Okay gang, I need some opinions. First a refresher:
45 yrs old
PSA 4.7 2/06
Biopsy 12 cores
Base - 3+3 10%,3+4 25%,3+3 25%,3+3 25%
Mid - 3+3 25%,Benign,3+3 60%,3+3 50%
Apex - Benign,Benign,Sespicious,Benign
Local urologist feels that based on numbers, there's a good chance that
it is confined. Now I'm at the agonizing point of deciding treatment.

My question is, what do we know of PBRT? I understand the science of the
Proton vs. the Photon etc. has anyone here had this treatment as opposed
to conventional radiology?

I am leaning towards robotic surgery for the reasons that at my age, I'm
concerned about what collateral damage I'd incur from radiation, and I
figure if I had the RLRP and start to show a PSA score down the road,
then I could opt for radiation at that time.

I feel physically I am in a good position for surgery. I've opted not to
explore cryosurgery or seeding.

Of course, my mindset is that if additional cancer shows in the eMRI and
bone scan that I might change my outlook as I am ultimately trying to
match the best possible treatment for my situation.

==> hi paul - your thinking is a little bit off.

PBRT and radiation is basically the same thing.  the body is going to
react to it the same way.   PBRT can control the depth of the
penetration whereas the RT passes through the body.  that is what if you
have PBRT, i don't think that RT would be an option.

you are the one who is going to have to look at the man in the mirror
and tell him that you did the best that you could for your body.   in my
case, i did not want the option i chose, but i knew that it gave my body
the best chance for survival and i have a clear mind because of it.

as to your being concerned about collateral damage..... EVERY treatment
has collateral damage.  it just varies both as to what damage you will
have and how long it takes to happen.

on surgery, choose your surgeon wisely because you are only going to
have the one chance to get to not only get the cancer but to minimize
the collateral damage.

hope this answered your concerns...

~ curtis

knowledge is power - growing old is mandatory - growing wise is optional    
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

I think your choice of surgery makes sense.  At your age you should
recover quickly and, if the surgeon is skilled, the risks of side
effects reasonably small.  You should try to find the surgeon with the
best track record you can find in treating patients like yourself and
not get hung up on the surgical method.   Recovery from RLRP may be a
bit faster, but by itself that shouldn't be an argument for choosing it
over straight RRP.

Hello Paul,
I was diagnosed when I was 49 and also had options on my mind.  Being
uneducated about all aspects I chose External Beam Radiation.........
Thanks to this news group and becoming more educated I went on to see other
Dr.s and avenues of treatment.
I chose RP and now about 7 to 8 years out....I am glad I did.
I do not know the differences concerning Robotic vs Standard RP but I do
know it is best to choose a surgeon that is "highly experienced" in this
field.
I feel that the collateral damage was minimal.
Where are you located?
Good wishes on your decisions and outcomes.
John Loomis

Hi Paul...My comments are inserted within your post...Best wishes and
good health, ron

There is a significant amount of PCa in several of your biopsy cores.
It would be prudent to send these samples out for an expert reading to
make sure there aren't any higher Gleason grades, and that the apex is
clean.  Search "expert pathology" within this list and you'll get some
names as well as info on how to proceed.

Hmmm, assuming your you are T1c (no abnormalities found on DRE) and
that your Gleason scores are correct, the Partin Tables (Partin II)
put you at 52% chance of organ confined.

Take a look at

Int J Radiat Oncol Biol Phys. 2004 Jun 1;59(2):348-52; Proton therapy
for prostate cancer: the initial Loma Linda University experience;
Slater JD, Rossi CJ Jr, Yonemoto LT, Bush DA, Jabola BR, Levy RP,
Grove RI, Preston W, Slater JM.

to get an idea of the range of experiences from "Proton Beam".  BTW,
most "Proton Beam" used in the above study at LL is actually a mix of
proton and photon.

Further, you are a very young man.  The risk of secondary cancers
following RT is something to be aware of in your case.  Also I assume
that you have no urinary difficulties and no small vessel disease such
as diabetes.  RT would be contraindicated if such comorbidities were
present.

If you are talking to Menon, Tewari or other robotic practioners of
that caliber, then you're in good hands.  I still have a concern with
lap and robotic procedures in that they can have margin problems at
the apex.  That was why I noted above that a clear reading in the apex
would be significant.  Being young and in good shape, even with the
standard "open" RP, you'd probably be out of the hospital in two days,
back at work in two weeks or less, and starting to work out again in 6
weeks.

Hi Paul:

My husband (also named Paul) is currently undergoing proton treatment
at Loma Linda. Therefore, I can't tell you the end results but I can
tell you what our thinking process was in coming to this treatment
decision.

First of all, my Paul is older than you. He will be 65 in a few days.
He is not an ideal candidate for robotic surgery (weight, hypertension
etc.) so we eliminated that option. We met with a medical oncologist
who specializes in pca. He recommended IMRT and/or seeds. Paul spoke
to about 10 men who had been through proton treatment at Loma Linda
before coming to a decision. Without exception, all had positive
things to say. They all said that they had experienced few, if any,
side effects during and after treatment.

