First, I'm sorry it's official; but welcome to the club.  Your membership
card is in the mail.

At 58, he has just about all the options open to him.  There is very little
difference between radiation and surgery by way of long-term survival.
However, there is a difference and surgery ekes out an advantage.  And, as
you said, there is a 2nd option in case of failure.

There is also very little difference in impotence and incontinence.  The
number of SEs are about the same.

For these reasons, someone who is in good shape and in their "young" 50s, I
recommend surgery.

But, I am not a doctor and I also had surgery.  And, as a matter of fact, it
didn't work for me.

Joan,

The choice of treatment is a matter of great controversy.

One doctor I spoke to, who I think may have represented a majority
view, recommended surgery for men under 60, radiation for men over
70, and for men between the two ages, surgery if healthy,
radiation if not.

The theory behind this is that surgery has a longer track record
and is thought by some to offer a higher probability of a "cure"
i.e., no recurrence of the cancer.  Radiation is thought to be
easier to recover from and less stressful on the body, hence more
appropriate for men with other health problems, men who will have
a tougher time healing because of their age, or men whose life
expectancy isn't as long as for a younger man.

Now having said that, I'll say that I chose radiation for my
treatment at age 57.  I did it because I thought the side effects
would be less and I was concerned about the surgeon that my HMO
offered me.  I also believed the statements I read that the
outcomes are about the same for modern surgery and radiation.
Whether those statements are true is a matter of debate with some
fiercely denying it and others fiercely defending it.

My last PSA, 3.5 years after treatment, looked very good and, so
far at least, I have no reason to complain of my choice.  I am
hopeful that I will never get a recurrence.  However, there are
men with what looked like good prognoses who have wound up with
recurrence from either treatment.

In my personal, non-expert opinion, the odds of successful
treatment may have more to do with the skill, experience, and
commitment of the doctor performing the treatment, than with the
specific modality.  You need to find a surgeon or a radiation
oncologist whose primary practice is treating prostate cancer, who
is up on the latest equipment and techniques, and whom you can
trust to do his best and not treat you cavalierly and rush through
the procedures in order to make his next golfing date.

Lastly, I would like to say that, with a Gleason 6 cancer, the
odds are very good that your husband, if he has a good doctor,
will do well with either treatment.  As I understand it, long term
success rates for both types of treatment are above 90% for men
who get either treatment at a good treatment center.

Best of luck.

   Alan

Wish you the best and speedy treatment for your husband.  Sorry for the
diagnosis...It is no fun but can be very rewarding to rid oneself of the
cancer.  Will feel like a hard battle won.

I was 49 when diagnosed.  I was under the belief that radiation was the path
to take.  I decided to get 2nd and 3rd and 4th opinions with all lab work I
had.
I did receive RP from a cancer specialist.  After 8 years I have a PSA of
less than 0.01
I do not have troubles with bladder, and can achieve erections and best with
25% of a 100 mgs viagra.
I only had one nerve spared and depending on the skill of the Dr. and cancer
more nerves can be spared.
The nerves do grow back to some degree.
This should not be a reason to avoid surgery with a prominent physician who
has done many, many RP's
It will be an educated decision for you and your husband to make, and I do
not want to persuade you in anyway, but give you my history.
Love your husband, and help him along this tough path.  He will grow strong
with this battle.
jloomis

Thank you all for your private as well as posted messages, well appreciated!

Joan

Hello Joan,
I am 56 and just went down the road you are taking about... Here goes the
path...
The past few yrs my wife Joan made me go for checkups PSA etc. The PSA
hovered about 5
My Dr finally convinced me to have a biopsy.
Biopsy positive for cancer, Gleason of 6 (3+3) and a T1c Stge. That means
cancer cells found by biopsy, localized and early stage. This occured in
late August.
I jumped on this news and figured that I wanted to be proactive and did my
homework to illuminate my choices.
I live in the Catskill Mtn. region of NY without good drs.
I went to a urologist in Greewich Conn. Follow the $$$ for better treatment
and Drs. i hope. That uro gave me the options, They are;
Watch and wait
Radical- open you up and take it out
laroscope - go in through small tupes + take it out
Robotic mimimal invasive surgery
Radiation seed or beam
That Dr advised that he does the robotics but I should see a rad Dr first.
I saw a rad Dr that said my age 56 indicated surgery would be better. I will
live long enuf that the cancer would likely return 15 yrs later and surgery
would be difficult then. I asked about the robotics and he suggested my uro.
I asked about his experience level. The rad dr said maybe 30 or so
proceedures. I thought I did not want to fly in a airliner with a pilot that
only landed 30 times.
As I was leaving the nurse wispered to look up a Dr Samadi in NYC that has
performed over 1000 robotic surgeries. This was in Mid Sept.
I looked him up on the internet, left a comment in a box and drove bak home
here in the Catskills.
By the time I was back here the dr had responded personally and said to call
in the AM. I did
He said my age and numbers make me a good candidate for robotic surgery and
I could see him later that week.
I saw him, liked his attitude, experience and fact that he is top of
department in Mt Sinai hosp NYC.
He said he could fit me in during Oct.
I said I had Broadway tickets for Grease on the 10th, he said I shouldnt
miss that. I said I have a daughter that is a Sr. in Syracuse University
majoring in Bio Medical engineering and her last parent weekend is on Nov
10. He then said How bout Oct 13 for the surgery, I would then be healed
enuf for that event.
WOW things were moving quick. Since I had done lots of prior homework on my
options and considering this Drs experience and abilities I said Lets
Roll...
This past Sat at 10 AM I had the robotic surgery to spare nerves to
hopefully maintain erectile function and preserve urinary continency. The
operation lasted 1 hr. Dr said nerves were spared and erectile and bladder
function will return
I walked a bit that pm
I walked more on Sunday, discharged by 6:30 PM Sun.
Stayed at my Moms for some TLC for 2 days. I feel pretty good considering
I have a catheter in till next Monday - somewhat a pain but considering the
facts- not that bad
I'm home now and looking forward to getting the tube out and resuming my
life.

