you some names.  I never considered
radiation, I was 59 at the time.  Anyway, that is my .02 worth.  Good
luck and get the book, Dr. Walsh's Guide to Surviving Prostate Cancer,
it's a good read.

May the force be with you.

Dale j.