So far, Paul has received 25 out of a total of 42 treatments. The
normal course is 44 (or 45, depending on which doctor is treating you)
treatments but Paul has an artificial hip and therefore has a special
treatment plan. His PSA was 3.5 (3.14, two days before the positive
biopsy) and so the LL doctor feels that the slightly reduced total
dose will provide good control over the pca. Time will tell.

The only side effects, so far, are minor urinary ones. Flomax is
helping with that.

Paul suggests that you visit the Proton Bob website if you have not
already done so:

http://www.protonbob.com/proton-treatment-homepage.asp

If you go to the Contact Us page, there is an email link to Bob
Marckini - aka "proton Bob". Bob gave Paul names, phone numbers and
email addresses of men who had already gone through proton treatment
at LL.

I have set up a blog that chronicles our time and adventures here. The
address is:

http://paulsprotontreatment.blogspot.com/

If you read this, start with earliest posts and work your way to the
present.

Hope this helps.

For DaVinci robotic laparoscopic surgery, you probably should include Dr.
Mark Kawachi at City of Hope among those you investigate. He's done many,
publishes his findings regularly, and is regarded as one of the top folks in
the nation in DaVinci LP.

Alex

snip]

That, for me, was the ultimate deciding factor.  Most of the
literature seems to suggest that cure rates and SEs for the major
treatments are comparable, so I figured that with surgery, if it was
going to fail, I'd know that it had failed sooner than I would with
radiation, and could make the next round of treatment decisions that
much sooner.

[snip]

Hey, good for you!  I've spoken here at the college about my own
experiences, and have gotten a few of my male colleagues to get
themselves checked out.  I've also become a sort of unofficial
counselor for men with various prostate troubles.  It's a good feeling
to be able to help out, especially when the news is good, eh?

--charlie

    Paul you sound like you've already done your research on this.
Bravo.... most that post here on diagnosis aren't  half as together as you
are.  In my opinion surgery is the way to go.  At your age you should come
out of this just fine. Keep us posted.

Very few here have undergone PBRT.  I think only four:

     cwarman89134@gmail.com CW89134
     wborglum@sbcglobaldot.net Desert Denizen
     keith340@webtv.net Keith Lundy
     jeffbalfoort@yahoo.com surfdog

None of these was less than 55-years-old.  None have reported failure.

However, being 45 (or in my case 46) mitigated the agony of deciding.
Because, at that age, surgery is the only answer when your numbers permit
it.

That's my opinion, but I am not a doctor.

...

I will address the surgery part only as you indicate
you are leaning that way.

1. Assuming you have decided on surgery you need
to decide among RP, LRP and RLRP.  Open surgery
has advantages for cancer control:

- for higher Gleason score. A GS of 3+4 is borderline.
- the higher chance of apical involvement.  (This seems
 likely but unconfirmed in your case.)
- the smaller the prostate.

2. Also you need to think about the lymph node
dissection method and that may be as important
as the surgical method.

3. hernia is a common side effect of prostatectomy
1 or 2 years later that is rarely discussed although
you can reduce the chance if your surgeon repairs
any subclinical hernia at the same time.

There are posts on my site (link is in signature)
of all three of these.  Under Labels on the right
hand side click on surgery to get a list of
surgery posts and these include a 4 part post
entitled RP vs LRP vs RLRP, a post on Lymph Node
Dissection methods and a post on Inguinal Hernia.
I would at least discuss these issues the doctor.
Under Key Posts in the right column click on
Prostate Cancer Calculators to get a list of
various online calculators into which you can plug
your lab results and get prognoses.  Also under
Key posts on the right click on Case Histories for
links to hundreds of histories on Yananow and some
other longer histories from other sources.

Hope that helps.

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

............

Hi Paul

What an awful diagnoses at such an early age - this cancer is a real
bummer. I was diagnosed with a PSA of 34 eight years ago at age 59,
yet of 8 cores I had much smaller percentage and fewer cores than
yours, so I would be concerned as to the total extent of the spread.
Because of my high PSA and good chance of cancer spread, I chose IMRT
radiation - it was a major mistake. Three years after radiation, the
major cancer nodes were gone but there was residual cancer at the
apex, base and seminal vesicles - this confirmed but a Prostascint-CT
fused scan by Dr Sodee in Cleveland. Dr Sodee has over 10 years
experience with this scan and is the best person do it. From his
experience, he has found that often even with low PSA levels and clear
margins, patients have had small remote mets. Selecting a treatment is
a difficult decision to make. Dr Horst Zinke study at Mayo may help.
His study found that the patients who had surgery even with extensive
mets had better long term outcomes.  I saw this study years after I
had my radiation. The advantage of surgery is that post surgery
pathology report will give an accurate definition of the type and
extent of cancer cells within the prostate area. Follow-up radiation
is then possible, best planned on the findings of a Prostascint-CT
fused scan. Some patients with aggressive cancer have even done early
chemo. Then for the last decision, you must find the best artist of
that treatment. For robotic surgery, look up Dr Tewari as he is highly
regarded. Forget about doctors bedside manners and look closely at the
doctors track record with other patients and how many procedures he
has done in total and how many is he doing recently - 'practice makes
perfect'.

You are fortunate to have discovered it early - chose a treatment and
practitioner wisely and hopefully you will not have to worry about it
again.

Lud