I will respond more about the actual choices and my existential philosophy
of mastering my destiny by knowledge and choice later if you so want. You
can respond directly to me at plangham@hvc.rr.com or through this newsgroup.
I am new at this and sometimes do not see messages.
This group is a great vehical for knowledge. There are some great people
here. Lots of help and support.

Good luckgathering the info. You have good options. Age and numbers are
similar to mine and information gives me hope that this is a beatable
problem and trust all will be fine.

Again good luck. Do not despair...there are options
Peter

Hello, Joan:

I had my surgery done just about a year ago at JH -- Pavlovich was my doc.
I've been happy with the results so far:  you can see my PSA history in my
signature; my erectile function is slowly returning (he could only spare
one nerve), and I have a little stress incontinence.  But of course, your
mileage will vary.  

I'd suggest the same things that others have/will:  read a lot and get
informed.  My choices for literature are Scardino, Walsh, and Lange.  The
treatment choices have similar efficacy, and the side effects are different
but comparable. I made my choice for LRP because I figured if initial tx
failed, I'd know sooner with surgery than with RT.  But that's just me; you
and hubby may very well have a different set of priorities.

Good luck!

--charlie

6/2006 PSA 5.2, DRE suspicious
7/2006 Biopsy:  2 of 10 positive, Gleason 7(3+4)
11/2006 LRP:  Clear margins
PSA < 0.01 on 1/2007, 3/2007, 6/2007, 9/2007
so far, so good ...

On Oct 16, 11:19 am, "Joan  and  her butterflydogs"
<butterfly...@verizon.net> wrote:

Hi Joan - -

I was diagnosed a year ago (at age 52) also with Gleason 6, Level
IIA.  I spent hundreds of hours exploring the options and came up with
a clear choice for me.  I had Dr. Gary Onik perform his focal
cryoablation procedure, where he freezes just the tumor and a tiny bit
of surrounding prostate gland tissue (a "male lumpectomy").  In
January this year, he first did an intensive 3-D mapping biopsy where
he took a sample every 5 mm (ended up being 42 samples!), and actually
discovered another speck of a tumor on the other side of my gland.  In
May he did the procedure, using two freezing (argon gas) probes on the
original tumor, and one on the speck.  About 3/4 of my prostate gland
and all of the nerve bundles are intact, and I was able to resume
intercourse with my wife of 31 years only 3 weeks later (admittedly I
wasn't 100% normal but was good enough; also I gather it's unusally
quick recovery).  As for incontinence, there is none with this
procedure, which is much less traumatic to the body than RP.

My PSAs - which have been around 1.0 for the past several years (I've
been checked regularly for several years since my grandfather & father
died of this disease, plus my older brother had it three years ago),
went up to 2.1 before the focal cryo.  Two months later it went down
to 1.05, and two days ago it dropped further to 0.6.

Also, apparently Dr. Onik is about to publish his comprehensive
results on everyone he's treated, and the results are extraordinary: a
much higher cancer-free rate than prostatectomy.  This is especially
remarkable since - though all of his patients have tumors contained
within the gland - many have high Gleason scores.

One theory for this result is that the dead (frozen) cancer cells,
which are left in the gland and only gradually slough off, have an
immunizing effect.  This would seem consistent with how other
immunizations work. It's surprising to me that none of the bigger
institutions (e.g. Columbia, Sloan-Kettering) have researched this.

You should know that Dr. Onik doesn't take insurance, and his fee is
steep (he founded the procedure and is probably the best at it, so you
get what you pay for).  I found that my health insurance pretty much
covered all the hospitalization, but they reimbursed me for less than
10% of Dr. Onik's $10,000 fee for the biopsy and the surgery.
Fortunately, I could afford it, and it's the best $9,000 I've ever
spent, by far.

Good luck in working through all your options.  It's a scary time I
know.

Gary Tennis